Why do physicians order costly CTs? Ultrasound yields better diagnosis, safer, less costly, expert argues

In the editorial, Why Has Computed Tomography Won and Ultrasound Lost the Market Share of Imaging for Acute Pelvic Conditions in the Female Patient?, Dr Benacerraf raises the question:

"How have we evolved to ordering the most expensive imaging technique first for these patients, only to be followed frequently by a far less costly ultrasound examination to clarify the CT findings? Ultrasound is the established modality of choice to evaluate the female pelvis, so why do patients with pelvic masses or pain get a CT scan? In my opinion, doing a CT scan first for female patients with lower abdominal pain is dangerous and wasteful, a drain of much-needed health care dollars."

Citing a recent study from the New England Journal of Medicine regarding the vast use of imaging procedures that involved radiation exposure, Dr Benacerraf emphasizes the fact that "radiation exposure is cumulative, and each exposure adds incrementally to the long-term danger of cancer." Alternatively, ultrasound is safe, radiation-free, and most frequently has superior diagnostic capability when evaluating patients with lower abdominal conditions. The advancement of ultrasound technology has resulted in machines that are less operator-dependent with the ability to produce images that can be evaluated in multiple views with 3D volume imaging.

Dr Benacerraf concludes: "It may be time for ultrasound to regain its rightful place in the evaluation of acute female pelvic and lower abdominal conditions and save the population from the dangerous radiation exposure and excessive cost of starting a workup with CT as a first-line imaging test."

Physicians weigh in on this subject online through the AIUM's Journal Club discussion this month at http://www.aiumcommunities.org/group/aiumjournalclub. The full text editorial may also be accessed through the journal club discussion.

Beryl Benacerraf, MD, is a clinical professor of radiology and obstetrics and gynecology at Harvard Medical School, and she is the editor-in-chief of the Journal of Ultrasound in Medicine, the official publication of the American Institute of Ultrasound in Medicine.