MDCT spurs boom in ER CT utilization

About this time each year my nieces and nephews are thoroughly enraptured with new toys. Batteries are replaced and recharged on a daily basis and, more often than not, the latest favorite is tucked under the pillow at bedtime, lest it wander too far away during the night.

Implementing a new piece of diagnostic imaging equipment, such as a multidetector CT (MDCT), in an emergency room setting seems to provoke a similar reaction among referring clinicians, according to research presented at the 2005 RSNA conference in Chicago.

Dr. Todd Mulderink, a third-year resident from the department of radiology at the University of Pennsylvania Health System (UPHS) in Philadelphia, reported the results of a retrospective study conducted at his institution on the impact of MDCT on ER CT utilization.

According to Mulderink, the implementation of MDCT in the ER has improved workflow and increased throughput due to the modality's faster scanning and reconstruction times.

"Although MDCT may lead to improved efficiency, it can also create increased workloads," he noted.

A single-slice helical CT scanner (CTi, GE Healthcare, Chalfont St. Giles, U.K.) in the UPHS emergency department was replaced in December 2003 with a multidetector system (Somatom Sensation 16, Siemens Medical Solutions, Malvern, PA) during a scheduled upgrade, Mulderink said.

The research team performed a retrospective query of both the RIS and PACS databases at the facility to determine all emergency department CT examinations in the two years preceding the Sensation 16 install and for 21 months after its implementation. The data was sampled in two-month time periods at five- to 12-month intervals.

The researchers compared the total number of patients scanned, the total number of studies, and the total number of images per patient for the CT scans ordered by the ER for both single-slice and multislice systems. The group found no significant differences in the demographics, either by gender or age, in the composition of the patients referred for CT exams by the emergency department in the 55-month study period.

What was significant, according to Mulderink, was the total number of patients scanned. The team found that CT use in its ER increased 65% following the implementation of MDCT. In 2002, approximately 1,000 single-slice CT exams were performed in January. A little more than three years later, with the implementation of 16-slice CT technology, the ER was performing more than 2,000 exams a month.

Although CT head exams increased slightly, by 2.9%, the use of CT for spinal studies (cervical, thoracic, and lumbar) rocketed up by more than 100%. Abdominal studies with MDCT increased by 21.0%, and extremity studies rose while CT chest usage increased 172.9%. Mulderink attributed part of the rise in utilization for CT spine studies to the capabilities of the new technology.

"Approximately 12 months following installation of the 16-row multidetector scanner, reconstructed targeted field-of-view, thin-section axial with sagittal and coronal reformations of the thoracic and lumbar spine could be obtained from the raw data of routine CT examinations of the chest and abdomen/pelvis," he said.

The increase in usage of the modality has resulted in a greater number of images for the radiology department to deal with, Mulderink said. The average number of images per patient with the single-slice system was 150.3; by January 2005, with the 16-slice unit, that number stood at an average of 563.5 images per patient study.

Mulderink noted that trauma patients in the emergency department commonly receive CT exams of the chest/abdomen/pelvis, head, and cervical spine with reconstructions of the thoracic and lumbar spines.

The end result of MDCT implementation in the UPHS emergency department has been to increase the workload on the facility's radiologists due to the significant rise in the volume of images from the modality. In addition, reconstructive algorithms for spine images altered the referral patterns for CT spine exams, which could lead to further increases in utilization as advanced imaging software for other areas becomes more widely deployed.

"Focused examinations of other anatomic areas could be reconstructed from other routine exams in the future, further changing referral patterns," Mulderink said.

By Jonathan S. Batchelor
AuntMinnie.com staff writer
January 4, 2006

Related Reading

Massachusetts insurers seek to cut imaging utilization, September 12, 2005

MedPAC, Medicare, and imaging growth, August 16, 2005

National health expenditures and another year of 'unsustainable growth', May 4, 2005

ACC, ACR debate stats on imaging growth, April 18, 2005

CT procedure volume surges, February 4, 2005

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