Towards appropriate imaging: Tips for practice

Background The best use of diagnostic imaging is a challenge for many health professionals and the health system. Potential hazards of inappropriate imaging include exposure to ionising radiation, false positive and negative results, unexpected incidental findings, overdiagnosis and cost. Objectives Using a fictional case, we aim to illuminate and discuss some of the challenges to appropriate diagnostic imaging and offer some solutions. Discussion While normal imaging results can reassure a patient, abnormal incidental findings can sometimes cause harm. When serious disease is very unlikely, verbal reassurance may be more appropriate than imaging. We remind doctors of the risks of ionising radiation, including how to access resources to estimate these risks and the need to ensure that the potential benefit of the test outweighs the risk - the process of justification. We point readers to imaging guidelines to help guide decisionmaking, such as the 'Diagnostic imaging pathways' resource. We look forward to relationships between radiologists and general practitioners characterised by collaboration and consultation, rather than just ordering and reporting.