Skip to content
2000
Volume 18, Issue 1
  • ISSN: 1874-4710
  • E-ISSN: 1874-4729

Abstract

Background

Evidence of inappropriate overuse and underuse of medical procedures has been documented in modern healthcare systems around the world. Excessive use of health services can contribute to a rapid increase in healthcare costs and harm the patient physically and psychologically; conversely, underuse can lead to the inability to provide effective treatments when clinically indicated.

Objective

The study's aim is twofold: a) to measure the appropriateness of PET prescription in a cohort of patients, offering empirical evidence of overuse of health care services; b) to evaluate how the overuse of PET could affect public health expenditure and, consequently, the system's financial sustainability.

Methods

In this observational study, we have analyzed prospectively and retrospectively health patient records who underwent 18F-FDG PET/TC scan at the Nuclear Medicine Department of the University Hospital Mater Domini in Catanzaro (Italy) from 29/09/2022 to 10/02/2023. Patients’ diagnostic questions have been defined as appropriate, not completely appropriate and completely inappropriate according to the 18F-FDG PET/CT recommendations defined by the “Conditions of Supply and Indications of Prescriptive Appropriateness of Italian NHS (National Health Systems)” published in the Official Gazette no. 15 of 20 January 2016 (Decree 9 December 2015) and by the AIMN (Italian Association of Nuclear Medicine) guidelines.

Results

We gathered data from 500 oncological patients (242 males and 258 females). The results show that 423/500 of patients' prescriptions were appropriate, while 77/500 of patients' prescriptions were completely inappropriate (63/77) or not completely appropriate (14/77).

Conclusion

Analysis showed a not complete adherence to national guidelines and no shared decision-making approach.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/crp/10.2174/0118744710290906240408094829
2025-03-01
2025-10-02

