Jason Olson, Deseret News

Medical procedures are often necessary. But do medical physicians ever suggest procedures that aren't needed? Apparently they do. Here's a list of medical procedures that cost Americans billions that aren't always needed. A list with more detail can be found at Choosing Wisely.

Unproven diagnostics
Jason Olson, Deseret News

Unproven diagnostic tests such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, shouldn't be conducted in the event of an allergy.

Sinus computed tomography (CT)

People shouldn't order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.

Patients with chronic urticaria.
Alex Garcia, Chicago Tribune

Patients with chronic urticaria don't need routine diagnostic testing.

Mike Terry, Deseret News

Asthma shouldn't be managed or diagnosed without spirometry.

Replacement immunoglobulin therapy
Sarah A. Miller, Deseret News

Replacement immunoglobulin therapy doesn't need to be recommended for reoccurring infections unless there are damaged antibody responses to vaccines.

Immunoglobulin therapy
Scott G. Winterton, Deseret News

Don't suggest immunoglobulin therapy for recurrent infections unless damaged antibody responses to vaccines have been shown.

Low back pain
Nati Harnik, AP

Don't perform imaging for low back pain before at least six weeks unless there are red flags.

Routine antibiotics
Jeffrey D. Allred, Deseret News

Routinely prescribing antibiotics for mild-to-moderate sinusitis shouldn't be done unless symptoms last for at least a week or if the symptoms worsen after initial treatment.

Dual-energy x-ray absorptiometry (DEXA)
Gary Porter, Milwaukee Journal Sentinel, MCT

Dual-energy x-ray absorptiometry (DEXA) screening for women younger than 65 and men younger than 70 with osteoporosis isn't necessary unless risk factors are present.

Annual electrocardiograms (EKGs)
Genaro Molina, Los Angeles Times, MCT

Annual electrocardiograms (EKGs) or any other kind of screening for patients that are low-risk that don't have symptoms aren't needed and shouldn't be performed.

Pap smears
Brian Nicholson, El Observador de Utah

Pap smears for women under the age of 21 aren't or who have had a hysterectomy for an unrelated cancer disease shouldn't be performed.

Stress cardiac imaging
Genaro Molina, Los Angeles Times, MCT

Don't perform stress cardiac imaging or non-invasive imaging in the first evaluation on patients lacking cardiac symptoms unless there are red flags present.

Annual stress cardiac imaging
Laura Seitz, Deseret News

Yearly stress cardiac imaging or advanced non-invasive imaging simply as part of a follow-up isn't needed for patients who are asymptomatic.

Pre-operative assessment
Jeffrey D. Allred, Deseret News

Don't conduct stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment for people who are going to have non-cardiac, low-risk surgery.

John Amis, AP

A follow-up echocardiography for mild, asymptomatic native valve disease adults isn't necessary unless there's a change in symptoms or signs.

Stenting of non-culprit lesions

Stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI) should not be performed.

Exercise electrocardiogram testing
Jason Swensen, Deseret News

People who are asymptomatic and have a low risk of coronary heart disease don't need to get screening exercise electrocardiogram testing.

Non-specific low back pain
Stuart Johnson, Deseret News

Patients with non-specific pain in their lower back don't need to get imaging studies done.


Patients don't need to get a CT or MRI as the result of a simple syncope assessment and a normal neurological exam.

Initial diagnostic test

Patients with a low pretest probability of venous thromboembo- lism (VTE), should get a high-sensitive D-dimer measurement as the beginning diagnostic test. But they should not get imaging studies conducted as the preliminary diagnostic test.

Preoperative chest radiography
Doctor Ted Liou

Patients don't need to get a preoperative chest radiography without a clinical suspicion for intrathoracic pathology.

An uncomplicated headache
Keith Johnson, Deseret News

Don't get imaging studies done as the result of an uncomplicated headache.

Suspected pulmonary embolism (PE)
Kristin Murphy, Deseret News

Imaging doesn't need to be done for a suspected pulmonary embolism (PE) unless there's a moderate or high pre-test chance.

Ambulatory patients with unremarkable history and physical examination don't require admission or preoperative chest x-rays.

