Making Wise Choices

The ACR joins a campaign designed to question the necessity of common procedures.Making Wise Decisions

The key ingredient needed to make a good choice is knowledge. For example, most radiologists know that routine imaging for low back pain is often overused.

Communicating this information to referring physicians and patients could help them make better choices and potentially reduce unnecessary imaging and health-care spending.

Now, the College is getting the word out on the overuse or misuse of imaging tests and procedures by joining the American Board of Internal Medicine Foundation in its Choosing Wisely™ campaign. For the initiative, national organizations representing a variety of medical specialties are identifying and questioning the necessity of common tests or procedures.

Intelligent Decisions

"The campaign is about helping patients and clinicians make smart choices for diagnostic tests," says Debra L. Monticciolo, M.D., FACR, co-chair of the ACR Choosing Wisely Working Group and professor of radiology at Scott & White Healthcare of Texas A&M University in Temple, Texas. Aside from the College, Choosing Wisely member organizations include the American Academy of Family Physicians, the American College of Physicians, the American College of Cardiology, and even Consumer Reports — a company that educates and empowers consumers about their purchasing decisions. (View a complete list of partner organizations at http://bit.ly/CWPartners.)

"We thought the campaign fit very well with our initiatives, including the ACR Appropriateness Criteria®," says Paul A. Larson, M.D., FACR, co-chair of the ACR Choosing Wisely Working Group, from Radiology Associates of Fox Valley in Neenah, Wis. "We clearly believe in appropriate imaging and that sometimes means less imaging."

Ideally, the campaign will spark conversations between physicians and patients to ensure that procedures and tests used are:

• Supported by evidence
• Not duplicative of other tests or procedures
• Free from harm
• Truly necessary

"We would love for physicians to recognize that a test or procedure they've been routinely ordering shouldn't be done anymore," notes Larson.

Defining Areas of Interest

To help guide the physician-patient discussion, all Choosing Wisely member organizations developed a list of five common tests or procedures that physicians and patients should question. "It'd be great if people were able to generalize — from what every group submits — that almost any test considered deserves a little bit of a discussion," says Larson.

For the College's five common practices, Larson, Monticciolo, and other members of the working group "worked hard to find procedures commonly used but maybe not always to the best advantage," says Monticciolo. The five statements recommend specific actions related to:

• Imaging for headache in ambulatory settings
• CT for pulmonary embolism
• Routine and preoperative chest X-rays
• Imaging children for suspected appendicitis
• Repeat ultrasound for benign ovarian cysts

View the complete list with detailed recommendations and related evidence-based information at http://bit.ly/CWLists.

To develop the ACR's submission, the working group turned, in part, to the ACR Appropriateness Criteria. "The criteria were a resource to us since we already had evidence-based information for many of the recommendations in our submission," says Larson. However, while the group used the evidence-based principles — available at www.acr.org/ac — to prepare the submission, members also hope that the national stage of Choosing Wisely and its promotion of quality and safety may encourage more frequent use of the criteria.

"This is an example of where the College is really ahead of the pack," says Monticciolo about the creation of the appropriateness criteria. "We recognized long ago that help was needed to make decisions. And with the increasing complexity of medical decision-making, it's become even more important."

In fact, the foundations of the Choosing Wisely, Image Gently®, and Image Wisely® campaigns are ultimately focused on making smart decisions. "All of the campaigns are similar because they stress the safest and most effective methods of diagnosis," says Monticciolo.

Despite the similarities among the campaigns, Choosing Wisely is unique with its cross-specialty cooperation. "This initiative could get a lot of attention — more than any one organization could create on its own," says Larson. Plus, the addition of Consumer Reports as a partner could bring in some additional interest.

"When you think of Consumer Reports, you think of reading about wise places or things on which to spend resources and money," he adds. "That might be where we want patients to be thinking."

Help your patients and referring physicians make smart choices. See how you can get involved in Choosing Wisely at http://choosingwisely.org.


By Raina Keefer
Raina Keefer (This email address is being protected from spambots. You need JavaScript enabled to view it.) is a freelance writer.

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