Utility of diagnostic spinal CT needs examination

Though overall rates of CT use have slowed, spinal CT use continues to rise, suggesting the need for an examination of its utility, according to a study published in the February issue of the Journal of the American College of Radiology.

Research that analyzes heterogeneous payer aggregates and trends in CT scanning of patients according to age or body region is sparse. Ghassan B. Hamra, PhD, of the International Agency for Research on Cancer in Lyon, France, and colleagues assessed trends in CT use from 2000 to 2011 in data from a health care database that holds information from private employer-provided insurance and Medicare Supplemental insurance. The researchers analyzed trends in CT scans performed based on patient age and the following anatomical regions: head/neck, abdomen/pelvis, chest and spine.

From 2000 to 2011, 35.6 million scans were performed. Of these scans, 34.5 million included the study’s four main body regions of interest. Head/neck made up 32.6 percent of this number, abdomen/pelvis were 38.6 percent of the scans, chest was 21.1 percent and spine was 4.8 percent.

Data demonstrated an increase in the rate of CT use over eleven years. Elderly subjects underwent the largest increase in scans used, with a 72 percent increase for men and 87 percent increase for women. Men and women saw the largest increase in scans between the ages of 18 to 24, with increases of 135 percent and 129 percent, respectively.

Head and neck diagnostic CT scans modestly increased from 2000 to 2011, with the largest change seen in men ages 18 to 24 who experienced an 88 percent increase in use. The rate decreased from 2009 to 2011 for all age groups. Use of abdomen/pelvis scans, on the other hand, varied over the time span. Rates almost tripled for men and women ages 18 to 24, and while men overall showed a 14 percent decrease in use, women underwent a 41 percent overall decrease.

Diagnostic chest CT use increased at varying rates, and particularly increased in women across most age groups. Both males and females showed similar rates of decline from 2009 to 2011. Lastly, spine CT scans were used at a lower rate than the other body regions. Spine CT saw the greatest increase since 2000, with use among men and women ages 18 to 24 increasing 321 percent and 339 percent, respectively.

“Although there may be clinical benefit to obtaining a negative CT scan, efforts are needed to reduce excessive CT use. Our results suggest that, beginning in 2009, there may be a community-wide recognition that CT use must be more carefully considered,” wrote the authors.

According to Hamra and colleagues, the study’s results, which paralleled findings from other studies, intimate that it may be important to understand differences in rates of change by exhibited categorization in order to determine the utility of diagnostic CT scans.