Strategies for taming the CT growth beast

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CHICAGO—Over the last seven years Massachusetts General Hospital (MGH) of Boston has achieved an impressive feat. MGH contained growth in outpatient CT imaging volume. The hospital based its CT-diet regimen on computerized radiology order entry with decision support. Pragya Dang, MD, explained the system and quantified the results during a Tuesday afternoon informatics course at the 94th annual meeting of the Radiological Society of North America (RSNA).
   
MGH introduced web-based computer order entry in 2001 and gradually rolled the system out across the entire outpatient physician population over the next two years. The hospital launched the next step—decision support—in 2004. The web-based program requires ordering physicians to enter indications and demographics for imaging studies. The decision support system assigns each order a high, intermediate or low level of appropriateness.
   
Dang collected data on outpatient imaging studies from October 2000 to December 2007 and recorded a significant decrease in CT volume growth and the growth rate after implementing decision support. The quarterly CT growth rate declined from 3.1 percent to 0.2 percent.
   
Dang attributed the results to two factors: the gatekeeper effect and the educational effect. Decision support serves as a gatekeeper, she said, by requiring physicians to comply with a new set of steps to order exams. In addition, the system serves an educational purpose by increasing awareness of CT volume growth among the referring physician population.
   
“Computerized radiology order entry with decision support is an effective way to reduce the image intensity creep,” summed Dang.