Suspected appendicitis

Computed tomography for children with suspected appendicitis shouldn't be performed until after an ultrasound has been considered.

Follow-up imaging
Kristan Jacobsen, Deseret News

Follow-up imaging for clinically inconsequential adnexal cysts doesn't need to suggested.

Gastroesophageal reflux disease (GERD)
Jeffrey D. Allred, Deseret News

For pharmacological treatment patients with gastroesophageal reflux disease long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated at the lowest level possible but enough for it to still be effective.

Colorectal cancer screening
Nick Ut, AP

Colorectal cancer screening should not be repeated by any method for 10 years after a quality colonoscopy is negative in individuals with average risk.

Repeat colonoscopy
Paul Barker, Deseret News

Colonoscopy should not be repeated for patients who have one or two small (< 1 cm) adenomatous polyps, without high- grade dysplasia, entirely removed with a high-quality colonoscopy.

Diagnosed with Barrett's esophagus
Laura Seitz, Deseret News

A follow-up exam isn't needed before three years for patients diagnosed with Barrett's esophagus who have had a second endoscopy confirming the lack of dysplasia on biopsy, according to published guidelines.

Functional abdominal pain syndrome
Michael Brandy, Deseret News

Patients with functional abdominal pain syndrome do not need repeated computed tomography (CT) scans unless there is some kind of change in symptoms or a medical change.

Solid tumor patients
Franco Ordonez, Charlotte Observer, MCT

Solid tumor patients do not need cancer-directed therapy if they have the following characteristics: no strong evidence that supports medical value of more treatment fighting cancer, no benefits from previous cancer-based interventions, performance status of 3 or 4, and ineligible for a clinical trial.

Radionuclide bone scans
Jae C. Hong, AP

At the staging of early prostate cancer, with a low-risk of metastasis, CT, PET, radionuclide bone scans shouldn't be conducted.

Early breast cancer
Scott G. Winterton, Deseret News

PET, CT, and radionuclide bone scans don't need to be done in the early staging of breast cancer with low-risk metastasis.

Asymptomatic individuals
Tom Smart, Deseret News

Asymptomatic individuals who have been treated for breast cancer with the intent to cure don't need surveillance testing or imaging.

White cell stimulation
Brian Nicholson, OKespaÑol

White cell stimulating factors for the main prevention of febrile neutropenia for patients that have a risk below 20 percent for this complication, should not be used.

Dialysis patients
Kristin Murphy, Deseret News

Dialysis patients with limited life expectancies without symptoms or signs don't need routine cancer screenings.

Chronic kidney disease
Calle Tornstroem, AP

Erythropoiesis-stimulating agents (ESAs) shouldn't be given to patients with chronic kidney disease hemoglobin levels at or above 10 g/dL unless there are symptoms of anemia.

Hypertension or heart failure

People with hypertension or heart failure or CKD from any cause, including diabetes, should stay away from nonsteroidal anti-inflammatory drugs (NSAIDS).

Peripherally inserted central catheters
Johanna Workman

Stage III—V CKD patients shouldn't obtain peripherally inserted central catheters (PICC) without first consulting nephrology.

Chronic dialysis
Laura Seitz, Deseret News

Before patients start chronic dialysis, the decision should be discussed by the patients, their families, and the physicians.

Stress cardiac imaging
Ravell Call, Deseret News

Coronary angiography and stress cardiac imaging shouldn't be conducted in patients who don't have cardiac symptoms unless there are high-risk factors.

Low-risk cardiac patients
Marcio Jose Sanchez, AP

Individuals who are low-risk don't need cardiac imaging.

Asymptomatic patients
Kira Horvath, Deseret News

Asymptomatic patients don't need radionuclide imaging as part of a routine follow-up.

Non-cardiac surgery
Doctor Ted Liou

Cardiac imaging isn't necessary as part of a pre-operative assessment patients who are preparing for low or intermediate-risk non-cardiac surgery.

Radiation exposure
Kristan Jacobsen, Deseret News

Methods to downsize the radiation exposure in cardiac imaging should be used as frequently as can be. This includes not performing such tests when benefits are limited.