Diagnostic imaging costs before and after digital tomosynthesis implementation in patient management after detection of suspected thoracic lesions on chest radiography.

objectivesTo evaluate diagnostic imaging costs before and after DTS implementation in patients with suspected thoracic lesions on CXR.

methodsFour hundred sixty-five patients (263 male, 202 female; age, 72.47 ± 11.33 years) with suspected thoracic lesion(s) after CXR underwent DTS. Each patient underwent CT when a pulmonary non-calcified lesion was identified by DTS while CT was not performed when a benign pulmonary or extrapulmonary lesion or pseudolesion was identified. The average per-patient imaging cost was calculated by normalising the costs before and after DTS implementation.

resultsIn 229/465 patients who underwent DTS after suspicious CXR, DTS showed 193 pulmonary lesions and 36 pleural lesions, while in the remaining 236/465 patients, lesions were ruled out as pseudolesions of CXR. Chest CT examination was performed in 127/465 (27 %) patients while in the remaining 338/465 patients (73 %) CXR doubtful findings were resolved by DTS. The average per-patient costs of CXR, DTS and CT were <euro>15.15, 41.55 and 113.66. DTS allowed an annual cost saving of <euro>8,090.2 considering unenhanced CT and <euro>19,298.12 considering contrast-enhanced CT. Considering a DTS reimbursement rate of <euro> 62.7 the break even point corresponds to 479 DTS examinations.

conclusionPer-patient diagnostic imaging costs decreased after DTS implementation in patients with suspected thoracic lesions. MAIN MESSAGES: • Digital tomosynthesis improves the diagnostic accuracy and confidence in chest radiography • Digital tomosynthesis reduces the need for CT for a suspected pulmonary lesion • Digital tomosynthesis requires a dose level equivalent to that of around two chest radiographies • Digital tomosynthesis produces a significant per-patient saving in diagnostic imaging costs.