Increase In Use Of CT Research Articles

Association between emergency department computed tomography utilization rate and patient satisfaction: A clinician level analysis across a regional healthcare system

BackgroundComputed Tomography (CT) use is common during emergency department (ED) visits, and ED clinicians may order CTs for myriad reasons, including desire to improve patient satisfaction. ObjectivesTo determine if greater CT use by ED clinicians is associated with increased average patient satisfaction scores for those providers. MethodsThe study took part across 15 non-pediatric hospitals in a regional healthcare system. We compared clinician CT use rate for adult patients discharged from the ED with Net Promotor Score (NPS) for that clinician. NPS is a patient satisfaction metric with a possible range of scores from −100 to +100. We included ED clinicians (physicians and non-physician providers (NPPs)) with at least 500 adult patient encounters resulting in ED discharge from July 2020 through June 2022. We assessed for an association between CT use and clinician NPS using univariate and multivariate regression models. ResultsAcross the 15 hospitals, 166 physicians and 74 NPPs were included in the study. The median CT rate was 25.7 ​% (range 7.1 ​%–48.9 ​%). In both models, there was a statistical association between CT utilization and NPS such that every absolute increase in CT use by 10 ​% resulted in a 3-point improvement in provider NPS on the 200-point scale. When examined in a sensitivity analysis, none of the hospitals individually showed this same association. ConclusionsWe found a 26 ​% rate of CT use by clinicians for adults discharged from the ED, with wide variation in utilization between clinicians. There was a small and inconsistent association between CT utilization and clinician specific NPS scores.

LO26: Reduction of CT scan use in emergency department patients with recurrent renal colic

Introduction: CT scan is the most common imaging modality for suspected renal colic and is used for about 80% of presentations. Cumulative ionizing radiation exposure from repeat CT scans increases long-term cancer risk. Despite a 10-fold increase in CT use to detect kidney stones in the ED in just over a decade, there has been no increase in the proportion of kidney stones diagnosed, number of significant alternate diagnoses or admissions to hospital. Choosing Wisely recommends to avoid ordering CT of the abdomen/pelvis in otherwise healthy patients<age 50 presenting to the ED with known history of kidney stones and with symptoms consistent with uncomplicated renal colic. The aim is that >90% of patients < age 50 with a history of renal stones arriving in Sunnybrook ED with symptoms consistent with renal colic will be managed without a CT abdomen/pelvis. Methods: Emergency physicians were engaged in the process at various stages, including a brainstorming session to perform a root cause analysis. A Driver diagram was created to generate change ideas. Outcome Measure Number of CT scans ordered for target population (Results: Results to date indicate that there is a non-sustained decrease in the number of CT scans performed on ED patients < age 50 with recurrent renal colic. The STONE score was infrequently used, thus making it difficult to standardize CT ordering for presumed renal colic. Conclusion: As a result of this QI initiative, there is awareness amongst emergency physicians of a patient population that is over imaged with CT scan, often with no change in management. Introduction of a low dose CT scan order was the greatest gain from this QI initiative. In order to decrease CT utilization, physicians need to be shown the lack of benefit of CT use and a safe alternative diagnostic approach.

Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults.

To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age. Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004-2014 in emergency and outpatient care and assessment of radiation exposure trend. Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72-1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16-48 %. The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations. • Literature highlights a remarkable increase in CT use over the last decades. • The paediatric age had higher exposure to X-ray risk. • A detailed retrospective analysis of more than 9 million scans was performed. • Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range. • This study raises concern about exposure for teenagers and young adults.

Utilization Trends in Noncardiac Thoracic Imaging, 2002-2014

PurposeTo analyze recent trends in utilization of the various noncardiac thoracic imaging modalities in the Medicare population. MethodsThe Medicare Part B databases for 2002 through 2014 were reviewed. All CPT codes pertaining to noninvasive imaging of the thorax were selected and grouped into seven categories: x-ray, CT, computed tomographic angiography (CTA), nuclear scans (noncardiac), MRI, MR angiography, and ultrasound. Yearly utilization rates per 1,000 Medicare beneficiaries were calculated. Medicare physician specialty codes were used to determine how many studies were performed by radiologists versus nonradiologist physicians. ResultsThe total utilization rate of all chest imaging peaked at 1,090 per 1,000 in 2005, then progressively declined to 913 by 2014 (−16%). In 2002, radiologists’ share of thoracic imaging was 87% and increased to 91% by 2014. Among all providers, the total utilization rate of chest CT rose sharply, peaked at 100 in 2007, and has remained steady at around 89-91 in more recent years. The CTA utilization rate rose progressively from 2 in 2002 to 23 in 2014. Utilization rates of nuclear chest imaging decreased steadily after 2002. Chest x-ray rates reached a peak of 976 in 2005 but then declined to 790 in 2014; this change was largely responsible for the decline in total thoracic imaging. ConclusionOverall thoracic imaging utilization rates have declined in recent years, despite an increase in use of CT and CTA. The decline largely resulted from a decrease in use of chest x-rays.

