Levin David C, Parker Laurence, Halpern Ethan J, Rao Vijay M
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.
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.
J Am Coll Radiol. 2014 Aug;11(8):788-90. doi: 10.1016/j.jacr.2013.12.010. Epub 2014 Apr 24.
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.
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.
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.
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.
2011年6月的一篇新闻报道称，医疗保险理赔数据显示，多家医院存在对胸部进行“双重”CT扫描（即先进行无对比剂扫描，随后进行有对比剂扫描）的过度使用情况。大多数放射科医生都认为，这种扫描仅应在极少数情况下进行。本研究的目的是确定在医疗保险人群中，所有胸部CT扫描中联合扫描所占的比例。
数据来源为2001年至2011年医疗保险B部分医生/供应商程序汇总主文件。选取了胸部CT的3个现行程序术语编码（有对比剂、无对比剂、无对比剂加有对比剂）。计算了每1000名受益人的使用率以及联合扫描所占的百分比。
联合扫描的使用率从2001年至2006年有所上升，2007年保持稳定，但此后急剧下降。2007年至2011年的复合年变化率为-10.4%。2001年至2006年，联合胸部CT扫描占所有胸部CT扫描的6.0%至6.1%。然而，从2006年至2011年，这一百分比逐渐下降，在2011年降至4.2%的低点。
尽管有2011年的新闻报道，但在全国范围内，仅极少部分的胸部CT扫描是先进行无对比剂扫描然后再进行有对比剂扫描。此外，这一比例从2006年至2011年下降了近三分之一，表明这种做法正在减少。4.2%这一数字可作为未来评判放射科设施的基准。
