System Inefficiencies Lead to Duplicate CT Studies

Acute trauma patients who receive imaging before being referred to a trauma center are likely to receive duplicate CT studies, leading to added radiation dose for patients and increased costs to the healthcare system, according to new research.

Ricarda Hinzpeter, MD, of the University Hospital Zurich, Switzerland, retrospectively examined all adult trauma patients transferred from other hospitals to a level-1 trauma center at University Hospital Zurich in 2014.

“CT is the modality of choice in the early imaging work-up of severely injured patients,” said Dr. Hinzpeter during an RSNA 2016 presentation. She added that severely-injured patients are often transferred from regional hospitals to level-1 trauma centers and are re-scanned.

Dr. Hinzpeter and her colleagues analyzed repeated CT scans and categorized them according to the reasons for duplication, including inadequate CT image data transfer, poor image quality, repetition of head CT after head injury with completion to whole-body CT (WBCT), and follow-up of injury known from previous CT.

They also calculated the cumulative radiation dose and costs associated with potentially preventable duplicative CT exams, which they defined as scans that were repeated because of inadequate image data transfer or poor image quality.

Reasons for Repeat CT Scans

In this study, 68 out of 298 patients whose conditions were not manageable in the referring hospital were transferred to the trauma center because of either severe head injury (n=45) or major body trauma (n=23). Seventeen other patients were transferred because they were being repatriated from a foreign country (n=14) or because there was no ICU capacity (n=3).

Of these 85 transferred patients, 74 (87.1 percent) had repeated CT scans. The reasons included:

• Inadequate CT image data transfer (n=29; 39.2 percent)
• Repetition of head CT with completion to WBCT (n=24; 32.4 percent)
• Follow-up of known injury (n=21; 28.4 percent).

None of the repeated CT studies were performed because of poor image quality.

Dr. Hinzpeter and colleagues determined that the cumulative dose-length product of all of the repeated CT scans was 1,383 mSv or 18.7 mSv per patient, while patients who underwent potentially preventable repeat CT scans (those due to inadequate CT data transfer) received an overall additional effective radiation dose of 631 mSv, or 21.8 mSv per patient.

The additional costs associated with all of the repeated CT exams was $70,433, while the additional costs of potentially preventable CT exams was $38,961.

On a percentage basis, patients who underwent clinically indicated repeat CTs received lower effective radiation doses than patients who underwent potentially preventable CTs.

“A considerable number of transferred trauma patients undergo potentially preventable repeated CTs, adding radiation dose to the patients, and costs to the healthcare system,” Dr. Hinzpeter said.

“Future efforts should be made for improving and accelerating image data transfer, allowing for timely and complete availability of CT image data, even in thesetting of acute trauma,” she said.

Co-author Hatem Alkadhi, MD, of the University Hospital Zurich, mentioned several effective digital initiatives for sharing adiologic images.

The use of a DICOM-email protocol is a potential solution for fast and secure connections between hospitals causing minimal problems with existing firewall policies, he said. Another solution is streaming, which allows physicians at the trauma center to electronically access the images obtained in the regional hospital’s emergency department, allowing trauma surgeons to review and evaluate CT images well ahead of patient arrival at the trauma center.