Additional scanning in the ER may or may not change the number of patients admitted to the hospital, but it sure can cut down on missed or incorrect diagnoses.

Still, scan results must be balanced with the patient's history and presentation because there ARE false positive and false negative readings of scans - particularly by non-radiologists.

And if someone isn't sick or injured enough to expect to spend several hours or more in the ER, then they probably should wait and go to an urgent care clinic or make an appointment with their primary physician.

It can certainly help the "bottom line" for a hospital!

With the increased number of CT and/or MRI has there been any documented increased in the number of cancer cases among these patients? I recently read that the more CT's a person has the risk of cancer rises dramatically. Maybe we should speak up if we have a broken bone and opt for a simpler option.

As a family practice physician , two words "defensive medicine" In fourteen years of practice I have been sued once and during a depostion I was asked "Why didn't you order a CT scan ?" although many physicians may not admit it, tests are ordered so that they are not placed in a similar situation. Usually a history, good physical exam, and clinical judgement will make the diagnosis. Unfortunately there are those whose hindsight is "20-20 vision" . By the way, the suit was dropped, but the scars remain

After 40 years as a Tech in Radiology,,,25 of that doing CT's....I honestly have never felt

more uncomfortable about irradiating the American public than I do now. I work (3) 12 hour night

shifts every week-end and it is a race to keep up with the unbelievable number of CT's ordered by

ER Docs. CT changed Medicine, for sure. You can see anatomy like never before. But there are too

many negative results for the number of scans performed. Some ER MD's have flat out told me that

if they didn't order a scan "I might be sued." I love caring for people and this makes me want to do

something else. My advice to everyone...ask if an Ultrasound will give a diagnosis before being ex-

posed to what is a significant dose of radiation and be very careful about the number of scans you

do have...keep track. Also, scanners measure the dose of each scan and you can get a copy of

this thru Medical Records. More is not better here unless you truly need it.

To your Health!!!!!

I have been in healthcare imaging for 17 years, and the overall number of imaging exams in general has increased due to a fear of being sued. These exams are not typically in the patients' best interest. Most of the ER patients I have seen in the imaging suite should actually be treated as Outpatients by their family physicians, however, they can't get in quickly enough so that overburdens the ER's and keeps emergency care from being done for those the ER was intended for.

Over the years, I have performed diagnostic x-rays, CT, MRI and ultrasounds. Over 90% of these "ER" exams are not truly emergent nor will they save a patient's life. Do I mind doing these exams? NO, but they need to be ordered as outpatient exams and not through the ER.

Humm, Hospital profits. The average cost for a MRI is $1300.00. I just spent a couple hours trying to find the cost of the imaging machine. No luck. I wonder if any hospital would disclose the cost-profit ratio? All in the ruse of better diagnostics. Maybe more elaborate scare tactics.Maybe just a way for hospitals to have another confusing test to (protect themselves). Oh ya, with the cost being passed along to the patient.

"costs of a CT scan vary widely from state to state, ranging from a few hundred dollars to a few thousand."

...if one state charges $500, and another $2000 then there is some gouging going on...can you say greed?

I'm an ER physician and yes, I absolutely over-order CT scans and xrays. I try as best I can to make the diagnosis properly - with a good history/physical. However, if there's a question, I err on the side of imaging. Like Michael-2284509, I've been burned by being too conservative. Lawyers couldn't care less about the appropriate practice of medicine. "Didn't you have access to a CT scanner? Why didn't you order a CT for this patient?" So there is always a part of my practice that is defensive. It's not worth it to me personally to practice any other way.

Sometimes I will try to bring the patient (or parents of the child) into the decision-making by explaining the possible risks of the radiation and the likelihood of finding whatever is the worst-possible diagnosis that I'm ruling out. Guess what? More often than not, the patients request the imaging.

And lest we in the ER shoulder the entire blame, let's not forget our consultants. We have thus far only convinced two of our cadre of surgeons that appendicitis is truly a clinical diagnosis and should not require a CT scan.

It is as much a societal issue as anything else. There seems to no longer be an acceptable error rate for making a diagnosis.

So come on down and get your unnecessary full-body CT. Keep the lawyers at bay and the oncologists in practice.

Follow the money, doctor offices and hospitals pay big money for these machines and what to recover the money spent as soon as possible. Of course they are going to suggest more tests!

You can blame trial lawyers and defensive medicine practices for this, especially in the emergency room. Billions are spent each year to make sure your headache isn't that one in a million aneurysm.

