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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