WEST PALM BEACH, Fla., Aug. 7 (UPI) -- More and more individuals are using medical imaging centers -- in which they receive computed tomography, or CT, scans -- routinely and without a doctor's recommendation or prescription, but the jury is still out on whether this trend represents a net benefit or detriment to America's health care system.
The clinics themselves, however, have reaped a significant financial reward from the booming business.
"Self-referral fits into a culture that is already in place in the medical community," Dr. Michael Brant-Zawadzki, a clinical professor of radiology at Stanford University School of Medicine and medical director of radiology at Hoag Memorial Hospital in Newport Beach, Calif., told United Press International. "Physician referrals for CT scans have also risen dramatically because of the sensitivity of CT. With increased information available to patients, they are now self-referring for all sorts of exams, from mammography to genetic testing."
In the late 1990s, imaging centers began accepting clients without physician referral or input. Self-referred clients usually have full-body CT exams that include a non-invasive evaluation of the coronary arteries for calcification, or of the lungs, abdomen and pelvis for cancer.
"In our society, which equates better technology with better care and believes that more information is necessarily beneficial, the potential profitability for independent screening has piqued the interest of entrepreneurial physicians, an interest that is expected to yield a 25 percent annual increase in revenues over the next several years," Judy Illes, lead author of the study and senior research scholar at Stanford Center for Biomedical Ethics and the department of radiology at Stanford University in Palo Alto, Calif., told UPI. "These projections are in sharp contrast, however, with the ongoing debate about the value and legitimacy of self-referred imaging that has clearly divided the medical community."
As they report in the August issue of the journal Radiology, through analyses of information available on the Internet, Illes and her researchers identified 88 imaging centers in 21 states that accept self-referrals. Of those centers, 43 also offer conventional, physician-ordered diagnostic services. More than half offer full-body screening and heart and lung scans are the most frequently offered procedures.
They found the greatest concentration of centers in California, with 30, mainly in the southern part of the state, and 13 in New York. They offered full-body scans ranging in price from $795 to $995, with a full-body scan including the head averaging $850. A full-body scan including a bone density test averaged $1,215.
About half of the centers offer neck-to-pelvis, full-body scans. Only 26 centers offering full-body scans are standard radiology offices or departments.
"This study is the first part in a larger research program," Illes said. "We wanted to know where these centers are. Now we will begin to look at what motivates self-referred imaging, its effect on the patient-physician relationship, and downstream costs to the healthcare system."
The centers are located in areas with a significantly higher percentage of European-Americans and a lower percentage of African-Americans and other minorities, except Asian Americans. Areas with screening centers also include a significantly higher percentage of people with advanced degrees than the national average and a lower percentage of people with below a ninth grade education.
"The geographic distribution of the centers suggests target populations of educated health-conscious consumers who can assume high out-of-pocket costs," Illes said.
Is the benefit of these exams worth the cost, even to people who can afford them? "There is no doubt that CT will increase the cost of healthcare overall, whether it remains consumer-oriented or becomes an accepted and reimbursed examination," Dr. Stephen Amis, professor and chairman of the Department of Radiology at Albert Einstein College of Medicine and Montefiore Medical Center in New York City, told UPI.
Brant-Zawadzki agreed, but noted no preventive tool cuts healthcare costs.
Dr. Stephen Swensen, professor of radiology at Mayo Medical School and chair of the department of radiology at the Mayo Clinic, estimated 907,200 new lung cancers would be detected if CT scans were performed on the U.S. population, which would incur a cost of $74.1 billion or $81,700 per cancer. He told UPI the question of whether this cost burden is acceptable will remain unanswered until more evidence indicates a clear reduction in mortality as a result of early disease detection.
To date, early detection of diseases, which full-body CT scans can detect -- notably lung cancer, coronary artery disease and colon cancer -- has not been proven in clinical studies to reduce mortality.
Due to the lack of such evidence, the American College of Radiology does not recommend full-body CT screening as part of routine self-care.
