High-tech imaging has changed health care by providing accurate pictures of a patient's hidden internal problems. The ability to reveal an otherwise invisible ailment as a high-definition image is truly a marvel of modern medicine.

Consider that just a couple generations ago, appendicitis was far from being a concrete diagnosis. About 20 percent of the time, people who underwent an operation for presumed appendicitis were discovered to have a normal appendix. Using today's technology, that number has dropped to just 4 percent, said Jennifer Meko, MD, Western Region Medical Director for MedSolutions Inc. There is clearly high value in high-tech imaging tests.

But is there also a downside to high-tech imaging? Have we become too reliant on the presumed satisfaction and sureness an image will impart? Perhaps. Imaging is growing at 10 percent to 20 percent a year. The reasons for this annual explosion in imaging include an aging population, direct-to-consumer marketing (such as billboards that advertise a hospital's new 64-slice CT scanner), malpractice concerns and easy availability (medical groups who own  their own scanning machine are more likely to order more tests).

While most people would contend that high-tech imaging is generally beneficial, the medical community has increasingly become concerned that the costs of inappropriate testing -- not just monetary, but also the potentially harmful effects of radiation exposure, allergic reaction to contrast dye, and need for follow-up tests and procedures for what often turn out to be harmless findings -- are taking a toll.

Time for change

When BlueCross BlueShield of Tennessee's (BCBS TN) imaging trend was increasing a whopping 25 percent a year in 2005, Ken Patric, MD, chief medical officer of the organization, was alarmed. Not only were the costs associated with imaging skyrocketing, but there were indications that many tests were unnecessary and perhaps unsafe.

"There is no test out there that is 100-percent accurate both in sensitivity and specificity," said Dr. Patric. One of his concerns was that some tests that are not specific enough to give a doctor a clear course of action were being administered rather often, and were perhaps lulling patients into a false sense of security when the radiologist did not find a specific problem.

Furthermore, tests were sometimes being given on outdated equipment, such as 1- or 4 -slice CT scanners, in doctors' offices, only to have to be redone on better equipment to provide the doctor with more information. And, for patients who saw several doctors, sometimes in several hospital systems in the course of a few weeks, scans were often repeated for each doctor or at each hospital. Lastly, some radiologists simply did not have the expertise to read certain types of scans, causing them to miss clues or simply not make a diagnosis, and causing the patient to undergo more testing.

When you consider that tests such as CT angiograms expose patients to approximately 350 times the radiation of a chest X-ray, the case for eliminating unspecific or unnecessary tests is rather compelling, said Dr. Patric. BCBS TN sought a solution that did not simply cut down on the amount of imaging procedures, but rather provided a framework for doctors to order the right test, with the right equipment, and to have the right people perform and interpret the tests. In 2006, after much due diligence, the health plan decided to try MedSolutions to tackle its growing imaging load.