2018 Section 5 - Rhinology and Allergic Disorders

CT practice pattern survey

FIGURE 5. Odds for CT utilization by geographic region. CT = computed tomography.

the survey, it would appear that CT scanning should be reserved primarily for patients with refractory symptoms despite medical therapy. The exception would be patients with a history of gastrointestinal pathology or antibiotic intolerance, in whom CT imaging may rule out sinus dis- ease and minimize associated risks of prolonged antibiotic usage. Another facet explored was the frequency of CT imaging in the management paradigm of FESS. The respondents re- ported obtaining on average 1 (58.8%) or 2 (36.6%) CT scans prior to proceeding with primary FESS. Interestingly, 40% of the participants acquired a new CT scan for im- age guidance prior to proceeding with surgery, with 64.7% utilizing a 1-mm or 2-mm axial CT with reconstruction for this purpose. A recent AAO-HNS and American Med- ical Association–convened Physician Consortium for Per- formance Improvement (PCPI) formed the Sinusitis Work Group to identify and define quality measures to improve outcomes for patients with sinusitis. 9 An important met- ric measured by the PCPI for overuse and codified by this group was the percentage of patients receiving more than 1 CT scan within 90 days after the date of diagnosis. If physi- cians may potentially be limited to 1 CT imaging study in the future, acquisition of a high-resolution thin-cut CT (2- mm or less) for initial diagnosis may represent the most cost-effective strategy. This should serve to provide accu- rate diagnosis, and may also suffice for navigation when surgery is contemplated.

The current survey also evaluated the financial impact of POC imaging on CRS. A majority of the respondents indicated that CT imaging acquisition is performed in hospital radiology departments or free-standing imaging centers. In-office CT scanners, most commonly CBCT, were owned by 24.5% of respondents. For these physi- cians, the majority (60.3%) billed for interpretation and performance of the CT imaging. Further, despite concerns about denials for in-office CT scanning, a majority of participants (87.1%) reported “never” or “ < 25% of the time” experiencing problems with carriers denying ability to image or reimbursing for the scans. POC CT imaging with CBCT or conventional scans has the ability to provide expeditious, high-quality, and convenient imaging for patients. Prospective investigations have demonstrated that pretreatment POC CT imaging may result in substantial reduction in unnecessary antibiotic prescriptions and greater compliance with otolaryngology care. 10 However, with increasing penetration of in-office CT platforms in otolaryngology and allergy offices, this metric will require ongoing close monitoring to ensure that utilization rates do not dramatically increase in the coming years. The radiation dose typically delivered by the CT scanner for sinus imaging was reported as < 0.5 mSv and 0.5 to 1.0 mSv, by 13.9% and 9.8% of respondents, respectively. Overall, 68.4% were unaware of the dosage of radiation delivered by the scanner. Brenner and Hall 6 estimated that, depending on the machine settings, the target organ being

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

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