Physicians and Outpatient Diagnostic Imaging: Overexposed?

To the Editor. —The recent article by Hillman et al 1 fails to address quality of care or outcome following treatment of any condition studied. Only the imaging cost was addressed. Rheumatologists in private practice regularly correct nonmusculoskeletal radiologists in their misinterpretation of bone and joint roentgenograms. Patients' roentgenograms with clearly abnormal sacroiliac joints are frequently misread, leading to unnecessary surgery, delay in diagnosis, and further inappropriate and costly care. Sequential follow-up comparisons of joint damage are rarely noted as a portion of radiologists' interpretations. Last, charges for roentgenograms become moot as Medicare, preferred provider organizations, and health maintenance organizations limit reimbursement, regardless of charge. If we are to limit the nonradiologist physician from performing roentgenograms in his or her own office, should we also limit radiologists from performing follow-up computed tomographic scans or magnetic resonance imaging (MR I) when an abnormality is found in a routine roentgenogram and force