June 18, 2014
By: Mark D. Hiatt, MD, MBA, MS
Exams that irradiate patients are common in today’s healthcare system. Although inadvertent, often exams are inappropriately or unnecessarily performed. This study evaluates the efficacy of utilization management (UM) in reducing unnecessary medical radiation.
The national health insurance plan studied covered nearly 5 million subscribers across the United States. The radiology benefits manager, HealthHelp, was one of the five major companies managing the utilization of advanced diagnostic imaging for health plans in the U.S.
Two consecutive years of results were examined.The radiation averted by avoiding inappropriate or unnecessary CT was expressed in terms of PA chest x-ray equivalents (CXREs).A consistent conversion factor was used relating the radiation from CT to CXREs, and the number of CTs avoided each year was derived from two components. The number of CTs requested then withdrawnwas then added to the number of CTs requested then changed to a more appropriate modality such as MRI or US.
In the first year, 8,628 CTs were requested then withdrawn and 2,412 were changed to a different modality. Approximately 3.3 million CXREs were spared.
In the second year, 10,635 CTs were requested then withdrawn and 2,643 were changed to a different modality. Approximately 4 million CXREs were spared(Fig. 1).
Combined, approximately 7.3 million CXREs were spared.
The analysis suggests that UM through RBM may be successful in reducing unnecessary radiation by limiting inappropriate and unnecessary CT. The oversight assured the judicious use of CT and averted unnecessary radiation exposure.
The total averted was equivalent to approximately 7 million chest x-rays over two years for one health insurance plan.