This term was first introduced by Richard Hayward, a consultant neurosurgeon in an article in the British Medical Journal in 2003

  • VOMIT (victims of modern imaging technology) - an acronym for our times. BMJ 2003;326:1273:

“…The history of imaging since the discovery of x rays has been one of an exponential rise in the volume and accuracy of information, acquired against a background of firstly increasing and then reducing invasiveness—and rising costs … It is small wonder that the flood of information from these investigations and our knowledge of how to deal with it may be several years out of step … So where does this leave us doctors? We adapt to a world in which we must accept VOMIT as a reasonable price for our technological advances. But it's also a world in which that well tried and tested concept, the doctor patient relationship, exists to help us translate the anxiety provoking generality into, we hope, the reassuringly individual.”

It is very important to remember that there is NOT a linear association between scan discovered changes and pain.

PAIN is present commonly with either mild or no scan changes.

Even severe scan changes exist very commonly with NO pain.

SO - just because there is pain and there is a scan change, it does not automatically create a causative relationship. This is particularly the case in persistent pain and especially in spinal pain.

This is robustly supported by the following references and guidelines:

  • Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Chou et al. Ann Intern Med. 2011;154:181-189:

“Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms.

Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs.”

“Critical analysis leads to formal endorsement: For the first time ever, the AAOS has endorsed clinical practice guidelines generated by another medical specialty society. At its meeting in June, the AAOS Board of Directors approved the endorsement of the American Pain Society’s Guideline on Management of Low Back Pain …”

The following poster (which is available for purchase via: www.aptei.com) was created with this in mind: