[QUESTION] Can a CT scan replace an X-ray examination?

Reading about the CT scan technology it is described as  

"well-suited to quickly examine people who may have internal injuries from car accidents or other types of trauma. A CT scan can be used to visualize nearly all parts of the body and is used to diagnose disease or injury as well as to plan medical, surgical or radiation treatment."

Further: "Your doctor may recommend a CT scan to help: Diagnose muscle and bone disorders, such as bone tumors and fractures"

Citation taken from www.mayoclinic.org

In the game I tested this with a patient having a mandibular fracture. Symptom database tells me that a head X-Ray is in order, yet I wanted to give the CT a go. If you can see a fracture on X-Ray, then on rotating X-Rays as well, can't you? Turns out: no, not possible. Fracture is not to be seen on CT.
A medical tech I know working in odontology tells me, it should be visible on a CT.

This is rather sad because when building an ER with TC centers, I would like to have a CT nearby to have first radiologic diagnosis. Why is that useful? Because in Doctor Mode specialist level no hints are shown and If I do not see hints in physical examinations then a CT could help locate inner fractures regardless their location. Even if they are comatose. So basically spoken: is it possible for fractures to be detected in CT or do I still need the specific X-Ray for it and is it the only way? And if yes, then why? Working as intended?

Hi, thanks for the message - yes, this will be one of the cases where balancing gameplay had to take priority over realism, as it would lead to mostly idle X-Ray machines (and no point for you to build them) as soon as you add a couple of CTs to the hospital. Still, it's perfectly understandable that you might prefer to go the more realistic way and I'm pretty sure that some of the mods aimed at realism tweak the symptoms and examinations exactly in this direction.

Any way of official workaround possible? I mean the problem is probably that conventional X-Rays and CT do exactly the same thing so conventional X.Rays WILL become obsolete over time once better and more versatile equipment is available. I get a nervous tick every time a game developer tells me that realism must be sacrificed for 'balancing', which is utterly nonsense for a game with such an exquisite eye for realism as project hospital. X-Rays have their use - mainly in clinics. Otherwise there couldn't be odontologists or other medical practitioners outside hospitals afford to have them. A CT has a (much?) bigger price-tag and comes with advantages and disadvantages.

So things to work on:
- price of equipment I see X-Ray machines ranging in between $50k to $150k  while USED CT scanners are around $100k-$250k so I estimate around $400k and above for a new CT scanner so CT scanners are a bit more of hospital equipment not found outside so approximating a CT should cost from five to ten times more than an X-Ray. If going for balancing then aim at the equipment price tag. If the player wants to upgrade all his old X-Rays to CT then why not? I have seen let's plays with players upgrading beds and stretchers because the new ones look more modern and not for the benefit of being able to do more.

- availability to patients: I would see a huge benefit in X-Rays changing from pure radiology to certain departments and the ability to access their according waiting rooms so that Patients would not need to run around the whole hospital. Imagine emergency and orthopedic as well as general surgery having access to their own X-Ray rooms in their department where patients are preferably sent without the need of building a separate waiting room.

- What about making X-Rays for patients not unconscious only? CT is usually first line of diagnosis in trauma centers after stabilizing the patient or employed for severe conditions like cancer. X-Ray is more for ambulant and mobile patients in clinical environment, thus patients that are awake.

- What about the time it takes to perform procedure? Is there a big difference? Is it balancing enough?

I can see that X-Ray rooms will become idle over time if you are able to build CTs without financial pain but then this is the way it is. Equipment is replaced by better equipment. X-Ray should be a starting equipment for new clinics and hospitals OR supplement clinical diagnoses as benefit while CTs are for more critical cases and for an advanced stage of the game. As your game does not reflect costs of treatment directly such as X-Ray being cheaper than CT you have put yourselves into some corundrum. As far as it concerns me, I would throw my old X-Ray machines to hell and back if I have access to CT later on and can pay for them. Unless I get there, I am happy with them.

It is a bit sad that you are not having oncology in your game. I wonder, whether a CT scanner could also be adjusted to do a radiation therapy thus a multi-latitude irradiation of tissue. This is something an X-Ray cannot do and would be a reason for a CT AND having X-Rays, as the first ones then tend to be clogged up by cancer patients so you might need the others for more mundane diagnoses.

The game also does not care about radiation dosage so while exposing the whole body to a full CT scan might be a life saver for an unconscious patient who cannot tell what hurts you would not expose your your whole body to radiation when just looking for whether it is a broken hand. There should be a notable difference in creating discomfort.

If you ask me, I would set the two rooms to X-ray: conscious patients only and add to discomfort with the CT to represent higher radiation dose taken IF this treatment is overkill. And make X-Ray more versatile for clinics like mentioned above as integral part of a department. That said, I am missing a radiologist and his office for radiology as well. The technicians performing the scan are radiographers - they take the pictures but are not able/allowed to interpret them correctly. This is a radiologist's job, who is a MD.
I have no problems about X-Rays being made obsolete with the superior CT scans over time. If rooms are idle, then I replace them with ones more in demand. Easy as it is. But balancing is silly here as I guess there are some players outside knowing that CT is a kind of 3D X-Ray scan and will go for this analysis just to be confused when it does not give results. That is a gunshot into one's own knee.

Just my 5 cents on the topic