title: The impact of a rural scanner in overcoming urban versus rural disparities in the utilisation of computed tomography.
abstract: OBJECTIVE
  In 2008, Oamaru Hospital became the second rural hospital in New Zealand to install a computed tomography (CT) scanner. This article assesses the impact of this on local CT scanning rates.
  
  
  METHODS
  Observational: review of radiology department data.
  
  
  METHODS
  Rural hospital imaging services.
  
  
  METHODS
  CT scanning patients residing in Otago region during the study period.
  
  
  METHODS
  There is no intervention in this observational study.
  
  
  METHODS
  CT scanning rates and waiting times before and after the introduction of the rural scanner.
  
  
  RESULTS
  Prior to the scanner being commissioned, there was a significant urban versus rural disparity in CT utilisation. Residents in the neighbouring urban centre were 1.4 times more likely to access CT (33.2 (95% confidence interval (CI) 32.2-34.2) versus 23.0 (95% CI 21.0-25.1) scans per 1000 residents per annum). Twenty months after the scanner was commissioned, the rate for the rural community had almost doubled to 45.6 (95% CI 43.0-48.2) and was 1.2 times greater than for the urban community. This difference was not sustained, and rural and urban communities had similar CT scanning rates in 2011 and 2012. Mean waiting time for residents in the rural community fell from 21.1 (95% CI 17.1-25.2) days prior to the scanner to 6.7 (95% CI 5.6-7.8) days after the scanner was commissioned.
  
  
  CONCLUSIONS
  On-site CT increased the rural scanning rate, corrected the rural-urban disparity and reduced waiting times without apparent over servicing.
authors.affiliation: Dunedin School of Medicine, University of Otago, Dunedin.
authors.forename: Garry
authors.initials: G
authors.lastname: Nixon
authors.affiliation: Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin.
authors.forename: Ari
authors.initials: A
authors.lastname: Samaranayaka
authors.affiliation: Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin.
authors.forename: Brandon
authors.initials: B
authors.lastname: de Graaf
authors.affiliation: Dunedin School of Medicine, University of Otago, Dunedin.
authors.forename: Roz
authors.initials: R
authors.lastname: McKechnie
authors.affiliation: Department of Emergency Medicine, Oamaru Hospital, Otago, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Rodwell
authors.affiliation: Dunedin School of Medicine, University of Otago, Dunedin.
authors.forename: Katharina
authors.initials: K
authors.lastname: Blattner
mesh_terms: D003952:Diagnostic Imaging / Q000295:instrumentation*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D009520:New Zealand; D019035:Rural Health Services; D014057:Tomography, X-Ray Computed; D019037:Urban Health Services
keywords: access; computed tomography; imaging; inequality; radiology