Imaging Overload: Redundant X-Rays in Arthritis Diagnosis Expose Patients to Unnecessary Radiation
A new study in rheumatology quantifies a common but problematic diagnostic pathway for axial spondyloarthritis, a form of inflammatory arthritis. Researchers found that patients frequently undergo multiple pelvic and lumbar radiographs before receiving a definitive sacroiliac computed tomography (CT) scan. In a cohort of patients with CT-confirmed disease, an average of 2.47 X-rays were performed beforehand, with over three-quarters of patients receiving two or more. This practice resulted in a significant cumulative radiation dose, with a median maximum-bound exposure of 2.80 millisieverts (mSv). The analysis concluded that these repeated radiographs add substantial radiation burden without improving diagnostic yield, whereas a single, appropriately indicated low-dose CT scan could provide the necessary structural assessment with far less exposure.
Why it might matter to you: This research highlights a critical issue in diagnostic stewardship relevant to all specialties utilizing thoracic imaging, including pulmonology. It underscores the importance of optimizing imaging pathways to minimize patient radiation exposure while maximizing diagnostic efficiency. For pulmonologists managing interstitial lung disease, lung cancer surveillance, or pulmonary complications of systemic diseases, the principles of avoiding redundant low-yield imaging and considering advanced modalities like low-dose CT earlier in the diagnostic algorithm are directly applicable and can improve patient safety.
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