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New study asks how often chest CT scans yield meaningful results

by Gus Iversen, Editor in Chief | December 24, 2014
Examples of chest X-ray
and CT scan
courtesy of RSNA
There are myriad reasons — medical, and economical — not to overuse CT scans. Chest X-rays are responsible for prompting as many as half of all the recommendations for additional imaging (RAIs), which lead to thoracic CT scans.

A new study published online by the journal Radiology looked at chest X-rays to figure out how often those images led to CT scans, and how often those CT scans yielded meaningful medical information.

Only 4.5 percent of outpatient X-rays contained a recommendation for chest CT scans; of those, 41.4 percent showed a corresponding abnormality and 8.1 percent revealed a newly-diagnosed, biopsy-proven malignancy.

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“The main conclusion, I think, is that for this particular clinical situation, there is a lot of value in that follow-up CT,” Dr. Tarik Alkasab, one of the lead researchers, told DOTmed News. “That emphasizes how important it is that people get that recommended follow-up image.”

Interestingly, more than one-third of the patients who received an RAI for chest CT scans did not have them performed within the year, which is another concern.

Alkasab and his team combed through over 29,000 reports of outpatient chest X-rays performed at a large academic center over 2008 to identify cases that included a recommendation for a chest CT. They found that older patients and patients with a history of smoking were more likely to have a chest CT recommended.

In a transitioning health care system, radiologists have been under increased scrutiny to use diagnostics responsibly. This study may indicate that RAIs after chest X-rays are making valuable contributions to patient care.

The researchers hope this study will help improve awareness of the importance of follow-up CT scans. They do not know what accounts for the low adherence to RAIs after X-ray, but are looking into the ways recommendation language affects recommendation adherence.

“Most of the prior studies of recommendation patterns have looked at broad swaths of imaging; all CTs, all X-rays, or all ultrasound, we looked at a very specific clinical situation,” said Alkasab.

He hopes the conversation about imaging will begin to shift from a less-is-better conversation to a when-is-it-recommended conversation.

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