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

Weight-Bearing CT International Study Group Hosts  Scientific Session at AOFAS Conference
News | Computed Tomography (CT) | June 15, 2018
June 15, 2018 —The Weight-Bearing CT International Study Group will host a scientific session on the benefits of weig
Florida Hospital First in State to Adopt NeuroLogica's BodyTom Elite CT
News | Computed Tomography (CT) | June 14, 2018
June 14, 2018 — NeuroLogica, a subsidiary of Samsung Electronics Co.
Riverain Technologies Issued U.S. Patent for Vessel Suppression Technology
News | Computed Tomography (CT) | June 14, 2018
Riverain Technologies announced that the United States Patent and Trademark Office (USPTO) has awarded the company a...
360 Photos | 360 View Photos | June 14, 2018
This is a 360 degree image from the Canon Aquilion 64-slice...
American Society of Neuroradiology Honors Peter Chang with Cornelius G. Dyke Memorial Award
News | Neuro Imaging | June 13, 2018
Peter Chang, M.D., current neuroradiology fellow at UCSF and recently recruited co-director of the UCI Center for...
NewYork-Presbyterian Expands Mobile Stroke Treatment Unit Fleet

Image courtesy of NewYork-Presbyterian Hospital

News | Stroke | June 11, 2018
NewYork-Presbyterian, in collaboration with Weill Cornell Medicine, Columbia University Irving Medical Center and the...
Latest additions to Somatom go. CT platform address advanced clinical fields and applications, including cardiology, CT-guided intervention and dual energy CT. How to lower radiation dose from Computed tomography scanners using ned technology.

Latest additions to Somatom go. CT platform address advanced clinical fields and applications, including cardiology, CT-guided intervention and dual energy CT.

Feature | Computed Tomography (CT) | June 04, 2018 | By Melinda Taschetta-Millane
Recent studies show a rapid increase in patient radiation exposure mainly due to increased use of medical imaging, pa
Lung Decision Precision
News | Lung Cancer | June 04, 2018
For smokers and former smokers, the threat of lung cancer always lurks in the shadows.
American Cancer Society Updates Colorectal Cancer Screening Guideline
News | Colonoscopy Systems | May 30, 2018
An updated American Cancer Society guideline says colorectal cancer screening should begin at age 45 for people at...
Researchers Use Radiomics to Overcome False Positives in Lung Cancer CT Screening
News | Advanced Visualization | May 29, 2018
A team of researchers including investigators from Mayo Clinic has identified a technology to address the problem of...
Overlay Init