Use of chest CT in EDs skyrocketed in 2000s

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According to a recent study published in JAMA Internal Medicine, the use of chest CT in hospital emergency departments (ED) to evaluate respiratory symptoms significantly jumped from 2001 to 2010.

Frank S. Drescher, MD, and Brenda E. Sirovich, MD, from the Geisel School of Medicine at Dartmouth in Hanover, N.H., analyzed data from the National Hospital Ambulatory Medical Care Survey. Overall, they found that CT imaging more than quadrupled in a ten-year span, going from more than 2 percent of all ED visits in 2001-2002 to more than 9 percent in 2009-2010.

“Our findings further highlight the urgent need for developing and implementing strategies to promote more judicious use of CT,” Drescher and Sirovich wrote. “Efforts by policy makers and medical-center leaders to realign incentives that promote the escalating use of CT remain a societal imperative.”

The authors note that their study found “overwhelming consistency” of the increased use of CT.

For patients with acute lower respiratory symptoms, for example, chest CT increased from more than 3 percent of ED visits to more than 12 percent. Meanwhile, for patients with nonacute upper respiratory symptoms, that number increased from 0.5 percent to more than 3 percent.

“Costs and the risks of exposure to ionizing radiation aside, excessive use of CT is associated with a proliferation of incidental findings and overdiagnosis, each of which trigger downstream cascades of even more imaging, radiation, and intervention,” Drescher and Sirovich wrote. “Although many factors have been implicated as drivers of the growth in use of CT, including fee-for-service incentive structures that can conflict with evidence-based decision making, solutions to such problems have been elusive.”

The authors did add that both the American Board of Internal Medicine Foundation’s Choosing Wisely campaign and the American College of Radiology have been more vocal about the harms associated with excessive imaging.

Rebecca Smith-Bindman, MD, and Andrew B. Bindman, MD, from the University of California, San Francisco, wrote an editorial that accompanied the study in JAMA Internal Medicine. They addressed a number of reasons why they believe the use of imaging continues to grow and called for a “system of accountability” in regards to physicians requesting unnecessary CT scans.

“When it comes to medical imaging tests, it is time for physicians who order the tests to join together with radiologists and other physicians who perform imaging studies to form a consensus guided by patients' values about the pressing need to perform imaging tests more wisely," Smith-Bindman and Bindman wrote.