Results from more than 13,000 Weight-Bearing CT scans over 6.8 years. Impact on costs, radiation exposure and time spent

Abstract

BackgroundThe purpose of this study was to assess the benefit of using Weight-Bearing CT (WBCT) instead of radiographs (R) and/or CT in a foot and ankle center regarding time spent for image acquisition, radiation dose, and cost effectiveness. Material and MethodsAll patients who obtained WBCT (PedCAT) from July 1, 2013 until March 15, 2020 were included in the study. Age, sex, primary pathology were analyzed. All parameters were compared between the time period using WBCT (yearly average) with the parameters from 2012, i.e. before availability of WBCT. The time spent for image acquisition (T) and radiation dose (RD) was calculated based on measured values from previous studies. For analysis cost effectiveness, device cost, reimbursement and working time cost of radiology technicians were taken into consideration within the local circumstances. Results13,156 WBCT scans were obtained in 5,798 patients (5,798 (44%) before treatment; 7,358 (56%) follow-up; mean age, 52.2; 46% male). Primary pathologies were forefoot deformities (n=1,189 (21%) and ankle instability/cartilage defect (n=832 (14%)), and hindfoot deformity (n=765 (13%)). 1,935 WBCT scans were obtained on average yearly, and 10.2 CTs (WBCT group). In 2012, 1,850 R and 254 CTs were obtained (R(+CT) group). Yearly RD was 4.3 uSv for WBCT group and 4.8 uSv for R(+CT) group (difference 0.5 uSv decrease with WBCT 10%, p<0.01). Yearly T was 113hours in total (3.5minutes per patient) for WBCT group and 493hours in total (16.0minutes per patient) for R(+CT) group (difference, 380hours, decrease with WBCT, 77%, p<0.01). Yearly profit was 53,543 Euro for WBCT group, -723 Euro for R(+CT) group. Conclusions13,156 WBCT scans in 5,798 patients as substitution of R(+CT) over a 6.8 year period at a foot and ankle center resulted in 10% decreased RD (minus 0.5 uSV on average per patient). Yearly T decreased 380hours (77%) in total (12.0minutes per patient). Yearly financial income increased more than 54,000 Euro in total (58 Euro per patient). RD decreased despite higher radiation dose for WBCT than for R alone, based on substitution of a high number of CTs by WBCT. Other centers with low usage of CT might not decrease RD by substituting R alone by WBCT.