ARRS: Spine CT inappropriate for some indications

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Patients who present to the emergency department following simple assault or ground-level fall do not require cervical spine CT, unless the patient has a condition that predisposes the patient to spine fracture, according to a study presented May 3 at the annual meeting of the American Roentgen Ray Society (ARRS) in Vancouver.

Andrew Nicholson, MD, and colleagues from the department of radiology and imaging sciences at Emory University school of medicine in Atlanta, suspected that the incidence of acute pathology detected on cervical spine CT for trauma was low, despite increasing utilization. They hypothesized that some inappropriate indications for cervical spine CTs were being ordered.

Nicholson and colleagues identified simple assault and ground-level fall as two indications with a low probability of resulting in a fracture or dislocation of the cervical spine. They completed a retrospective chart review and categorized results as negative for acute traumatic process, positive or equivocal.   

Among the 218 exams for simple assault, none were positive, said Nicholson. In the series of 154 cervical spine CT scans that were obtained for ground-level fall, there was one positive exam, diagnosed in a patient with ankylosing spondylitis, a condition known to increase the risk of fracture of the spine.

"The criteria that exist for cervical spine imaging can be vague in certain circumstances and lead to many patients receiving this exam who likely don't need it," said Nicholson in a statement. The researchers suggested that patients with one of these indications do not undergo an initial diagnostic workup that includes CT, unless a known predisposition to cervical fracture exists.

"While this study looks at a relatively small subset of the CT exams ordered from the ED, we believe it can have a significant impact on radiation dose reduction at a population level," said Co-author Chad Holder, MD, in the statement. "These patients frequently have CT scans of the head and/or the face at the same time. The radiation dose to the lenses of the eyes, thyroid and lymph nodes from cervical spine CT is not insignificant; reducing unnecessary radiation exposure to these organs is important.”

Nicholson referred to the need for radiologists to lead efforts to contain overutilization of imaging exams.