JACR: H1N1 outbreak yields low imaging utilization rates

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Unenhanced chest CT lung window image reveals that lingula, right middle lobe, and both lower lobes show patchy, peripheral, rounded, peribronchial ground-glass opacities with air bronchograms. Image source: American Journal of Roentgenology

In an evaluation of the utilization of radiology resources among individuals diagnosed with H1N1, 70 percent of patients were found to have received no imaging studies and patients sufficiently ill to require imaging underwent an average of 1.4 chest radiographic studies, said a recent study that appeared in the January issue of the Journal of the American College of Radiology.

The study recruited 222 patients diagnosed with or presumed to have the H1N1 infection from May 1 to July 18, 2009. The patients were  from the University of Michigan Health System in Ann Arbor, Mich., and included participants from outpatient clinics, the emergency room or transfer from outside hospitals.

James Schafer, MD, from the department of radiology at the University of Michigan Hospital, and colleagues separated the study participants who received imaging into two groups: based on whether or not they required advanced mechanical ventilation and were admitted to the intensive care unit (group one, 14 individuals). The remaining 52 patients (group two) were primarily treated as outpatients or briefly as inpatients without mechanical ventilation.

The authors said that the result of the study “reveals both reassuring and troubling information. Of the 222 patients with documented H1N1 infection seen within our health system, only 30 percent received any kind of related diagnostic radiology exam, with all 66 receiving at least one chest radiograph. Resource use was highest in the ICU population, with a mean of 33.5 chest radiographs, 5.1 abdominal radiographs, 1.1 thoracic CT exams and 4.2 nonthoracic CT exams [per patient]."

During the length of the study, the authors found that 71 percent of all radiographic exams were obtained during one month in the ICU population, while the non-ICU populations’ imaging studies were spread out relatively evenly over the course of the study period.

“Radiology utilization was not uniform but dramatically asymmetric, with more than half of all ICU studies performed in the short time frame of three to four weeks," said the authors. “These peaks in demand during a large-scale pandemic are also likely to correspond to periods of maximal absenteeism among radiology technologists and radiologists, which may result in added stress to radiology providers.”

Healthcare organizations may not be able to account for sudden peaks in imaging needs, as in the case of a flu pandemic, the authors wrote. Schafer and colleagues offered suggestions for radiology departments in terms of how to appropriately utilize imaging resources available, noting teleradiology as a way of facilitating a “clean” working environment for radiologists in order to reduce the risk of transmission of the infection and also allowing recently infected radiologists to work from home.

The authors concluded by suggesting that the information from their study should be utilized by healthcare organizations in the planning of their radiology resource needs during a possible H1N1 flu pandemic in 2010.