CT EXAMINATION INDICATIONS AND JUSTIFICATION IN TUNISIA

A RETROSPECTIVE STUDY

Azza Hammou – CNRP- Tunis WHO International consultation meeting : Justification

of use of CT for IHA of Asymptomatic People Munich - 15-17 October 2014

INTRODUCTION

• HEALTH CARE SYSTEM

• MEDICAL IMAGING EQUIPMENT XR MACHINES

• CT INDICATIONS IN PEDIATRIC GENERAL HOSPITAL

• USE IN ADULTS : PRIVATE CENTERS/ PUBLIC FOR ASYMPTOMATIC PERSONS

TUNISIA : 12 Million inhabitants, No PP, No RR, RAS imported, largely used in Medical, Industrial, research, education

REGULATORY INFRASTRUCTURE FOR SAFE USE OF IONIZING RADIATIONS

• Legislative and regulatory infrastructure

• Regulatory body responsibilities and functions

• Prevision for radiation protection of patients , public and workers

• Implementation of radiation protection principles :

– Justification : medical prescription

– Optimization : quality management, maintenance , Training , Diagnostic RL, RPO, Risk assessment, Patient dose evaluation

THE HEALTHCARE SYSTEM IN TUNISIA

Provide public system private,

In the public sector

- health centers providing primary care,

- district and regional hospitals,

- university hospitals.

The private healthcare system

• in Tunisia the private healthcare system has significantly expanded in terms of infrastructure as well as capacity and healthcare personnel.

• Some services in the private sector are covered by health insurance.

Tunisian Social Security system.

Tunisians and residents are fully covered : per treatment or procedure or a lump sum - some cases of hospitalization and surgery. - type of cover: cash advance or third party payment, - the level of cover desired: amount reimbursed,

payment caps, reference price of drugs etc. - Employers are required to enroll their employees

in the Social Security scheme (CNSS /CNAM) within a month of their arrival in the company.

XR MACHINES DENTAL CT

MAMMO PANO O;DENSITO

Grand

Tunis

493 657 59 62 45 13

Nord Est 105 171 15 16 17 6

Nord Ouest 55 72 11 4 3 2

Centre Est 292 371 35 29 26 17

Centre Ouest 45 52 8 4 6 2

Sud Est 86 78 14 8 10 2

Sud Ouest 37 35 4 2 0 0

TOTAL 1113 1436 146 125 107 42

Medical inventory : CNRP 2011

CT indications and justifications

Example 1 CT in Pediatric Hospital

• 300 Beds. all specialties unclouded

• 5000 hospitalizations /y

• Imaging department : US, MRI, Fluoroscopy, Fixe

and Mobile XR machines

• 3000 CT/Y

• Indications : Cerebral : 45%

• 1 Region: chest, hip , Orbit, Sinus,… 25%

• 4 Regions : 20%

• 2 Regions : 5 %

• Angioscan : 5%

Example 2 : CT INDICATIONS AND

JUSTIFICATIONS IN ADULTS

• 30 interrogated centers

• 19 answers : 10 university or regional

general hospitals, 11 private cliniques or

imaging center

• 3questions : Ca Score, total body CT scan

for check up, screening for BP Cancer

Answers public/private

Question Ca Scoring BPC Screaning Check up

Public Health 3/10 3/10 0/10

Private sector 3/11 3/11 1/11

Comments

• All CT exams are indicated by a referent

Doctor : justification by Written request

– No reimbursement for auto indication or non

justified request

– No interpretation by the radiologist

– Important number of patients for the number

of machines in public hospitals

– Insufficient number of multi slice CT Scanners

Indications of CT scan for Check up

• Check up : Abdominal US + Chest X ray

• Head Ct scan by psychologist

• Auto indication is not covered by CNAM

• No in public hospitals

BP Cancer Screaming

• Chest X ray

• Lung CT rarely indicated by labor MD if

smoker, diabetes …

• Low dose protocole ( SPC)/ + CA if

positive

Calcium Scoring

• In Public hospitals

– 64 slides, or more in patients with coronary

history

– Only prior to Coro Scan

• Private Radiologists : if the tool exist on

the machine, even without coro scan in

asymptomatic persons

IAEA 16

THANK YOU