A nasty brouhaha has developed over an inflammatory posting by a radiologic advocacy group on the website of the National Council on Radiation Protection (and measurement) in response to the NCRP report entitled “Increased Average Radiation Exposure of the US Populations Requires Perspective and Caution.” The NCRP report is pretty balanced.

However, the follow up press release and commentary by two academic radiologists (Gerard White, F.A.C.R., and John Boone, F.A.C.R.) is a pure economic and political piece which proposes non-radiologists who self-refer (the article presumes radiologists do not) are responsible for egregious cost increases, inappropriate care, and the increased radiation risks of the US population! 

Radiologists engage in as much if not FAR MORE self referral for dubious reasons, so this release is very unfortunate indeed, and must be responded to very firmly. We have prepared a response, which I encourage you to read.

A search of the literature on “self-referral” on MedLine reveals a huge preponderance of references related radiologists self-ordering (e.g. self-referral) CTs. Lately, for example, huge increases of CT of the abdomen to r/o aneurysm following unrelated studies have been noted, associated with questionable risk factors. There’s plenty of damning literature there for radiologists. Plus, reliable third party sources estimate that of CT radiation exposure, 96% is applied by radiologists, compared with 0.6% by cardiologists. There are some alarming things about potentially unnecessary medical radiation exposure in the NCRP report that bear careful consideration. But it’s not like radiology is uninvolved.

I called my counterpart at ACR on this, and I believe he was genuinely concerned this has occurred. ACR and ACC leaders have been working together to take the high road on changing our past dysfunctional dynamic toward working together on appropriate use criteria (AUC), multi-modality AUC, joint proposed registry quality improvement projects, and other positive efforts.

That’s why this kind of seriously skewed commentary is damaging ultimately to both ACR and ACC. We must respond to the inaccuracies and egregious accusations in this document, but hopefully we can contain it to the NCRP site and correcting the information for those who have accessed it.

This is risky business. All imaging specialties refer patients sometimes to their own practice settings -- it often makes sense for patients and efficiency. There are disclosure mechanisms that can help avoid inappropriate self-referral. The minority of imaging physicians of all specialties -- obviously including radiology as much as any other -- who engage in inappropriate self referral should not be tolerated by any of us. But this missive was all about crass competition and divisiveness. It’s sad.