Data Dives

Double Chest CT Scans Persist, New Data Show

By Jordan Rau

August 8th, 2011, 1:03 PM

Hospital use of double chest scans in 2009 barely changed from the previous year, despite clinical guidelines that say these CT tests should be used sparingly, according to newly released Medicare data.

In a double CT scan, patients get two imaging tests consecutively: one without dye and the other with dye injected into their veins. Medicare has identified the use of both tests on the same patient as a measure of overuse of medical imaging equipment, which is one of many reasons health care costs are growing so quickly.

The 2009 data, released on Medicare’s Hospital Compare website, show Medicare chest scan patients getting two CTs at the same time dropped only slightly to 5.2 percent of patients, from 5.4 percent of patients in 2008.

A total of 625 hospitals performed the tests on at least one out of every 10 patients using a hospital outpatient facility. That represented a fifth of the 3,121 hospitals whose rates Medicare reported publicly, and was virtually unchanged from 2008, when 618 hospitals performed the tests on at least a tenth of their patients.

More than 71,000 patients received double chest CTs. In 2009, 88 hospitals gave double scans to at least one out of every two patients. Blue Ridge Regional Hospital in Spruce Pine, N.C., had the highest rate of double scans: 90.5 percent of patients received one in 2009. That rate was a tiny bit higher than the previous year. The hospital told KHN earlier this year that it uses double scans out of extra caution, because so many of its patients work in the coal industry.

Other hospitals with the highest rates of CT scans in 2009 were: East Texas Medical Center in Fairfield, Tex. (86 percent); Avoyelles Hospital in Marksville, La. (83 percent); Memorial Medical Center of West Michigan in Ludington, Mich. (83 percent); Shanon Medical Center in San Angelo, Tex. (82 percent) and Marion General Hospital Marion, Ind. (81 percent).

3 Responses to “Double Chest CT Scans Persist, New Data Show”

  1. margaret diamond says:

    And this is one of the reasons we spend twice as much as other countries on Health Care. How do we change this abuse?

  2. Robert Hughes MD says:

    OK. So, what are the clinical indications and guidelines by the ACR ?
    Before a criticism, it is fair to know the indications.
    I suspect that there are times that this “double study” has real clinical value.
    Otherwise you are just promoting rationing.

  3. The use of “double-scans” discussed in this article is declining. The Medicare data used in the hospital compare program is 3 years old and only now released to hospitals. However, before these reports from the Medicare Outpatient Efficiencies Measures program for 2008, many providers had already changed practice patterns. Use of these rare double scans dropped 22 percent from 2006–2010.

    Today, these scans, warranted only for a small number of patients, account for only 4.9 percent of Medicare Chest CT scans. American College of Radiology (ACR) guidelines, ACR Appropriateness Criteria, and radiation reduction education for doctors who order scans likely contributed to this decline. Since 2008, overall imaging growth in Medicare is less than 2 percent annually – in line with or below other physician services.

    Unnecessary scans should be eliminated. ACR works closely with Medicare to develop measures, such as those for chest CT, to alert and educate providers who order scans to risks of unnecessary radiation exposure.

    Congress can help by mandating accreditation that includes radiation safety and image quality requirements for all imaging providers. And by encouraging use of computerized ordering systems to educate doctors on the best exam for a given condition before the scan is ordered.

    Shawn Farley
    Director of Public Affairs
    American college of Radiology