Radiologists Lead the Pack in Lumbar Punctures

Radiologists are performing more and more lumbar punctures, according to recently published research.

This is an upward trend that has been growing for the past 14 years, said a group of researchers from the Harvey L. Neiman Health Policy Institute. In an article published in the American Journal of Neuroradiology, the team revealed that from 2004 to 2017, the percentage of radiologist-performed procedures increased from 37 percent to 54 percent, largely because fluoroscopic guidance from a radiologist is frequently needed for more complex cases.

The team, led by Derek Johnson, M.D., assistant professor of radiology and neurology at the Mayo Clinic in Rochester, reached this determination after evaluating a 5-percent sample of Medicare beneficiaries – approximately 2.5 million individuals – during the same time frame.

Based on the team’s evaluation, radiologists stood out from the pack for lumbar puncture performance among physicians. Most other specialists either performed fewer procedures, such as neurologists who dropped from 23.5 percent to 10 percent, or stayed roughly the same. The largest absolute increase was seen among non-physician providers – from 4.2 percent in 2004 to 7.5 percent in 2017.

According to their analysis, per 100,000 Medicare beneficiaries, 203.4 lumbar puncture procedures were performed in 2017, up from 163.3 procedures in 2004. From their evaluation, Johnson’s team made several observations:

• The rise in radiologist-conducted procedures was not uniform across all states, but the five most populous – California, Texas, Florida, New York, and Pennsylvania – all saw increases.
• For inpatient and outpatient settings, radiologists were the most common lumbar puncture provider.
• Emergency medicine physicians performed 80 percent of procedures in the emergency department.
• Radiologist-performed lumbar punctures produced a smaller increase in patient co-morbidities over the study period than did procedures performed by non-radiologists.

With more patients reaching Medicare age, providers must be ready to perform these procedure more frequently, said Richard Duszak, M.D., FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University.

“The Medicare-age population is projected to grow from 56 million in 2020 to 94 million in 2060, and a proportionate increase in [lumbar punctures] can be anticipated,” said Duszak, who is also a senior affiliated research fellow at the Neiman Institute. “As demand for [lumbar punctures], thus, increases, both radiology and non-radiologist practices must prepare to fill this growing clinical void.”

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