Evidence-based guidelines could help prevent dangerous radiation overdoses, says MedSolutions

Jul 14 2010

Utilization management programs that use evidence-based guidelines to ensure appropriate use of diagnostic imaging tests could help prevent dangerous radiation overdoses like the one highlighted in a recent New England Journal of Medicine editorial, said MedSolutions (www.medsolutions.com), a leading provider of medical management services.

The editorial, which examines the safety of CT scans, tells the story of a 59-year-old schoolteacher who received 100 times the average radiation dose during a brain CT. The overdose could have been avoided had the woman's doctors followed evidence-based guidelines like those used by MedSolutions when ordering the scan. These guidelines help physicians select the right test for a patient's condition. In many cases similar to this one, a basic physical exam may rule out a stroke and confirm the diagnosis of Bell's Palsy. In turn, this could eliminate the need for an imaging procedure; thus, the patient would avoid any radiation exposure and the risks associated with it.

"When used properly, CT scans and other advanced imaging tests are essential to accurate diagnosis and treatment," said Gregg Allen, M.D., chief medical officer of MedSolutions. "However, research shows that up to one third of these procedures are ordered inappropriately – exposing patients to potentially harmful radiation while providing no medical benefit. Utilization management programs that use evidence-based guidelines can enhance quality and safety by ensuring that patients receive the right test at the right time, thereby minimizing unnecessary radiation."

Utilization management programs can also help to prevent overdoses like this one by ensuring that tests are performed at credentialed imaging centers equipped with the latest technology and staffed by trained personnel. MedSolutions maintains extensive quality control requirements for all imaging facilities in its network. In addition to maintaining accreditation from the American College of Radiology, all network facilities follow a documented Radiation Safety program, an "As Low As Reasonably Achievable" (ALARA) program, and engage in ongoing preventive maintenance for imaging equipment.

CT scans and other advanced imaging tests have come under increased scrutiny in recent months due to concerns about safety and overutilization. According to a recent survey, 91 percent of physicians practice defensive medicine – ordering more tests and treatments than necessary – to protect themselves from lawsuits.

As part of its initiative to reduce unnecessary radiation from medical imaging, the Food and Drug Administration is considering the adoption of new measures – such as adding radiation safeguards to medical imaging equipment, recording dose information in patient medical records, and providing consumers with tools to track their radiation exposure.

Utilization management programs that use evidence-based medical guidelines to ensure patients receive clinically appropriate imaging studies provide a more immediate way to address patient safety concerns while curbing inappropriate utilization and medical spending.

"While no one can discount the importance of common-sense measures such as tracking radiation exposure or making imaging equipment safer, many of these safeguards could take years to fully implement – leaving patients vulnerable to excess radiation exposure and other risks," said Dr. Allen. "An evidence-based utilization management approach, such as those used in some radiology management programs, can have an immediate impact on quality and safety – providing physicians with an additional level of clinical support while offering patients peace of mind in knowing that they are receiving the right test."