More than $5 million was spent last year getting X-rays that may have been completely unnecessary, said a radiologist at King Edward VII Memorial Hospital.

Patients often pressure their doctors to schedule tests that will alleviate their fears of injury according to Dr. George McInnes, a consultant radiologist.

Due to the non-invasive nature of scans and X-rays ? and the fact that the tests are covered by health insurance ? many locals have no qualms about having them.

As more and more patients demand unnecessary exams, those who genuinely need the scans have to contend with long waits. Also, those patients receiving scans that may be deemed unnecessary are exposed to what could be avoidable amounts of radiation.

?As the demand increases for examinations, which are unlikely to yield positive results, those x-rays and scans where the result is crucial to patient care are inevitably delayed,? Dr. McInnes said.

Concerned about the problem, he gave a lecture to local doctors during one of the hospital?s weekly lecture series. At the lecture he also introduced and presented physicians with the most recent guidelines compiled by The Royal College of Radiologists in London, England.

?The aim of the guidelines is not to restrict doctors who refer patients to radiology departments, but to provide them with valuable information so they can make the best use of the facilities available to arrive at a diagnosis quickly in the most efficient, cost effective way and in a way without exposing the patient to any more ionising radiation than necessary,? said Dr. McInnes.

Argus Insurance footed the bill for The Royal College guidelines that will assist physicians in choosing when it is appropriate for scans like x-rays, computerised tomography (CT scan) and magnetic resonance imaging (MRI) to be given to reduce the unnecessary exposure of patients to radiation.

?People don?t understand the inherent risk from some exams,? said president and CEO of Argus Insurance Group Gerald Simons.

?It?s useful from time to time to speak about these topics and sensitise the medical community to issues concerning the use of testing,? he added.

The handbook outlines clinical problems, such as proceeding with an x-ray when the bone in the foot is tender due to trauma, or if the patient is unable to bear weight on the injured area.

Dr. McInnes stressed that doctors did not ?want to scare away people who actually need these examinations?.

?X-rays and CT scans do expose patients to ionising radiation but the radiation dose of a CT scan is substantially more than from an X-ray. Balanced against the risk of missing an important diagnosis, the risk of such radiation exposure is pretty small,? he added.

The Bermuda Hospitals Board Annual Report of 2002 reports 31,703 X-rays were given. By taking an average of the most common exams, the approximate total spent on x-rays for the year 2002 was $5,579,728.

During the same year, the report stated that 4,512 CT scans were given costing approximately $6,357,408.

Some scans, such as ultrasounds and MRIs, do not employ radiation, but there was also an increased demand ? and therefore long waiting lists ? for these tests as well.

The guidelines will help to assist physicians in showing those patients insisting on an unnecessary scan that certain tests are deemed useless for the specific problem as many patients are not familiar with the exact scan they need.

Dr. McInnes warned that Bermuda could see healthcare costs skyrocket if trends in the US catch on locally.

?The cost of healthcare is spiralling out of control in the US with doctors, terrified of being sued, performing the most complex and expensive examination available to ?cover themselves?.

?As we are located so close to the US we are subject to strong influences and if medicine were to be practiced that way (here in Bermuda), the cost would be passed on to every individual in vastly increased health insurance premiums,? said Dr. McInnes.

As of March 2003, (figures for the amount of scans given for 2003 are not yet available) the price for a chest X-ray was $133 while a CT scan of the head cost $593 and an MRI costs $1,050.

?Just because you have insurance you can?t have every test. There is no way of avoiding the that fact that the more hospital visits you take, the higher the premium. That?s just the way it goes. There?s no magic to it,? Mr. Simons said.

Mr. Simons said he could not tell if the guidelines would help reduce costs for insurance company and inevitably for the patient in the long run.

?What we hope to do in distributing these guidelines is give help to those doctors whose patients demand X-rays (by) persuading the patient that it may not always be in their best interest,? said Dr. McInnes.

?Our hope is that with these guidelines at a doctors? side, patients in Bermuda can feel confident that when they are referred to the radiology department, there is a very good reason for the examination and a good chance that the result, positive or negative, will help in their future management,? he added.