The value of thoracic computed tomography scans in clinical diagnosis: a prospective study.
BACKGROUND
Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.


OBJECTIVE
To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.


METHODS
A before and after survey of physicians who had ordered thoracic CT scans.


METHODS
Vancouver General Hospital--a tertiary care teaching centre in Vancouver, British Columbia.


METHODS
Physicians who had ordered CT scans.


METHODS
Physicians completed a standard questionnaire before and after the CT scan result was available.


METHODS
Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.


RESULTS
Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (--7.89 days for each unit increase in priority).


CONCLUSIONS
The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.
Turner
Mark O
MO
Respiratory Division, University of British Columbia and Vancouver General Hospital, Vancouver Coastal research Institute, Vancouver, British Columbia.
Mayo
John R
JR
Müller
Nestor L
NL
Schulzer
Michael
M
FitzGerald
J Mark
JM
D001955:British Columbia; D006769:Hospitals, General; D006784:Hospitals, Teaching; D006801:Humans; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012140:Respiratory Tract Diseases / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014850:Waiting Lists