Radiology, Rising Healthcare Costs and Self-Referral

Huffington Post—April 28, 2009

by Helene Pavlov, M.D., Radiologist-in-Chief, Hospital for Special Surgery

Over the past few months a number of articles have surfaced discussing on one hand, the ills of our health insurance system and the impact from expensive high tech imaging examinations including CT scans, MRIs and other imaging technologies and on the other hand, the importance of these diagnostic examinations on patient outcomes.

The fact is that imaging has contributed to the increase in the cost of healthcare over the last few years. More and more images are being prescribed, but what many fail to realize is that physicians are incentivized by equipment vendors and their colleagues to install their very own MRIs, CTs and X-Ray machines in their offices and to self-refer.

Additionally, patients do not always realize that "All Images and Image Interpretations are not created equal." Non-radiologist physicians with imaging equipment in their offices have the ability and license to take an image using CT or MR, similar to having a camera. Anyone can do it, or can they?

Capturing a diagnostic image appropriate for the underlying condition and then correctly interpreting that image is not an easy task. Imaging perfection and accuracy requires the expertise of a trained radiologist. Radiologists are physicians with four years of dedicated residency training in the physics of ionizing radiation (X-ray and CT) as well as magnetic resonance (MR) post medical school. This training is focused on image acquisition as well as training in image interpretation. Typically, radiologists do another year or more of fellowship training in a specific subspecialty (gastrointestinal, musculoskeletal, etc.) and become highly proficient in recognizing image artifacts that can mimic or mask diseases and subtle conditions to the untrained eye or the eye of a non-radiologist physician.

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Patients have an advocate on their side when imaging is concerned and they should ask for and receive the highest quality in patient care at all times. Patients should know to ask their physicians the following questions -- "Who is performing my imaging examination?" "Who will interpret my imaging examination study?" and "Who is truly looking out for me?"

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