Facility Management

The recent creation of the Society for Cardiovascular Computed Tomography may give birth to a new era of cooperation among radiologists and cardiologists that might also sound the death knell for electron-beam CT.

A Florida radiologist has been named as a defendant in a whistleblower lawsuit alleging Medicare fraud though improper lease arrangements, kickbacks, and upcoding.

The political heat surrounding diagnostic imaging has gone up several degrees over the last few years. The American College of Radiology’s political action committee is now a top financial contributor among healthcare organizations. The college regularly lobbies politicians on Capitol Hill and testifies before Medicare advisory panels regarding imaging issues. Congress responded in the spring by convening a special hearing to examine and possibly revamp imaging credentialing and reimbursement.

The keys to radiologist profitability are productivity and efficiency. Outside reading arrangements that permit remote reading at a workstation can greatly assist a group's profitability because the radiologist can read more studies, enhancing productivity while remaining efficient. But the news on such opportunities is mixed. While new Centers for Medicare and Medicaid Services policy changes have opened the door to certain out-of-state reading arrangements, other outside arrangements remain questionable under the fraud and abuse laws. Of particular concern are proliferating outside arrangements for sharing CT angiography reads with cardiologists.

McKesson has signed a definitive agreement to acquire Medcon, an Israeli developer of Web-based cardiology PACS and IT. The proposed acquisition, valued at $105 million, reflects the strategy of McKesson. The IT provider is aggressively promoting integrated healthcare systems that stretch across medical specialties including radiology, gastroenterology, ophthalmology, and cardiology.

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.

Accreditation is moving forward in some ways but backward in others. The American College of Radiology, the prime driver in the U.S., has expanded its MR accreditation process to include 3T scanners, acknowledging demands for accreditation by third-party payers and regulators and citing the increasing adoption of this technology as the reason.

Full-field digital mammography has turned into a superstar of x-ray, doubling in revenue and units shipped last year over 2003. Growth is expected to continue, although the pace may slow as the backlog of ordered systems shrank by year’s end to just 10% more than the number shipped.

Backers of a huge study examining the effect of PET on patient management face regulatory problems that threaten to delay a planned July 1 implementation of expanded Medicare Part B coverage of FDG-PET for cancer imaging.

In just seven years, computer-aided detection has become an indispensable tool for breast imaging centers. As experience accrues, CAD's role in cancer detection with mammography is evolving. Some longtime users find that initial surges in cancer detection rates eventually return to pre-CAD baselines in stable screening populations. Now the focus is on CAD's ability to find cancers at an ever earlier stage. Research is shifting toward optimizing CAD in practice and developing its potential for tumor classification.

It’s been a long time coming, but the country’s watchdogs are finally starting to bark. For as long as I can remember, legislators concerned over the well-being of U.S. citizens have focused on the makers of equipment as their primary, if not their only, concern. They worried whether equipment was safe and did what it was supposed to do, and for good reason. But, oddly, the hand-wringing in Congress and, consequently, at the FDA typically ended once those products left the loading docks.

The Institute of Medicine has recommended sweeping changes to quality standards now being applied to breast imaging facilities. If Congress, which requested the study, enacts these changes, facilities will face a substantially greater burden in collecting patient data, potentially increasing the need for information technology.

Given the high quality of FDG-PET imaging, the likelihood that other useful PET tracers will be approved for clinical applications, and the enthusiasm with which the larger radiology community has embraced PET/CT, the future of single-photon scintigraphy in diagnostic imaging is a relevant discussion for nuclear medicine and radiology departments. Decisions have to be made about the allocation of funds, space, and physician training.

Breast imaging facilities may come under increased regulatory scrutiny, as new recommendations prepared for Congress call for additional data tracking and mandatory accreditation for breast ultrasound and MRI. The report also includes suggestions to offset financial burdens incurred by centers adopting these new measures.

The 2005 Society for Cardiovascular Magnetic Resonance meeting reflected the opportunities and challenges unique to this diagnostic imaging discipline. Cardiac MR's growing professional acceptance helped spur a third consecutive attendance record this year, and the number of scientific papers and posters submitted for presentation rose as well.

Answers to an examination request are never read by referring physicians; they have to be verbally transmitted by the radiologist, preferably while that radiologist is in the middle of another complex case.

As more women in the U.S. turn to mammography to detect breast cancer, the availability of mammographers and technologists certified for breast imaging is decreasing, according to a survey published in the May issue of Radiology.

Over the years, we've grown comfortable and familiar with the digital revolution in radiology. Actually, in many quarters it is no longer a revolution but an accomplished fact.

Heart rate and CT density at the aortic root significantly affect image quality in coronary CT angiography, according to a study presented at the European Congress of Radiology.

Orbis has a new look: a graphical user interface called NICE (new interface for cool ergonomics). NICE integrates international standards, thereby laying the groundwork for expansion of the Orbis installed base beyond its stronghold in western Europe. Orbis is a suite of hospital IT applications developed by Agfa’s latest corporate acquisition GWI that operates at more than 2000 medical sites in Germany, Austria, Switzerland, and France. The standardized interface allows individual adaptation, which optimizes the ergonomics of Orbis, according to the company. GWI demonstrated the new interface at the Information Technology for Healthcare trade show in Frankfurt in April.

Over the years, we've grown comfortable and familiar with the digital revolution in radiology. Actually, in many quarters it is no longer a revolution but an accomplished fact.

Times are tough for breast centers. Reimbursement rates are flat, while costs for labor and supplies are climbing. In any other business, managers would be tempted to cut corners to make ends meet. But this is breast care.

The 2005 Society for Cardiovascular Magnetic Resonance meeting reflected the opportunities and challenges unique to this diagnostic imaging discipline. Cardiac MR's growing professional acceptance helped spur a third consecutive attendance record this year, and the number of scientific papers and posters submitted for presentation rose as well.

Overall penetration of the electronic medical record is relatively low in the U.S. And the gap in its adoption between large, well-financed organizations and smaller, cash-strapped physician practices is even larger, according to presenters at the American Medical Informatics Association meeting in Boston.

I entered private practice on a full-time basis in 1984, having quit my position in a state-run general hospital following a disagreement over lack of funding for continuing medical education. The imaging center that I joined had just been granted permission to buy a CT scanner. This would not be news today. But 20 years ago, establishment of a private CT center in Sarcelles, a suburban town 15 km north of Paris, was news indeed. CT scanners were scarce in France, and procedures required users to attain a certificate of need, which was a very cumbersome process.