Rising demand for medical imaging: what happened to evidence based medicine?

Arnaud Chiolero professor of public health and epidemiologist Too much medical imaging seems to occur in response to a low tolerance to uncertainty, in a context of defensivemedicine.1 Thebelief that uncertainty canbe resolvedby imaging leads to increaseduse “in patients who stand very little chance of receiving any benefit.”1 The overuse of imaging is not only useless but costly, overburdens health systems, and is a major cause of overdiagnosis and overtreatment.2 This trend seems out of control. What happened to evidence based medicine in this story? It might be the only reasonable way to combat the overuse of imaging. Evidence based medicine emerged 30 years ago, aimed at more scientific and empirically grounded clinical practice to provide safer,more consistent, andmore cost effective care,4 notably by producing reliable clinical practice guidelines.3 Looking at the use of medical imaging in the NHS, one might think that evidence based medicine has been lost somewhere. The inadequacy and wide variation in implementing evidence based medicine has been well documented in all areas of medicine.4 The American Board of Radiology proposed some solutions a couple of years ago, including developing evidence based appropriateness criteria for imaging, guidelines for conducting imaging studies, and point-of-care decision support, as well as strengthening the education of referring physicians, patients, and the public.5 This is a real evidence based action plan, and it is time to apply it to medical imaging.