Diagnostic imaging costs before and after digital tomosynthesis implementation in patient management after detection of suspected thoracic lesions on chest radiography

Abstract

Objectives: To evaluate diagnostic imaging costs before and after DTS implementation in patients with suspected thoracic lesions on CXR.

Methods: Four hundred sixty-five patients (263 male, 202 female; age, 72.47 ± 11.33 years) with suspected thoracic lesion(s) after CXR underwent DTS. Each patient underwent CT when a pulmonary non-calcified lesion was identified by DTS while CT was not performed when a benign pulmonary or extrapulmonary lesion or pseudolesion was identified. The average per-patient imaging cost was calculated by normalising the costs before and after DTS implementation.

Results: In 229/465 patients who underwent DTS after suspicious CXR, DTS showed 193 pulmonary lesions and 36 pleural lesions, while in the remaining 236/465 patients, lesions were ruled out as pseudolesions of CXR. Chest CT examination was performed in 127/465 (27 %) patients while in the remaining 338/465 patients (73 %) CXR doubtful findings were resolved by DTS. The average per-patient costs of CXR, DTS and CT were <euro>15.15, 41.55 and 113.66. DTS allowed an annual cost saving of <euro>8,090.2 considering unenhanced CT and <euro>19,298.12 considering contrast-enhanced CT. Considering a DTS reimbursement rate of <euro> 62.7 the break even point corresponds to 479 DTS examinations.

Conclusion: Per-patient diagnostic imaging costs decreased after DTS implementation in patients with suspected thoracic lesions.

Main messages: • Digital tomosynthesis improves the diagnostic accuracy and confidence in chest radiography • Digital tomosynthesis reduces the need for CT for a suspected pulmonary lesion • Digital tomosynthesis requires a dose level equivalent to that of around two chest radiographies • Digital tomosynthesis produces a significant per-patient saving in diagnostic imaging costs.

Fig. 1

a-e A 60-year-old man with a suspected pulmonary lesion on the right lung. a Posteroanterior chest radiography in the upright position shows one suspected pulmonary nodule in the right lung (arrow). b-d Digital tomosynthesis images show the existence of a true lung opacity (arrow). e CT confirms the pulmonary opacity in the right lung (arrow)