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Potential Impact of the American College of Radiology Appropriateness Criteria on CT for Trauma

¹ Department of Radiology, Eastern Virginia Medical School, 4720 Brompton Dr., Virginia Beach, VA 23456.
² Present address: Department of Radiation Oncology, St. Vincent's Comprehensive Cancer Center, 325 W 15th St., New York, NY 10011.

OBJECTIVE. The purpose of our study was to identify the current imaging utilization patterns at a level 1 trauma center, the radiation dose and financial costs of this imaging, and what impact, if any, the American College of Radiology (ACR) appropriateness criteria might have on these factors.

MATERIALS AND METHODS. Two hundred trauma patients were retrospectively chosen for inclusion in the study. Patients were selected on the basis of receiving any form of ionizing radiation within the first 3 hr of arrival at an academic level 1 trauma center. Exclusion criteria included an absence of imaging, patients transferred from outside institutions with previously acquired imaging studies, and patients who first underwent surgery and subsequently returned for imaging within the 3-hr inclusion time of the study. These data were then analyzed for imaging utilization practices, estimation of radiation dose, cost, and the impact of the ACR criteria on these factors.

RESULTS. A total of 660 CT examinations were performed for a total charge of $837,028. An estimated effective dose of 16 mSv was sustained by the typical patient in the study. Overall, application of the ACR criteria was found to have the potential to reduce imaging costs by 39% and the estimated radiation dose by 44%.

CONCLUSION. The ACR appropriateness criteria have the potential to have a strong positive impact on the overall cost of imaging and radiation dose received for patients in the setting of trauma. These criteria should be emphasized to clinicians to help guide their imaging decisions.

Keywords: appropriateness criteria • CT • emergency radiology • radiation dose • trauma

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