Search

Background and Aim: Scintigraphic gastric emptying study (GES) is the criterion standard for diagnosis of gastroparesis. Adult studies demonstrated that extending GES to 4 hours increases its ability to diagnose delayed gastric emptying. Most pediatric centers assess GES up to 2 hours postmeal. The aim of the present study was to assess the effect of extending GES from 2 to 4 hours in evaluation of children with suspected gastroparesis., Methods: We conducted a chart review of all children who had a 4-hour GES with standard radiolabeled solid meal in 2009-2010. Results of GES at 1, 2, and 4 hours were compared. Patients were diagnosed as having gastroparesis using adult criteria: if gastric retention of meal was >90%, 60%, and 10% at 1, 2 and 4 hours, respectively. A telephone survey assessed GES time at top 20 pediatric gastroenterology centers in the United States. Cost of evaluation of patients diagnosed as having gastroparesis was estimated. Full-time equivalents of nuclear medicine technicians and number of nuclear medicine studies done at Ann & Robert H. Lurie Children's Hospital of Chicago from 2007 to 2010 were examined., Results: A total of 71 patients (32 boys, average age 10.8 years) were studied. Sixty-two percent (n=44) children had abnormal GES; 23% (8/35) of them who had normal values at 2 hours had abnormal GES at 4 hours (P<0.0001). Twenty-eight percent of patients had delayed GES at 1 hour: all persisted to have abnormal GES at 2 and 4 hours. Cost of evaluation of a child for gastroparesis was $9014. Only 5 of the top 20 pediatric gastroenterology centers in the United States conducted 4-hour GES. Transitioning from 2 hours to 4 hours only required scheduling adjustments and did not result in limitation in the number of scheduled patients., Conclusions: Extending GES to 4 hours results in a considerable increase in diagnosis of gastroparesis.

Aim: The aim of this study is to estimate how much scintigraphy the population will need in a well-developed healthcare system with fairly equitable access to healthcare., Methods: This is a retrospective population-based study. The data used came from Taiwan's National Health Insurance reimbursement claims dataset, the National Account compiled by Taiwan's Statistical Bureau of the Directorate General of Budget, Accounting and Statistics, and the National Health Account by Taiwan's Department of Health from 2001 to 2005. Frequency and expenditure variables were derived from these datasets., Results: The annual scintigraphy use rate in Taiwan was 13.57/1000 people from 2001-2005. On average, expenditures for scintigraphy accounted for 0.24% of National Health Insurance expenditures, 0.13% of the nation's total health expenditures and 0.00008% of the gross domestic product of Taiwan. The ratio of scintigraphy to computed tomography use was 0.37 and the scintigraphy to magnetic resonance imaging ratio was 1.14. The ratio of expenditures for scintigraphy and computed tomography was 0.23 and that for scintigraphy and magnetic resonance imaging was 0.36., Conclusion: A comparative approach is useful for assessing healthcare needs. Although the Taiwanese experience might not apply to all countries, the results of this study can serve as an international benchmark for assessing the need for scintigraphy in countries around the world.

We have assessed the potential impact of a regular half-day session on Saturday only, or Sunday only, and compared this with a whole weekend on-call service for lung scans. We predicted the effect of these services using the data gathered over 2 years (1992-94), looking at the results of lung scans and admission and discharge of patients. The on-call service in all three cases would be justified if resources from the savings on patient discharge and bed availability could be earmarked for the nuclear medicine service. The cost of introducing such an on-call service for the department would be Pounds 3000 per year per session at the weekend and up to Pounds 10,000 per year for a full weekend on-call service. The total cost to the hospital would be negligible.

In the light of the control of expenditure and changes in radiopharmaceutical costs, changes in study protocols, new investigation procedures and inappropriate placing in Korner categories, the BNMS Council set up a working party to derive an agreed set of costings for Nuclear Medicine techniques. Using data from three hospitals with additional information from another nine, we have agreed the 1988 cost of individual nuclear medicine procedures in the UK. These figures include staffing (radiopharmacy, nursing, physics, medical including consultant), radiopharmaceuticals and other consumables, indirect costs (secretarial, administrative, portering), variable overheads (service contracts, stationery) and fixed overheads (rates, lighting, heating, building and engineering). Capital costs, equipment and buildings were not included. Because figures include salary and overhead costs they are difficult to compare with the majority of other previous nuclear medicine costings, apart from Bretland et al., or with data for other imaging modalities. Comparison of these costings with Korner schedules shows marked overlap between the Korner groups. Such groups therefore form a poor method of costing nuclear medicine procedures. We propose alternative groupings.

The cost of nuclear medicine procedures in a small department run as part of a general imaging service in the financial year 1984/5, using standard commercial nomenclature and concepts (variable, semi-variable and fixed costs), are reported. The necessity for a standard costing system and the use of overhead absorption rates for all three types of cost are emphasized, and the value is shown of doing enough work to make economic use of the equipment and staff time. Nuclear medicine procedures appear to be comparable in cost to imaging procedures involving fluoroscopy.