Save money, patient dose by keeping radiologists in the loop

Radiologists should be consulted in the ordering process of chest CT exams, according to a study from Ankara Training and Research Hospital in Turkey. Researchers performed a retrospective study on the value of chest CT in emergency department (ED) visits, aiming to establish instances of medical waste and unneeded radiation exposure.

The demand for medical imaging has rapidly grown over the past 40 years, and the U.S.'s appetite shows no signs of slowing down. The market is expected to reach $33.4 billion by 2020.  However, recent studies have shown that diagnostic imaging, CT in particular, may be overused in the ED. The modality is used in addition to x-ray if a radiologist deems it necessary. The study's lead author Erdem Fatihoğlu, MD, pointed to CT as having higher costs but not providing better outcomes.

Fatihoğlu et al. examined more than 1,000 patients who visited the Ankara hospital’s ED over a 10-month period and received both a chest x-ray and a chest CT exam. The x-rays and CT images were reviewed by radiologists who were given little information about the patient’s conditions. They were simply told if patients were classified as “trauma” or “non-trauma." The radiologists first read the x-ray and determined if a chest CT was necessary. If it was, they then recorded any additional findings.

After reviewing the data, more than 75 percent of the patients could have been treated without a CT exam. Some 80 percent of CT exams were deemed unnecessary in the non-trauma group. In the trauma group, the radiologist’s recommendation was enough to predict the chances of finding additional conditions on CT, while the non-trauma group required both the radiologist’s recommendation and the patient’s age.

“In addition, younger patients, who have less additional findings on chest CT, are more vulnerable to the potential neoplastic effects of ionizing radiation. So a consideration of age can also prevent these harmful effects,” wrote Fatihoğlu et al. “To save resources and decrease exposure to ionizing radiation, the inclusion of radiologists into both the evaluation and the ordering processes would be of great benefit.”

CT exams are the largest source of medical radiation in the U.S., and the elimination of unnecessary imaging studies could save up to $81 billion each year. Increasing the involvement of radiologists in the ordering process is a step toward cutting costs and patient dosage.