Alabama Nasal & Sinus Center

Alabama Nasal & Sinus Center

Point-of-Care CT Imaging

In-office CT (point of care imaging)

Over the past several years, point-of-care imaging (radiographic imaging done in the office) has grown in response to such factors as improved patient access, the availability of prompt clinical diagnosis and treatment, and low radiation CT imaging equipment suitable for an office setting. Point-of-care imaging represents a modality of service that is in line with the Institute of Medicine’s six dimensions of high quality care; care that is safe, timely, effective, efficient, equitable, and patient-centered [1].  The Alabama Nasal and Sinus Center is proud to be able to provide patients with timely, effective, efficient, and patient-centered diagnostic imaging studies and interpretation by Drs. Sillers and Lay.

All otolaryngologists receive training in head and neck imaging as part of their medical specialty training, and it is a component of the Scope of Knowledge for Board Certification.  We believe that patients should receive the most appropriate imaging modality to help diagnose their condition.  For patients undergoing Computed Tomography (CT) imaging of the paranasal sinuses, skull base and temporal bones, both conventional CT and cone beam CT (CBCT) imaging are appropriate methods for imaging these anatomical structures.  Physicians should have the discretion to determine the most appropriate imaging modality for the care of the patient.  CBCT provides greater spatial resolution at a significantly lower level of radiation than a conventional CT scanner [2].  We have recently upgraded our in-office cone beam scanner, investing in new hardware and the latest software available.  This new technology allows us the opportunity to provide patients imaging of the paranasal sinuses, skull base, and temporal bone in the comfort and convenience of our office.  Other radiographic imaging that we commonly order, including MRI of the head, thyroid ultrasound, and neck CT, are all still done outside the office.   

The benefits to point-of-care imaging are extensive. In a study by The Lewin Group, the authors reported that the increase in office-based imaging is a factor in the reduction of the number of more costly and riskier diagnostic procedures [3].  Other studies have demonstrated that point of care imaging of the paranasal sinuses results in substantially less unnecessary antibiotic prescriptions and significantly greater compliance with care [4].  With point-of-care CT imaging, the otolaryngologist is provided with digital 3-D images which can be reviewed with the patient at the time of the initial office visit.  This ability improves patient education, reduces patient anxiety, and improves patient compliance with prescribed treatment.  Point-of-care imaging provides prompt diagnosis and treatment, and fewer trips to a medical center or doctor’s office.  This results in lower costs to the patient and health plan. Prompt diagnosis and treatment also results in significantly less time away from work for the patient.  In short, health outcomes are improved in a safe, effective, and efficient manner.

Dr. Sillers and Lay are members of the American Academy of Otolaryngology-Head and Neck Surgery, which is a founding member of the Intersocietal Accreditation Commission (IAC) - CT Division.  Thankfully, we have just completed re-accreditation of our office by the IAC.  Accreditation requires documentation of continuing education in the areas of radiation safety and CT of the sinuses and temporal bone as well as thorough quality assurance and improvement procedures and training of personnel involved in administration of all aspects of the imaging procedure.  CBCT is an FDA approved CT Imaging modality that meets the standards required for CT accreditation by the IAC - CT Division.  Imaging studies should only be ordered when absolutely necessary in the best interest of the patient and essential for quality care.  CT accreditation helps to ensure standardization, quality and safety in CT imaging.  

In summary, patients and physicians benefit from proper utilization of point-of-care diagnostic imaging services.   An overall reduction in utilization of resources has been demonstrated.  In addition, an increase in effective diagnosis and treatment as well as patient satisfaction and compliance make point-of-care imaging a win-win proposition. 

References

[1] Institute of Medicine- Six Dimensions of High Quality Care

[2] Miracle, A.C., Mukherji, S.K.,Conebeam CT of the Head and Neck, Part 1: Physical Principles, AJNR 30, June-July 2009

[3] The Lewin Group, Issues in the Growth of Diagnostic Imaging Services: A Case Study of Cardiac Imaging, May 2005

[4] Tan, BK, Chandra, RK, et. al.  A randomized trial examining the effect of pretreatment point-of-care computed tomography imaging on the management of patients with chronic rhinosinusitis symptoms.  Int Forum Allergy Rhinol. 2011; 1(3): 229-234.

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