Reducing emergency department (ED) computed tomography (CT) utilization in women treated for gynecologic cancers

Ostby, Stuart A.; J, Evans; Smith, Haller J.; Boitano, Teresa; Toboni, Michael D.; Heimann, Matthew A.; Booth, James; Thomas, Jarred J.; Straughn, J. Michael

doi:10.1016/j.ygyno.2019.11.024

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…Among studies targeting several imaging modalities or diagnoses, 74–79% of the studies showed a reduction in use of low-value imaging. In contrast, studies targeting one specific modality only showed that targeting X-ray [ 37 , 47 , 48 , 63 , 64 , 83 , 86 , 90 , 92 , 98 , 104 , 112 , 119 , 124 , 130 ], CT [ 41 , 46 , 49 , 53 , 54 , 58 , 60 , 62 , 67 , 69 , 70 , 77 , 79 , 82 , 87 , 88 , 94 – 96 , 101 , 102 , 106 , 108 , 121 – 123 , 125 – 127 , 129 ] or MRI [ 45 , 68 , 75 , 105 , 118 ] led to a 87, 86, and 83% reduction in low-value imaging, respectively. Few studies included other imaging modalities.…”

Section: Resultsmentioning

confidence: 99%

“…Single-component interventions such as education, shared-decision-making, and financial measures alone often had no effect on use of low-value imaging [ 55 , 61 , 70 , 82 , 107 ]. Studies with more than 30% reduction in use of low-value imaging were both single-component ( n = 11) and multi-component ( n = 8) interventions [ 37 – 39 , 41 , 42 , 44 , 69 , 73 , 75 , 80 , 81 , 83 , 85 , 86 , 96 , 108 , 116 , 117 , 131 ]. All these studies targeted refereeing physicians while one also targeted imaging staff.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

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“…CT uses the principle that X-rays generate attenuation through objects, and different tissue structures have different attenuation coefficients, which can represent the internal structure of objects to some extent. Through the data of different angles obtained by scanning the projection of objects through the CT system, few algorithms are adopted to obtain the X-ray attenuation coefficients of objects, which are converted into the corresponding gray values at the same time, so that the cross-sectional images corresponding to objects can be displayed [13,14]. Compared with the traditional X-ray examination, CT scanning technology can clearly and intuitively detect the damage status of patients' lumbar and thoracic vertebrae, so as to better grasp the damage status of patients' vertebral body, which is helpful to guide clinical diagnosis and treatment, and to improve the prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Postoperative Analgesia in Patients with Thoracolumbar Compression Fracture without Nerve Injury by CT using Filtered Back Projection Reconstruction Algorithm

Fan¹,

Ji²,

Qian³

et al. 2022

jist

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To study computed tomography (CT) images based on filtered back projection (FBP) reconstruction algorithm, and analyze the clinical efficacy of dexmedetomidine (Dex) combined with dezocine in thoracolumbar vertebral compression fractures patients without nerve injury during surgery, 75 patients with thoracolumbar vertebral compression fractures were divided into the experimental group (dexmedetomidine combined with dezocine intravenous injection) and the control group (dezocine intravenous injection). The anterior/middle vertebral height and kyphotic angle, assessment of thoracolumbar function (Japanese Orthopaedic Association Score) (JOA)/pain level (visual analogue scale) (VAS), onset of sensory block/palinesthesia/post-anesthesia care unit (PACU) stay/duration of anesthesia, dosage of intravenous analgesic drugs/rate of supplementary analgesics, adverse reactions, and other indicators were observed. It found that CT image was clearer and the resolution was higher after algorithm processing; after treatment, the height of anterior/middle vertebral height in the experimental group was greater than that in the control group, P < 0.05; JOA was greater than that in the control group, and VAS score was less than that in the control group, P < 0.05; the time of onset of sensory block/palinesthesia/PACU stay, the dosage of intravenous analgesic drugs/the rate of supplementary analgesic drugs, incidence of adverse reactions were less than those in the control group, and duration of anesthesia was greater than that in the control group, P < 0.05. Therefore, this drug has a significant analgesic effect on patients with thoracolumbar fracture after surgery.

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Gynecology

Wairiri¹,

Božanović²,

Pejović³

et al. 2021

Oncologic Emergency Medicine

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Reducing emergency department (ED) computed tomography (CT) utilization in women treated for gynecologic cancers

Cited by 6 publications

References 16 publications

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Evaluation of Postoperative Analgesia in Patients with Thoracolumbar Compression Fracture without Nerve Injury by CT using Filtered Back Projection Reconstruction Algorithm

Gynecology

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