Aptly named “Obtenir la bonne image pour mon patient”, the campaign, led by Heads of the European Radiological Protection Competent Authorities (Herca), launched earlier this month. It not only reiterates the harmful effects of over-imaging to medical professionals but additionally raises patient awareness on the topic.
Diagnostic imaging is common practice in medicine, and nothing is alarming regarding a safe dosage of ionising radiation (the radiation you find in regular x-rays, CT scans or mammography). What is being targeted in this intervention is the robust reasoning for requesting diagnostic imaging, as highlighted across European countries where almost 20% of such investigations are not adequately justified. In December 2015 results showed Luxembourg was the highest user of diagnostic imaging in Europe. Consequently, the health ministry decided to take action to reduce the number of non-justified examinations, improve doctor-patient education while maintaining the high quality of care delivered to the Luxembourgish population.
What has Luxembourg learnt since? By implementing a plan of action which was then audited, the health ministry aimed to better document and understand the effects of the new policy. The public health campaign focused on awareness as demonstrated by their involvement in Herca. They introduced continued professional development and education on the subject, so as to standardise imaging requests from medical practitioners and subsequently they developed a set of good practice policies for healthcare institutions in the country. Tangible goals were set to reduce the number of unnecessary investigations by 50%, bring a standardisation of imaging practice to 100% and most importantly maintain and optimise safe doses of medical radiation per examination for the general public.
Possible reasons for unnecessary imaging include bolstering a clinical diagnosis--which could otherwise be confirmed without imaging, performing imaging which would otherwise not alter a patient’s treatment plan, or requesting x-rays for a pregnant woman which could be postponed if not urgent. Patients, too, play their role in driving the demand for unnecessary imaging as witnessed in cases of appeasing the “worried-well”, where perhaps medical practitioners should intervene and prioritise empowering the patient via education.
What can we learn from Luxembourg? Findings from the health intervention in 2017 demonstrated that 39% of imaging in Luxembourg was shown to be imprecise or incomplete with an equal percentage of inappropriate CT scans. Luxembourg has followed suit of precisely what the European Commission Radioprotection act for 2000 emphasised. The campaign is not a call for doctors to restrict their practice but instead to reconsider the genuine need and value of investigation for the patient. Leaflets produced by the Herca during November’s joint campaign consist of 7 key questions to doctors ranging from the need for a repeat radiological image, factors to consider when imaging children, to opting for efficient non-ionising imaging alternatives. All these can be found on the ministry’s website and are readily available for public use.
Dr Lilani Abeywickrama is a Luxembourgish ophthalmologist currently based in Milan. Her main interest is advocating healthy living and precision technology within her specialty and is pursuing her interests in the field of healthcare management.