Diagnostic imaging costs before and after digital tomosynthesis implementation in patient management after detection of suspected thoracic lesions on chest radiography.
Insights Imaging 2014;
5:147-55. [PMID:
24420070 PMCID:
PMC3948899 DOI:
10.1007/s13244-013-0305-1]
[Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/28/2013] [Accepted: 12/09/2013] [Indexed: 12/19/2022] Open
Abstract
Objectives
To evaluate diagnostic imaging costs before and after DTS implementation in patients with suspected thoracic lesions on CXR.
Methods
Four hundred sixty-five patients (263 male, 202 female; age, 72.47 ± 11.33 years) with suspected thoracic lesion(s) after CXR underwent DTS. Each patient underwent CT when a pulmonary non-calcified lesion was identified by DTS while CT was not performed when a benign pulmonary or extrapulmonary lesion or pseudolesion was identified. The average per-patient imaging cost was calculated by normalising the costs before and after DTS implementation.
Results
In 229/465 patients who underwent DTS after suspicious CXR, DTS showed 193 pulmonary lesions and 36 pleural lesions, while in the remaining 236/465 patients, lesions were ruled out as pseudolesions of CXR. Chest CT examination was performed in 127/465 (27 %) patients while in the remaining 338/465 patients (73 %) CXR doubtful findings were resolved by DTS. The average per-patient costs of CXR, DTS and CT were €15.15, 41.55 and 113.66. DTS allowed an annual cost saving of €8,090.2 considering unenhanced CT and €19,298.12 considering contrast-enhanced CT. Considering a DTS reimbursement rate of € 62.7 the break even point corresponds to 479 DTS examinations.
Conclusion
Per-patient diagnostic imaging costs decreased after DTS implementation in patients with suspected thoracic lesions.
Main Messages
• Digital tomosynthesis improves the diagnostic accuracy and confidence in chest radiography
• Digital tomosynthesis reduces the need for CT for a suspected pulmonary lesion
• Digital tomosynthesis requires a dose level equivalent to that of around two chest radiographies
• Digital tomosynthesis produces a significant per-patient saving in diagnostic imaging costs
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