  • From This Site

    /content/journals/crp/10.2174/0118744710290906240408094829
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Robertson-PreidlerJ. Biller-AndornoN. JohnsonT.J. What is appropriate care? An integrative review of emerging themes in the literature.BMC Health Serv. Res.201717145210.1186/s12913‑017‑2357‑2 28666438
     [Google Scholar]
  2. OrszagP.R. The Overuse, Underuse, and Misuse of Health Care.WashingtonCongressional Budget Office2008
     [Google Scholar]
  3. SiY. BatemanH. ChenS. HanewaldK. LiB. SuM. ZhouZ. Quantifying the financial impact of overuse in primary care in China: A standardised patient study.Soc. Sci. Med.202332011567010.1016/j.socscimed.2023.115670 36669284
     [Google Scholar]
  4. GlasziouP. StrausS. BrownleeS. TrevenaL. DansL. GuyattG. ElshaugA.G. JanettR. SainiV. Evidence for underuse of effective medical services around the world.Lancet20173901009016917710.1016/S0140‑6736(16)30946‑1 28077232
     [Google Scholar]
  5. TanA. KuoY.F. GoodwinJ.S. Potential overuse of screening mammography and its association with access to primary care.Med. Care201452649049510.1097/MLR.0000000000000115 24828844
     [Google Scholar]
  6. NasseryN. SegalJ.B. ChangE. BridgesJ.F.P. Systematic overuse of healthcare services: A conceptual model.Appl. Health Econ. Health Policy20151311610.1007/s40258‑014‑0126‑5 25193241
     [Google Scholar]
  7. MorganD.J. BrownleeS. LeppinA.L. KressinN. DhruvaS.S. LevinL. LandonB.E. ZezzaM.A. SchmidtH. SainiV. ElshaugA.G. Setting a research agenda for medical overuse.BMJ2015351h453410.1136/bmj.h4534 26306661
     [Google Scholar]
  8. BerwickD.M. Avoiding overuse—The next quality frontier.Lancet20173901009010210410.1016/S0140‑6736(16)32570‑3 28077229
     [Google Scholar]
  9. AlberJ.M. BrewerN.T. MelvinC. YackleA. SmithJ.S. KoL.K. CrawfordA. GlanzK. Reducing overuse of cervical cancer screening: A systematic review.Prev. Med.2018116515910.1016/j.ypmed.2018.08.027 30149037
     [Google Scholar]
  10. SegalJ.B. BridgesJ.F.P. ChangH.Y. ChangE. NasseryN. WeinerJ. ChanK.S. Identifying possible indicators of systematic overuse of health care procedures with claims data.Med. Care201452215716310.1097/MLR.0000000000000052 24374418
     [Google Scholar]
  11. MathiasJ.S. GossettD. BakerD.W. Use of electronic health record data to evaluate overuse of cervical cancer screening.J. Am. Med. Inform. Assoc.201219e1e96e10110.1136/amiajnl‑2011‑000536 22268215
     [Google Scholar]
  12. ZhangY. ZhouZ. SiY. When more is less: What explains the overuse of health care services in China?Soc. Sci. Med.2019232172410.1016/j.socscimed.2019.04.018 31048192
     [Google Scholar]
  13. BlackW.C. Overdiagnosis: An underrecognized cause of confusion and harm in cancer screening.J. Natl. Cancer Inst.200092161280128210.1093/jnci/92.16.1280 10944539
     [Google Scholar]
  14. LichtenfeldL. SchwartzL.M. WoloshinS. Overdiagnosed.J. Clin. Invest.20111218295410.1172/JCI57171
     [Google Scholar]
  15. SinghH. DickinsonJ.A. ThériaultG. GradR. GroulxS. WilsonB.J. SzafranO. BellN.R. Overdiagnosis: Causes and consequences in primary health care.Can. Fam. Physician2018649654659 30209095
     [Google Scholar]
  16. KaleM.S. KorensteinD. Overdiagnosis in primary care: Framing the problem and finding solutions.BMJ2018362k282010.1136/bmj.k2820 30108054
     [Google Scholar]
  17. PicklesK. CarterS.M. RychetnikL. Doctors’ approaches to PSA testing and overdiagnosis in primary healthcare: A qualitative study.BMJ Open201553e00636710.1136/bmjopen‑2014‑006367 25783420
     [Google Scholar]
  18. ArmstrongN. Overdiagnosis and overtreatment as a quality problem: Insights from healthcare improvement research.BMJ Qual. Saf.201827757157510.1136/bmjqs‑2017‑007571 29572297
     [Google Scholar]
  19. MoynihanR. DoustJ. HenryD. Preventing overdiagnosis: How to stop harming the healthy.BMJ2012344may28 4e350210.1136/bmj.e3502 22645185
     [Google Scholar]
  20. BrodersenJ. SchwartzL.M. HeneghanC. O’SullivanJ.W. AronsonJ.K. WoloshinS. Overdiagnosis: What it is and what it isn’t.BMJ Evid. Based Med.20182311310.1136/ebmed‑2017‑110886 29367314
     [Google Scholar]
  21. ChalmersK. PearsonS.A. ElshaugA.G. Quantifying low-value care: A patient-centric versus service-centric lens.BMJ Qual. Saf.2017261085585810.1136/bmjqs‑2017‑006678 28842517
