RESUMO
AIMS AND OBJECTIVES: This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. MATERIALS AND METHODS: In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. RESULTS: The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination. CONCLUSIONS: We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care.
Assuntos
Medicina Defensiva/ética , Uso Excessivo dos Serviços de Saúde , Autorreferência Médica/ética , Proteção Radiológica , Radiologia/ética , Temas Bioéticos , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Humanos , Imageamento por Ressonância Magnética/ética , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Uso Excessivo dos Serviços de Saúde/economia , Próstata/diagnóstico por imagem , Exposição à Radiação/efeitos adversos , Exposição à Radiação/ética , Radiologia/economia , Sensibilidade e Especificidade , Glândula Tireoide/diagnóstico por imagem , Imagem Corporal Total/ética , Imagem Corporal Total/métodosRESUMO
The paradigm of personalised medicine has many different facets, further to the application of pharmacogenetics. We examine here (direct-to-consumer) personal genome analysis and whole body scans and summarise findings from the Nuffield Council's on Bioethics recent report "Medical profiling and online medicine: the ethics of 'personalised healthcare' in a consumer age". We describe the current situation in Germany with regard to access to such services, and contextualise the Nuffield Council's report with summaries of position statements by German professional bodies. We conclude with three points that merit examination further to the analyses of the Nuffield Council's report and the German professional bodies. These concern the role of indirect evidence in considering restrictive policies, the question of whether regulations should require commercial providers to contribute to the generation of better evidence, and the option of using data from evaluations in combination with indirect evidence in justifying restrictive policies.