Appropriateness of selection criteria for CT examinations performed at an emergency department

Investigating the Potential Overuse of Pan-Computed Tomography (PanCT) Examinations in Trauma Cases in Emergency Departments

Background and Objectives: The increasing use of whole-body computed tomography (WBCT) examinations, also known as panCT, in emergency departments for trauma patients has raised concerns about potential overuse and the associated risk of unnecessary radiation exposure. The purpose of this study was to examine the utilization patterns and findings of panCT scans performed over one year at a major academic hospital. Materials and Methods: This retrospective cohort study included 531 stable trauma adult patients who underwent panCT scans in 2023. De-identified data for each patient, including the radiology report, age, gender, and total dose-length product (DLP) of the panCT scan, were retrieved and reviewed. Radiology reports were classified based on the findings as negative (no acute traumatic injuries) or positive, with positive reports further subclassified based on injury location. Injury severity scores (ISS) were also calculated based on the findings of the radiology reports. Statistical analysis was performed using the Python programming language to assess any association between the independent variables (age and gender) and the dependent variable (report findings: negative or positive). Results: About 57% (n = 303) of the panCT scans included in the analysis were negative. The chi-squared test and logistic regression revealed a significant association between age and report finding (negative or positive), while no association with gender was found. One-third of positive cases (n = 72) had injuries only in the head and neck (H&N) region, and another one-third (n = 72) had injuries only in chest-abdomen-pelvis (CAP) region. Most cases (n = 373; 70%) had an ISS between 1 and 8, which is a mild score. Conclusions: This study showed a high rate of negative panCT scans, suggesting potential overuse of panCT. The study results highlight the need for more selective CT imaging approaches in emergency settings. Following evidence-based guidelines and decision-support tools could promote appropriate utilization of panCT scans, reducing unnecessary radiation exposure while ensuring that high-risk patients in emergency setting receive appropriate imaging.

Evaluating the Necessity and Radiation Risk of Brain CT Scans Requested by the Trauma Emergency Department

Background

Numerous Computed Tomography (CT) scan requests for trauma patients have raised serious concern about the impacts of radiation such as radiation-induced cancers.

Objective

This study aimed to evaluate the necessity rate of requested head CT scans for traumatic patients and to ultimately estimate the risk of radiation-induced brain cancer.

Material and Methods

In this retrospective analytical study, traumatic patients, who had undergone a head CT scan in a two-month period from August 23 to October 22, 2018, were considered as the study population. Two radiologists reviewed each patient individually to evaluate the rate of normal and abnormal cases. Dose length product in milligrays (mGy) was utilized to calculate the effective dose (ED) in millisieverts (mSv), resulting in an assessment of the risk of radiation-induced brain cancer using ICRP 103.

Results

Among 523 scans, 460 patients (88%) received normal reviews, while only 47 patients (9%) had findings related to their current trauma. The mean effective dose value was 1.05±0.36 mSv. Risk of the radiation induced brain cancer was calculated to be 0.037 and 0.030 new cancer cases in 10000 males and females per Gy, respectively.

Conclusion

Final results demonstrated that a significant number of traumatic patients undergoing a CT scan are in fact, healthy. Such reckless usage of CT and consequently the excess exposure could result in a dramatic rise in cancer rates. The need to limit unnecessary CT scan usage and keeping the radiation given to patients as low as reasonably achievable (ALARA) when collecting essential diagnostic data is more critical than ever.

Evaluating the Outcome of an Unnecessary Request for CT Scan in Be'sat Hospital of Hamadan

Aim

This study aimed to investigate the frequency of unnecessary tests requested in Be'sat Hospital in Hamadan.

Materials and Methods

This descriptive research was conducted in order to investigate the frequency of unnecessary requests for CT scan and radiography of patients referring to the imaging department of Be'sat Hospital in Hamadan in a 4- to 6-month period. Patient information, including gender, age, type of CT scan test, the reason for requesting the test, the expertise of the requesting physician, and the result of the radiologist's report on each test, was extracted and collected.

Results

A total of 1000 CT scans were evaluated. The mean age of these patients was about 36 years and most of them were men. The highest and lowest percentages of unnecessary cases were related to CT scans of the brain (42.3%) and facial bones (2.3%), respectively. The most and the least unnecessary CT scans based on the reason given for the request were related to multiple physical trauma (30.7%) and chronic kidney disease (1.5%), respectively.

Conclusion

In all tests, over 74% of the reports were unnecessary and less than 26% were necessary. Therefore, it is necessary to reduce unnecessary requests to reduce the radiation dose of patients. Also, the knowledge of doctors should be increased in the field of appropriate evaluation of CT scan tests based on clinical guidelines.