     [Google Scholar]
  22. LyuH. XuT. BrotmanD. BlackwellM.B. CooperM. DanielM. WickE.C. SainiV. BrownleeS. MakaryM.A. Overtreatment in the United States.PLoS One2017129e018197010.1371/journal.pone.0181970
     [Google Scholar]
  23. ChassinM.R. GalvinR.W. The urgent need to improve health care quality.JAMA1998280111000100510.1001/jama.280.11.1000 9749483
     [Google Scholar]
  24. HofmannB. WelchH.G. New diagnostic tests: More harm than good.BMJ2017358j331410.1136/bmj.j3314 28720607
     [Google Scholar]
  25. HeathI. Role of fear in overdiagnosis and overtreatment--An essay by Iona Heath.BMJ2014347aug06 2g612310.1136/bmj.g6123 25954986
     [Google Scholar]
  26. HicksL.K. Reframing overuse in health care: Time to focus on the harms.J. Oncol. Pract.201511316817010.1200/JOP.2015.004283 25804988
     [Google Scholar]
  27. BenejamC.T. ToledoB.R. CalvoM.M.P. PeñaA.M.P. Impact of overdiagnosis and overtreatment on the patient, the health system and society.Aten. Primaria201850S2869510.1016/j.aprim.2018.08.004 30563626
     [Google Scholar]
  28. O’SullivanJ.W. AlbasriA. NicholsonB.D. PereraR. AronsonJ.K. RobertsN. HeneghanC. Overtesting and undertesting in primary care: A systematic review and meta-analysis.BMJ Open201882e01855710.1136/bmjopen‑2017‑018557 29440142
     [Google Scholar]
  29. WelchH.G. BlackW.C. Overdiagnosis in cancer.J. Natl. Cancer Inst.2010102960561310.1093/jnci/djq099 20413742
     [Google Scholar]
  30. HarrisR.P. SheridanS.L. LewisC.L. BarclayC. VuM.B. KistlerC.E. GolinC.E. DeFrankJ.T. BrewerN.T. The harms of screening: A proposed taxonomy and application to lung cancer screening.JAMA Intern. Med.2014174228128510.1001/jamainternmed.2013.12745 24322781
     [Google Scholar]
  31. KleinertS. HortonR. From universal health coverage to right care for health.Lancet20173901009010110210.1016/S0140‑6736(16)32588‑0 28077231
     [Google Scholar]
  32. JadvarH. CollettiP.M. Delgado-BoltonR. EspositoG. KrauseB.J. IagaruA.H. NadelH. QuinnD.I. RohrenE. SubramaniamR.M. ZukotynskiK. KauffmanJ. AhujaS. GriffethL. Appropriate use criteria for 18 F-FDG PET/CT in restaging and treatment response assessment of malignant disease.J. Nucl. Med.201758122026203710.2967/jnumed.117.197988 29025980
     [Google Scholar]
  33. SanmartinC. MurphyK. ChoptainN. Conner-SpadyB. McLarenL. BohmE. DunbarM.J. SanmugasunderamS. De CosterC. McGurranJ. LorenzettiD.L. NoseworthyT. Appropriateness of healthcare interventions: Concepts and scoping of the published literature.Int. J. Technol. Assess. Health Care200824334234910.1017/S0266462308080458 18601803
     [Google Scholar]
  34. MulleyA.G.Jr The global role of health care delivery science: Learning from variation to build health systems that avoid waste and harm.J. Gen. Intern. Med.20132013S3S646S65310.1007/s11606‑013‑2457‑6
     [Google Scholar]
  35. BrownleeS. ChalkidouK. DoustJ. ElshaugA.G. GlasziouP. HeathI. NagpalS. SainiV. SrivastavaD. ChalmersK. KorensteinD. Evidence for overuse of medical services around the world.Lancet20173901009015616810.1016/S0140‑6736(16)32585‑5 28077234
     [Google Scholar]
  36. CrossA.J. GeorgeJ. WoodwardM.C. AmesD. BrodatyH. IlomäkiJ. ElliottR.A. Potentially inappropriate medications and anticholinergic burden in older people attending memory clinics in Australia.Drugs Aging2016331374410.1007/s40266‑015‑0332‑3 26645294
     [Google Scholar]
  37. CarterS.M. DegelingC. DoustJ. BarrattA. A definition and ethical evaluation of overdiagnosis.J. Med. Ethics2016421170571410.1136/medethics‑2015‑102928 27402883
     [Google Scholar]
  38. HensherM. TisdellJ. ZimitatC. “Too much medicine”: Insights and explanations from economic theory and research.Soc. Sci. Med.2017176778410.1016/j.socscimed.2017.01.020 28131024
     [Google Scholar]
  39. CarterS.M. Overdiagnosis, ethics, and trolley problems: Why factors other than outcomes matter—An essay by Stacy Carter.BMJ2017358j387210.1136/bmj.j3872 28814560
     [Google Scholar]
  40. RawalH. NguyenT. KleinL.W. Effects of appropriate use criteria on percutaneous coronary intervention volume and case selection.Health Sci. Rev.20224210004610.1016/j.hsr.2022.100046
     [Google Scholar]
  41. FitchK. BernsteinS.J. AguilarM.D. BurnandB. LaCalleJ.R. LazaroP. Van het LooM. McDonnellJ. VaderJ. KahanJ.P. The RAND/UCLA Appropriateness Method User’s Manual.Santa Monica, CARAND Corporation2001
