Abstract
BackgroundComputed tomography (CT) scanning is a relatively high radiation dose diagnostic imaging modality with increasing concerns about radiation exposure burden at the population level in scientific literature. This study examined the epidemiology of adult CT utilisation in Western Australia (WA) in both the public hospital and private practice settings, and the policy implications.MethodsRetrospective cohort design using aggregate adult CT data from WA public hospitals and Medical Benefits Schedule (MBS) (mid-2006 to mid-2012). CT scanning trends by sex, age, provider setting and anatomical areas were explored using crude CT scanning rates, age-standardised CT scanning rates and Poisson regression modelling.ResultsFrom mid-2006 to mid-2012 the WA adult CT scanning rate was 129 scans per 1,000 person-years (PY). Females were consistently scanned at a higher rate than males. Patients over 65 years presented the highest scanning rates (over 300 scans per 1,000 PY). Private practice accounted for 73% of adult CT scans, comprising the majority in every anatomical area. In the private setting females predominately held higher age-standardised CT scanning rates than males. This trend reversed in the public hospital setting. Patients over 85 years in the public hospital setting were the most likely age group CT scanned in nine of ten anatomical areas. Patients in the private practice setting aged 85+ years were relatively less prominent across every anatomical area, and the least likely age group scanned in facial bones and multiple areas CT scans.ConclusionIn comparison to the public hospital setting, the MBS subsidised private sector tended to service females and relatively younger patients with a more diverse range of anatomical areas, constituting the majority of CT scans performed in WA. Patient risk and subsequent burden is greater for females, lower ages and some anatomical areas. In the context of a national health system, Australia has various avenues to monitor radiation exposure levels, improve physician training and modify funding mechanisms to ensure individual and population medical radiation exposure is as low as reasonably achievable.
Highlights
Computed tomography (CT) scanning is a relatively high radiation dose diagnostic imaging modality with increasing concerns about radiation exposure burden at the population level in scientific literature
Public hospital CT scans could be performed under several ‘admission’ types: inpatient services were the most common (43%), outpatient/clinic (30%) and emergency patients (26%) were the most frequent; while only 1% of public hospital services were undertaken on private patients and billed directly to Medicare
The Medical Benefits Schedule (MBS) CT scans, with the exception of the small number performed by a public hospital, were all conducted in private radiological clinics, which may or may not have an affiliation with or proximity to a hospital
Summary
Computed tomography (CT) scanning is a relatively high radiation dose diagnostic imaging modality with increasing concerns about radiation exposure burden at the population level in scientific literature. Computed tomography (CT) scanning is considered to be a relatively high radiation dose diagnostic imaging modality [1]. In response to the growing utilisation of CT imaging [2,3], many nations have established or are in the process of implementing guidance and reference for the radiation dose delivered to the patient by CT examinations [4,5,6,7]. The Organisation for Economic Co-operation and Development (OECD) has reported substantial increases in the per capita rate of CT scanning across the majority of developed countries [2]. Other research has noted an increasing utilisation of CT in Australia [3]
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