Patterns and trends of computed tomography usage in outpatients of the Brazilian public healthcare system, 2001–2011

Abstract

While the patterns and trends of computed tomography (CT) are well documented in developed countries, relatively little is known about CT usage in developing countries, including Brazil. We evaluated CT usage among outpatients from the public healthcare system in Brazil (SUS), which is the unique healthcare provider to about 75% of the Brazilian population. We collected the annual number of CT procedures and type of CT examinations performed in SUS for the period 2001-2011. Age at examination was evaluated for 2008-2011. CT usage in Brazil has more than tripled during the study period, but the most striking annual increase (17.5%) was observed over the years 2008-2011. Head was the most frequently examined region for all age groups, but a decreasing trend of proportional contribution of head CT, with a simultaneous increase of abdomen/pelvis and chest CT over time was observed. CT examination for pediatric and young adult patients was about 13% of all CTs (9% if we considered age-standardized CT rates). CT usage has grown rapidly in Brazil and may still be increasing. Increased CT usage may certainly be associated with improved patient care. However, given the high frequency of pediatric and young adult CT procedures and the suggested associated cancer risk, efforts need to be undertaken to reduce unwarranted CT scans in Brazil.

Patterns and trends of Computed Tomography usage among pediatric and young adult patients in a private hospital in Rio de Janeiro, 2005-2015

“…In our study hospital, head/neck was the most frequent CT examination for patients under 20 years old, except for patients aged 15-19 years old, for whom abdomen/pelvis was the most frequent CT exam. These results contrast with the pattern observed for SUS outpatients, for whom the head/neck is the most frequent imaged body region for all patients under 20 years of age [19]. These differences may reflect the earlier insertion of modern multi-slice CT scanners in the private setting than in the public healthcare system.…”

“…One third of the patients did more than one CT examination in the hospital between 2005 and 2015, with the frequency of patients with multiple exams increasing with patient age. In our study, pediatric and young adult CT exams corresponded to about 8% of all CTs, which was lower than the 13% reported for outpatients of the Brazilian public healthcare system [19]. We may suggest that this might be due to the greater availability of other diagnostic imaging examinations in the private hospital, such as magnetic resonance imaging and ultrasound [22].…”

“…Several studies have reported that head/neck is the most frequent pediatric CT examination [3,7,19,26,27], while abdomen/pelvis is the most frequent examination among adults [3,26]. In our study hospital, head/neck was the most frequent CT examination for patients under 20 years old, except for patients aged 15-19 years old, for whom abdomen/pelvis was the most frequent CT exam.…”

“…A recent study in Brazil showed that CT use among outpatients of Brazilian public healthcare system (SUS), has more than tripled between 2001 and 2011 [19]. Of note, about 13% of all CT procedures were performed in pediatric and young adult patients (< 20 years), which is among the highest frequencies of CT use in this age group worldwide [19].…”

“…This coverage has increased over the last years and currently reaches around 25% of the Brazilian population. Differences in CT use between the public and private subsystems may be expected, mainly due to the greater availability of CT scanners in the last [19].…”