The current approach to testing for heart disease is flawed. Seriously flawed. People concerned about having a heart attack, need a study that will check for the blood flow going to the heart. We have published two papers in peer reviewed medical journals showing people are receiving twice as many injections of radioactive materials to look for heart disease using nuclear studies. We have shown and now UCLA, Harvard and Iranian physicians have confirmed our results. You would think the Government and Pharmaceutical company would have admitted this by now since the Pharmaceutical company paid for and published a paper showing Sestamibi redistributes (moves around), which means you only need 1 (not 2) injections of Sestamibi. As they say, "wait for it!", the 2 injection approach misses 40-70,000 people a year. And, "wait for it!", the first paper published in 1925 by Blumgart, is where we got the idea of questioning the company and the government. Now that it's published in a Government journal, maybe we can (1) quit mis-diagnosing people and sending them home to die, (2) reduce the amount of radiation people are getting exposed to and (3) actually do the test right.

I think the real issue that needs to be discussed is why are Dr ordering advanced imaging. After working several years in an ER and an equal number of years on the finance side, i can attest most of the time the advanced imaging cost the facility more then it was reimbursed.

Most of this could be pushed towards MD concerned about missing something (malpractice) and patients demanding these tests.

I totally agree that the increase is due to physicians covering all bases to avoid being sued. In addition to that, there are individuals who will insist on the procedure, or as just stated in the prior post, "demand" is a better word.

Add me to the list of ER docs over-ordering CTs by the dozen to avoid lawsuits.  We are taught in residency, "Just practice good medicine, and you won't have to worry about losing a lawsuit"-- which may be true-- but what they forgot to tell us was that after I'd been sued twice, I no longer worried about what it takes to WIN the lawsuit-- Now I worry about how not to get sued in the first place!  Making my chart bulletproof against lawyers means more CT scans-- a LOT more.  And patients know this:  after Natasha Richardson died, many dozens of parents brought their kids (or spouses) in for CT scans.  No matter how I tried to explain that their family member absolutely did not meet criteria for a scan, MANY still said "they said Natasha Richardson was fine too.  If you're wrong, you can bet you'll hear from my lawyer."  No problem ma'am, here's some radiation for your son's brain.  Would you like fries with that?

People don't want malpractice reform.  They'd rather have cancer. 

When I was in med school, in 1995, our Surgery chairperson taught us that if you were operating for appendicitis, 1 out of 5 should be normal (no appendicitis)-- otherwise, you probably weren't operating enough and you were likely to miss an appendicitis that then ruptures.  Today, 15 years later, no surgeon in our hospital will operate for appendicitis without a CT scan, because they need to be right 100% of the time or they risk being sued. The result is hundreds of unnecessary scans a year, patients backed up waiting for the CT scanner, and some of those patients wind up with a ruptured appendix while they wait 6 to 7 hours for the scan (it's a minimum 3 hour wait for the oral contrast to work its way through the intestine-- after that it just depends on how many other patients are also waiting for scans). 

More radiation, longer wait times, and in some cases poor outcomes due to delayed diagnoses.

I'd like to see the utilization numbers in Texas, where they have malpractice reform, compared with NY.

having been a Hospital Risk Manager and now working for a personal injury attorney with an emphasis on medical malpractice cases, I can say I have seen both sides; recently we talked with a potential client who had severe abdominal pain; she thought she had appendicitis and went to the ER, where she had an abdominal CT; lo and behold, it showed she had a large ovarian mass and she was diagnosed several days later with ovarian cancer. Let's not forget the patients where a CT is really indicated, such as this case. The problem as I see it with over imaging in the ER is multi-faceted; First of all you have patients who don't even belong in the ER going for symptom that could be addressed in an urgent care setting or a physician's office; the patient becomes demanding , the ER doc is tired and he caves in to the demands of patients; he or she is the doctor-- patients can demand lots of things, does that mean you, as the professional, have to give in to it? you don't have to; the patient may be angry and leave AMA; oh well. physiciians know what the standard of practice is; adhere to it and you will be fine; you cannot prevent every lawsuit; if a patient comes in and says "this is the worst headache of my life" you better do the tests; however, with a vague headache and some other symptoms you have to make some choices, as the physician you have to make some judgements; if you allow paranoia about getting sued you won't help yourself or your patients..

The current standards of care regarding care of the emergency department patient with trauma, chest pain and abdominal pain have evolved to encourage more liberal use of CT scanning. Health care facilities and physicains need to follow these guidelines and standards or risk missing infrequent but devastating conditions. If a CT scan is not ordered and there is a bad outcome, the facility and physicaian are subject to malpractice claims. The patient and or family will claim that the test was available but not ordered and the bad outcome could have been prevented. There is no significant progress regarding tort reform. Thus, the use of CT will continue to rise.