Overdiagnosis and overimaging: an ethical issue for radiological protection

• Published in: Radiologia medica 2019-08, Vol.124 (8), p.714-720
• Main Authors: Salerno, Sergio, Laghi, Andrea, Cantone, Marie-Claire, Sartori, Paolo, Pinto, Antonio, Frija, Guy
• Format: Article
• Language: English
• Subjects: Contrast media; Diagnostic Radiology; Ethics; Imaging; Interventional Radiology; Ionizing radiation; Medical imaging; Medicine; Medicine & Public Health; Musculoskeletal system; Neuroradiology; Physicians; Prostate; Radiobiology and Safety; Radiology; Ultrasound
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-019-01029-5

Aims and objectives This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. Materials and methods In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. Results The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination. Conclusions We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care.