We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Note |

Overpowering Images

Rita F. Redberg, MD, MSc
JAMA Intern Med. 2016;176(1):17. doi:10.1001/jamainternmed.2015.6933.
Text Size: A A A
Published online


In the past decade, medical imaging has made great advances, and we can now see many parts of the human body with amazing detail. While there has been an exponential increase in medical imaging, there are few data demonstrating improvements in outcome, and imaging that requires ionizing radiation is known to be harmful. Indeed, the Centers for Medicare and Medicaid Services is so concerned about the increased use of advanced imaging that, starting in 2016, there will be requirements for adherence to appropriate use criteria. The “slippery slope” story of Dr Michael Barry et al1 illustrates one of the unintended harms of graphic imaging: dramatic pictures make clinicians (and patients) more likely to want to “do something” instead of considering a more conservative therapy. Their example is of a sports-related orthopedic injury, but in my own field of cardiology we see this same pattern. An “oculostentotic reflex” is when a cardiologist sees a stenosis on coronary angiography and wants to stent it, even if the patient is asymptomatic and would therefore derive no benefit. Barry et al call for more reports and studies of conservative therapy, which would be helpful. We also need to be more cautious about ordering imaging and then feeling that we must “do something” about the images. Their story is another reminder of the importance of treating the patient and not the laboratory test or the image.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...