The prolonged national debate about health care has led to specific passage of functional changes mandated by Obamacare. Given the vagaries of its many new segments, the most salient has been the modification of insurance coverage. Of the triumvirate of access, cost and quality, the emphasis of the legislation has been on the first, the critics have focused on the second and to some degree quality has taken a backseat. Yet it is still on the bus!

It may be a sidebar issue, but the Obama administration has acknowledged that the quality of medical care can improve. And when coupled with cost considerations, the target is utilization and the bull’s-eye is imaging. For radiology, the increased attention on too much of what was once thought to be a pristine good thing translates into an impending assessment of inappropriate CT and MR studies. In fact, that surveillance which may be a stalking horse for all radiographic tests in general. Such heightened scrutiny will open opportunities for research studies on apt imaging protocols and at the same time mandate that we examine traditional paradigms for even mundane uses of radiological tests to determine if what is customary is really necessary.

Therefore, I endeavor here to consider some common practices most of us do and offer suggestions derived from published studies and my experience as a radiologist that reflect on quality and at the same time may be accomplished with the same or less reliance on imaging. I confine myself to examples of the seemingly humdrum daily work that many of us who do general radiology do often.