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Stress Imaging Tests, Chest X-Rays Among 5 Tests That Might Be Unnecessary

Nine leading physician specialty societies representing nearly 375,000 physicians have identified specific tests or procedures that they say are commonly used but not always necessary in their respective fields, according to ABIM Foundation's Choosing Wisely campaign.

The lists of "Five Things Physicians and Patients Should Question" provide specific, evidence-based recommendations physicians and patients should discuss when making healthcare decisions.

The lists include the following questions:

  • Do patients need brain imaging scans like a computedtomography (CT) or magnetic resonance imaging (MRI) after fainting, also known as simple syncope? Probably not. Research has shown that, with no evidence of seizure or other neurologic symptoms during an exam, patient outcomes are not improved with brain imaging studies. (American College of Physicians)
  • Do patients need stress imaging tests for annual checkups? Not if you are an otherwise healthy adult without cardiac symptoms. These tests rarely result in any meaningful change in patient management. (American College of Cardiology)
  • Should patients going into outpatient surgery receive a chest x-ray beforehand? If the patient has an unremarkable history and physical exam, then no. Most of the time these images will not result in a change in management and has not been shown to improve patient outcomes. (American College of Radiology)
  • Do patients need a CT scan or antibiotics for chronic sinusitis? Most acute rhinosinusitis resolves without treatment in two weeks and when uncomplicated is generally diagnosed clinically and does not require a sinus CT scan or other imaging. (American Academy of Allergy, Asthma &Immunology)
  • Should dialysis patients who have limited life expectancies and no signs or symptoms of cancer get routine cancer screening tests? These tests do not improve survival in dialysis patients with limited life expectancies, and can cause false positives which might lead to harm, overtreatment and unnecessary stress. (American Society of Nephrology)
  • Should women under 65 or men under 70 be screened for osteoporosis with dual energy x-ray absorptiometry (DEXA)? No, research has shown that in patients with no risk factors, DEXA screening is not helpful in this age group. (American Academy of Family Physicians)

The complete lists from the specialty societies, available at www.ChoosingWisely.org, include additional detail and evidentiary information communicating when a particular test or treatment may be appropriate based on clinical evidence and guidelines. The societies include:

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians
  • American College of Cardiology
  • American College of Physicians
  • American College of Radiology
  • American Gastroenterological Association
  • American Society of Clinical Oncology
  • American Society of Nephrology
  • American Society of Nuclear Cardiology

Consumer Reports (CR) is working with the ABIM Foundation and the specialty societies to lead the effort. Eleven consumer-oriented organizations are joining Choosing Wisely to help disseminate information and educate patients on making wise decisions. They include the AARP, Alliance Health Networks, National Business Coalition on Health, and National Partnership for Women & Families.

A 2010 survey from Consumer Reports (CR) showed that nearly 44 percent of an estimated 1,200 healthy 40-to 60-year-old men and women with no known heart disease, risk factors or symptoms had received screening tests for heart disease rated by CR as very unlikely or unlikely to have benefits that outweigh the risks.

Patient advocates are calling the Choosing Wisely campaign a significant step toward improving the quality and safety of healthcare. Studies have shown that as much as 30 percent of care delivered is duplicative or unnecessary and may not improve people's health. In fact, such unnecessary care may harm or hinder patients' health.

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Source: ABIM Foundation, April 4, 2012


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