X-ray Use in Chest Imaging in Emergency Department on the Basis of Cost and Effectiveness

Abstract

The increasing use of imaging in the emergency department (ED) services has become an important problem on the basis of cost and unnecessary exposure to radiation. Radiographic examination of the chest has been reported to be performed in 34.4% of ED visits, and chest computerized tomography (CCT) in 15.8%, whereas some patients receive both chest radiography and CCT in the same visit. In the current study, it was aimed to establish instances of medical waste and unnecessary radiation exposure and to show how the inclusion of radiologists in the ordering process would affect the amount of unnecessary imaging studies. This retrospective study included 1012 ED patients who had both chest radiography and CCT during the same visit at Ankara Training and Research Hospital between April 2015 and January 2016. The patients were divided into subgroups of trauma and nontrauma. To detect unnecessary imaging examinations, data were analyzed according to the presence of additional findings on CCT images and the recommendation of a radiologist for CCT imaging. In the trauma group, 77.1% (461/598) and in the nontrauma group, 80.4% (334/414) of patients could be treated without any need for CCT. In the trauma group, the radiologist recommendation only, and in the nontrauma group, both the radiologist recommendation and the age were determined to be able to predict the risk of having additional findings on CCT. Considering only the age of the patient before ordering CCT could decrease the rate of unnecessary imaging. Including radiologists into both the evaluation and the ordering processes may help to save resources and decrease exposure to ionizing radiation.