American College of Radiology blog

Is Radiology Recession-Proof?

As more Americans are feeling the effects of the economy, it should come as no surprise that people are opting out of health care. The primary reason? Costs.

A survey of 12,000 Americans released last week found that about 20 percent of Americans have skipped medical care. About the same percentage thought they would have a difficult time paying for medical care in the future. However, only about 8 percent of those surveyed indicated skipping some form of medical imaging. More than half said they skipped a doctor’s visit.

Does that mean that Americans value medical imaging over a visit to their primary care doctor? That would be hard to determine from this one study. But it is something to think about.

The College is interested in knowing what you think.

• Has your practice or hospital experienced any effects from the economy?

• Or, have patients cancelled any imaging studies due to costs?

I look forward to hearing your thoughts.

ACR, Patient Groups, Industry Make Case for CTC Coverage

Despite significant evidence of CT colonography’s effectiveness as a screening tool for colorectal cancer, on Feb. 11, the Centers for Medicare and Medicaid Services (CMS) announced a proposed decision not to cover the exam, stating that the evidence was inadequate to conclude that CTC would provide health benefits to the average Medicare beneficiary.

In the CMS proposed decision memo, opponents to coverage cited unknown effects from radiation exposure associated with the exam, questions as to the amount of training necessary to properly read the exam, and concern that it would be difficult to generalize the results of the ACRIN CT Colonography Trial to the average practice setting and specifically to the Medicare population.

The ACR and other societies have been working together to reverse CMS’s proposal by educating members of Congress that using CTC as a screening method for colorectal cancer will help more people to get screened, aid in early detection and ultimately help save lives.

At a Capitol Hill briefing last Monday, Elizabeth McFarland, M.D., chair of the ACR Colon Cancer Committee, made a presentation to congressional and regulatory staff members on behalf of the College as to the effectiveness and importance of this exam. In response to these efforts, several lawmakers have signed on to letters written to CMS urging them to cover CTC.

In a letter to the editor published in Saturday’s New York Times, Andrew R. Spiegel, chief executive of the Colon Cancer Alliance, Ilyse Schuman, managing director of the Medical Imaging and Technology Alliance, and myself, reinforced the proven cost-effectiveness of CTC as well as its “potential to enhance colon cancer screening compliance.”

The 30-day public comment period for the proposal ended on Friday, CMS is expected to make a final (at least for the immediate future) decision on coverage by May 12.

For those of you who currently offer/perform CTC:

• Has your practice seen an increase in CTC volume since the results of the ACRIN study were published in the New England Journal of Medicine last fall or a decrease since CMS proposed not to cover the exam?

And if you do not currently offer/perform CTC:

• Will Medicare’s final coverage decision determine whether or not you add this exam to your practice or seek out training?
  
  

I look forward to your thoughts.

Savings Through Spending: Obama’s Budget Announced

On Thursday, President Obama announced his $3.6 trillion budget plan for the 2010 fiscal year. The plan would create a “health care reserve” costing $634 billion over 10 years, in an effort to provide universal health coverage. Tax increases and cuts to Medicare and Medicaid would fund the reserve.

According to the plan, increased spending on insuring all Americans upfront will save money in the long run, because patients will seek out care and engage in preventative measures to reduce the occurrence of chronic (and often costly) diseases.

The proposed plan would seek to control imaging costs through the use of radiology benefit management companies in the Medicare program. The ACR, however, has argued that the use of Appropriateness Criteria in an order entry system is a better way to monitor imaging, and ensures that patients receive the best study for their condition in a timely manner.

Other health care measures in the plan include:

• $1 billion to the FDA to improve food safety
• $6 billion for cancer research
• $76.8 billion toward EMR adoption and medical treatment comparison
• $330 million toward addressing doctor and nurse shortages

What do you think about the budget plan in terms of health care reform?

What do you think are the strengths and shortcomings of the plan?

I look forward to your comments.

How We’ll Tackle 2009

Get organized …
Lend a hand …
Listen more …

These may seem like your basic list of New Year’s resolutions, but they’re actually taken straight from our colleagues in the field.

In the latest edition of ADVANCE for Imaging and Radiation Therapy Professionals, I offered my vision for what the ACR would put forward in 2009. You can read what I (and others) had to say here.

It’s no secret that we will face another round of hard issues in the year ahead. With the Obama Administration taking office in just a few days, there are already items on the table that will affect us. Prior authorization is one of them; changes to how Medicare reimburses for the technical component of imaging exams is another.

Education and advocacy remain at the heart of the College’s mission, and we will continue to strengthen our presence in the face of the forthcoming health care legislation.

There are a great many items on the agenda for 2009. New courses will be added to the ACR Education Center over the next few months. ACR staff is working to tailor your membership to your needs, using the newly launched Practice of Radiology Environment Database (PRED), and much more.

Despite any challenges we encounter this year (and there will be challenges), the ACR will remain at the forefront to lead the way. Please write in with what you think radiology’s biggest challenges are for the coming year and how you think the ACR can help.

I very much look forward to your input.

ACR, Alliance for Radiation Safety in Pediatric Imaging Launch “Image Gently™” Campaign to Publicize Proper Radiation Dose for Children

The College has joined the Alliance for Radiation Safety in Pediatric Imaging, a coalition of medical organizations and government bodies, to launch the “Image Gently” campaign, which focuses on informing medical imaging professionals about opportunities to lower radiation dose used in pediatric imaging.

