Facility Management

PET/CT has come a long way. Improved PET detectors with better optical response, faster electronics, and software that rapidly matches CT and PET scans have dramatically advanced the hybrids, promising whole-body exams in 15 minutes or less. Yet nothing says progress like number of slices. The CT component has marched forward from quadslice to eight-slice, then from eight to 16. Now 64-slice PET/CT is at hand.

To paraphrase Mark Twain, reports of the death of diagnostic MR spectroscopy are greatly exaggerated. CPT 76390 is considered standard of care as an effective imaging technique for the diagnosis, treatment, and monitoring of patients with brain lesions by Cigna Healthcare, a respected healthcare provider,1 though declared "investigational" by Blue Shield, Anthem, and Medicare. Radiologists and other physicians are confused and annoyed by some insurers' refusal to reimburse for their MRS services.

Radiologists' transition from reliance on axial views to 3D interpretation of multislice CT data is not a question of if, but when. The increasing data load of 16- and 64-slice scanners challenges efficiency, as does the rise in imaging volume overall. The need to interpret more cases in less time will continue to put pressure on radiologists. But users at a range of sites, from academic centers to private practice, say 3D techniques are one way to work smarter instead of harder.

Discoveries relating to the imaging of hypoxia, angiogenesis, and ligand receptors demonstrate the scientific prowess of the In vivo Cellular Molecular Imaging Center at Johns Hopkins University and justify its reputation as one of the top molecular imaging laboratories in the world.

Guaranteed profits with no financial risk: That is the lure of "per-click" leasing. The in-office imaging strategy promises to make self-referral financially safe and operationally easy to execute, according to attorney Thomas Greeson.

Digital mammography's superiority over film in cancer detection in select patients took industry watchers and researchers by surprise. While proponents hoped for a best-case scenario of a clinical draw between the two techniques, few expected digital to excel.

Exquisite images of the brain, spine, body, and joints will adorn vendors' booths at the RSNA meeting, attesting to the benefits of clinical 3T. But, unlike the many ultrahigh-field MR scans that vendors have displayed in the past, most of these 3T images will come from systems designed for everyday clinical practice.

Vendors have created CT scanners for every price point and clinical need, and medical facilities are snapping them up.

Doves like truces. A truce gives the two sides a chance to enjoy peace, if only for a short time. Maybe they’ll like it enough to stop fighting altogether, or so the thinking goes.

Doves like truces. A truce gives the two sides a chance to enjoy peace, if only for a short time. Maybe they’ll like it enough to stop fighting altogether, or so the thinking goes.

Inland Imaging center in Spokane has found a unique way to avoid the usual friction between hospitals and radiology groups by hosting a PACS for its largest partner hospital.

Virtual colonoscopy is likely to perform well in the American College of Radiology Imaging Network Trial, but the result could be a $2 billion boost in national colon cancer screening costs, according to a presentation Monday at the Sixth Annual Virtual Colonoscopy Symposium in Boston.

Clinical data are mounting to show that radiofrequency ablation of small kidney tumors is a safe, effective alternative to open or laparoscopic resection. Distinct intervention protocols and complementary techniques could further boost RFA’s efficacy and expand its application to areas previously deemed unsafe.

Radiologists have seized control of imaging to measure bone mineral density, increasing their turf by 20% in a six-year period, according to researchers from Thomas Jefferson University.

The FDA wants to alter how PET radiopharmaceuticals are regulated, though the proposed changes may not take effect until 2008.

Today's log at the imaging center shows 15 patients scheduled for different examinations. Most come with abdominal or musculoskeletal symptoms, and almost half of them are overweight. The daytime sonographer called in sick earlier, so the radiologist needs to make a tough call: Does she perform 15 ultrasound exams herself or does she shuttle everyone through to any of the CT or MR scanners available?

Dr. James H. Thrall's column "Utilization management steps onto center stage" (July, page 29) carries the subtitle "Referring physicians and radiologists must wrestle decision making back from insurers," prompting the question, Was decision making usurped or abandoned? As chief medical officer of CareCore National, one of the aggravating "1-800 programs" Thrall refers to, I present a perspective from the other side.

Hysterectomy and myomectomy still dominate the uterine fibroid treatment options. But specialists, including gynecologists, are gradually gravitating toward minimally invasive alternatives. The pace for change may quicken when definitive long-term outcomes on uterine artery embolization are published later this year.

Ultrasound has long been a prime target in imaging turf wars because it does not employ ionizing radiation. Radiology lost cardiac ultrasound, and it is questionable that the specialty will continue to be a major player in obstetrics.

A clinical imaging study published in The New England Journal of Medicine on Sept. 16 could spark substantial new demand for full-field digital mammography.

As more physicians begin to use FDG-PET for diagnosing Alzheimer's disease, the demand for automated software systems that help interpret complex metabolic scans is increasing. Several new automated expert systems have been developed that can improve diagnostic accuracy and help assess risk for the disease.

Tracking information about workflow, payment, and outcomes has never been more important for breast imaging centers. Some clinical and technical data collection has long been mandated by the Mammography Quality Standards Act, and new recommendations by the Institute of Medicine could require centers to step up their efforts. But regulatory demands are not the only reason for breast centers to make the most of what information systems have to offer.

Advances in electronic image transmission have the potential to change the face of radiology. Using technology supported by PACS and radiology information systems, interpreting radiologists can provide timely services to multiple facilities while practicing "virtually" from almost any location. This capability has allowed entry of international teleradiology into the U.S. market, and it has opened the door to increased competition for interpretation contracts, even across state lines.

Digital mammography is more accurate than film in detecting cancer in women under age 50, those who have dense breasts, and in pre- and perimenopasual women, according to the long-awaited results from the Digital Mammography Screening Trial (DMIST).

PACS appears to be finally coming of age as institutions around the world increasingly recognize the benefits of electronic record keeping. The biggest providers of PACS, the film-turned-PACS vendors could expect this to be the time when they realize earnings from their decade-plus investment in this technology. But it is more complicated than that.

Thirteen years after its passage by Congress, the Mammography Quality Standards Act remains a sore subject for radiologists. While breast imagers unanimously agree that the MQSA has vastly improved mammography quality, they give the rule low marks for its cost and the burdensome details of compliance.

No doubt, the Mammography Quality Standards Act has improved the quality of breast imaging. As this month's cover story clearly establishes, long-time mammographers have seen a decided improvement in clinical practice since the MQSA was adopted in 1992.

Reimbursement for radiofrequency ablation of tumors continues to broaden, with local Medicare agencies and most major insurers covering the procedure for unresectable liver neoplasms. Palliative RFA treatment of bone metastases follows as the next most widely accepted procedure. These positions are bolstered by existing CPT codes for the treatments.

Much has happened in the year since the FDA approved the first MR-guided ultrasound device for the treatment of uterine fibroids. The pioneers of this new product area, InSightec and its imaging partner GE Healthcare, have launched initiatives to find other clinical applications. One is a pivotal trial of ExAblate 2000 for the treatment of breast fibroadenomas. Another combines two feasibility studies of the safety and efficacy of the device for ablating breast cancers and eliminating brain tumors through an intact skull.