"There are hundreds of thousands of cervical spine (C-spine) examinations performed in the U.S. each year; very few of them have abnormal findings," says Dr. Larvie. This has sparked controversy over the cost of using CT rather than plain film radiography to examine possible C-spine injuries. "We evaluated emergency department C-spine imaging from 1992 to 2001 at an academic medical level 1 trauma center to reveal utilization trends and determine the relative diagnostic yield and costs of plain radiography and CT," says Dr. Larvie.
Between 1992 and 2001 the number of plain film exams declined, while the number of CT examinations increased. In 2001 there were 1,131 plain film exams, compared to 1,908 CT scans, says Dr. Larvie. Plain film examinations had a low incidence of true positive findings (.50%) compared to CT (5.85%), he says. Furthermore, there was a higher incidence of false positive findings for plain film than there was for CT, he says. The direct cost of C-spine CT imaging was 16% lower than for plain film imaging. While equipment and maintenance costs are higher for CT than for plain film radiography, "overall direct costs are lower because CT takes significantly less time than a plain film examination," says Dr. Larvie.
The lower cost, and the fact that CT is better able to show C-spine trauma, make CT the preferred exam for C-spine imaging, says Dr. Larvie.
Dr. Larvie's colleagues include James Rhea, MD, Robert Novelline, MD, and Daniel Rosenthal, MD, of Harvard Medical School and Massachusetts General Hospital, Boston.
The study will be presented May 6, during the American Roentgen Ray Society Annual Meeting in San Diego.
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