Healthy tools improve medical imaging

New evidence suggests that imaging technology may be getting ahead of our ability to manage it. The research, presented at the American Orthopedic Society for Sports Medicine annual conference this week, found that medical imaging showed hip abnormalities in 70% of professional and collegiate hockey players, even though only 2 of the 39 actually experienced mild pain.

Similar findings have been published before, most notably in the spine. In fact, if you randomly x-rayed people off the street, most would have spinal abnormalities show up on the radiographs, even if they had no pain or impaired movement. Shouldn't this be good news? Yes, except that patient reports of pain in the back or joints is often investigated using some form of imaging technology. And when the images reveal abnormalities it is often assumed that they are the cause of the pain, which can lead to surgical fixes. What outcomes research in spinal surgery is finding is that often the repair corrects the abnormality, but not the pain.

One solution is the development of better assessment tools that can work alongside imaging to help with health decision-making. Researchers at Intermountain Health Care in Utah appear to have done just that in the area of angiography, or vascular imaging. The current gold standard for assessing coronary risk is known as the Framingham Risk Score, which combines total cholesterol, HDL ("good") cholesterol, blood pressure, diabetes risk, age and gender into a score that predicts your risk of heart attack. By adding two additional measures of risk (complete blood count and metabolic profiles) to Framingham, Intermountain researchers were able to increase the precision of that gold standard in predicting the likelihood of death within 30 days of angiography by 30% in women, and 57% in men. After 5 years, the new score still outscored the gold standard in predicting death by 29% in women and 25% in men. This was a large study, following 5,000 patients. Using such a health decision-making tool could help reduce the number of people who get angiography in the first place. This is an area especially ripe for such decision support, since it has been estimated that 30% of angiograms are unnecessary.

Together, these findings sound a further call for more research and guidelines in the rational use of imaging technologies. We also need more patient-centered approaches that avoid a hasty rush to imaging-induced surgery by carefully assessing whether pain is manageable with conservative measures, and fully informing patients about what is known and unknown about the effectiveness of available treatment options. Its a hard lesson for American health care to learn, but in addition to being financially unsustainable, oftenmore care isn't necessarily better.