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The risks of inappropriateness in cardiac imaging.

Picano E - Int J Environ Res Public Health (2009)

Bottom Line: Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome.Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war.Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy. picano@ifc.cnr.it

ABSTRACT
The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

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Related in: MedlinePlus

Inappropriateness in stress echocardiography (left) and cardiac stress imaging (right). Data are derived from [5] (Pisa and Brisbane echo labs in Italy and Australia) and [6] (Mayo Clinic nuclear cardiology lab in the USA).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2697934&req=5

f4-ijerph-06-01649: Inappropriateness in stress echocardiography (left) and cardiac stress imaging (right). Data are derived from [5] (Pisa and Brisbane echo labs in Italy and Australia) and [6] (Mayo Clinic nuclear cardiology lab in the USA).


The risks of inappropriateness in cardiac imaging.

Picano E - Int J Environ Res Public Health (2009)

Inappropriateness in stress echocardiography (left) and cardiac stress imaging (right). Data are derived from [5] (Pisa and Brisbane echo labs in Italy and Australia) and [6] (Mayo Clinic nuclear cardiology lab in the USA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2697934&req=5

f4-ijerph-06-01649: Inappropriateness in stress echocardiography (left) and cardiac stress imaging (right). Data are derived from [5] (Pisa and Brisbane echo labs in Italy and Australia) and [6] (Mayo Clinic nuclear cardiology lab in the USA).
Bottom Line: Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome.Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war.Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy. picano@ifc.cnr.it

ABSTRACT
The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

Show MeSH
Related in: MedlinePlus