Surveillance and Radiation Therapy for Stage I Seminoma—Have We Learned From the Evidence?

To analyze, in the setting of stage I seminoma, the factors affecting adjuvant treatment decisions and resulting survival outcomes, using a national dataset. We identified 33,094 stage I seminoma patients after orchiectomy from 1998 to 2012 from the National Cancer Data Base. Factors affecting treatment selection (active surveillance [AS] vs adjuvant treatment [AT]) were identified using a parsimonious multivariate logistic regression model. Propensity scores for treatment decision were generated and incorporated into a multivariate Cox regression analysis of overall survival. This process was then repeated within the AT cohort for factors predictive for chemotherapy [CT] versus radiation therapy [RT]. Only 33% of patients received AS, and 65% received AT (89% RT and 11% CT). From 1998 to 2012 the proportion receiving AS increased from 23% to 60%, whereas RT utilization decreased from 73% to 21%, and CT utilization increased from 2% to 17%. Utilization of low-dose RT increased from 1.5% in 1999 to 34% in 2012. There was a small absolute overall survival advantage to AT over AS at 10 years (95.0% vs 93.4%, propensity adjusted hazard ratio 0.58, P<.0005). There has been a significant increase in use of AS for stage I seminoma, influenced by both sociodemogrpahic and clinicopathologic factors. Between AT options, there has been significant increase in use of CT, mirrored by a decline in use of RT. Although overall survival remains high for all 3 treatment strategies, AT seems to be associated with a small absolute survival advantage over AS up to 10 years out from diagnosis.

Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities

Radiation exposure from medical sources now equals or exceeds that from natural background sources, largely attributable to a 20-fold increase in CT use since 1980. Increasing exposure to children and fetuses is of most concern due to their heightened susceptibility. More recently, CT use may be leveling or decreasing, but it is unclear whether this change is widespread or varies by type of institution. We sought to characterize trends in CT utilization in California hospitals and emergency departments among children and pregnant women, looking at different types of facilities, such as teaching, private, public and nonprofit institutions. We examined frequency of CT examinations by year from 229 facilities reporting CT usage in routinely collected California statewide data for 2005-2012. We modeled trends overall and by facility type. CT scans for pediatric and pregnant patient visits in the emergency department increased initially, then started to decline after 2008. Among hospital admissions, rates declined or leveled after 2005. In the emergency department, CT rates varied between types of facilities, with teaching hospitals reducing use sooner and more sharply than other types of facilities. CT utilization in California among children and pregnant women has begun to level or decline. Still, population exposure remains at historically high levels, warranting consideration of potential public health implications. Further examination of reasons for trends among hospital types, particularly how teaching hospitals have reduced rates of CT utilization, may help identify strategies for CT reduction without compromising patient care.

Imaging Trends and Radiation Exposure in Pediatric Inflammatory Bowel Disease at an Academic Children's Hospital

The purpose of this study was to retrospectively evaluate diagnostic imaging trends and radiation exposure in pediatric inflammatory bowel disease (IBD) at a U.S. academic children's hospital between 2001 and 2010. Pediatric IBD patients within our health system during the 2001, 2006, and 2010 calendar years were identified. The number of abdominopelvic radiologic and endoscopic examinations (total and by modality) performed during each 1-year-period was recorded for each subject. Means were compared using the Wilcoxon rank sum test. The cumulative lifetime number of diagnostic examinations by modality and estimated effective radiation dose (using Monte Carlo simulation software and CT dose-length product values) was calculated for the 2010 IBD subject cohort. There was a 53% increase in the average number of abdominopelvic diagnostic examinations obtained per pediatric IBD patient comparing 2001 with 2010 (1.29 ± 2.19 vs 1.98 ± 3.46, p = 0.004). Abdominal radiography (p = 0.02), MRI (p < 0.0001), and esophagogastroduodenoscopy (EGD) (p = 0.01) showed significantly increased use. The increase in use of CT and ileocolonoscopy was not significant (p > 0.05). There was significantly reduced use of contrast enema, small-bowel follow-through (SBFT), and upper gastrointestinal (UGI) series (all, p < 0.0001). The average pediatric IBD patient seen in 2010 (mean age, 13.9 years) had undergone 1.08 CT, 0.82 MRI, 1.36 abdominal radiographic, 0.14 contrast enema, 0.52 SBFT, 0.54 UGI, 1.00 ileocolonoscopy, and 0.72 EGD examinations during his or her lifetime, with an average cumulative lifetime estimated effective radiation dose of 4.6 mSv. Although the number of yearly diagnostic examinations performed for pediatric IBD patients increased significantly between 2001 and 2010, the cumulative lifetime estimated effective radiation dose is relatively low in most of these patients.

