In Review - News from the 2004 Meeting of the RSNA

ACR criteria could cut ER imaging waste by billions

Reliance on standard CT protocols overlooks evidence found on physical examination

By: James Brice

Emergency room physicians could save billions of dollars annually and spare their patients unnecessary radiation exposure by adopting American College of Radiology appropriateness criteria to guide the use of CT and computed radiography for trauma patients.

Dr. Johnathan L. Hadley, a radiology resident at Eastern Virginia Medical School in Norfolk, reported the results of a study showing that CT and CR were routinely prescribed for 200 consecutive trauma patients at his institution's level I trauma center. Imaging use was nearly identical for all the patients, despite major differences in the nature and severity of their injuries.

The 200 patients received 660 CT exams and 429 CR procedures in the first three hours after they arrived at the trauma center, according to Hadley.

The story would have been quite different if ACR appropriateness criteria had been applied, he said.

Compliance could have cut imaging billing charges for CT by $300,000 and bottom-line insurance costs by more than $60,000. Probable CR cost reductions were not calculated. Radiation exposure would have decreased by an average of 7 to 9 mSv.

If ACR criteria were applied to the nine million patients who appear in emergency rooms in the U.S. after accidents every year, a $17 billion cost savings and 2500 fewer radiation-induced cancer deaths would result, Hadley said.