Aging Pearls: Radiology
Carol L. Howe, MD, MLS, College of Medicine, University of Arizona
Did you know that the rate of high tech radiology procedures such as CT scans and MRIs in the Medicare-insured population has been increasing at a disproportionate rate compared with both routine radiography and with the rate of growth in that same population?
· “On average, between 1998 and 2001, utilization per Medicare enrollee increased 16% per year for MR imaging and 7% -15% per year for CT, US, interventional radiology, and nuclear medicine, while that for radiography increased 1% per year.”[1](abstract) The data, as reported in this 2005 study reveals “almost a doubling of per capita utilization every decade. This increase in utilization, which is sometimes attributed to technologic progress, is a measure of the increasing power of radiology to help patients.” 1(p.829)
· Mammography is more accurate as a whole in older patients when compared with younger patients. “Researchers attribute the improved performance of mammography to a decrease in overall breast density and increased content of radiolucent fat with aging.”[2](p. 378)
· Some older patients with a chief complaint of lower back pain may actually have osteoarthritis of the hip. Therefore, always think of doing an x-ray of the hip and/or pelvis working up older patients with low back pain. [3]
· Age can definitely affect the rate at which radiographic evidence of pneumonia resolves. “Approximately 90 percent of patients younger than 50 years of age show radiographic resolution by 4 weeks, compared with only 30 percent of patients older than 50, even in the absence of concurrent disease.”[4]
Questions for Discussion
1. Only women need to be screened for osteoporosis with DEXA scans. True or False? Please discuss.
2. Should chest x-rays be ordered routinely pre-operatively in patients over age 65?
3. Dementia is a clinical diagnosis. Because of this providers do not need to order routine imaging studies. True or False? Please discuss.
Updated April 15, 2011
[1] Bhargavan M, Sunshine JH. Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology. 2005;234(3):824-32.
[2] Oddone EZ, Heflin, MT, Feussner, JR. Screening for cancer. In: Cassel CK. Geriatric Medicine: An Evidence-Based Approach. 4th ed. Berlin; London: Springer; 2003:375-391.
[3] Staiger TO, Gatewood M, Wipf JE, Deyo RA. Diagnostic testing for low back pain. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2011. Last updated February 7, 2011.
[4] Ost D, Fein A, Feinsilver SH. Nonresolving Pneumonia. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2011. Last updated August 25, 2010.