Neurology: Are Imaging Tests, Procedures Always Necessary?

Brian Callaghan, a neurologist from the University of Michigan, has begun pushing nationally for a closer look at whether or not we are overusing Magnetic Resonance Imaging (MRI) and other neurological tests and services. In addition to being expensive, testing at the doctor's can run additional risks, such as the harm that can come from a false-positive result. Callaghan argues that just because a test is done traditionally for a problem doesn't mean it is the best way to treat it.

Callaghan supports a campaign called "Choosing Wisely" that works with more than 70 specialty societies in the medical world, encouraging the conversation between patients and doctors about whether or not certain tests, treatments, or procedures are going to be wasteful or unnecessary. The societies the campaign works with, most noticeably the American Academy of Neurology (AAN), have complied lists of five medical services that may be unnecessary.

Callaghan and his team took a look at the AAN's list and expanded it, added 69 more treatments, diseases, and symptoms that should be looked into for other recommendations addressing neurological care. They examined recommendations from other societies, like the American Academy of Sleep Medicine and the American Academy of Neurological Sciences, and focused in on the duplicate recommendations, deciding that those are the main treatments to focus on.

The five most occurring diseases and symptoms were lower back pain, dementia/delirium, headaches, concussions, and strokes. Treatments and tests that appeared most included MRI and other imaging tests, and opioids/pain medications.

"The two biggest areas that might be done more than they should are imaging for low back pain and imaging for headaches," Callaghan said. "It's a big problem and it costs a lot of money - we're talking a billion dollars a year on just headache imaging."

Callaghan stresses that his team is not recommending that doctors go ignored, or that you should say no if the doctor wants to talk an image of your lower back pain or headache. He says he just wants to open the conversation to "inspire more thought and discussion about the specific purpose of a test," according to a news release.

"Ordering an MRI for a headache is very quick, and it actually takes longer to describe to the patient why that's not the best route," Callaghan said. "These guidelines are meant for physicians and patients both, to trigger a conversation."

The team came up with areas that need to have additional recommendations, like movement disorders, and they want to develop some way to make it easier for doctors to follow guidelines. "These are all areas where lots of physicians agree that you're more likely to get harmed by doing the procedures," Callaghan said.

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