Boom in facial trauma CT triggers plunge in hospital costs

As CT took over radiography's role in facial trauma, radiologists expected hospital costs to jump. At least one center, however, reports that the opposite has happened.

Dr. Brian G. Turner and colleagues at Massachusetts General Hospital observed that the number of facial trauma evaluations performed with CT during the past decade had steadily increased, while the number of x-ray examinations for the same condition had dropped.

The investigators retrospectively compared CT and x-ray imaging records for all patients presenting with suspected facial trauma in 1992 and in 2002. They found that CT not only replaced x-ray but also helped reduce both the volume and overall costs associated with facial imaging studies. Their study appeared in the September issue of the American Journal of Roentgenology.

A total of 890 patients underwent 1093 facial imaging exams during 1992, while 828 patients underwent 854 facial exams in 2002. The overall number of facial imaging examinations per patient declined, on average, from 1.23 in 1992 to 1.03 in 2002.

Of the 890 patients examined in 1992, 671 underwent radiography, 153 had CT, and 66 received both. In 2002, those numbers practically reversed: 584 underwent CT, 228 had x-ray, and 16 had both.

CT's availability, speed, and relatively easy operation worried insurance companies concerned about potential cost surges brought about by CT overuse. The radiography-CT trade-off, however, saved the hospital $29,601.

X-ray with positive or suspicious results used to be followed by CT for problem-solving, cranking up costs. Now one MSCT exam is sufficient.

Changes in technology may have influenced results. The 1992 CT protocol included two unenhanced acquisitions with a single-slice scanner with 3-mm slices at 3-mm intervals, hard-copy interpretation, and no PACS. The 2002 CT protocol included multislice scanning with 4 x 1.25-mm slices at 1.25-mm intervals, 3D reconstruction, and soft-copy review on a PACS workstation for both CT and x-ray imaging.

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