J Korean Soc Radiol.  2017 Sep;77(3):157-165. 10.3348/jksr.2017.77.3.157.

Clinical Significance of Short-Term Repeat Computed Tomography Examination on the Same Anatomic Region

• Hwang J
• Paik SH
• Park JS
• Lee H

• KMID: 2405730
• DOI: http://doi.org/10.3348/jksr.2017.77.3.157

Abstract

PURPOSE
To evaluate the clinical significance of repeat CT examination (RCE) of the same anatomical area within a month, for the accurate diagnosis and patient management.
MATERIALS AND METHODS
Between October to December of 2013, our retrospective cohort enrolled 182 patients whose outside CT scans were registered in our PACS, and who underwent RCE of the same anatomical region within 1 month of the previous CT. The RCEs were classified into four categories: unrelated, follow-up, duplicative, and supplementary examinations. We then categorized the clinical significance of RCE, based on changes of clinical symptoms, management, and CT findings.
RESULTS
Of the 182 patients enrolled, the classification based on unrelated, follow-up, duplicative, and supplementary examinations were 4 (2.2%), 114 (62.7%), 20 (11%), and 44 (24.1%) cases, respectively. Of these, appropriate examinations were 155 (85.2%) and inappropriate examinations were 27 (14.8%) cases. of the percentage of appropriate-unhelpful and inappropriate-helpful examinations were 4 cases (2.2%) and 5 cases (2.7%), respectively. Consequently, there were 9 cases (4.9%) of cause-clinical significance discordance (CCSD).
CONCLUSION
More than 80% of the RCEs were beneficial to clinical practice. The guideline for RCEs needs to be extensively broadcast, and used to train physicians to help reduce the number of not only CCSD, but also unhelpful RCEs, which were 4.9% and 14.3%, respectively, in our study.

MeSH Terms

Classification
Cohort Studies
Diagnosis
Follow-Up Studies
Humans
Retrospective Studies
Tomography, X-Ray Computed

Figure

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  Fig. 1. Schematic diagrams of the classification system for repeat CT examinations.

Reference

1.Lee SI., Saokar A., Dreyer KJ., Weilburg JB., Thrall JH., Hahn PF. Does radiologist recommendation for follow-up with the same imaging modality contribute substantially to high-cost imaging volume? Radiology. 2007. 242:857–864.

2.Bhargavan M., Sunshine JH. Utilization of radiology servic-es in the United States: levels and trends in modalities, re-gions, and populations. Radiology. 2005. 234:824–832.

3.The Korean Society of Radiology. The survey before applying guideline for repeated CT and MRI examinations. Won-ju: Health Insurance Review & Assessment Service;2014.

4.The Korean Society of Radiology. CT examination and re-peat CT examination guidelines. Wonju: Health Insurance Review & Assessment Service;2013.

5.Kassing P., Duszak R. The Neiman Report. Repeat medical im-aging: a classification system for meaningful policy analy-sis and research. Reston: Harvey L. Neiman Health Policy Institute;2013.

6.The Korean Society of Radiology. The assessment about test application of the guideline for repeated CT and MRI exami-nations. Wonju: Health Insurance Review & Assessment Ser-vice;2015.

7.Chen RC., Lin HC., Chu D., Chen T., Hung ST., Kuo NW. Physi-cians' characteristics associated with repeat use of com-puted tomography and magnetic resonance imaging. J Formos Med Assoc. 2011. 110:587–592.

8.Chen RC., Chu D., Lin HC., Chen T., Hung ST., Kuo NW. Association of hospital characteristics and diagnosis with the re-peat use of CT and MRI: a nationwide population-based study in an Asian country. AJR Am J Roentgenol. 2012. 198:858–865.