     [Google Scholar]
  42. KorensteinD. FalkR. HowellE.A. BishopT. KeyhaniS. Overuse of health care services in the United States: An understudied problem.Arch. Intern. Med.2012172217117810.1001/archinternmed.2011.772 22271125
     [Google Scholar]
  43. GrilliR. ChiesaV. Overuse in cancer care: Do European studies provide information useful to support policies?Health Res. Policy Syst.20181611210.1186/s12961‑018‑0287‑z 29458403
     [Google Scholar]
  44. DjulbegovicB. ElqayamS. DaleW. Rational decision making in medicine: Implications for overuse and underuse.J. Eval. Clin. Pract.201824365566510.1111/jep.12851 29194876
     [Google Scholar]
  45. XueH. ShiY. HuangL. YiH. ZhouH. ZhouC. KotbS. TuckerJ.D. SylviaS.Y. Diagnostic ability and inappropriate antibiotic prescriptions: A quasi-experimental study of primary care providers in rural China.J. Antimicrob. Chemother.201874125626310.1093/jac/dky390 30285113
     [Google Scholar]
  46. TungM. SharmaR. HinsonJ.S. NothelleS. PannikottuJ. SegalJ.B. Factors associated with imaging overuse in the emergency department: A systematic review.Am. J. Emerg. Med.201836230130910.1016/j.ajem.2017.10.049 29100783
     [Google Scholar]
  47. MartellaM. LenziJ. GianinoM. Diagnostic technology: Trends of use and disponibility in the last decade among sixteen OECD countries.Popul. Med.2023550750710.18332/popmed/163665
     [Google Scholar]
  48. OECDTackling wasteful spending on health.2017 Available from: https://www.oecd.org/els/health-systems/Tackling-Wasteful-Spending-on-Health-Highlights-revised.pdf (Accessed on: June 10, 2023).
     [Google Scholar]
  49. MartinoF. Di GesùI. ToscanoF. SteccoA. FossacecaR. CarrieroA. Appropriatezza nel management radiologico.Management in radiologia.Springer2010414710.1007/978‑88‑470‑1717‑7_3
     [Google Scholar]
  50. LeeS.J. ParkH.J. Single photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging for radiotherapy planning in patients with lung cancer: A meta-analysis.Sci. Rep.20201011486410.1038/s41598‑020‑71445‑5 32913277
     [Google Scholar]
  51. AlessioA.M. KinahanP.E. ChengP.M. VesselleH. KarpJ.S. PET/CT scanner instrumentation, challenges, and solutions.Radiol. Clin. North Am.200442610171032vii.10.1016/j.rcl.2004.08.001 15488555
     [Google Scholar]
  52. SeamP. JuweidM.E. ChesonB.D. The role of FDG-PET scans in patients with lymphoma.Blood2007110103507351610.1182/blood‑2007‑06‑097238 17709603
     [Google Scholar]
  53. Ul-HassanF. CookG.J. PET/CT in oncology.Clin. Med.201212436837210.7861/clinmedicine.12‑4‑368 22930885
     [Google Scholar]
  54. JerusalemG. HustinxR. BeguinY. FilletG. PET scan imaging in oncology.Eur. J. Cancer200339111525153410.1016/S0959‑8049(03)00374‑5 12855258
     [Google Scholar]
  55. NanniC. ZamagniE. VersariA. ChauvieS. BianchiA. RensiM. BellòM. RambaldiI. GallaminiA. PatriarcaF. GayF. GamberiB. CavoM. FantiS. Image interpretation criteria for FDG PET/CT in multiple myeloma: A new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe).Eur. J. Nucl. Med. Mol. Imaging201643341442110.1007/s00259‑015‑3200‑9 26475305
     [Google Scholar]
  56. SquillaciE. BolacchiF. ScaggianteJ. RicciF. PuglieseL. BergaminiA. GaraciF. FlorisR. Inappropriateness of diagnostic imaging examinations in the inpatient setting: A case study research.Radiol. Med.2017122322122710.1007/s11547‑016‑0708‑4 27888429
     [Google Scholar]
  57. BackhusL.M. FarjahF. VargheseT.K. ChengA.M. ZhouX.H. WoodD.E. KesslerL. ZeliadtS.B. Appropriateness of imaging for lung cancer staging in a national cohort.J. Clin. Oncol.201432303428343510.1200/JCO.2014.55.6589 25245440
     [Google Scholar]
  58. von ElmE. AltmanD.G. EggerM. PocockS.J. GøtzscheP.C. VandenbrouckeJ.P. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies.J. Clin. Epidemiol.200861434434910.1016/j.jclinepi.2007.11.008 18313558
     [Google Scholar]
  59. SainiV. BrownleeS. ElshaugA.G. GlasziouP. HeathI. Addressing overuse and underuse around the world.Lancet20173901009010510710.1016/S0140‑6736(16)32573‑9 28077230
     [Google Scholar]
  60. JohnsonE.M. RehaviM.M. Physicians treating physicians: Information and incentives in childbirth.Am. Econ. J. Econ. Policy20168111514110.1257/pol.20140160
     [Google Scholar]