Falls, Older Adults, and the Trend in Utilization of CT in a Level I Trauma Center

The purpose of this article is to evaluate the trend in the utilization of CT for fall victims older than 55 years admitted to a level I trauma center. We used trauma registry data (1996-2006) of a level I trauma center. By using the International Classification of Disease, Ninth Revision (Clinical Modification) codes, we identified the type and frequency of CT examinations for each patient. We used negative binomial regression to evaluate the association between CT utilization rates and age, year of admission, sex, insurance status, ethnicity, ICU admission status, injury severity score, and final disposition (i.e., deceased vs alive). We used logistic regression to evaluate predictors of repeat (i.e., ≥ 2) CT scans. During the study period, the utilization rate of head, abdomen, thorax, and other body region (including spine and extremities) CT examinations increased, on average, by 7%, 16%, 14%, and 15% per year, respectively. Older age was associated with a higher utilization of head CT. Male sex and ICU admission were associated with higher utilization for all types of CT examinations. Repeat head and abdominal CT scans increased, on average, by 28% (95% CI, 20-36%) and 24% (95% CI, 2-51%) per year, respectively. We quantified the increase in utilization rates of all types of CT scans for fall victims admitted to a level I trauma center. We found a marked increase in CT use over time, both for initial as well as repeat studies, and an association between CT use and variables such as sex. Future studies should focus on the evaluation of CT appropriateness and their influence on patient outcomes.

Slowing the Increase in the Population Dose Resulting from CT Scans

The annual number of CT scans in the U.S. is now over 70 million. The concern is that organ doses from CT are typically far larger than those from conventional X-ray examinations, and there is epidemiological evidence of a small but significant increased cancer risk at typical CT doses. Because CT is a superb diagnostic tool and because individual CT risks are small, when a CT scan is clinically indicated, the CT benefit/risk balance is by far in the patient's favor. Nevertheless, CT should operate under the ALARA (As Low As Reasonably Achievable) principle, and opportunities exist to reduce the significant population dose associated with CT without compromising patient care. The first opportunity is to reduce the dose per scan, and improved technology has much potential here. The second opportunity is selective replacement of CT with other modalities, such as for many head and spinal examinations (with MRI), and for diagnosing appendicitis (selective use of ultrasound + CT). Finally, a fraction of CT scans could be avoided entirely, as indicated by CT decision rules: Clinical decision rules for CT use represent a powerful approach for slowing down the increase in CT use, because they have the potential to overcome some of the major factors that result in some CT scans being undertaken when they are potentially not clinically helpful. In the U.S. and potentially elsewhere, legislative approaches are a possible option, to improve quality control and reduce clinically unneeded CT use, and it is also possible that upcoming changes in heath care economics will tend to slow the increase in such CT use.

The effect of a CT and MR preauthorization program on ED utilization

Objectives To determine if a new outpatient preauthorization process for radiologic studies was associated with a change in emergency department (ED) CT and MRI utilization rates. Methods: This was a retrospective study set in an urban tertiary teaching hospital. Subjects included all nonadmitted ED patients who had either a CT or MRI during a control or preauthorization period. The study group consisted of those patients whose insurance required preauthorization. The control group consisted of those patients for whom preauthorization was not required. We used a multiple regression with autoregressive error adjusting for seasonal and monthly variation to obtain the rates of change of CT and MRI usage over time for the control and preauthorization periods. Results The control period consisted of 29,303 ED visits over 54 weeks not resulting in hospital admission. The preauthorization period contained 33,858 patients over 64 weeks. The baseline ordering of CT and MRI was not significantly different between the groups. After controlling for seasonal and monthly variation, our results demonstrated that while both insurance groups demonstrated an increase in use of CT and MRI from the control to preauthorization periods, there is a statistically significant increase only in the rate of MRI utilization in the study group during the preauthorization period. Conclusion A telephone preauthorization process for radiological studies produced a statistically significant change in the rate of ordering MRI studies, but not CT, in the study group. We conclude that this preauthorization process may have resulted in additional ED visits for outpatient MR scans.

The thyroid cancer epidemic: Is it the dark side of the CT revolution?

The rapid increase in CT use since 1990 and especially in the past 10 years has been accompanied by a coterminous worldwide increase in incidence of thyroid cancer especially in women. Are the two trends independent or related? Specific information from many countries and seven American states suggest that the relationship is real as no other cause can account fully for the temporal change in the frequency of this malignancy. Moreover, newer techniques of CT performance with or without the administration of iodinated contrast material favor the likelihood of a contingent association of image test utilization and thyroid cancer induction.