Excess radiation increases the risk of cancer. Why is CMS loosening regulations? 

Computed tomography (CT) scans are an important tool for diagnosing conditions and injuries by creating three-dimensional images. However, overuse of CTs—whether through excessive radiation doses or unnecessary scans—increases the risk of cancer. A study this year estimated that CT scans conducted in 2023 may result in more than 100,000 radiation-induced cancers over patients’ lifetimes. Yet the Centers for Medicare and Medicaid Services (CMS) is considering relaxing the rules for CT scan quality reporting. 

CMS proposes change to radiation quality metric

One way to reduce cancers from excessive radiation is to regulate the dose that patients are given in CT scans. In 2023, we wrote about a new quality metric that CMS adopted to ensure that radiologists use the recommended dose of radiation for CT scans—enough to get adequate image quality, but not so much that patients receive unnecessary radiation. CMS estimated this measure could prevent nearly 14,000 cancers among Medicare beneficiaries and save the program as much as $5 billion each year.   

However, CMS is now proposing to make reporting of the outpatient version of this metric optional. Opponents of this change are encouraging clinicians, patients, and others to submit a comment to CMS to keep this quality metric compulsory; the Lown Institute has submitted a comment in favor of the mandatory metric. 

Lown data show unnecessary scans exceedingly common

Clinicians and hospital leaders can also reduce preventable cancers from over-radiation by avoiding unnecessary imaging. The Lown Hospitals Index measures how well hospitals avoid twelve low-value services, including how well they avoid performing CTs and other scans for patients who fainted but do not have other symptoms of serious disease. These are among the highest-volume overuse metrics included on the Lown Index, with nearly 900,000 low-value scans identified over three years in the Medicare population.

Low-value imaging is not only harmful on its own, it can also lead to cascade events (follow-up tests and procedures) that add to patient risk and cost. According to a survey of hundreds of doctors, 30% reported that they experienced cascades without a meaningful outcome on a monthly basis, and more than half said that care cascades led to negative impacts on both patients and physicians.

LEARN MORE: See how well your hospital did on avoiding low-value scans on the Lown Hospitals Index, and for more on low-value care, join us for a conversation with experts on back surgery overuse at U.S. hospitals!