Overdiagnosis and overimaging: an ethical issue for radiological protection

Abstract

Aims and objectives This study aimed to analyse the key factors that influence the overimaging using X-ray such as selfreferral, 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.

Clinical and epidemiological observations on individual radiation sensitivity and susceptibility

“…When we are faced with the question, whether susceptibility testing should be offered prior to radiotherapy or employment in a job involving radiation exposure, a broad evaluation of the issue is needed. Important publications on this topic include Beauchamp and Childress (2013), Cowley (2016), Offit and Thom (2007), Perko et al (2019), Salerno et al (2019), ICRP (2018), Brandl and Tschurlovits (2018), Malone and Z€ olzer (2016), and NCRP (2010). The obvious ethical justification for seeking evaluation of susceptibility is the potential to reduce adverse effects of radiation exposure (beneficence), but other ethical issues also need to be considered including autonomy and justice.…”

Working to Solve the Thyroid Cytopathology Conundrum

“…16 Indeed, there is some literature that suggests a North American focus might better be divided into countries because, for example, Canadian neurosurgeon defensive medicine differs from United States neurosurgeon defensive medicine. 14 Schnadig and others identify additional potential causes of papillary thyroid cancer overdiagnosis, including ethical and potentially legal issues of self-referral, professional advancement, or other conflicts of interest 1,18,19 ; however, given the evidence from the medical literature, it is reasonable to assume that defensive medicine has some significant role in the overdiagnosis of papillary thyroid cancers.…”

Effect of Beta-blockers on Tachycardia in Patients with Pulmonary Embolism

“…The "best practice advice" stated in this report was that "clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered" [2]. On the other hand, lab tests and imaging could be important secondary factors in quick diagnosis [3][4]. This states that clinical judgment is often the most important diagnostic factor in patients presenting with acute PE [5].…”