Appropriate Use of CT Scan in the Emergency Department



This chapter describes a case study in a community-based acute care hospital that was able to successfully reduce the Computed Tomography (CT) utilization in their Emergency Department by 8.7 % for 1 year, and 13.8 % since the prior 2-year period. The reduction was especially important because 10 % of the U.S. population gets a CT scan each year, and use of CT imaging is growing more than 10 % per year, and with it, increased long-term exposure can increase potential cancer risks. The cross-functional team applied the Six Sigma methodology and tools to define the problem, measure the current state, identify root causes, and develop medical research-based and evidence-based CT guidelines to reduce CT utilization. The information presented in this case study is not designed or intended to provide medical advice or recommendations.


Compute Tomography Emergency Department Compute Tomography Scan Emergency Department Physician Compute Tomography Exam 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Baumgarten, D. A., Francis, I. R., Bluth, E. I., Bush, W. H., Jr., Casalino, D. D., Curry, N. S., Israel, G. M., Jafri, S. Z. H., Kawashima, A., Papanicolaou, N., Remer, E. M., Sandler, C. M., Spring, D. B., & Fulgham, P. (2007).Expert panel on urologic imaging: 14 American college of radiology ACR appropriateness criteria acute onset flank pain—suspicion of stone disease Date of origin: 1995 Last review date: 2007.Google Scholar
  2. Cancer risks and radiation exposure from computed tomographic scans how can we be sure that the benefits outweigh the risks? (2009). (Reprinted) Archives of Internal Medicine, 169(22), 2049. December 14/28 American Medical Association. All rights reserved. Downloaded from on December 17, 2009.
  3. de Gonza′ lez, A. B., Mahesh, M., Kim, K. –P., Bhargavan, M., Lewis, R., Mettler, F., & Land, C. (2009). Projected cancer risks from computed tomographic scans performed in the united states in 2007 Internal Medicine, 169(22), 2071–2079
  4. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study, BMJ 2009;339:b2431 doi: 10.1136/bmj.b2431.
  5. Institute for Clinical Systems Improvement (2009). Pulmonary Embolism (PE) diagnosis algorithm (9th ed.).Google Scholar
  6. Katz, S. I., Saluja, S., Brink, J. A., & Forman, H. P. (2006). Genitourinary imaging. Original research radiation dose associated with unenhanced CT for suspected renal colic: Impact of repetitive studies. AJR, 186, 1120–1124. 0361–803X/06/1864–1120 (American Roentgen Ray Society).Google Scholar
  7. Kirsch, T. D., Hsieh, Y. -H., Horana, L., Holtzclaw, S. G., Silverman, M., & Chanmugam, A. (2010). Computed tomography scan utilization in emergency departments: A multi-state analysis. The Journal of Emergency Medicine, 7, 771–779Google Scholar
  8. Marchione, M., (2010). CT scans pose a growing danger to Americans. Experts call for increased regulation to improve safety, (Associated Press).Google Scholar
  9. Medical Liability Monitor (2008). Rate survey. Published in the January 5, 2009 issue of American medical news
  10. Mettler, F. A., Huda, W., Yoshizumi, T. T., Mahesh, M. (2008). Effective doses in radiology and diagnostic nuclear medicine: A catalog Radiology. 248(1), 254–263Google Scholar
  11. Smith-Bindman R. (2012). Environmental causes of breast cancer and radiation from medical imaging: findings from the institute of medicine report. Archives of Internal Medicine. 172(13), 1023–1027Google Scholar
  12. Stoker, J., van Randen, A., Lame′ris, W., & Boermeester, M. A. (2009). Imaging patients with acute abdominal pain. Radiology, 253(1), 31–46 Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Southern Polytechnic State UniversityMariettaUSA

Personalised recommendations