  61. HeA.J. The doctor–patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city.Soc. Sci. Med.2014123647110.1016/j.socscimed.2014.10.055 25462606
     [Google Scholar]
  62. WeeksJ.C. CatalanoP.J. CroninA. FinkelmanM.D. MackJ.W. KeatingN.L. SchragD. Patients’ expectations about effects of chemotherapy for advanced cancer.N. Engl. J. Med.2012367171616162510.1056/NEJMoa1204410 23094723
     [Google Scholar]
  63. BlankT. GravesK. SepuchaK. ThomasL.H. Understanding treatment decision making: Contexts, commonalities, complexities, and challenges.Ann. Behav. Med.200632321121710.1207/s15324796abm3203_6 17107293
     [Google Scholar]
  64. SicilianiL. BorowitzM. MoranV. Waiting Time Policies in the Health Sector: What Works? OECD.Health Policy Studies2013
     [Google Scholar]
  65. SicilianiL. MoranV. BorowitzM. Measuring and comparing health care waiting times in OECD countries.Health Policy2014118329230310.1016/j.healthpol.2014.08.011 25217838
     [Google Scholar]
  66. MariottiG. SicilianiL. RebbaV. FelliniR. GentiliniM. BeneaG. BertoliP. BistolfiL. BrugalettaS. CamboaP. CasucciP. DessiD. FaronatoP. GalanteM. GioffrediA. GuarinoT.M. PofiE. LivaC. Waiting time prioritisation for specialist services in Italy: The homogeneous waiting time groups approach.Health Policy20141171546310.1016/j.healthpol.2014.01.018 24576498
     [Google Scholar]
  67. KoopmanschapM.A. BrouwerW.B.F. RoijenH.L. van ExelN.J.A. Influence of waiting time on cost-effectiveness.Soc. Sci. Med.200560112501250410.1016/j.socscimed.2004.11.022 15814175
     [Google Scholar]
  68. MullenP.M. Prioritising waiting lists: how and why?Eur. J. Oper. Res.20031501324510.1016/S0377‑2217(02)00779‑8
     [Google Scholar]
  69. AkbariA. MayhewA. Al-AlawiM.A. GrimshawJ. WinkensR. GlidewellE. PritchardC. ThomasR. FraserC. Interventions to improve outpatient referrals from primary care to secondary care.Cochrane Libr.200820084CD00547110.1002/14651858.CD005471.pub2 18843691
     [Google Scholar]
  70. World Health OrganizationGlobal pulse survey on continuity of essential health service during the COVID-19 pandemic.2022Available from: https://www.who.int/teams/integrated-health-services/monitoring-health-services/global-pulse-survey-on-continuity-of-essential-health-services-during-the-covid-19-pandemic (Accessed on: May 16, 2023).
     [Google Scholar]
  71. Eurofound. Mental health and trust decline across EU ad pandemis enters another year.2021Available from: https://www.eurofound.europa.eu/publications/report/2021/living-working-and-covid-19-update-april-2021-mental-health-and-trust-decline-across-eu-as-pandemic (Accessed on: June 3, 2023).
  72. GardnerT. FraserC. Longer waits, missing patients and catching up: How is elective care in England coping with the continuing impact of COVID-19? The Health Found.2021Available from: https://www.health.org.uk/news-and-comment/charts-and-infographics/how-is-elective-care-coping-with-the-continuing-impact-of-covid-19 (Accessed on: June 3, 2023).
  73. NHS performance summary: August-September 2021Nuffield Trust: London2021
     [Google Scholar]
  74. VainieriM. NutiS. MantoanD. Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy.BMJ Open20221211e06141510.1136/bmjopen‑2022‑061415 36424104
     [Google Scholar]
  75. Ministry of HealthOfficial Gazette.Available from: https://www.gazzettaufficiale.it/eli/id/2016/01/20/16A00398/s 2016
  76. GrimshawJ.M. RussellI.T. Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations.Lancet199334288831317132210.1016/0140‑6736(93)92244‑N 7901634
     [Google Scholar]
/content/journals/crp/10.2174/0118744710290906240408094829
Loading
Guideline Adherence as an Indicator of PET Scan Overuse in an Italian Teaching Hospital: An Observational Study
Current Radiopharmaceuticals 18, 56 (2025); https://doi.org/10.2174/0118744710290906240408094829
/content/journals/crp/10.2174/0118744710290906240408094829
/content/journals/crp/10.2174/0118744710290906240408094829
Loading

Data & Media loading...

Supplements

Supplementary material is available on the publisher’s website along with the published article.

file format download Download

  • Article Type:     Research Article
Keyword(s): adherence to guidelines; excessive testing; healthcare services; healthcare utilization; inappropriate care; Overuse; unnecessary treatments

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test