Unacceptable quality in medical imaging

Just saw this somewhat disturbing piece, in Diagnostic Imaging, indicating a 31 percent defect rate in outpatient imaging services:

Chesbrough reported Monday at the 2009 RSNA meeting that 11% of the sample studies had significant quality defects that potentially led to missed pathology or inappropriate therapy. They included studies where the selected field-of-view made it impossible for the clinician to fully appreciate the presence or extent of disease. Ultrasound studies were performed with the wrong transducer. Prostate ultrasound was performed without an endorectal coil. Obsolete equipment produced spinal images so poor that the edge of the spinal facets could not be seen. Brain CT produced artifacts that mimicked brain tumors.About 20% of the studies involved coding, compliance, or billing mistakes, Chesbrough said. These included studies that lacked physician orders for the examination or were based on inappropriate indications, he said. Some studies were billed under complete diagnostic CPT codes, yet only limited studies were actually performed. In other cases, protocol scanning was performed, with all patients receiving pre- and postcontrast exams, but without the necessary clinical indications for both procedures.

We're used to stories about high cost and overutilization of medical services, including diagnostic imaging. That's troubling but it's a product of the payment system, which is hard to fix. On the other hand, it seems reasonable to expect that exams that are being done are at least being done properly. If the 11 percent figure is generalizable, that's fairly disturbing.