Facility Management

Dr. Harry Genant, emeritus professor of radiology at the University of California, San Francisco and a pioneer in the development of bone density measurement, spoke with Diagnostic Imaging about the increasing availability of bone densitometry tests and the need to standardize vertebral fracture measurement to improve the accuracy of osteoporosis diagnosis as well as patient compliance with therapy.

Although radiologists recognize ultrasound's value for the evaluation and diagnosis of musculoskeletal conditions, most prefer to use MR imaging in their daily practice, according to a recent survey.

Specialists such as rheumatologists, physiatrists, sports medicine physicians, and orthopedic surgeons increasingly use ultrasound in their clinical practices. But most radiologists find reassurance in their firm grip on musculoskeletal MR imaging. A number of them fear, however, that in forfeiting musculoskeletal ultrasound they risk losing musculoskeletal imaging altogether.

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.

The federal government has initiated a temporary reimbursement scheme for PET imaging that proponents hope will translate into permanent coverage for many oncologic indications currently not funded through Medicare.

We've known for some time that abdominal aortic aneurysm screening has great potential to save lives among our growing middle-aged and elderly populations. The Society for Interventional Radiology, which added ultrasound AAA screening to its Legs For Life program in 2000, reported last year that it has screened nearly 46,000 individuals and that the results prompted 11% of them to have a medical procedure or see their doctor. Ultrasound has a sensitivity of 95% and a specificity of 100% in detecting AAA.

Years ago, tomosynthesis was cited as one reason radiology needed digital mammography. A digital detector could be arced around the breast to capture multiple views from different angles, stripping away tissue that obscures cancers. But despite the commercial introduction of digital mammography five years ago, the use of tomosynthesis remains limited to a few isolated medical centers.

Most musculoskeletal radiologists prefer to use MRI in their daily practice even though they recognize the value of ultrasound to evaluate and diagnose many MSK conditions, according to results of a survey presented at the 2004 RSNA meeting.

There's no doubt that computer-aided detection increases the ability to pick up breast cancers. But questions remain about which users benefit most from CAD, as cancer detection rates vary widely with breast imaging experience. Even proponents note that improvements in the technology are needed to decrease false positives while increasing accuracy in detecting cancerous masses.

Buoyed by a new CPT code for vertebral fracture assessment, digital radiography is making fresh inroads into women’s health imaging.

Requirements for a Medicare-mandated PET tumor registry that will track how FDG-PET imaging influences patient management were announced Sunday at the opening session of the Academy of Molecular Imaging annual meeting in Orlando.

Europe has traditionally lagged behind the U.S. in its interest in open MR technology. Now the launch into the European market of two MR systems, each claiming performance comparable to 1.5T but friendlier to patients, may at last buck that trend.

When Dr. Peter Kullnig offered patients at his imaging center in Graz, Austria access to their images, his intent was to protect their privacy. With private logins to the center’s Web-based PACS, patients controlled access to their records. They could open those records to their own physicians and doctors to whom they were referred.

"John, Roberta has been ordering a lot of cone-down and magnification views on patients."

Provided cost-effectiveness issues can be resolved, whole-body imaging appears destined to enter everyday clinical practice as a comprehensive initial scanning method in oncology and other areas, according to an ECR presentation Friday.

Lack of reimbursement kept PET imaging on a slow track for most of the 1990s. The PET community's efforts to churn out data to persuade the government of the modality's effectiveness began to pay off early in the new century.

Researchers have discovered that three promising PET radiopharmaceutical agents for imaging amyloid plaques are targeted to two different types of surface receptors that potentially expand the amount of diagnostic information available for early Alzheimer's disease detection.

Radiology groups in growing numbers are entering into imaging joint ventures with hospitals. These are beneficial to both parties for many reasons, but all such joint ventures must address important strategic decisions. One is the choice of what Medicare enrollment status the joint venture will operate under. This choice is generally enrollment as an independent diagnostic testing facility (IDTF) versus radiology group practice. The latter is the better choice, in my view, but the requirements for onsite service by the radiologists can make qualifying for non-IDTF status difficult.

There’s no doubt that computer-aided detection increases the ability to pick up breast cancers. But questions remain about which users benefit most from CAD, as cancer detection rates vary widely with breast imaging experience.

Integrating a profusion of digital healthcare information systems is central to providing efficient, high-quality healthcare, and this need spans national boundaries. To address the increasingly global task, the Integrating the Healthcare Enterprise initiative expanded to six new countries last year.

The radiology department at Leiden University Medical Center performs approximately 150,000 examinations each year. We developed and implemented a simple fee-for-service tool to monitor clinical output and relate this to required input.

The Centers for Medicare and Medicaid Services approved in January a narrow coverage for FDG-PET imaging of cervical cancer. Medicare will reimburse for the initial staging of cervical cancer in a patient with a negative CT or MRI for extrapelvic metastatic disease.

The RSNA projected its 2004 meeting as "radiology's global forum," which was more than a catchy slogan. Congress president Dr. Brian C. Lentle was born in Cardiff and trained at the University of Wales, and four doctors from the Republic of Ireland, France, Australia, and England were made honorary members at the meeting. The scientific program was dedicated to Englishman Sir Godfrey Hounsfield, the inventor of CT, who died last August.

The radiology department at Leiden University Medical Center performs approximately 150,000 examinations each year. We developed and implemented a simple fee-for-service tool to monitor clinical output and relate this to required input.

Digital mammography has so much to offer that it might, almost, overcome the fact that it has yet to prove clinical superiority over screen-film mammography. Many users have, in fact, already decided that digital is worth its higher cost-about 40% of all mammography systems sold in the first half of 2004 were digital.

In a move likely to help teleradiology services and the companies that provide their equipment, the Centers for Medicare and Medicaid Services will soon implement a policy that permanently relaxes billing requirements for offsite readers. The shift, which is expected to take place by April, could create business opportunities for teleradiology and nighttime interpretation companies, as well as for hospitals and radiology groups across the nation.

Cardiologists can make money owning CT scanners and performing coronary CT angiography, according to Timothy Attebery, CEO of South Carolina Heart Center in Columbia. Income from the center's coronary CTA scans has risen from $200,000 in 2002 to a projected annualized income of $1 million in 2005.

The talk at the 2004 RSNA meeting was all about CT. Even with only the smallest handful of papers presented on 64-slice experience, radiologists discussed the latest generation of scanner as the new must-have equipment.