Application of ACR appropriateness criteria in ER could save millions

[John Jacobus <crispy_bird@YAHOO.COM>]

Statement from the annual  Radiological Society of

North America (RSNA)meeting.



http://www.diagnosticimaging.com/webcast04/showArticle.jhtml?articleID=54201252



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Application of ACR appropriateness criteria in ER

could save millions 





by James Brice 

Emergency room physicians could save millions of

dollars annually and spare their patients from

unnecessary radiation exposure by adopting American

College of Radiology appropriateness criteria to guide

the use of CT and computed radiography for trauma

patients, according to a study reported Monday. 



Dr. Jonathan Hadley, a radiology resident at Eastern

Virginia Medical School in Virginia Beach, found that

CT and CR were routinely prescribed for 200 trauma

patients enrolled in the study. Imaging utilization

was nearly identical for all 200, even though 35% of

the patients presented with no radiographically

identifiable injuries, 17% had bumps and bruises, and

only 48% suffered injuries serious enough to require

hospitalization. 



The 200 patients received a total of 660 CT exams and

429 CR procedures in the first three hours after

arriving at the medical school's Level I trauma

center. They generated $837,028 of imaging-related

charges, or $4953 per patient, according to Hadley. In

the process, each patient received an estimated

whole-body exposure of 16 mSv of radiation. 



The story would have been quite different if ACR

appropriateness criteria had governed how imaging was

prescribed, Hadley said. Compliance with those

guidelines would have cut imaging costs by $300,000,

and radiation exposure would have dropped to an

average of 7 mSv. In reality, the savings would have

been about five times greater if Hadley had used

actual insurance payable figures rather than charges

for his standard. 



In the question and answer session, he had difficulty

answering whether chest x-rays should be routinely

performed on apparently asymptomatic trauma patients

to rule out pneumothorax. 



Still, the difference translates into big numbers when

applied to the nine million patients who appear in

emergency rooms in the U.S. after accidents every

year. ER compliance with the ACR appropriateness

criteria would save $17 billion on imaging annually

and would ultimately reduce the number of deaths

associated with radiation-induced cancer by at least

2500 annually, he said. 



"If you are going to image every patient who comes

through the door, there is going to be a tremendous

cost, both financially and in terms of unnecessary

radiation exposure to those patients," Hadley said. 



 







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"That government is the strongest of which every man feels himself a part."

Thomas Jefferson



-- John

John Jacobus, MS

Certified Health Physicist

e-mail:  crispy_bird@yahoo.com





		

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