Barriers to reducing useless exams in ionizing medical imaging: an overview.

Appropriateness in imaging studies is recognized as an important feature in National Health Services, especially in those nations where per capita health spending has been substantially increased. This is important in view of the projected spectacular rise of ionizing imaging tests in next years; yet their explosive growth in performance is challenging to be interpreted as it may represent an added value when appropriate, and an added cost when inappropriate or overused. In order to define this, over the past thirty years researchers have conducted several studies to examine the relationship between risks and perceived usefulness, attitudes, and the usage of ionizing examinations, embracing the risk-benefit relation as a suggested policy for improving health services. However, until relatively recently, little had been done on these issues, and even now, both patients and physicians generally ignore the potential harmful effects of the inappropriate use of diagnostic medical procedures. So, the aim of this review is to discover, basing on the literature, why inappropriateness is still so high and to show that many of the difficulties faced by National Health Services in the reduction of inappropriateness are caused by a lack of awareness of, and training in, communication strategies.