More CT = Lower Costs and Fewer Tests at Mass General

Researchers found that while 20% of facial trauma patients in 1992 received a CT exam, the percentage had risen to 70% by 2002, while the percentage receiving just X-rays dropped from 80% to 30%. In addition, the total number of imaging examinations (X-ray plus CT) provided to patients had dropped over the period, the number of examinations per patient had dropped, and the total amount spent on imaging for such patients had dropped as well.

The primary explanation for the findings, according to researchers, is that CT costs less, does more, and increasingly substitutes for X-ray examinations:

• Said the report: "With respect to the use of hospital resources and costs, our results show a significant overall cost savings because CT has become less expensive than radiography, and the use of CT has increased relative to radiography. In 2002 alone, $29,601 was saved using CT as the predominant imaging method when compared with what 2002 costs would have been if radiography had been the predominate imaging technique."

The authors said they conducted the study, in part, because insurance companies thought that increased use of CT for facial trauma might mean imaging was being overused. The authors' conclusion: No overuse. The increased use that occurred translated into lower cost, better accuracy, and greater productivity.

Specific Findings from the Study:
• The time required for CT exams dropped from 40 minutes in 1992 to 35 seconds in 2002-a significant factor in emergency room care.

• Despite the increased use of CT, the number of imaging exams per patient dropped from 1.23 in 1992 to 1.03 in 2002.

• The total imaging costs that would have been incurred in 2002 if the practice pattern of 1992 had continued was $143,030, for an average of $161 per patient. In contrast, the actual costs in 2002—reflecting increased used of CT scans and reduced use of X-ray-totaled $103,467, an average of $125 per patient for all imaging examinations.

• Greater CT speed translated into increased comfort and safety for patients, quicker treatment by physicians, and savings in room use and provider time.

• Improvements in CT from 1992-2002 reduced radiation exposure and cost by eliminating the need for a second test that was often required in 1992 to provide adeuqate detail.

Change in Costs Resulting from Greater Use of CT, 1992-2002, at Mass General
	1992	2002	% change
Total imaging costs	$143,030	$103,467	- 28%
Number of imaging exams/patient	1.23	1.03	- 16%
Cost of imaging/patient	$160.71	$124.96	- 22%
Total number of patients	890	828	- 7%
Time required for CT	40 minutes	35 seconds	- 98%
Source: Trends in the Use of CT and Radiography in the Evaluation of Facial Trauma, 1992-2002: Implications for Current Costs," Turner BG, Rhea JT, Thrall JH, Small AB, Novelline RA; American Journal of Roentgenology, 2004; 183: 751-754.