Monday, April 6, 2009

Beware the Radiologic 'Incidentaloma'!

The last few postings in the Radiology Quality category have detailed the risks of pursing trivial CAT scan abnormalities. Physicians created the term incidentalomas to describe these lesions that were discovered incidentally, or by accident. There is an epidemic of these lesions today as the volume of CAT scanning increases each year. When a scan uncovers an abnormality, the healthy patient is dragged into the medical arena. This unlucky patient may not be healthy for long. These scans are a potent accelerant that fuels the vicious cycle of unnecessary and excessive medical care.

Medicare expenditure for radiologic imaging tests, including CAT scans, is exploding. John Iglehart analyzed this trend in the March 5, 2009 issue of The New England Journal of Medicine.

Medicare Expenditures for Imaging Studies

Year 2000 Annual Expenses: $3.6 billion
Year 2006 Annual Expenses: $7.6 billion

The government capped fees paid for imaging studies performed in out-patient facilities and doctors’ offices in an effort to rein in spiraling costs. This did not work. When reimbursement for these services was frozen, the volume of these imaging studies increased resulting in additional costs to the federal government. Plan B anyone?

Why do individual doctors order so many scans? Most of them have no financial incentive to do so, yet they are quick to pull the CAT scan trigger. On the next posting, I’ll offer some explanations.


  1. An interesting blog. Found the reference on sermo. I forwarded a link to a few people.

  2. Dr. Kirsch- Hi, it's Jason, very interesting site and valuable info!

  3. I agree with you completely. I am a working CT Technologist and it sickens me to see the amount of uneeded Cat Scans that are ordered at my workplace a week so the ordering physcian can make a quick buck from the system. A good example of this is ordering a Brain CT on a patient that the family has made a "No Code". What good does a CT do a patient in a comatose state when they have been designated a "No Code". No matter what the scan may or may not discover nothing is going to be done for the patient no matter the outcome of the scan. So why order one in the first place? It only creates another hugh bill that the family or American Taxpayer is going to have to pay and does nothing to help the patient in the end!

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