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Belgian multicentre study on lumbar spine imaging : radiation dose and cost analysis : evaluation of compliance with recommendations for efficient use of medical imaging

Bieke De Roo (UGent) , PIETER HOSTE (UGent) , Nele Stichelbaut, Lieven Annemans (UGent) , Klaus Bacher (UGent) and Koenraad Verstraete (UGent)
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Abstract
Purpose: To assess compliance of lumbar spine imaging referrals with national imaging recommendations and to evaluate the impact of inappropriate imaging on the collective radiation dose and health insurance costs. Method: In 2011 and 2015, 633 lumbar spine imaging referrals were evaluated across 9 Belgian hospitals. For each patient, a new clinical anamnesis and physical examination were performed. Together with the referral, this data were confronted with the national imaging recommendations. Collective radiation dose was estimated for the radiography and CT procedures. Cost analysis was based on national reimbursement fees. Statistical analysis was performed using multilevel linear and logistic regression models. Results: The fraction of unjustified imaging referrals decreased from 50 % in 2011 to 41 % in 2015 (p = 0.255). The odds of a justified examination are 3.1 times higher when the referral is done by a specialist instead of a general practitioner. The highest percentage of unjustified examinations was found for CT (85 % in 2011, 81 % in 2015; p = 0.044). Seventy-five percent of the collective dose of both the 2011 and the 2015 study population was not justified. Adherence to the recommendations could result in an estimated 16 % and 5 % cost reduction for the 2011 and 2015 study samples, respectively. Conclusions: Between 2011 and 2015, no significant improvement was found in requesting justified lumbar spine imaging procedures, although a positive trend was observed for CT. A shift from CT to MRI is necessary to improve the appropriateness of lumbar spine imaging referrals and to reduce the collective radiation dose.
Keywords
Spine, Diagnostic imaging, Referral, Radiation dosimetry, Costs, CLINICAL DECISION-SUPPORT, CT, APPROPRIATENESS, RADIOGRAPHY, GUIDELINES, REFERRALS, REDUCE

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MLA
De Roo, Bieke, et al. “Belgian Multicentre Study on Lumbar Spine Imaging : Radiation Dose and Cost Analysis : Evaluation of Compliance with Recommendations for Efficient Use of Medical Imaging.” EUROPEAN JOURNAL OF RADIOLOGY, vol. 125, 2020, doi:10.1016/j.ejrad.2020.108864.
APA
De Roo, B., HOSTE, P., Stichelbaut, N., Annemans, L., Bacher, K., & Verstraete, K. (2020). Belgian multicentre study on lumbar spine imaging : radiation dose and cost analysis : evaluation of compliance with recommendations for efficient use of medical imaging. EUROPEAN JOURNAL OF RADIOLOGY, 125. https://doi.org/10.1016/j.ejrad.2020.108864
Chicago author-date
De Roo, Bieke, PIETER HOSTE, Nele Stichelbaut, Lieven Annemans, Klaus Bacher, and Koenraad Verstraete. 2020. “Belgian Multicentre Study on Lumbar Spine Imaging : Radiation Dose and Cost Analysis : Evaluation of Compliance with Recommendations for Efficient Use of Medical Imaging.” EUROPEAN JOURNAL OF RADIOLOGY 125. https://doi.org/10.1016/j.ejrad.2020.108864.
Chicago author-date (all authors)
De Roo, Bieke, PIETER HOSTE, Nele Stichelbaut, Lieven Annemans, Klaus Bacher, and Koenraad Verstraete. 2020. “Belgian Multicentre Study on Lumbar Spine Imaging : Radiation Dose and Cost Analysis : Evaluation of Compliance with Recommendations for Efficient Use of Medical Imaging.” EUROPEAN JOURNAL OF RADIOLOGY 125. doi:10.1016/j.ejrad.2020.108864.
Vancouver
1.
De Roo B, HOSTE P, Stichelbaut N, Annemans L, Bacher K, Verstraete K. Belgian multicentre study on lumbar spine imaging : radiation dose and cost analysis : evaluation of compliance with recommendations for efficient use of medical imaging. EUROPEAN JOURNAL OF RADIOLOGY. 2020;125.
IEEE
[1]
B. De Roo, P. HOSTE, N. Stichelbaut, L. Annemans, K. Bacher, and K. Verstraete, “Belgian multicentre study on lumbar spine imaging : radiation dose and cost analysis : evaluation of compliance with recommendations for efficient use of medical imaging,” EUROPEAN JOURNAL OF RADIOLOGY, vol. 125, 2020.
@article{8649596,
  abstract     = {{Purpose: To assess compliance of lumbar spine imaging referrals with national imaging recommendations and to evaluate the impact of inappropriate imaging on the collective radiation dose and health insurance costs.

Method: In 2011 and 2015, 633 lumbar spine imaging referrals were evaluated across 9 Belgian hospitals. For each patient, a new clinical anamnesis and physical examination were performed. Together with the referral, this data were confronted with the national imaging recommendations. Collective radiation dose was estimated for the radiography and CT procedures. Cost analysis was based on national reimbursement fees. Statistical analysis was performed using multilevel linear and logistic regression models.

Results: The fraction of unjustified imaging referrals decreased from 50 % in 2011 to 41 % in 2015 (p = 0.255). The odds of a justified examination are 3.1 times higher when the referral is done by a specialist instead of a general practitioner. The highest percentage of unjustified examinations was found for CT (85 % in 2011, 81 % in 2015; p = 0.044). Seventy-five percent of the collective dose of both the 2011 and the 2015 study population was not justified. Adherence to the recommendations could result in an estimated 16 % and 5 % cost reduction for the 2011 and 2015 study samples, respectively.

Conclusions: Between 2011 and 2015, no significant improvement was found in requesting justified lumbar spine imaging procedures, although a positive trend was observed for CT. A shift from CT to MRI is necessary to improve the appropriateness of lumbar spine imaging referrals and to reduce the collective radiation dose.}},
  articleno    = {{108864}},
  author       = {{De Roo, Bieke and HOSTE, PIETER and Stichelbaut, Nele and Annemans, Lieven and Bacher, Klaus and Verstraete, Koenraad}},
  issn         = {{0720-048X}},
  journal      = {{EUROPEAN JOURNAL OF RADIOLOGY}},
  keywords     = {{Spine,Diagnostic imaging,Referral,Radiation dosimetry,Costs,CLINICAL DECISION-SUPPORT,CT,APPROPRIATENESS,RADIOGRAPHY,GUIDELINES,REFERRALS,REDUCE}},
  language     = {{eng}},
  pages        = {{5}},
  title        = {{Belgian multicentre study on lumbar spine imaging : radiation dose and cost analysis : evaluation of compliance with recommendations for efficient use of medical imaging}},
  url          = {{http://dx.doi.org/10.1016/j.ejrad.2020.108864}},
  volume       = {{125}},
  year         = {{2020}},
}

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