Facility Management

Pacific Coast Ultrasound of Los Alamitos, CA, operates at the nexus between medical need and self-indulgence, specializing in prenatal diagnostics and medically supervised 3D/4D prenatal elective ultrasounds. Throughout February, the center, which positions itself as a certified independent diagnostic facility, promotes a month-long tribute to Valentine’s Day.

For the better part of a year, imaging industry analysts have been studying and hypothesizing about the impact of the Deficit Reduction Act. I considered myself an optimist throughout most of last year, believing that an idea this bad would not make it into practice, at least not in 2007.

Expanded coverage for PET drove demand for procedures in 2006, helping push unit sales, which also benefited from local pressures on providers to keep up with the competition. Demand for upgrading the installed base to PET/CT from dedicated PET could bolster sales in the near term, just as the popularity of the modality continues to rise.

The shortage of radiologists, coupled with an increase in imaging studies ordered per patient and improved technology, has assured the meteoric rise of teleradiology. It is clearly a burgeoning field in the healthcare delivery system.

Researchers in Germany have found that low-dose 64-slice CT colonography accurately detects colorectal polyps in a screening population and tested a new visualization tool that streamlines interpretation. They released their studies at the 2006 RSNA meeting.

Millions of dollars may have been spent on the latest CT, PET, MRI, or other digital modality in your imaging center. The purchase of a PACS, RIS, or electronic medical records system may have been made, too.

The dramatic rise of informatics in healthcare in the past decade has benefited radiology perhaps more than any other medical specialty. The digitization of image creation, storage, and retrieval has nudged radiology even closer to the core of medical practice.

Over the years, we've had the privilege of checking the vital signs of many imaging modalities. Diagnostic Imaging served as a witness to the rise and fall of digital subtraction angiography and reported the PET crisis of the mid-1990s.

As the Super Bowl and college basketball’s March Madness draw near, bookies in Las Vegas are narrowing their picks and setting the odds. They have a matrix for choosing winners and losers. Season records, players, injuries, home team advantage, time off between games, and even expected weather conditions all play a part in their picks.

Capping two years of development, Naviscan PET Systems of San Diego launched at the 2006 RSNA meeting a second generation of its PET product line, PEM Flex Solo II. The compact high-resolution scanner is optimized to assess breast lesions metabolically, although it could image other small body parts.

When their hospital clients number in the hundreds, big teleradiology firms have to be efficient. Now two companies are making the same technologies and services that made them successful available to small fry. At the 2006 RSNA meeting, NightHawk and Virtual Radiologic unveiled plans to make productivity tools and resources developed for in-house use available to clients.

Those acquainted with Dr. Marc S. Levine could sum up his curriculum vitae with an inspiring statement: "unsung hero of double-contrast barium radiography." Affable and witty, Levine has led the gastrointestinal imaging section at the University of Pennsylvania Hospital since 1998 and topped last year by winning the Eminent Scientist of the Year Award from the International Research Promotion Council for helping to improve medicine in developing countries.

Radiology practices face serious challenges to their financial health. Reimbursement is under almost continuous attack, with the latest salvo arising from the Deficit Reduction Act and threats of worse to come in the near future.

Burned out and discouraged, many physicians consider chucking their careers because of the state of healthcare today, according to a survey of physician morale conducted by the American College of Physician Executives.

Half of the people in the U.S. older than 50 could suffer fractures caused by osteoporosis over the next 13 years, according to a 2005 Surgeon General's report. Such ominous predictions move musculoskeletal conditions to the top of a long list of chronic diseases confronting baby boomers.

As if haunted by some kind of Ghost of Healthcare Future, the latest crop of breast imaging papers reported at the RSNA meeting conveyed an ominous undercurrent of uncertainty.

'Tis the season for congressional wrangling over Medicare reimbursement to physicians. Before the 109th Congress adjourned, it did not eliminate reimbursement reductions to the technical side of imaging, which come from two reimbursement reductions included in the Deficient Reduction Act of 2005. Private payers also will be very quick to take advantage of these cuts, if they haven't already.

At the RSNA meeting this year, I found that customers are focusing on upgradeability and low-cost entry rather than the latest and greatest 3T MRI. I surmise that many vendors at the RSNA are sensing this change of heart and mindset.

Clinical extensions will be the main thrust of MR vendors in the year ahead. Breast, orthopedic, and cardiac MR will take on added weight. Speed will continue to be an issue as companies attack motion artifacts accompanying scans as one means to extend clinical capability. Efforts will focus on making results more reproducible and less dependent on the skill of operators.

The good news is that Congress passed a bill that eliminated a reduction in Medicare physician payment for 2007. The bad news is that it had no money left over to reverse or delay the huge imaging reimbursement cuts called for in the Deficit Reduction Act.

Lame duck lawmakers, as well those staying on for the 110th Congress, are feeling the heat from the imaging community to delay the implementation of draconian reimbursement cuts slated to take effect in less than a month.

Contrary to popular practice, both pre- and postcontrast imaging is necessary for proper MR evaluation of articular cartilage repair, according to new research conducted in Japan. The small study could carry implications for treatment evaluation.

Radiologists face a choice between relinquishing control of ultrasound for good or reclaiming a modality that could thrive in their hands through the next decade. An indication of which way the specialty is leaning can be gleaned from an October seminar in which luminaries dissected practice trends and applications in use of ultrasound.

GE Healthcare's latest invention, SnapShot Cine, is a multislice CT software enhancement that borrows its method from the days of axial scanning. The big difference is that it cuts the x-ray dose for cardiac scans by 70% or more compared with conventional CT.

Over the last five years, outsourcing has become a global trend in business because, when performed properly, it can produce efficiencies not attainable when these functions are performed internally by an organization. Although outsourcing has existed in radiology practice for some time, its use has recently risen, driven by a more competitive marketplace and the need to increase efficiencies. Businesses must find the most efficient way to produce their goods if they are to remain competitive and profitable.

I recently completed a task that we expect will lead to a more refined search engine for the Diagnostic Imaging Web site and those of our sister publications at CMPMedica. The project required perusing some 400-plus articles in the radiology literature from the past 30 years, covering every conceivable subcategory, and tagging those that best define each clinical application and modality. It involved some tedious parsing of wheat from chaff but provided ample opportunity for reflection on how far radiology has come.

Cardiologists impressed by the diagnostic power of PET/CT are beginning to recognize its clinical importance. In sites where the transition from PET to PET/CT has been made, rising cardiac PET imaging volumes have followed.

Carbon-11 tracer's 20-minute half life makes it too expensive for most community hospitals, but it can minimize radiation exposure and enable repeat measurements without interference from previous studies.