Facility Management

This year has been a miserable one for the makers of PET/CT units, so miserable that one vendor-Hitachi Medical Systems of America-has stopped marketing its hybrid scanners. Others are struggling under the weight of a plunge in sales of some 30% compared with the same periods last year.

My physician friend "Bob" recently got fed up with his traditional family medicine practice and dropped out. He didn't quit medicine but decided to buck the rules and reimbursement schedules of third-party payers and create a boutique medical practice.

Breast MR is approaching celebrity status. A raft of expert opinions, notably from the American Cancer Society, has established MR in public and professional minds as a leading means to diagnose cancer among patients at high risk and possibly even among patients in the general population.

In the Promised Land of personalized medicine, roulette-style drug selection is a thing of the past. Eschewing delivery by trial and error, physicians prescribe drugs precisely tailored to a patient's genetic code. Imaging plays a heroic role in targeting the best therapy and monitoring response. Disease is foreseen years ahead of time, when perhaps it can be stopped in its tracks.

A spate of European studies within the last year contributes to the evidence that MRI may soon replace scintigraphy and x-ray to detect bony metastases and soft-tissue involvement.

Representatives of the Access to Medical Imaging Coalition worried that freestanding outpatient imaging was heading toward disaster when they arrived at the White House on Sept. 10 to lobby for support from the Bush administration.

Coronary CT angiography is one of the most promising new applications of CT technology. Despite the increasing number of detectors in CT scanners, however, coronary CT imaging had not solved the key issue: dealing with a structure that is in almost constant motion. That is, until the advent of dual source CT.

Integration of medical informatics systems continues to penetrate deeper into the hospital enterprise, driven by a search for increased efficiencies and better patient care-all on a tight budget. While the integration of radiology information systems and PACS occurs at the radiology department level, the convergence of healthcare informatics reaching across departments and entire enterprises has begun. Orthopedic and women's clinics, cancer and cardiac imaging centers are all adopting digital modalities and attendant support systems.

Barely three years after the introduction of 64-slice CT, Toshiba America Medical Systems will ask the market at this year's RSNA meeting to embrace scanners capable of 256 slices. Siemens Medical Solutions will introduce a 128-slice scanner just one year after releasing its dual-beam CT. Philips will tout newly upgradable CT scanners, and GE Healthcare will demonstrate image quality enhancements that company executives say will deliver soft-tissue contrast similar to that found with MR.

An Arizona woman will always remember the incident that was nearly as frightening as learning that she had cancer. The incident was being left inside a PET/CT scanner after the imaging center was locked up and staff had gone for the day.

In keeping with family tradition, my niece has entered the radiology business. She is getting ready for her first RSNA meeting, and one day she asked me, “As a potential customer, what would you want to see or hear at our booth this year?” Her question, simple as it seemed, was hard to answer.

The Deficit Reduction Act has undercut reimbursements for outpatient centers, ripening the market for consolidation -- and RadNet has been harvesting. The company last week acquired Liberty Pacific MRI of Encino for $2.8 million, the fourth California imaging center RadNet has bought in little more than a month.

The worst effects from the Deficit Reduction Act may be over, according to GE Chairman and CEO Jeffrey R. Immelt. But Pierre-Jean Sivignon, chief financial officer of Koninklijke Philips Electronics, has some reservations.

Strategic moves and executive spin shaped the week.Features: RadNet’s purchase of Liberty Pacific MRI clears the way for strategic and tactical operations-DI SCAN describes how. GE’s Immelt and Philips’ Sivignon spin DRA and logistical problems. Sivignon dodges questions about new products. Siemens launches industry’s lowest priced MRI. The prize behind door number 1.5T (Where’s Monty Hall when you need him?).

Siemens unveils submillion dollar 1.5TPositron readies cardiac PET cameraVarian upgrades brachytherapyNasdaq plans to drop brachytherapy firm

A new multicenter study from Italy shows virtual colonoscopy is comparable to gold standard optical colonoscopy for detecting suspicious lesions in patients at higher than normal risk for colorectal cancer.

Hidden NSF cases appearDel Medical sales boom in 4QWeb tool calculates hand-carried ROIFDA clears low-dose x-rayACRIN Trial looks at cervical cancer UltraRAD recruits new exec

Rule changes slated for adoption by Medicare could be a factor when choosing the type of CT scanner to buy. The changes are part of an effort to diagnose patients earlier.

CT vendors came off the best sales year in their history in 2006, generating $1.75 billion in U.S. sales from new equipment. But they have little to be happy about now.

The imaging community dodged a bullet last week when legislators, heeding radiologists and vendors’ concerns, dropped provisions from a compromise bill to reauthorize the State Children’s Health Insurance Program (SCHIP). Had the provisions been enacted, imaging providers would have suffered even deeper reimbursement cuts than they are already enduring, with potential fallout for equipment vendors following close behind.

The American Society of Radiologic Technologists has changed the focus and name of its 2008 annual meeting.

Compared with optical colonoscopy, CT colonography achieves similar outcomes with a fraction of the number of polypectomies, according to a study of more than 6200 patients from the University of Wisconsin Medical School.

E-Z-EM revels in ACRIN resultsAquarius to strut at RSNA 2007Fonar revenues rise, losses fallMerge rallies usersVarian recruits Stanford oncologist

The topic of radiation dose reduction in CT scanning has produced an abundant literature. One practitioner alone, Dr. Manudeep K. Kalra, head of the Massachusetts General Hospital's CT dose protocol optimization program, has published about 50 papers on the topic.

The extra radiation inherent in new CT technologies has made more urgent the need for strategies to reduce exposure. Two recently published studies address the issue of dose reduction with the latest generation of 64-slice and dual-source scanners.

Medicare has very specific rules regarding how the supervision of diagnostic tests must be performed. To be eligible for payment, testing services in physician offices, independent diagnostic testing facilities, or provider-based entities must comply with the proper level of supervision. An overview of these rules includes the specifics for supervising and billing for services performed using physician extenders.

Small-field-of-view positron imaging, optimized for breast cancer detection, is jockeying for position among several adjuncts to x-ray mammography. A proponent of the technology, Dr. Kathy Schilling, believes it has an edge over MRI.

Questions remain from practitioners, payers, and administrators regarding the economic impact of coronary CT angiography on established diagnostic modalities and the effects on reimbursement within imaging. To address these concerns, we have developed the CCTA Data Registry, which now consists of more than 20,000 cases. Preliminary results indicate that coronary CTA is being utilized appropriately and affects savings for the healthcare system.

Breast ultrasound significantly increases detection of cancers in high-risk women but takes a big toll on the rate of benign biopsies, according to the initial results of a screening trial sponsored by the American College of Radiology Imaging Network and the Avon Foundation.

I read Greg Freiherr's column "Why the NEJM study on CAD is wrong" on your website. Please always keep in mind the following about computer-aided detection: