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Cost and Radiation Consciousness

The tremendous costs of health care impact individuals as well as systems, and are projected to more than double in the next ten years.


Bending the Cost Curve through Cost and Radiation Consciousness

The intent of this program is to raise awareness of the costs of providing health care and to promote the judicious use of resources – nowhere is this more important than in the safety net.

While radiologic imaging studies are highly effective diagnostic tools available to physicians and patients, awareness of cost and radiation risks deserves greater attention in safety net settings.

Over the past decade, the demand for Radiologic imaging studies such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound has increased at a faster rate than for any other health care service, for reasons ranging from wider availability of these technologies and effectiveness as diagnostic tools to favorable reimbursement rates. Medicare data also points to possible overutilization of radiologic services, with some studies estimating that up to 30% of CT scans may be medically unnecessary. More recently, both the medical community and the general public have become aware of the risks of radiation exposure from CT scans.

Overutilization of radiologic services, particularly in a resource-constrained setting like Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), not only has implications for patient safety in the form of greater radiation exposure, but also negatively impacts system costs and patient access to care.

This pilot project aims to raise awareness among San Francisco safety net providers who request ambulatory radiologic imaging studies on the cost of those studies as well as on patient safety risks associated with CT scans. We will leverage our eReferral system infrastructure to present referring clinicians with cost data and radiation exposure data at the point of referral for MRI, CT, and ultrasound studies.



  • Kruger JF, Chen AH, Rybkin A, Leeds K, Frosch DL, Goldman LE -- Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study. BMJ Qual Saf 2014 (pdf)



Bending the Cost Curve through Cost and Radiation Consciousness

Project Lead: Alice Hm Chen, MD, MPH Profile

Project Lead: Alexander Rybkin, MD Profile

Lead Evaluator: L. Elizabeth Goldman, MD, MCR Profile



Advisory Group:

Donald Abrams, MD – Professor, UCSF and Chief of Hematology and Oncology at ZSFG


Diana Coffa, MD -- Associate Residency Director in Family and Community Medicine at UCSF

Dr. Coffa provides primary care to medically underserved patients at the Family Health Center at Zuckerberg San Francisco General Hospital. She is involved in continuous quality improvement work at the Family Health Center and has a special interest in the impact of systemic interventions on resident and student education.


Lukejohn Day, MD – Assistant Clinical Professor, UCSF Division of Gastroenterology and ZSFG Medical Director for Medical Subspecialties


J. Claude Hemphill, MD, MS – Professor, UCSF Division of Neurology and Chief of Neurology at ZSFG


David Lown, MD, MA, Chief Medical Officer, San Francisco Community Clinic Consortium and Family Physician at St. Anthony Medical Clinic

Dr. Lown is Chief Medical Officer of the San Francisco Community Clinic Consortium (SFCCC), a group of 11 community clinics and health centers. Dr. Lown's professional interests relate to systems improvement, including issues around clinical practice and health care delivery redesign, as well as the use of technology to improve systems of care and health outcomes.


Amir Matityahu, MD – Associate Clinical Professor, UCSF Department of Orthopaedic Surgery at ZSFG


Nancy Omahen, NP – ZSFG Referral Coordinator, Department of Radiology

Nancy is the eReferral coordinator/department consultant for the SFGH Department of Radiology, where she reviews referrals to all imaging studies. Nancy’s primary interests in the healthcare system are patient and staff education, including education of providers to ensure appropriate use of resources with the most appropriate imaging available with the least risk to the patient.


Rebecca Smith-Bindman, MD – Professor of Radiology and Biomedical Imaging, Epidemiology and Biostatistics at UCSF