Clearly, it would be great to have all patients done on the most state-of-the-art systems. But there are other perspectives that are important. In a world where our resources may be more tightly allocated it is good to consider those.
Professional quality and clinical service sometimes feel like they are at odds. For instance, there are many times when someone orders a test and I'm not sure it is the best one. From time to time they are insistent on doing it their way. The service part of me says to do the test. The quality part of me wonders if I am "pimping" myself by not refusing.
So where does that leave me?
Many aspects of our lives and jobs are gray areas, and frequently this is one of them. Ultimately you must fall back on quality patient care and recognize when your professional opinion is just that - one of many opinions.
On an ongoing basis, we annually evaluate our imaging protocols with all of our technical partners. There is significant heterogeneity between machines and centers. Some members of the practice have expressed opinions that only the highest quality scans should be done. Clearly, it would be great to have all patients done on the most state-of-the-art systems. But there are other perspectives that are important. In a world where our resources may be more tightly allocated it is good to consider those.
First, consider patient access. Often patients want to be scanned close to their homes, or where their doctors are. That may be, in some cases, essential to them actually showing up for their appointments. Moreover, more access, even with slightly older systems may allow patients to be scheduled at times convenient to them.
Increasing regulation of the healthcare industry may reduce the number of outpatient imaging centers. Tighter financial times may also reduce the number of systems that are upgraded. So, the radiologist’s role in maintaining access may be very important.
We need to be certain that appropriate studies are ordered, so that the scanners are not filled with studies that are not cost-efficient. But we also need to remember that older system quality may be perfectly acceptable for most diagnoses, and their use increases access.
Second, consider the bang for the buck. It is great to use a new tool. But just because it is new, or makes better pictures, does not mean it improves outcomes. If you plan to dig your heels in to demand more scans be done on newer systems you should be sure that there is literature or industry data that there is a better outcome.
That said, we have not, as an industry always produced this information. As our resources are tighter, it will be important that we attempt to share such information and experience. That way we'll have a better idea when using a newer system is for the patient's best interest, not just when it is pleasing to our eyes.