Many presenting complaints in the Emergency Department call for cardiothoracic imaging. Some can be assessed by point-of-care ultrasound, but, for the most part, plain radiography is the established routine. Whether the pretest probability of disease warrants such widespread use is one matter. This article documents yet another – duplication of imaging.
These authors review four years of radiology from their institution and document 3,627 patients for whom both CXR and chest CT were ordered. Their main analysis breaks down the use of radiology mostly looking at the order of which these studies were requested, and whether results from one were available prior to the completion of the other.
For the most part, the CXR was ordered first, and the images were available for review before the subsequent CT chest. However, in 354 (9.8%) cases, the CXR images hadn’t even yet been acquired when the CT chest was ordered. This probably generally overlaps the 134 (3.7%) cases where the CT chest was ordered simultaneously or prior to the CXR. Regardless – if the results were clinically irrelevant, why order the test?
I think it’s fair to say many of the CXRs included in this study were pointlessly redundant – especially when the decision for CT was obviously made prior to their acquisition. No doubt the CXR is included in most ED protocols for certain chief complaints, and is ordered reflexively without thought.
Looking for waste to target in the system? Here you go.
“Inefficient Resource Use for Patients Who Receive Both a Chest Radiograph and Chest CT in a Single Emergency Department Visit”
http://www.ncbi.nlm.nih.gov/pubmed/26387774