Hospital shifts its CT scan procedures

Ashland Community Hospital received some unwanted exposure itself when it wound up on a list of hospitals that may have exposed patients to extra radiation by overusing CT scans. But a spokesman said the hospital already has gotten the message and has drastically reduced a practice of performing two scans on a patient.

The hospital performed a CT scan with an injectable dye plus a CT scan without the dye on 40 percent of its Medicare patients who received chest CT scans in 2008, the most recent year that figures were available, according to a nationwide map of hospital "double-scan" procedures created by The New York Times using federal data.

In contrast, Rogue Valley Medical Center in Medford had a 6 percent double-scan rate and Providence Medford Medical Center had a 2 percent rate. Three Rivers Community Hospital in Grants Pass had a 0 percent rate in 2008.

Ashland Community Hospital had the worst double-scan rate in Oregon that year, followed by Santiam Memorial Hospital outside Salem, which had a 32 percent double-scan rate.

Most hospitals along the I-5 corridor and the coast had 0 to 3 percent double-scan rates, although three hospitals in Central Oregon had rates of eight to 14 percent. In California, Oregon and Washington, only three hospitals between Modesto, Calif., and the Canadian border registered above 30 percent for double scans.

One CT chest scan delivers about 350 times the radiation of a standard chest X-ray, according to The New York Times.

In 2008, Ashland Community Hospital was just beginning to make changes to its radiology practices to lower CT double-scan rates, said Rob Hibner, director of radiology at Ashland Community Hospital.

In the past 18 months, the hospital has cut its double-scan rate to about 2.5 percent of all patients, or about seven double scans for 275 patients getting chest CT scans, Hibner said.

Double-scan rates for Medicare patients weren't immediately available, but Medicare patients make up close to half of the hospital's patients, he said.

The Medford Radiological Group, which interprets radiological exams from most radiology centers in the valley, set up standard protocols a few years ago that have been used at facilities like Ashland Community Hospital, Providence Medford Medical Center and Rogue Valley Medical Center. Those protocols meant Ashland Community Hospital performed far fewer double scans, Hibner said.

Ashland Community Hospital's standard now is to use a single CT scan with injectable dye for most patients, he said.

The radiology field has changed and experts are now more concerned about the impact of radiation exposure. Medicare has also grown concerned about overuse of CT scans, Hibner said. Beyond the health risk, there's an associated cost. The Times story reported that in 2008, Medicare paid hospitals roughly $25 million in extra charges for double scans.

Hibner said the drastic reduction in double CT scans at the hospital is proof that hospitals can change their practices when presented with information about patient safety and overuse of procedures.

"We're proof. We've changed. We got on board with radiologists in the valley and we've improved patient care," Hibner said. "It's made a huge difference for us. Less radiation is better for everyone."

Hibner said the long-term effects of exposure to CT scan radiation are still being studied. Some studies have shown an uptick in cancer risk for people who have received CT scans.

"The goal is always to deal with the least amount of radiation for the maximum benefit," Hibner said. "The industry has changed over the years."

Dye is frequently delivered to patients via an intravenous line for a CT, or computed tomography, scan because the dye can help structures like veins show up better.

Sometimes dye shouldn't be used because it could obscure a problem, Hibner said.

Hibner said Ashland Community Hospital previously had a practice of performing CT scans with dye plus scans without dye in many patients for medical reasons. He said the purpose was never to try to bill Medicare or private insurance companies higher amounts.

Staff reporter Vickie Aldous can be reached at or 541-479-8199.

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