Groups Urge Caution on 45 Standards of Care

American College of Radiology
21. Don't do imaging for uncomplicated headache. It's not likely to change management or improved outcome unless there are specific risk factors for structural disease.

22. Don't image for suspected pulmonary embolism without moderate or high pre-test probability. Deep-vein thrombosis and PE are rare in the absence of elevated d-Dimer levels and certain risk factors. CT pulmonary angiography has limited value.

23. Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam. Only 2% of these tests lead to change in management.

24. Don't use CT to evaluate suspected appendicitis in children until an ultrasound has been considered. Ultrasound is nearly as good and provides less radiation exposure, preferred for children.

25. Don't recommend follow-up imaging for inconsequential adnexal cysts because in women of reproductive age, they are almost always physiologic. Ovarian cancer does not arise from these benign-appearing cysts. In post menopausal women, use 1 cm as a threshold for simple cysts. 

American Gastroenterological Association
26. For pharmacological treatment of patients with gastroesophageal reflux disease, long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest dose to achieve therapeutic goals.

27. Do not repeat colorectal cancer screening by any method for 10 years after a high-quality colonoscopy is negative in average-risk individuals. Screening should begin at 10 year intervals at age 50.

28. Do not repeat colonoscopy for at least five years for patients who have one or two small (<1 cm) adenomatous polyps, without high grade dysplasia, completely removed via a high-quality colonoscopy.

29. For patients with Barrett's esophagus who underwent a second endoscopy confirming absence of dysplasia on biopsy, follow-up exam should not be performed in less than three years.

30. For a patient with functional abdominal pain syndrome, CT scans should not be repeated unless there is a major change in clinical findings or symptoms.