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- “ After a period of substantial increase from 1993 to 2007, volume-adjusted ED imaging RVUs declined from 2007 through 2013, largely because of the decreased use of CT and MRI.”
Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades
Raja AS et al.
AJR 2014;203:355-360 - “ After a period of substantial increase from 1993 to 2007, volume-adjusted ED imaging RVUs declined from 2007 through 2013, largely because of the decreased use of CT and MRI. Additional studies are needed to determine the causes of this decline, which may include quality improvement activities, advocacy for appropriateness by leadership, concerns regarding radiation exposure and cost, and health information technology intervention.”
Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades
Raja AS et al.
AJR 2014;203:355-360 - “ The change was most notable for the use of CT and MRI; a 493% increase in CT RVUs between 1993 and 2007 and a 2475% increase in MRI RVUs between 1993 and 2008 was followed by a 33.4% decline in CT between 2007 and 2012 and a 20.6% decline in MRI RVUs between 2008 and 2012.”
Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades
Raja AS et al.
AJR 2014;203:355-360 - Decrease in CT Utilization: What is the Reason?
- radiation dose scare
- bundling of codes (abdomen and pelvis)
- new ER imaging guidelines
- decision support software
- reading outside discs in the ER (vs repeat studies)
- pressure by insurance companies to limit reimbursement for ER studies
- “ Although both the total number and the proportion of emergency department visits managed independently by nonphysician providers and associated with CT have grown rapidly in the past decade, nonphysician health care providers are less likely to order CT compared with physicians.”
Ordering of CT by Emergency Department Provider Type: Analysis of a Nationally Representative Sample
Lee CI et al.
AJR 2012; 199:1054-1059 - “ Although both the total number and the proportion of emergency department visits managed independently by nonphysician providers and associated with CT have grown rapidly in the past decade, nonphysician health care providers are less likely to order CT compared with physicians.The types of ordering providers and their different practices should become part of the discourse regarding appropriate CT utilization.”
Ordering of CT by Emergency Department Provider Type: Analysis of a Nationally Representative Sample
Lee CI et al.
AJR 2012; 199:1054-1059 - “ Controlling for hospital level and patient level variables, patient visits managed solely by nonphysician providers had 0.38 times the odds of CT utilization compared with patient visits managed by physicians.”
Ordering of CT by Emergency Department Provider Type: Analysis of a Nationally Representative Sample
Lee CI et al.
AJR 2012; 199:1054-1059 - Why do nonphysicians order less CT’s-
- Some thoughts
- Follow guidelines strickly
- Not afraid of malpractice
- Less knowledge about when to use CT
- Less understanding of the patients symptoma and their significance
- “ Radiologists’ recommendations account for only a small proportion of outpatient high-cost imaging examinations. Pulmonary nodule follow-up is the most common cause for radiologist generated examinations.”
When Does a Radiologists Recommendation for Follow-up Result in High Cost Imaging?
Lee SI et al
Radiology 2012; 262;544-549 - “ Radiologists’ recommendations account for only a small proportion (1558 of 29,232, 5.3%) of outpatient CT, MR imaging, and PET performed.”
When Does a Radiologists Recommendation for Follow-up Result in High Cost Imaging?
Lee SI et al
Radiology 2012; 262;544-549 - “ Altering radiologists’ recommendation behavior is unlikely to result in a substantial decrease in high-cost imaging utilization.”
When Does a Radiologists Recommendation for Follow-up Result in High Cost Imaging?
Lee SI et al
Radiology 2012; 262;544-549
- “ Among ED transfer patients, CD import of outside imaging from the sending institution into the receiving institutions PACS significantly decreased the rates of subsequent imaging utilization.”
Outside Imaging in Emergency Department Transfer Patients: CD Import Reduces Rates of Subsequent Imaging Utilization
Sodickson A etal.
Radiology 2011; 260:408-413 "We do not recommend using our growth models to forecast future use of CT, as this would require the unlikely assumption that the factors promoting and limiting growth will remain unchanged. Recent developments, such as increased awareness of cost and radiation concerns, national health care reform legislation, and the economic recession, are likely to affect the diffussion behavior of the technology."
National Trends in CT Use in the Emergency Department: 1995-2007
Larson DB et al
Radiology 2011; 258:164-173"In these ways CT is highly suited for the ED: It provides rapid, minimally invasive, high resolution imaging that can quickly direct patients toward further treatment when the results are positive and provide reassurance for practioners (from clinical and legal perspective) when the results are negative."
National Trends in CT Use in the Emergency Department: 1995-2007
Larson DB et al
Radiology 2011; 258:164-173"Between 1995 and 2007 the use of CT in the emergency department in the United States increased exponentially, with rates increasing from 2.8% to 13.9% of all patient visits; use had not begun to taper by 2007."
National Trends in CT Use in the Emergency Department: 1995-2007
Larson DB et al
Radiology 2011; 258:164-173"Use of CT has increased at a higher rate in the ED than in other settings. The overall use of CT had not begun to taper by 2007."
National Trends in CT Use in the Emergency Department: 1995-2007
Larson DB et al
Radiology 2011; 258:164-173