Health Technology Forecast survey predicts ultrasound expansion

Healthcare facilities should begin planning to implement digital radiography, including a full digital information infrastructure such as a PACS.

So says the latest edition of the Health Technology Forecast, which offers specific recommendations on hundreds of technologies in dozens of areas, including healthcare information systems, respiratory care, women’s healthcare, neurosciences, and diagnostic imaging.

Although plain film imaging still represents 70% of procedures performed in radiology departments, according to the report, digital systems offer substantial cost and storage advantages, after the initial infrastructure and equipment are in place.

The Forecast sees an expanded role for ultrasound, whose relative low cost, noninvasiveness, absence of ionizing radiation, and ability to provide real-time images make it attractive to thousands of imaging departments. Given the highly competitive market for ultrasound, hospitals should be able to negotiate discounts up to 25%, the report says.

Price discounts should also be available in CT, MRI, and SPECT, according to the report. Many facilities are replacing older scanners with spiral CT and multislice systems, and there is increased interest in electron beam CT (EBT) to evaluate heart disease. CT scanners are being used more frequently for detection of blood vessel stenosis and for radiation treatment planning before radiation therapy, as with Siemens Somatom Plus 4 CT system, which can be set up in a radiation therapy treatment room to give almost-real-time images to the radiation oncologist (SCAN, 2/15/00).

The areas of MRI sales especially likely to see growth are high-field and low-field, with specialized systems coming to the fore, the report says. Although it has some drawbacks, breast MRI offers screening advantages in some situations. Smaller bore systems are useful for imaging extremities such as the foot, knee, shoulder, or wrist, although their limited use has so far kept most hospitals from buying them.

MR angiography is replacing x-ray angiography in some applications, as MRA emits no ionizing radiation and uses no contrast agent, reducing the procedure’s risk. It is particularly useful for assessing carotid artery stenosis, according to the Forecast.

Nuclear medicine studies are available through a variety of systems and the report advises buyers to look carefully at the number and types of studies to be performed before purchasing a system. Medicare will reimburse some single-photon emission CT (SPECT) procedures, which should stimulate its use.

Medicare coverage is also giving PET a boost. Although PET imaging is now used mostly in oncology, the technology is finding increasing popularity for cardiovascular studies. Despite widespread reimbursement availability, the report’s authors advise against most facilities acquiring this technology. They argue that regional PET centers offer the most cost-effective approach to sharing the financial burden of installing PET (although not mentioned in the report, the new mobile systems are an affordable on-site alternative for studies using the radiopharmaceutical rubidium, which can be prepared in the unit).

The report also discusses such alternative cardiovascular diagnostic studies as intravascular ultrasound and digital angiography and suggests they will compete with x-ray. The Health Technology Forecast predicts there will be 3 million cardiac catheterizations performed annually by 2010.

The 76-page report is mostly text with a few tables. It has been compiled from other ECRI publications and resources and was written by the agency’s in-house experts. ECRI is a nonprofit health services agency funded by the federal government and a healthcare technology assessment center of the World Health Organization. For information on purchasing the Health Technology Forecast, write ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, or telephone 610/825-6000, ext. 5888.