2018 Section 5 - Rhinology and Allergic Disorders

CT practice pattern survey

TABLE 1. Practice patterns of the respondents in obtaining confirmatory imaging for suspected chronic sinusitis in different clinical scenarios*

Frequency

Scenario

Never

< 25%

25% to 50%

51% to 75%

> 75%

CT scan prior to initiating medical therapy CT scan after completion of first round of medical therapy CT scan after completion of second round of medical therapy CT scan to rule out sinusitis in patients with severe headaches

69 (21)

177 (54)

44 (13.4)

22 (6.7)

16 (4.9)

56 (17.1)

124 (37.9)

58 (17.7)

44 (13.5)

45 (13.8)

35 (10.6)

107 (32.4)

69 (20.9)

47 (14.2)

72 (21.8)

5 (1.5)

58 (17.6)

70 (21.3)

76 (23.1)

120 (36.5)

Plain films to diagnose chronic rhinosinusitis

295 (89.7)

23 (7.0)

5 (1.5)

3 (0.9)

3 (0.9)

MRI to diagnose chronic rhinosinusitis

258 (78.4)

70 (21.3)

1 (0.3)

0 (0)

0 (0)

*Values are n (%). CT = computed tomography; MRI = magnetic resonance imaging.

FIGURE 3. Type of sinus CT scan typically obtained by respondents prior to sinus surgery. CT = computed tomography.

80 (24.5%) and 20 (6.1%) of the physicians, respectively. Cone beam CT (CBCT) and conventional CT was owned by 57 (74.0%) and 20 (26.0%) of respondents, respectively. For those owning a CT scanner, 44 (60.3%) billed for in- terpretation and performance of the CT imaging, whereas 4 (5.5%) billed for interpretation but not for performance, and 8 (11.0%) reviewed but did not bill for the interpreta- tion or performance of the CT scan. A radiologist read and billed for the interpretation and performance of the scan for 17 (23.3%) respondents. The respondents reported ex- periencing problems with carriers denying ability to image or reimbursing for the scans as follows: < 25% of the time (277; 87.1%), 25% to 50% of the time (34; 10.7%), 51% to 75% of the time (5; 1.6%), and > 75% of the time (2; 0.6%). The radiation dose typically delivered by the CT scanner is illustrated in Figure 4. Table 2 illustrates the statistical association between key variables, including years in practice ( > 10 years), aca- demic vs private practice, percentage of practice devoted to rhinology ( > 50%), and presence of in-office CT scanner with CT usage patterns in clinical practice. Figure 5 shows

the odds of CT utilization patterns based on geographic location.

Discussion The relative ease of access and rapid expansion of utiliza- tion of CT scanning has led to concerns about overuse with increased costs to the healthcare system and excessive radi- ation exposure with associated risk of radiation-induced malignancies. Diagnostic imaging costs rank among the fastest growing expenditures for Medicare. It is estimated that 62 million CT scans, including 4 million in children, were obtained in 2006, compared to 3 million in 1980. 6 Fazel et al. 7 followed 952,420 nonelderly adults (between 18 and 64 years of age) in 5 healthcare markets across the United States between 2005 and 2007. During the 3-year study period, 68.8% enrollees underwent at least 1 imaging procedure, with mean cumulative effective radiation dose of 2.4 millisieverts (mSv). Given the high prevalence of rhinosinusitis in the gen- eral population, it would seem to be intuitive that CT

International Forum of Allergy & Rhinology, Vol. 5, No. 6, June 2015

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