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CT use for respiratory symptoms quadruples in past decade in US

An analysis of medical care surveys found a significant increase in the use of CT in the assessment of respiratory symptoms in U.S. EDs during the past 10 years, according to data published in JAMA Internal Medicine.

Researchers cautioned that use of the technology may pose more harm than good in patients.

"CT can be an essential tool in guiding the management of acute or life-threatening pulmonary disease," wrote Frank S. Drescher, MD, and Brenda E. Sirovich, MD, MS, both of the Outcomes Group at the White River Junction VA Medical Center in Vermont. "Increasing use of CT, however, has raised concerns about the effects of ionizing radiation on organs within the radiation field, including the thyroid, lungs and breast. Beyond the risk posed by ionizing radiation, high resolution CT may have unintended downstream consequences related to incidental findings and overdiagnosis, leading to a costly and potentially harmful diagnostic, therapeutic or interventional cascade."

The researchers used data from the National Hospital Ambulatory Medical Care Survey from 2001 to 2010, isolating visits by adults aged 18 years and older who presented with a primary respiratory symptom.

Results showed that CT use quadrupled during that period, from 2.2% in 2001-2002 to 9.4% in 2009-2010 (OR = 4.6; 95% CI, 3.4-6.2).

Drescher and Sirovich also reported that CT use increased most in patients who presented with nonacute upper respiratory symptoms or those with the least acute reason for imaging, from 0.5% to 3.6% (OR = 7.4; 95% CI, 1.3-42).

"Although many factors have been implicated as drivers of the growth in use of CT, including fee-for-service incentive structures that can conflict with evidence-based decision making, solutions to such problems have been elusive," Drescher and Sirovich wrote. "Recently, however, the American Board of Internal Medicine Foundation's Choosing Wisely campaign and the American College of Radiology have addressed the harms of excessive medical imaging. Our findings further highlight the urgent need for developing and implementing strategies to promote more judicious use of CT."

The researchers stated that de-escalation of CT use can be achieved, in part, by the efforts of medical leaders and policymakers to realign incentives. – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.