[Computerised axial tomography: equipments and use in the ACBC. Instructions on the appropriate use of CAT]

Baile MA, Fernandez B, Latorre K, Ramirez D Rueda JR
Record ID 32001000042
Original Title: Tomografía axial Computerizada: Equipamientos y utilización en la CAPV. Indicaciones de uso adecuado
Authors' objectives: 1. To determine the characteristics and use of existing computerised axial tomography (CAT) apparatus and equipment in the Basque health service. 2. To summarise data relating to surveys carried out to analyse the reliability of CAT exploration in the diagnosis and treatment of different pathologies. 3. To draft recommendations on the use of this image technology in accordance with its suitability.
Authors' results and conclusions: Currently, there are a total of 25 units operating in the ACBC of which 60% are installed in Osakidetza/SVS hospitals. The average age of the CAT units presently in use is six years. In 1999, the number of CAT units in the ACBC was 11.9 CAT units per million inhabitants, a figure which is a little under the average according to data available from neighbouring countries. The distribution of equipment according to the three provinces that form the Basque Country is 17.8 in Gipuzkoa (48%), 10.6 in Araba and 0.8 in Bizkaia. In Gipuzkoa, there is the same number of apparatus in public and health centers. On the other hand, in Bizkaia and Araba, two thirds of the apparatus are installed in public health centers. In 1996, more than 92,000 explorations were made with CAT units in all 24 health certers existing in this community. In1998, and taking into consideration only those center on which we have up-to-date information, the increase with regard to 1997 was 8% in public centers and 18% in private ones. The 22% increase in activity of Cruces Hospital should be highlighted. The percentage of activity corresponding to private centers is manteined at about 20% throughout the period under study, except in the case of Araba which represents about 6% of the total activity. When we analyse the number of explorations for every 100 inhabitants, variations can be seen between the three Historic Territories. Thus, in 1996, 40 explorations/1000 inhabitants were made in Araba, compared to more than 67 and 33 in Bizkaia and Gipuzkoa respectively. 1997 shows the aforementioned increase, having made a total of 48 explorations for every 10000 inhabitants in Araba, more than 70 in Bizkaia and more than 33 in Gipuzkoa. During 1998 and 1999, the number of explorations in Araba was similar (48 and 51/1000 inhabitants) while in Bizkaia this increased to more than 90 in 1998 and more tha 86 in 1999. 89.5% os explorations are made in hospitalized patients, 20% in ambulatory patients and 10.5% of requests come from Medical-Surgical Emergency Services. More than 43% of the explorations performed correspond to brain/cranium explorations, only 14.6% to the abdomen, 11% cover more than one area, such as the thorax, abdomen and/or pelvis. The thorax represents 7% and explorations of the vertebral column represent 6%. According to area, neurologists and neurosurgeons are responsible for 14% of the requests. Oncologists represent 12.5% of the total number of explorations.
Authors' recomendations: 1. The number of CAT units per million inhabitants in operation in the ACBC coincides within the values for countries with a similar socio-economic level. With regard to distribution, we observe that almost half of the CAT units installed in the ACBC are in Gipuzkoa, whose population represents only a third of the total for the Basque Country. In this province, there are a high number of CAT units in the private sector. The average age of units in operation is around 6 years, but 6 of those belong to the public sector and 4 of the units have been in operation for almost 10 years or more. 2. With regard to sources of informaiton concerning the activities performed by CAT units, it should be pointed out that: - It is advisable to unify health care information systems in the public health system, including the motive for the request for the exploration. - Current information systems do not provide data for analysing the diagnostic efficiency of CAT explorations. 3. With regard to the scientific evidence on the effectiveness of CAT explorations, we should point out that the scientific literature on the subject provides only a few surveys that assess the final impact on the health of patients subjected to a CAT or other kind of exploration. In addition to the lack of sound scientific evidence there is also the problem of not knowing to what extent the results of existing surveys can be extrapolated to our environment. In some cases, CAT explorations may not lead to a diagnosis dfferent from other diagnostic techniques, but its aspects, the overall information relating to a process, information on the treatment, development or the associated pathology, may vary quantitatively or qualitatively. Moreover, CAT explorations reduce the diagnosis time and may cause a modification of the decision prior to treatment in 50% or cases. 4. With regard to instructions on the appropriate use fo CAT, this is a technique chosen for the diagnosis of lesions of bone structures, without forgetting its role prior to conventional radiographic exploration. There is certain evidence of the usefulness of computerised tomography as a diagnostic proof of cerebral traumatism and in cases of suspected intracranial haemorrhage. Likewise, in thoracic and abdominal pathology, scientific evidence suggests that CAT explorations are used almost always as a complementary technique.
Authors' methods: Information on the characteristics of CAT units, by means of a questionnaire sent to all public and private health centres that have CAT units in this community. Information on the use of CAT equipment between 1996 and 1999. Systematic review of the scientific literature on this subject by selecting surveys, clinical practice guidelines and standards concerning the recommendations for the use of CAT units, published in medical and scientific reviews of proven quality. - Identification and selection of the most relevant surveys: a total of 1,804 references were recovered, and from these 459 articles were selected. - Preparation of tables summarising the scientific evidence (enclosed document). - Preparation of recommendations on correct usage.
Project Status: Completed
Year Published: 2000
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Diagnostic Techniques and Procedures
  • Tomography, X-Ray Computed
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.org

Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)

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