Is the party over for high-tech imaging's sustained growth?

Is it the end of an era, or only a short breather before the next growth spurt begins? Only time and hindsight will tell us, but what is clear right now is that the constant growth in high-tech CT and MR imaging has stalled out. As shown in our Overread article, “CT, MR volumes starting to plunge, several experts say”, the steady gains in CT and MR volumes that were a staple for more than a decade have stopped. According to one national expert, volumes plateaued in the second half of 2009 and have declined since then.

The most optimistic observers acknowledge the slowdown but see it as a short-term thing. Once the healthcare reform legislation passed this year takes full effect, 32 million more people will be insured and the pace of imaging will pick up, they reason. This makes sense. We know that lack of insurance dissuades people from seeking care and the size of the uninsured population in the U.S. is considerable.

Some also blame the economy. This too makes sense. Between lack of insurance, high unemployment rates, and copays, referrals for imaging are sure to be down, and down further for the most expensive scans. The good news here is that we can again see an opportunity for recovery as the economy improves and, again, as healthcare reform brings more people onto insurance rolls.

Other problems are more intractable. CT in particular has been hard hit by dose concerns. Never mind that radiology as a community has stepped forward with solutions, or that vendors are more focused on limiting dose-and doing so successfully through techniques like iterative reconstruction-now than they have ever been. Once a perception sinks in, it can be hard to overturn.

Interestingly, the same thing seems not to have happened with MR and contrast-associated nephrogenic systemic fibrosis. More careful screening protocols at MR facilities and an awareness of how limited a pathology this actually is seems to have controlled the damage there.

It's notable that we've been here before. In the mid-1990s, concerns about the Clinton healthcare reform plan and a saturated market walloped MR sales. Similarly, CT volumes and sales didn't really take off until the late 1990s with the advent of multislice scanners. You could argue that the dramatic growth in high-tech scan volumes we've seen through most of this decade was an aberration.

Where to from here? By all indications, probably up. The economy seems to be improving, and not only will healthcare reform add to the insurance rolls and boost utilization, its approval has removed much uncertainty and cleared the way for facilities to once again consider equipment purchases. Reports from vendors suggest increasingly busy marketing departments as prospective customers begin to look at buying new equipment.

Of course, the situation is still far from rosy. Many radiologists will acknowledge that CT has been overused, particularly in emergency departments. But with new systems that reduce radiation dose and more careful efforts to control utilization, as is being demanded by payers, we can still return to a sustainable growth path that has kept innovative imaging at the heart of the diagnostic process. The value provided by CT and MR is just too great for these modalities to be relegated to the sidelines.