我们是结束了成像？

在成像的进步已经极大地改变癌症治疗的方方面面 - 从诊断和治疗监测和预防。它的影响远远超出了癌症，在整个医疗保健频谱拉伸。然而，随着技术的进步和其潜在的暴涨，所以有关于过度使用和合理利用成像的担忧，以及成本对国家的医疗体系。据辐射防护和测量全国理事会，据估计，自20世纪80年代每年的医疗照射增长了6倍。

对于有关统计数据的原因是那样明显，因为它们是复杂的。临床，法律和经济因素参与，以及被授权的病人的需求。

“显然，成像已经彻底改变了医学，但有一个明显的悖论，”说马歇尔·希克斯，医学博士，影像诊断的头在MD安德森癌症中心。“When applied and used appropriately, imaging is undeniably valuable. Yet, as it has become more accessible and more prevalent, an overuse issue has developed — both across the country and beyond cancer — that we’re now trying to address as a society." As the United States continues to try and tackle growing health care costs, the field of medical imaging is on notice, with policy makers and insurers taking a stand against excessive use and cost. Many professional medical societies have launched campaigns promoting "appropriateness criteria" and/or clinical guidelines for imaging and procedures.

过成像和乳腺癌

一个专业的社会的奇怪动机建议MD安德森研究人员调查过成像诊断早期乳腺癌的问题。188bet体育网址

2011年,美国内科医学委员会launched "Choosing Wisely," an initiative that encourages conversations between physicians and patients that, ultimately, may discourage the overuse of the country’s health resources. As part of its participation in the national campaign, in 2012, the American Society of Clinical Oncology (ASCO) generated a "top five list" that recommended against the use of CT, positron emission tomography (PET), tumor markers and nuclear bone scans in early-stage breast cancers.

卡洛斯巴塞纳斯，医学博士，在乳腺肿瘤医学助理教授指出，美国国家综合癌症网络的建议 - 金标准治疗指南 - 明确规定，对妇女早期疾病，诊断的正确程序只包括乳房X线照片，超声波检查，临床检查和血汗工作。

“这是不建议由国家指导方针对程序ASCO广泛的建议，给了我们的想法，调查和了解是多么普遍过测试和成像真的是，”巴塞纳斯说。“我们已经知道，分期手续的过度使用是一个问题，也可能影响诊断妇女早期乳腺癌的成本效益 - 只是没有到什么程度”

For the retrospective study, Barcenas and his MD Anderson colleagues analyzed claims from a national database of 42,651 women between 2005 and 2010 with an initial diagnosis of breast cancer. All were younger than 65 and had undergone breast cancer surgery. Claims for imaging and tumor markers were analyzed between the specific period of three months before surgery and one month after.

在这些患者中，37％的人对不必要的分期试验中的至少一个要求，超过五年期的利率变化很小。最令人震惊的研究人员是有18％的肿瘤标志物188bet体育网址进行 - 一个升级程序，在非转移性乳腺癌诊断的设置没有任何作用。

Undergoing chemotherapy had the highest association with overuse of staging procedures, with hormone and radiation therapy also being overused. Finally, the youngest of breast cancer patients — women under 35 years old — were most likely to undergo inappropriate testing. However, this statistic may reflect the perception that the younger population is perceived to be at higher risk of metastatic and/or aggressive disease, Barcenas explains.

The researchers found regional differences in overuse trends, and a higher rate of unnecessary procedures in women with preferred provider organization (PPO) coverage compared to those with health maintenance organization (HMO) coverage.

沙龙佐丹奴，医学博士，卫生服务研究的椅子188bet体育网址，说，这项研究旨在提供一些验证188bet体育网址，医生，实际上，给予他们的权限不会为了不必要的检查。

“Often doctors think they’re not being good to their patients if they don't do all they can by way of testing," explains Giordano, chair of Health Services Research, who co-authored the study with Barcenas. "But there's a shift in focus to doing what matters for the patient and what's proven to improve outcomes, rather than testing for the sake of testing. Ultimately, our goal is to bring the best care and value to our patients."

Partnering with the patient

绝大多数情况是可以理解，说MD安德森的乔治·张，医学博士，结直肠外科医生，对癌症患者的主要问题是复发。而作为癌症患者，幸运的是，活得更久，他们对监督的愿望仍在继续。“特别是对于大肠癌的监视，有很少的数据是为了帮助我们监测病人并指导我们提供的护理 - 我们实际使用更多地是基于专家意见的指导方针，”张教授在肿瘤外科说。“因此，我们真的没有办法与患者沟通合适。”

张和全国各地的同事们又展开了研究，与病人的帮助下，专门解决数据问题，以及了解他们的个人需要。由联盟协作组进行，由一个非盈利性研究机构在2010年的合理医疗费用法案提供资金赞助，研究人员希望更好地了解病人监控寻找什么。188bet体育网址最终，他们要确定如何监控可定制，根据复发的风险，待处理能力，同样重要的是，自己的个人喜好。

“我们的研究合作伙伴医生和患者在制定既有的决策工具的希望，”长安，这项研究的首席研究员。“监测是固有的以病人为中心，但通信是整个癌症的经验是至关重要的。最后，病人的照顾各方面的最重要的组成部分。”