[ RadSafe ] Article: Cautions against CT overuse fall on deaf ears . . .

[John Jacobus]

I thought this would be interesting . . . "To me, it
is agonizing that so much of the resources of the
hospitals are spent for unnecessary imaging studies," 

At roughly $400/scan, not counting interpretation by a
physician, you would think that insurers would
complain.  

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Cautions against CT overuse fall on deaf ears at West
Virginia ER
9/27/2005
By: Edward Susman

SAN DIEGO - The ordering of unnecessary CT scans
continues to be a problem in at least one hospital in
the southern U.S., despite numerous warnings about the
modality's overuse, according to a presentation Monday
at the American Neurological Association meeting.

In 2002, the National Cancer Institute (NCI),
concerned about the effects of CT radiation on young
patients, urged U.S. doctors to be more discriminating
in how those tests are used. Five years earlier,
practice parameters for head CT scans in children with
recurrent seizures had been published.

Dr. Leslie Allen, a resident in pediatrics at the Joan
C. Edwards School of Medicine at Marshall University
in Huntington, WV, decided to see how well the
emergency department (ER) was following the guidelines
when assessing epileptic children who presented with
acute seizure activity. She said she found the results
disheartening.

"There was a significant increase in the number of
emergent CT scans performed after the release of the
NCI statement in 2002," Allen said. "As physicians we
should make judicious use of CT scans a priority."

She reported that two years before NCI guidelines were
released and distributed at her facility 61 children
were brought into the ER with seizures, five of whom
underwent head CT scans. However, only two of those
five actually met the NCI criteria for a CT scan. Two
years later, 66 children were brought into the ER with
seizures and 16 underwent CT scans. Only four of the
16 should have been scanned under NCI criteria. "All
these tests were ordered by the emergency department.
I talked to radiologists at the hospital, and they
said they have told the ER not to do those tests,"
Allen said.

In the total study period from 2000-2004, 127 cases
were reviewed revealing 21 head CT. All but two of the
scans were either normal, showed no change from
previous scans, or revealed sinusitis. Of the other
two scans, one finding seen on CT was not found on
MRI. Most importantly, none of the findings on CT made
any difference in how the patients were managed, Allen
pointed out, adding that the increase in CT scans was
statistically significant (p < 0.05). The next phase
of research will be interviews with ER doctors to find
out more details on increased CT use, Allen said.

Meanwhile, other physicians at the meeting offered
their opinions on why CT was being overutilized.

"We think they are doing it because of malpractice
concerns," said co-author Dr. Charlotte Jones, an
assistant professor of pediatrics at Marshall
University. "They may also be under pressure of
parents to 'do something' for their children." Jones
suggested that interventions to reduce CT overuse, and
subsequently lower radiation exposure, should be aimed
at ER doctors as well as at parents.

"To me, it is agonizing that so much of the resources
of the hospitals are spent for unnecessary imaging
studies," commented Dr. William Sheremata, a professor
of neurology at the University of Miami in Florida.

Dr. Armand Sabet, an assistant professor of neurology
at the University of Kentucky in Lexington, noted that
he practices in the same geographical area as the
Marshall study. 

"I believe these results," Sabet said. "I would not be
surprised to see the same thing at my hospital."

By Edward Susman
AuntMinnie.com contributing writer
September 27, 2005

Copyright © 2005 AuntMinnie.com

+++++++++++++++++++
"Anyone who has never made a mistake has never tired anything new."
-- Albert Einstein

-- John
John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com

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