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CT scans, X-rays may expose South Florida patients to excessive radiation

A small number of hospitals in South Florida and the nation appear to give too many imaging tests, and as a result may needlessly expose patients to radiation, federal officials said Wednesday.

New federal figures provided fresh evidence that beneficial tests such as CT scans, X-rays and mammograms are being overused by some doctors in hospitals, raising the risk for patients and wasting health-care dollars. The figures show how often each hospital gives imaging tests in circumstances that could be deemed unnecessary, said Dr. Barry Straube, chief medical officer at the U.S. Centers for Medicare and Medicaid Services, which released the numbers.

Straube cautioned that officials haven't done enough research to say how many repeat tests is too many for a hospital to give, but said publicizing the figures will step up pressure on hospitals with high numbers.

"We hope these four new measures will shine a spotlight on imaging … and discourage overuse of radiation," Straube said.

For example, 24 percent of patients who got a chest CT scan at Columbia Hospital in West Palm Beach actually got two, one with a contrast dye and one without. The national average is 5.4 percent, and officials said double tests are often avoidable. Chest CT scans can expose patients to 133 times as much radiation as a chest X-ray and can cost more than $1,000 each. Likewise, 24 percent patients who got CT scans of the abdomen at Cleveland Clinic in Weston also got double tests. Only a few of the 30 hospitals in South Florida rated out of the ordinary on any of the tests.

Richard Morin, a researcher at Mayo Clinic in Jacksonville who is chairman of a radiation safety panel for the American College of Radiology, said overuse of imaging tests has become a big issue only in the past decade.

"The physicians who are ordering too many are not trying to order inappropriately, they just don't know," said Morin, who was not involved in the federal figures. "We need more education."

Researchers say doctors may overuse imaging tests for several reasons: To protect themselves against malpractice lawsuits, because they rely on technology to confirm their diagnoses and in some cases to make money. A study last year that included South Florida found that a small but significant 2.1 percent of patients were exposed to more than 20 millisieverts of radiation yearly, the maximum annual dose recommended for health-care employees. Past research shows that doctors who had ownership in imaging machines ordered 27 percent to 54 percent more scans.

The new federal figures also included how often mammograms were repeated within 45 days of the first test and how often back-pain patients got MRI scans without first trying basic treatment like physical therapy.

Morin said high numbers of repeat mammograms may be a good thing, despite the extra radiation, if they aimed to detect a growing tumor. The imaging figures — as well as dozens of other statistics on hospital death rates, infection rates and good practices.

Hospital industry officials said institutions have little to do with who gets imaging scans within their walls. Typically, the tests are ordered by a patient's doctor — usually a generalist or specialist who is not a radiologist.

"You're not going to have a hospital administrator saying, 'Doctor so and so, we need to do more of the contrast imaging tests,' " said Linda Quick, president of the South Florida Hospital and Healthcare Association.

On the other hand, she said hospitals typically employ radiologists or contract with them, and could exert some influence on them to help change practice patterns of the doctors who order the tests.

Source: Sun-Sentinel