Hospitals often find it helps to use a CT scan in diagnosing chest problems. But double scanning has come into question as too expensive and possibly dangerous. Fortunately, it is on the decrease.
Scanning twice is now generally regarded as rarely necessary. It costs Medicare millions of extra dollars. More serious, it burdens the patient with additional lifetime radiation exposure. A single CT chest scan equals at least 70 times the radiation as a chest X-ray.
Several smaller Maine hospitals did substantial double scanning in 2008, according to a Medicare survey. It showed zero double scanning at most larger hospitals including Eastern Maine Medical Center and St. Joseph Hospital in Bangor and the Maine Medical Center in Portland.
More than 76,000 patients received double scans in 2008, according to a Kaiser Health News report on the survey. Of more than 200 hospitals listed as doing double scans on more than 30 percent of their Medicare outpatients, two were in Maine. Calais Regional Hospital did 152 chest scans, and 46 percent were done twice the same day. That figure has been reduced to 26 percent for the first five months of this year and is continuing downward, said DeeDee Travis, director of community relations.
Cary Medical Center in Caribou did 443 chest scans, and 40 percent were done a second time. Shawn Laferriere, chief of radiology, said that radiologists earlier often did scans both with and without contrast material. Now a single scan is usually sufficient. He said that Cary Medical Center now double scans less than 1 percent. It also tracks each patient’s radiation exposure.
At Aroostook Medical Center in Presque Isle, double scanning has dropped from 37 percent to 26 percent and should continue downward, said Chris Miller, supervisor for imaging services.
At Down East Community Hospital in Machais, Doug Jones, chief executive officer, said it was clear that its 2008 double scanning rate, 18 percent, was too high. It now is 2.7 percent.
Mount Desert Island Hospital had a reported 2008 double-scan rating of 15 percent. Bill Swain, public affairs officer, said the hospital did not consider that number too high: “We are very careful about doing additional imaging unless it is medically necessary.”
In Maine, as in the nation, double scanning of chest CTs is becoming outmoded and unnecessary. One hospital official said that older doctors tended to prescribe it to make sure of getting all necessary information. But present guidelines of the American College of Radiology say that there are few reasons to do a double scan.
The shift in theory and practice of chest CT scans is one example of the current effort to slow the increase in national health care costs by discouraging costly and unnecessary procedures and devices.
Changing the medical culture is a far better way to cut costs than slashing spending for agencies or recipients of benefits.