Overuse of Medical Imaging in Low-Middle Income Countries: A Scoping Review

Abstract

Purpose: The overuse of medical imaging is a key component of medical resource overutilization. Primary reasons for this include high costs, overdiagnosis, incidental findings and direct harms. Although the overuse of medical imaging is well-researched in high income countries, it is still unclear what evidence there is for the overuse of medical imaging in low-middle income countries (LMICs). Understanding the extent of medical imaging overuse in LMICs could encourage doctors and policymakers to address the problem of overuse, which may facilitate better use of limited resources. Methods and Materials: A scoping review was performed according to the PRISMA Extension for Scoping Reviews Checklist. Electronic academic databases Medline via Ovid, Embase and CINAHL were searched for relevant studies. Results: Forty studies were identified, with a total of 42,413 patient participants across 15 LMICs. Computed tomography (CT) scan was the most frequent imaging modality of study (20/40), followed by magnetic resonance imaging (MRI) (13/40), and ultrasound (US) (6/40). Guidelines were used as a tool to define imaging overuse in 58% (23/40) of the included studies. However, only 5% (2/40) of studies used local guidelines. The overall results of the review showed that 35% of MRI, 55% of CT, 40% of radiography, 62% of ultrasound and 12% of single-photon emission computed tomography (SPECT) investigations were recorded as an overuse. Conclusion: The results of this study show that there is evidence for the widespread overuse of medical imaging in LMICs, including the overuse of CT, MRI, radiography, ultrasound and SPECT. The majority of studies demonstrated a lack of local imaging guidelines. Future research may focus on developing guidelines designed for the local disease epidemiology and the financial context of the locality, to better identify overuse and promote more contextually appropriate imaging practices.

Keywords

• medical imaging
• overutilization
• low-middle income countries (LMICs)
• scoping review
• guidelines
• radiology