title: Availability, requesting practices, and barriers to referral for high-resolution CT of the lungs: results of a survey of U.S. pulmonologists.
abstract: OBJECTIVE
  The authors performed this study to assess the availability of high-resolution computed tomography (CT), current referral practices, and potential barriers to the clinical use of high-resolution CT in patients with diffuse lung disease.
  
  
  METHODS
  The authors sent a survey to 450 pulmonologists who were members of the American College of Chest Physicians. They sought information about the availability of high-resolution CT services, explored the physicians' current requesting practices and the monthly number of referrals, and assessed the influence of six factors on the decision to refer.
  
  
  RESULTS
  The authors received completed surveys from 230 pulmonologists (52.6%). High-resolution CT services were available to all respondents and had been used by 226 (98.3%) of them during the preceding 12 months. Two-thirds of respondents referred one to four patients per month, and one-third referred five or more. Monthly referral volume did not significantly vary among different practice types. The pulmonologists expressed a preference for hospital-based imaging facilities and routinely reviewed the images from the examinations they ordered. The most frequent reason for high-resolution CT was classification of a known interstitial process. High-resolution CT was infrequently requested to evaluate symptomatic immunocompromised patients. Confidence in the radiologist's high-resolution CT interpretation was the most important factor influencing the referral decision, and radiation dose to the patient was the least important.
  
  
  CONCLUSIONS
  High-resolution CT services are widely available to and frequently requested by U.S. pulmonologists in a variety of practice settings. High-resolution CT may be underutilized in symptomatic immunocompromised patients. Radiologists should be aware that the perception of their skill in high-resolution CT interpretation is an important determinant in the pulmonologist's decision to refer.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC Rm 3254, Baltimore, MD 21287, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Scatarige
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Edward F
authors.initials: EF
authors.lastname: Haponik
authors.forename: Barry
authors.initials: B
authors.lastname: Merriman
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D015272:Pulmonary Medicine / Q000193:education; D011857:Radiographic Image Interpretation, Computer-Assisted; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed; D014481:United States