Published by the Students of Johns Hopkins since 1896
August 5, 2020

ER doctors question increased CT scan use

By Ann Wang | October 14, 2010

Emergency departments nationwide may be overusing CT and MRI scans, a new study by Hopkins doctors has found.

As a result, younger patients are being exposed to more radiation,  average emergency room visits are both longer and costlier and emergency rooms are more congested as patients have to wait for the time-consuming procedures.

From 1998-2007, the number of CT or MRI scans done on emergency room patients tripled. However, the proportion of those scans that resulted in a diagnosis of and hospitalization for a life-threatening condition remained steady, at roughly one positive diagnosis per fifty scans.

The researchers looked at data collected from 127 emergency departments nationwide, and considered detection of skull fractures, cervical spine fractures, intracranial hemorrhages and liver or spleen lacerations to be life-threatening diagnoses.

“There’s two things that we’re concerned about,” Thomas Kirsch, of the Bloomberg School of Public Health and one of the study’s authors, said in a phone interview with The News-Letter. “One is the safety issue. CT scans have quite a bit of radiation that can be associated with cancers in the future. The other thing is health care cost.”

Estimates suggest that the ionizing radiation from CT scans may contribute to up to 2 percent of the cancer diagnoses in the US. CT, or computed tomography, scans essentially compile many two-dimensional X-ray images into a three-dimensional image of the patient. MRI, or magnetic resonance imaging, scans use a magnetic field, and do not involve ionizing radiation.

The researchers found that undergoing a CT or MRI scan added an average of about 2 hours to a patient’s stay.

Kirsch speculated that the reasons for the increase in CT and MRI scan use could include increased availability of the technology, the effectiveness of the scans for detecting certain types of internal injuries, fear of lawsuits, emergency department staff who are trained to prescribe scans and the belief by patients and clinicians that the scans are a standard of care.

The authors of the study caution that a more detailed analyses of specific patients and cases should be undertaken before they can conclude whether the increase in use is truly excessive.

“This study is the first of a series of studies aimed at improving the utilization of imaging resources during emergency department visits,” Frederick Korley, of Hopkins’ Department of Emergency Medicine and one of the study’s authors, wrote in an email to The News-Letter. “Traditionally, physicians practice in a cost-blind manner . . . In future studies we  will investigate the reasons for the recent increase in the utilization of imaging resources, and examine how to best incorporate cost considerations to the medical decision-making process, without sacrificing excellent patient care.”

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