Prevalence of Unnecessary Pelvis and Hip Radiographs in Trauma Patients After Boney Pelvis CT

Purpose: Boney pelvis computed tomography (CT) has become a mainstay in the evaluation of pelvic trauma. Frequently radiographs are obtained prior to CT acquisition in the setting of trauma. Radiographs continue to be heavily relied upon for perioperative management and surgical planning. As a result, additional radiographs are frequently obtained shortly after CT acquisition. Given the availability of transparent 3D reconstructed CT images which have the potential to replace redundant radiographs, we sought to quantify the prevalence of repeat pelvis and hip radiographs after CT acquisition and its financial impact.

Methods/Materials: A single-center retrospective review of all patients who underwent boney pelvis CT and subsequently received an additional hip or pelvic radiograph within the 3 days of the CT was performed following IRB exemption. Demographics, exam type, and rates of surgical intervention were recorded. Financial analysis was performed using Centers for Medicare & Medicaid Services Physician Fee Schedule data and x-ray technologist labor costs using acquisition time and median hourly wages in our region.

Results: Between 4/1/2017 and 4/1/2022, 311 patients received a total of 511 radiographs of the pelvis or hip(s) within 3 days of receiving a boney pelvis CT. 316 (62%) of the studies were pelvic radiographs, and 194 (38%) were hip radiographs. The median age was 60 years old (range 12-102). 173/311 (56%) of patients underwent surgical intervention within 30 days of the CT acquisition. The estimated cost based off physician and facility RVU conversions was $19,432.07 while the estimated x-ray technologist labor cost was $3,774.00. The estimated total cost of obtaining these redundant radiographs was $23,206.07.

Conclusions: There are many pelvis and hip radiographs performed in the acute setting following recent boney pelvis CT acquisition. Reconstructing transparent 3D images of boney pelvis CT scans could reduce the need for repeat radiographs of the pelvis and hip in the acute setting. This could result in significant cost reduction. Further efforts should be made to validate the use of transparent 3D reconstruction of CT scans in place of repeat radiographs to mitigate unnecessary imaging.