Are combined CT scans of the thorax being overused?
OBJECTIVE
A news article in June 2011 reported that Medicare claims showed considerable overuse of "double" CT scans of the thorax (ie, combined scans without contrast followed by with contrast) at a number of hospitals. Most radiologists agree that they should be done only on rare occasions. The aim of this study was to determine what proportion of all thoracic CT scans are combined scans in the Medicare population.


METHODS
The data sources were the Medicare Part B Physician/Supplier Procedure Summary Master Files for 2001 to 2011. The 3 Current Procedural Terminology codes for thoracic CT (with contrast, without contrast, and without plus with contrast) were selected. Utilization rates per 1,000 beneficiaries and the percentage that were combined scans were calculated.


RESULTS
The utilization rate of combined scans increased from 2001 through 2006, remained steady in 2007, but then decreased sharply thereafter. The compound annual rate of change from 2007 to 2011 was -10.4%. From 2001 through 2006, combined thoracic CT scans constituted 6.0% to 6.1% of all thoracic CT scans. However, from 2006 to 2011, this percentage progressively declined, reaching a low of 4.2% in 2011.


CONCLUSIONS
Despite the 2011 news report, only a very small percentage of thoracic CT scans nationwide are done both without and with contrast. Moreover, that percentage dropped by almost one-third from 2006 to 2011, suggesting that the practice is declining. The figure of 4.2% can be used as a benchmark against which to judge radiology facilities in the future.
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania; HealthHelp, Inc, Houston, Texas. Electronic address: david.levin@jeffersonhospital.org.
David C
DC
Levin
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.
Laurence
L
Parker
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.
Ethan J
EJ
Halpern
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.
Vijay M
VM
Rao
D003287:Contrast Media; D006801:Humans; D006278:Medicare; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
D003287:Contrast Media
CT with contrast; Medical economics; radiology and radiologists; socioeconomic issues; thoracic CT; utilization of imaging