A man sees his doctor after fainting — does he need a brain imaging scan when there is no evidence of seizures or other neurological signs and symptoms?
According to 9 US medical society’s :–
NO
(because in patients who have a witnessed faint or syncope but with no
suggestion of seizure and no report of other neurologic symptoms and signs, the
likelihood of a central nervous system cause of the event is extremely
low
This is just one questionable test or
investigation out of a compendium of 45 clinical "don't do’s"
drawn together by the American Board of Internal Medicine as part of a campaign called
Choosing Wisely : The campaign is an an attempt to reduce the
number of common but often unnecessary tests and procedures which have no
evidence to support their use. Such tests contribute to the high cost of
healthcare and may even harm someone’s health, for example if they are
exposed to excessive radiation through diagnostic imaging or suffer
complications of surgery that they didn’t need but had because of a
false-positive test result.
The lists of questionable tests
includes :
•
Patients with no symptoms and at low risk for coronary heart disease :
Do not order an exercise stress test
•
Patients with non-specific low back pain : Do not do imaging studies
(MRI of spine etc) within the first 6 weeks unless there are “red flag
symptoms” such as severe or progressive neurological deficits – most
patients will have no significant changes on the scan and will settle down.
•
Patients who might have a deep vein thrombosis but according to
pretest probability charts have a low risk ; Do not order imaging studies as an
initial test instead, but first obtain a high-sensitive D-dimer measurement
(this is a blood test).
•
If a patient is going for surgery but has no clinical suspicion for
intrathoracic pathology : Do not do a preoperative chest X-ray.
•
Patients in early stages of prostate cancer with a low risk for
metastatic spread : do not do scans such as positron emission tomography (PET),
CT or radionuclide bone scans, as there is no evidence to suggest that such
scans improve the detection of metastatic cancer or survival.
•
If a patient has no symptoms of heart disease and are at low risk,
don’t do an annual ECG
•
Patients with acute mild-to-moderate sinusitis: Don’t routinely
prescribe antibiotics for unless symptoms last for seven or more days, or
symptoms worsen after initial clinical improvement
If this has left you worried about being exposed to radiation during diagnostic imaging such as a chest x-ray, you might want to read what
the British Medical Journal recently published on the topic
This summarised that
:
•
The demand for imaging, especially computed tomography, has
increased vastly over the past 20 years
•
An estimated 30% of computed tomography tests (CT scans) may be
unnecessary
•
Ionising radiation (as in x-rays and other radiological
investigations) may be associated with cancer and other non-cancer sequelae
•
The risks of iatrogenic radiation exposure (i.e. from medical
tests) are often overlooked and patients are seldom made aware of these risks
•
The requesting doctor must balance the risks and benefits of
any high radiation dose imaging test, adhering to guideline recommendations if
possible
•
Difficult cases should be discussed with a radiologist, ideally
at a clinico-radiological or multidisciplinary team meeting
