About 20% of scans ordered by orthopedic surgeons appear to be “defensive imaging,” primarily ordered to avoid malpractice litigation, according to a report presented at the annual meeting of the American Academy of Orthopaedic Surgeons held in San Diego earlier this month. Furthermore, more than one-third of total diagnostic imaging expenses generated by orthopedic surgeons appear to be linked to the practice of defensive medicine.

Defensive medicine is the use of diagnostic or therapeutic measures conducted more so as a safeguard against possible malpractice liability rather than ensuring the health of the patient.

Researchers at Children’s Hospital of Philadelphia sent surveys to 640 members of the Pennsylvania Orthopaedic Society. Of the 2,000 imaging orders initiated by the 72 physicians who responded, 19% were ordered for defensive purposes—accounting for $113,369 (34.8%) of the total costs generated by the tests analyzed in the study. Among the orders studied, the following were done for defensive purposes:

38.7% of MRIs

11.4% of radiographs

33% of CT scans

46.4% of bone scans

52.9% of ultrasounds

Defensive imaging was 58% greater among surgeons who had been named in a lawsuit in the previous 5 years.

This was the first prospective study to collect data on the prevalence of defensive medicine in orthopedics, indicating that defensive imaging is both common and costly. According to the researchers, medical costs as well as the health risks posed by excessive diagnostic tests add to the urgency to ease defensive-medicine pressures.