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.2020 Apr;30(4):1839-1846.
doi: 10.1007/s00330-019-06551-8. Epub 2019 Dec 2.

Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness

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Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness

Madan M Rehani et al. Eur Radiol.2020 Apr.

Abstract

Objective: To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness.

Methods: From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1-3 (red) as "not usually appropriate," 4-6 (yellow) "may or may not be appropriate," and 7-9 (green) "usually appropriate." Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC).

Results: 9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease.

Conclusions: We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria.

Key points: We are faced with a situation wherein patients in age group 0-40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years. More than half of CT exams were unrelated to follow-up of a primary chronic disease. Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.

Keywords: Patient safety; Radiation protection; Radiologic technology; Radiology; Referral and consultation.

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References

    1. Sistrom CL (2009) The appropriateness of imaging: a comprehensive conceptual framework. Radiology 251(3):637–649 - DOI
    1. American College of Radiology (ACR) (2018) ACR Appropriateness Criteria [Internet] [updated 2019; cited 2019 July 29].https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria . Accessed 7 Nov 2019
    1. The Royal College of Radiologist. iRefer: radiological investigation guidelines tool, RCR, Londonhttps://www.rcr.ac.uk/clinical-radiology/being-consultant/rcr-referral-g... . Accessed 7 Nov 2019
    1. European Society of Radiology. Referral guidelines for imaging.https://www.myesr.org/referral-guidelines-imaging . Accessed 7 Nov 2019
    1. Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS) (2016) Appropriate Use Criteria Program.https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst... . Accessed 7 Nov 2019

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