Diagnostic imaging in Australia accounted for 15.5 per cent of Medicare benefits paid in 2003/2004 and has become a major driver of rising health care costs.1 While the principle of 'accountability' requires Government to ensure that public funds are spent judiciously, there are signs of expenditure stemming from inappropriate application of medical imaging. It is common for Imaging Specialists to provide examples of unnecessary examinations for particular clinical conditions and for desirable examinations to be omitted. A recent article cites previous research indicating that up to a third of radiological examinations are totally or partially inappropriate. 2
Issues
Inappropriate imaging has a number of potential adverse outcomes. Unnecessary or excessive examinations may expose patients to risk without benefit, including the risk of false-positive results.2 On the other hand, failure to provide the most appropriate examination may result in inefficient diagnosis and ineffective treatment. From the perspective of 'accountability', inappropriate services are a threat to the effective allocation of resources to health care.
A significant threat to appropriate imaging is lack of knowledge. The task of keeping up-to-date with developments in clinical practice is increasingly difficult, due to expanding research activity and publications, clinical specialisation and sub-specialisation and new applications of technology. It is difficult to acquire and maintain the necessary breadth and depth of knowledge for confident and correct decision-making. A 'medical knowledge crisis' is well recognised, as is the need for improved knowledge management and electronic decision support systems in the health sector. 3,4 The development of decision support systems has been suggested as a specific strategy to increase the appropriateness of diagnostic testing. 1
Organisation's Mission
There is a hierarchy of organisations responsible for Diagnostic Imaging Pathways.
The Department of Health, as the principal health authority of the Government of Western Australia is committed to:
- "promoting, protecting, maintaining and restoring the health of the people of Western Australia"
Royal Perth Hospital, which hosts the development, dissemination and evaluation of Diagnostic Imaging Pathways, is the largest provider of public health services in the state of Western Australia and is committed to:
- "the delivery of excellence in health-care"
The Division of Imaging Services, which employs key staff concerned with the development, dissemination and evaluation of Diagnostic Imaging Pathways, is the largest public provider of diagnostic imaging services in the state of Western Australia and is committed to:
- "achieving international standards in diagnostic imaging through clinical, research and teaching activities"
Objectives
The primary objective of Diagnostic Imaging Pathways is to achieve the appropriate application of medical imaging technology to diagnosis. Diagnostic Imaging Pathways is disseminated as an education and decision support tool for requestors and providers of medical imaging services. Reference to Diagnostic Imaging Pathways will facilitate the effective allocation of resources to health-care by:
- reducing the incidence of unnecessary or excessive examinations which may expose patients to risk without benefit, including the risk of false-positive results
- increasing the incidence of appropriate examinations which will result in efficient diagnosis and effective treatment
Intended Audience
The principle users of Diagnostic Imaging Pathways are intended to be:
- Current and future referrers to diagnostic imaging services
- Medical and surgical specialists, general practitioners, junior medical officers and medical students
- Current and future providers of diagnostic imaging services
- Imaging specialists and students, imaging technologists and students
The information provided in the Diagnostic Imaging Pathways is designed to support, not replace, the relationship that exists between a patient and a physician.
Last reviewed in May 2009.