News | March 13, 2012

Study Finds Variation in CT Scan Ordering by ED Docs

March 13, 2012 — A new study by Brigham and Women’s Hospital (BWH) researchers found significant variation in the use of head computed tomography (CT) exams among doctors within the emergency department (ED). The study will be published in the April 2012 issue of The American Journal of Medicine.

With advanced imaging a driver of increasing health care costs, strategies to reduce variation in head CT use and other high-cost imaging studies may reduce cost and improve quality of care. This study is part of an effort by researchers at BWH to develop strategies for achieving the appropriate use of expensive radiologic exams.

In the current study, researchers investigated whether a head CT was performed in 55,281 patient visits to an adult-only ED throughout 2009. Patient variables included patient age, gender, severity of the emergency, emergency department location, and disease categorization. Physician-specific variables included years in practice and gender.

Overall, 8.9 percent of the visits generated head CT examinations, with per-physician ordering rates ranging from 4.4 percent to 16.9 percent.  Researchers did not find any significant correlation between physician age or gender and CT ordering, as described in previous studies.

“Even after accounting for a number of factors associated with ordering behavior, we found that greater than two-fold variability in head CT use still persists,” said lead study author Luciano Prevedello, M.D., MPH, of the BWH center for evidence-based imaging and department of radiology.

Patients receiving head CT were more likely to be male, older, and in a more urgent emergency category. Patients with head trauma were more likely to receive a CT, followed by patients with stroke, headache, and other types of trauma.

“The variability may have been due to physician’s practice style, knowledge gaps, risk tolerance, or other factors,” says Prevedello. “We are currently investigating the impact of real-time evidence-based clinical decision support (embedded in the electronic health record) on variation in test ordering behavior of physicians to improve quality of care and improve appropriateness of testing.”

Robert G. Stern, M.D., department of radiology, University of Arizona College of Medicine, Tucson, Ariz., an expert in the field said, “attempts to reduce utilization of expensive imaging studies have been made in the past, without any real focus on quality of care and appropriate ordering patterns. Prevedello and his colleagues underscore the need to develop evidence-based systems to reduce costly and inappropriate resource allocations.”

Prevedello’s study is part of a group of studies led by BWH researchers investigating orders for imaging studies and the use of decision support systems for improving the orders’ appropriateness.

One such study looked at the use of CT pulmonary angiography for the assessment of pulmonary embolism. They found significant reductions in CT pulmonary angiography use, and a corresponding increase in its yield for diagnosing pulmonary embolism, following implementation of computerized decision support systems. 

For more information: www.brighamandwomens.org

Related Content

FDA Clears AiCE Image Reconstruction on Canon's Aquilion Precision CT
Technology | Computed Tomography (CT) | October 21, 2019
Canon Medical Systems USA Inc. has received U.S. Food and Drug Administration (FDA) 510(k) clearance on its Advanced...
FDA Clears Modules of AI-Rad Companion Chest CT From Siemens Healthineers
Technology | Computed Tomography (CT) | September 26, 2019
The U.S. Food and Drug Administration (FDA) has cleared three modules of AI-Rad Companion Chest CT, an intelligent...
Videos | Computed Tomography (CT) | August 07, 2019
This is an example of in-stent restenosis shown using spectral CT imaging.
Achenbach to Receive Inaugural 2019 Stephan Achenbach Pioneer Award in Cardiovascular CT
News | Computed Tomography (CT) | July 10, 2019
The Society of Cardiovascular Computed Tomography (SCCT) will present Stephan Achenbach, M.D., FSCCT with the inaugural...
New Type of Cardiac Care to Cut Imaging Wait Times and Unnecessary Hospital Admissions
News | Computed Tomography (CT) | June 20, 2019
A new type of care for cardiac patients at St. Paul’s Hospital, Vancouver, has the potential to reduce heart imaging...
Canon Medical Receives FDA Clearance for AiCE Reconstruction Technology for CT
Technology | Computed Tomography (CT) | June 18, 2019
Canon Medical Systems USA Inc. has received 510(k) clearance on its new deep convolutional neural network (DCNN) image...
SCCT Announces 2019 Gold Medal Award Recipients

Jonathon Leipsic, M.D., (left) and Gilbert Raff, M.D., (right)

News | Computed Tomography (CT) | June 05, 2019
The Society of Cardiovascular Computed Tomography (SCCT) will present the 2019 Gold Medal Award to Jonathon Leipsic, M....
Johns Hopkins Medicine First in U.S. to Install Canon Medical's Aquilion Precision
News | Computed Tomography (CT) | March 26, 2019
Johns Hopkins Medicine now has access to the first Ultra-High Resolution computed tomography (UHR CT) system for...
Siemens Healthineers Debuts Cardiovascular Edition of Somatom go.Top CT
News | Computed Tomography (CT) | March 14, 2019
Siemens Healthineers will introduce the Somatom go.Top Cardiovascular Edition, a new version of its established...