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Much of the time imaging is ordered because it's more advanced, but doctors aren't seeing things that may show up on the basic exercise test.
Much of the time imaging is ordered because it's more advanced, but doctors aren't seeing things that may show up on the basic exercise test. / Stockbyte/Getty Images

When trying to detect heart disease, the initial instinct for many doctors and patients is to order the most advanced imaging tests. But according to a recent study, basic exercise stress tests may be as or more effective.

“Patients should be asking, ‘Why is this testing ordered?’ ” says physician Martha Gulati, director of preventive cardiology and women’s cardiovascular health at Ohio State University and co-author of the study. “Sometimes they are appropriate, but not always.”

She identified three questions about imaging that patients should discuss with their doctors.

Is it covered? Many stress tests with imaging are covered by insurance, but not all. “We should be more responsible with how much everything costs,” Gulati says.

Is it safe? Nuclear imaging uses radiation to detect blood flow in the heart, Gulati says. According to a 2007 study, cancers resulting from radiation exposure from CT-related imaging account for as many as 2% of cancers in the USA.

What will it show? “Much of the time they order imaging because it’s more advanced, and they’re not seeing things that show up on just the basic exercise test,” Gulati says. Exercise capacity, heart rate and chest pains all can be gleaned from basic stress tests, but that information is sometimes ignored once the more advanced test is ordered.

— Mark W. Sanchez

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