Children obviously have smaller bodies than adults and the Alliance want to ensure that imaging providers are accounting for the potential adverse affects imaging could have on younger patients as the grow. As part of this effort, the College and all Alliance member organizations urge that, when performing imaging exams on children, providers:

 Significantly reduce, or “child-size,” the amount of radiation used

 Not over-scan:
- Scan only when necessary
- Scan only the indicated region
- Scan once; multi phase scanning (pre-and post contrast, delayed exams) is rarely helpful

 Be a team player:
- Involve medical physicists to monitor pediatric CT techniques 
- Involve technologists to optimize scanning

The Image Gently Web site (www.imagegently.org) was developed as a resource for all radiology professionals. It includes educational material as well as imaging protocols. We ask that you share this important with your imaging staff and referring physicians. Remember, what we do now will affect children for their lifetime. I hope you take the time to review the educational material on the Image Gently Web site (www.imagegently.org) and familiarize yourself with the information the ACR will be providing you in the coming weeks.

Here are some statistics:

 4 million pediatric CT scans were performed in 2006
 The number of pediatric CT scans performed in the United States has tripled in the last five years

Questions for you:

• Have you noticed an increase in pediatric imaging over the course of your careers?
• Do you have any suggestions for lowering CT dose in pediatric patients that perhaps were not included in the Image Gently Web site?

I look forward to hearing your thoughts.

Presidential Candidate Health Plans: Exactly Where Do They Stand?

You have, no doubt, heard the 2008 Presidential candidates speak about their health care plans and how they think that their plans will fix what is wrong with America’s health care system.

It occurred to me in watching the endless hours of coverage on television that you might want to see in black and white exactly what the candidates’ plans are.

Click here to read a table that ACR staff has put together regarding the health plans of the major candidates in quick, bullet point form.

What do you think are the strong points and shortcoming of some of these plans?

Did the Recent NEJM Article Overstate Any Cancer Risk Associated With CT Scans?

An article titled, Computed Tomography-An Increasing Source of Radiation Exposure, published in the Nov. 29 issue of the New England Journal of Medicine (NEJM) has re-ignited a firestorm in the medical community and created confusion in the minds of many of our patients.

The study claimed that up to 2 percent of all cancers in the United States may be caused by radiation received from CT scans and equates radiation exposure and effects experienced by many atomic bomb survivors in Japan to present day patients who receive computed tomography (CT) scans.

The ACR immediately issued a response in order to allay patient fears engendered by media reports on the study, lay out what the radiology community has been doing to address radiation risk, and help give physicians some guidance on what they might say to their patients. The response was referenced in many newspaper articles nationwide and I was interviewed by several newspapers regarding this issue.

But, I wanted to find out what you think about the utilization of CT and any associated cancer risk. Please write in with your thoughts regarding how CT is being utilized and whether you think the cancer risk was overstated in the NEJM article. I look forward to hearing what you have to say.

Nephrogenic systemic fibrosis in relation to gadolinium based contrast agents for MRI

There has been a lot of discussion on nephrogenic systemic fibrosis in relation to gadolinium based contrast agents for MRI.

The ACR Safety Commission recently posted Updated ACR Screening Recommendations on Gadolinium-Based MR Contrast Agents, Renal Disease Patients, and Nephrogenic Systemic Fibrosis (NSF) to the MR Safety section of the ACR Web site. There is also a special section (page 12) on NSF in the ACR Guidance Document for Safe MR Practices.

I hope that members are taking advantage of these resources. The College would like to know how recent events associated with NSF may be changing your daily practice.

For instance:

• Since the association between gadolinium contrast agents and NSF has become known, are you doing fewer contrast enhanced MRI examinations? 

• Have you reviewed your policies and/or procedures, particularly for at-risk patients?

What are your thought on these questions?

• Concerning use of IV gadolinium contrast agents, should patients with eGFR between 30 and 60 be treated any differently than those with better renal function?

• How do you feel patients should be screened for risk of NSF associated with gadolinium contrast?

I look forward to reading your comments.

CT Colonography in the News

You have probably read about the CT Colonography study highlighted in this week’s New England Journal of Medicine and asked:

1)Is this the study conducted by the American College of Radiology Imaging Network?

2) What is the difference between the study published in NEJM this week and the ACRIN study?

3) Why has the ACR not released further details or made an official statement?

The answers are:

1) The NEJM study is not the ACRIN trial. The study published in NEJM is a large single site trial whose principal investigator is ACR member, David H. Kim, M.D., of the University of Wisconsin. 

2) The ACRIN trial is a large, multicenter trial. ACR member, C. Daniel Johnson of the Mayo Clinic, Scottsdale, Arizona is the principal investigator. He presented the results of the trial at the ACRIN meeting last week.

3) Because it has not been published yet, neither the ACR nor ACRIN can make further details available, in accordance with the publication guidelines of the major scientific journals. The ACRIN trial is expected to be published in the coming months, at which time the College will use every available avenue to give members the latest on this important trial and continues to educate government and private payers as to the benefits and limitations of CTC.

In the meantime, I want to know your take on CT colonography. If studies continue to show the viability of the exam as a screening tool, do you think that you or your colleagues will seek out training in the technique? How do you see the performance of CTC fitting into your practice?

Let’s Talk!

Harvey L. Neiman M.D. FACR
Executive Director
American College of Radiology

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