La. Admin. Code tit. 48 § I-11517

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11517 - Computed Tomography

A. Description of Service

1. Computed tomography (CT) is a diagnostic service utilizing an X-Ray source, detector and computer to reconstruct from multiple projections a pictorial representation of the internal structure of an object. CT scanning is based upon the principle of conventional radiology: tissues may be distinguished by their respective densities, which are determined by the amount of radiation transmitted through the objects. CT scanning differs from conventional X-Ray in that numerous images are recorded as the X-Ray equipment traverses the body or head area. These images are reconstructed onto a screen or film in a representation of a selected slice of the body.

2. CT scanning is much more sensitive than conventional X-Ray to differenced in tissue density and thus more readily permits the identification of tumors and other soft tissue abnormalities. In addition to its superior diagnostic capability, CT scanning may reduce patient risk by replacing painful invasive diagnostic procedures, such as cerebral angiography and pneuoencephalography, and by reducing the need for exploratory surgery.

3. The evolution of CT has been extraordinarily rapid. The first brain scanner was introduced by EMI in 1972 following five years of development. Progress was quickly made toward the development of body scanners which showed organs such as the pancreas, kidneys and lungs. The speed and accuracy of scanning is now much advanced from the early stages of development.

B. Application and Effectiveness of CT Scanning

1. CT can help physicians determine the site, type and extent of head and body neoplasms and other diseases of soft tissue structure. In the case of malignancies, CT is superior as an aid in radiation treatment planning due to its capability to depict the size and location of tumors. CT is also useful in solving problems where there is conflicting information, either from several radiologic studies or between radiologic studies and the clinical status of the patient. In the head, CT can diagnose virtually all of the neurological disorders that are known to be associated with some physical abnormality of the brain. CT is applicable to the examination of the chest, including the pleura, mediastinum and lung. In the abdomen, CT can examine the retroperitoneum, liver, spleen, pancreas, kidneys, adrenal glands, uterus, ovaries, bladder and prostate. CT is also quite useful in diagnostic work-ups of trauma or accident victims, as well as in guiding biopsy of deep masses in the chest and abdomen.

2. Hundreds of studies of the effectiveness of CT have been conducted. Nearly all report that CT is safe and medically useful and indicate that it provides accurate diagnostic information, improves therapy and reduces the need for other diagnostic procedures.

C. Cost

1. The typical charge for all types of CT scans was estimated at $350 in 1984. It is, therefore, a relatively expensive methodology, but according to some studies, it reduces other diagnostic and therapeutic charges proportionately. Several costly diagnostic procedures are no longer required because of CT-e.g., radionuclide brain scanning, pneumoencephalography and polytomography. The use of many other imaging procedures has been markedly reduced-e.g. abdominal arteriography, lymphangiography and conventional x-ray tomography of many organs. In addition, CT has been shown to reduce hospital stays and to eliminate certain surgical procedures.

2. More clinical research is needed to identify the most cost-effective diagnostic uses. As with any expensive methodology, identifying and avoiding inappropriate use is important in containing the cost of health care. Studies have reported that CT is not cost effective when it is used to evaluate persons with headaches and other chronic symptoms or to confirm diagnostic findings previously noted by other imaging or clinical tests.

3. The average proce of new CT scanners is approximately $1 million. As new scanners have been bought to replace older units, a secondary market has sprung up for used scanners which is supplying smaller hospitals with a more cost effective means to introduce CT capability.

D. Service Area. The service area for a fixed CT scanner is the health planning district in which the CT scanner is or will be located. The service area for a mobile CT scanner is the health planning district in which the applicant facility is located.

E. Resource Goals

1. The following criteria and standards are applicable to CT scanners for Section 1122 review, as a type of major medical equipment.

2. An initial CT scanner (if purchased or leased, when the expenditure is capitalized) is subject to full 1122 review, regardless of the cost of the equipment. An additional CT scanner, which is not a back-up or replacement scanner, is subject to expedited review.

3. The applicant must project that, within two years after initiation, an initial CT scanner (head or body) will operate at a minimum of 1000 medically necessary patient procedures a year. The applicant should document the anticipated caseload and the source of new patients expected to be served by the proposed CT scanner service. If the anticipated caseload assumes referrals from other facilities, documentation of the linkage agreements must be provided. The documentation shall be quantified and approved by the referring facility's governing body.

4. The applicant must document that the following personnel will be available to the institution:

a. a board-certified or board-eligible radiologist formally trained in the interpretation of CT scanning must be available when the unit is available for patient use and on call at other times;

b. a radiologic technologist trained in the operation of CT scanning equipment should be available when the unit is available for patient use and on call at other times;

c. facilities should document the availability of specialists in the following areas: neurology, general and orthopedic surgery, and internal medicine.

F. Back-up or Replacement Scanners

1. An applicant institution may request that an existing scanner be declared obsolete, even though it will be used as a back-up for a replacement unit. The existing scanner will only be considered as a backup CT unit for planning and review purposes if documentation is supplied to the effect that the existing scanner is subject to extraordinary down time or if other special circumstances apply.

La. Admin. Code tit. 48, § I-11517

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P. L. 96-79, and R.S. 36:256(b).