Is More Imaging Always Better?

No.  There are many downsides to doing more imaging.  Imaging is expensive.  Some imaging tests expose you to potentially harmful radiation.  Doing more imaging is time consuming and may take you away from other productive activities.   Imaging tests can lead to invasive procedures which carry risk.  Imaging should be done however when it is indicated and the benefits outweigh the risks.

More imaging uncovers more incidental findings

Additional imaging tests can lead to more imaging tests.  Many imaging tests uncover incidental findings.  These are findings that are unrelated to the symptoms or problems you may have.  Some incidental findings can be important or potentially caught before they cause problems.

It is common to do an imaging test where a potential abnormality is uncovered.  Another test is then recommended by the radiologist.  Additional more focused testing may lead us to a diagnosis.  This additional focused testing may then lead to another incidental finding which needs more image tests.

What are some examples of incidental findings?

A common example of this is for lung nodules.  We may find these spots on X-rays, or CTs of other body parts that include a part of the lungs.  We then image the chest and find more lung nodules or lymph nodes which are a bit too large.  Many of these findings are benign.  But given the chance for cancer, we end up following these nodules over time to ensure they are benign.

Another example is when we see a liver lesion on CT of some other body part that includes a portion of the liver.   An abdominal MRI is then done which uncovers adrenal nodules and kidney cysts.  These then need potential workup and follow up with additional testing.  Not to mention the anxiety associated with finding indeterminate lesions in your organs.

There are published guidelines for incidental findings

We have published national guidelines for following and evaluating incidental findings.   Not all radiologists use these.  Some use their judgement and experience.   This can lead to more testing.  More follow up.  Many of these findings are benign but we have to make sure, especially in our litigious culture.

Therefore, more imaging is not always a good thing.  It can lead to unnecessary worry, cost, loss of time, etc.  It is important to image when the benefits outweighs the risks.  When more imaging is likely to lead to better outcome.

Many imaging tests are ordered for questionable or non indicated symptoms

More imaging tests should be done when the clinical condition indicates.  I see many imaging tests ordered for conditions which are questionable at best.  Doctors just making sure even though they know finding an abnormality is very low probability.  Or they are just making sure.

Imaging tests should therefore be ordered with care and using good judgement.   Not every headache or abdominal pain should get imaging.   Imaging tests can uncover questionable or incidental abnormalities which lead to more testing, some of which is invasive and has risk.   Not to mention the costs, radiation exposure lost time, etc.

Unfortunately, the legal climate in medicine is such that ordering the imaging test is much easier then potentially missing an unlikely diagnosis which leads to a bad outcome.   It’s always the best course to discuss the pros and cons of ordering more testing with your doctor.  Imaging tests save lives and lead to the correct diagnosis in many cases.   They have revolutionized medicine but carry risks as well.


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