du Boulay G H, Hawkes S, Lee C C, Teather B A, Teather D
Institute of Neurology, London, England.
Neuroradiology. 1990;32(2):124-36. doi: 10.1007/BF00588562.
All spinal magnetic resonance imaging examinations carried out during a three month period were analysed retrospectively in order to determine the clinical reasons for the scan requests. Technical details of the examinations they received and the clinical profiles formed a data set which revealed 10 separate "Clinical groups" for management purposes. Hardware, salary and expendables were costed as though the imaging unit had been sited within a National Health Service radiology department. A spread sheet was designed capable of calculating costs per patient for a variety of types of working week and of different staffing structures, sensitive to the mixture of clinical groups referred for examination. The spreadsheet also accomodated straight line depreciation for hardware value and interest rates for borrowed capital. A second, prospectively observed, sample of spinal MR examinations was used to improve the accuracy of the timing of the length of patient examinations. Costs were compared with those for patients submitted for myelography and radiculography at the adjacent hospital during the same period. The comparison indicated that spinal MR was less costly than myelography and radiculography. The most important element of the extra cost of myelography related to the need to admit patients to hospital for at least one night for this examination because of the likelihood of headache and other common (though usually minor) complications following lumbar puncture and/or the injection of contrast medium. From the limited information that it was possible to obtain in the period of follow up, it appeared that MR had either been superior or equivalent to myelography or radiculography in all the clinical groups of patients where both could be tested. There were a number of groups in which no myelograms had been requested, presumably because clinical suspicions had pointed toward conditions like tumours, developmental abnormalities and demyelinating diseases in which neurologists and neurosurgeons have already made up their minds about the superiority of MR.
为了确定扫描申请的临床原因，对三个月内进行的所有脊柱磁共振成像检查进行了回顾性分析。他们接受的检查的技术细节和临床资料形成了一个数据集，出于管理目的，该数据集揭示了10个不同的“临床组”。硬件、工资和消耗品的成本计算方式，就好像成像单元位于国民健康服务体系的放射科一样。设计了一个电子表格，能够计算不同类型工作周和不同人员配置结构下每位患者的成本，并对转诊检查的临床组混合情况敏感。该电子表格还考虑了硬件价值的直线折旧和借贷资金的利率。使用第二个前瞻性观察的脊柱磁共振检查样本，以提高患者检查时长计时的准确性。将成本与同期在相邻医院接受脊髓造影和神经根造影的患者的成本进行了比较。比较结果表明，脊柱磁共振成像的成本低于脊髓造影和神经根造影。脊髓造影额外成本的最重要因素与患者因腰椎穿刺和/或注射造影剂后可能出现头痛及其他常见（尽管通常较轻）并发症而需要住院至少一晚进行该项检查有关。从随访期间能够获得的有限信息来看，在所有可以同时进行这两种检查的患者临床组中，磁共振成像似乎要么优于脊髓造影或神经根造影，要么与之相当。有一些组没有申请脊髓造影，推测是因为临床怀疑指向肿瘤、发育异常和脱髓鞘疾病等情况，在这些情况下，神经科医生和神经外科医生已经认定磁共振成像具有优越性。
