Radiology’s point of view: Work with us on CT scans

When working with your radiology department to reduce the time it takes to get abdominal computed tomography (CT) scans for emergency patients, be sure to look at the issue from their perspective, suggests the nation’s leading radiologist.

Radiologists will be open to the idea of improving patient flow through in the ED but they also will be highly concerned with the quality of the diagnostic study, says James Borgstede, MD, FACR, president of the Board of Chancellors for the American College of Radiology in Reston, VA, and an assistant professor of radiology at the University of Colorado in Denver.

Quality studies also can help improve flow through, he says. If you end up doing one high-quality study instead of two or three CT scans until you get it right, your patient will move out faster.

"Rather than have the patient come in for an ultrasound of the gallbladder, then a CT scan of the abdomen and pelvis, and then coming back for an ultrasound of the pelvis, could we target one examination that might give us all the answers?" Borgstede asks.

"The appropriateness is the key," he notes. (See "Sources" at the end of this article for more information on guidelines for using CT in the ED.)

Contrast studies can be difficult

The use of contrast for CT scans could be a difficult issue when working with radiology to reduce times for CT scans.

While some ED managers may be eager to eliminate contrast to move the patient faster, Borgstede notes that being too aggressive with that strategy will just result in missed diagnoses and having to send the patient back for second CT with contrast when the first one is unclear.

He advises working closely with radiology to determine how far you can go in eliminating contrast studies, establishing protocols, and creating a cooperative relationship.

More communication always is better and helps the department managers avoid feeling like they’re always at odds, Borgstede says.

"The two department heads need to sit down and see what they’re both trying to accomplish," he says.

"The head of radiology should be able to see your need to move patients out faster, and the ED manager needs to see the need for quality radiological studies. The two goals don’t have to conflict," Borgstede points out.

Sources

For more information on working with radiology, contact:

  • James Borgstede, MD, FACR, President, Board of Chancellors, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191-4397. Phone: (800) 227-5463. Web site: www.acr.org.
  • The American College of Radiology web site (www.acr.org) has appropriateness criteria for various radiologic studies, including abdominal computed tomography scans, and it is available in a form that can be downloaded to a handheld computer. At the web site, go to "Departments" at the upper left and then click on "ACR Practice Guidelines."