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We like pretty pictures and, in pulmonary medicine, we use computed axial tomography (CT) to generate pretty pictures to help us diagnose and manage patients with respiratory complaints. In 2007 more than 10 million chest CT scans were performed across the USA, representing an astounding 11 000% increase in the CT rate since 1980.1 CT scans rely on ionising radiation to generate images, and recent estimates suggest that CT scans may be responsible for 24% of the total ‘background’ radiation to which the population is exposed in a given year.2 Thankfully, there are several large-scale efforts to reduce the radiation exposure related to CT scans and to mitigate the health risks imposed by ionising radiation.3 What is not being adequately addressed is the issue of economic costs (and benefits) of CT scans. CT scans are expensive for patients and to the healthcare system, with prices ranging from $500 to $1500 per scan.4 Recently, the cost-effectiveness ratio of lung cancer screening with CT scans was reported to be $2.3 million dollars per quality-adjusted life saved,5 providing us with a sobering reminder that these ‘pretty pictures’ are not without significant costs.
Chronic obstructive pulmonary disease (COPD) is a condition that lends itself to anatomical medical imaging. For practical reasons, COPD is largely defined based on spirometric criteria. However, there is general discontent with this approach because spirometric measurements are relatively insensitive and correlate only very loosely with histological abnormalities or with patient symptoms or outcomes. …