Facility Management

"Bones! You've got to do something."

A powerful clinical case can be made for using cardiac CT angiography as a screening tool to help avoid cardiac catheterization. But does the technique make financial sense in nonemergent cases? A new cost-effectiveness study says yes -- if the price is right.

Tumors require new blood vessels in order to grow beyond a few millimeters in size. Once this "angiogenic switch" is thrown, a series of events occur that lead to the progression and spread of cancer. The vessels formed by tumors are not only larger and more numerous but also more permeable than normal vessels1 (Figure 1). Thus, when a patient with a tumor is injected with a gadolinium-chelate MR contrast agent, the tumor enhances more than the surrounding normal tissue.

Of the $120 billion spent on healthcare in the U.S. annually, about 10% to 20% is wasted on inappropriate treatment. What if some of those funds were invested in enterprise information systems? Imagine the possibility of routinely using such systems to identify trends in medical imaging procedures and highlight potential errors, inaccuracies, and waste.

Working smarter is a critical element of improving workflow. At the Society for Computer Applications in Radiology meeting today, Cerner unveiled a work-in-progress that addresses that point head on.

Carrie Becks, president of RED Marketing and Jerry Dalrymple, MD, owner and medical director of Parkview Imaging, outline the essentials for communicating with patients and referrers.

Revenue from the delivery of new CT units in the U.S. last year grew 15% compared with the previous year, and unit volume rose about 3%, making 2005 the best sales year in the history of the modality. The availability of 64-slice scanners capable of coronary CT angiography led the industry to those heights. This year, however, vendors are just hoping to hold onto last year’s gains.

Radiofrequency ablation is a growing part of the practice established by interventional radiologist Dr. Paul Christy and his partners at Methodist Hospitals’ Interventional Radiology Center in Omaha. Most of their RFA practice focuses on lung tumors, but they also treat tumors of the liver and bone. The 13-person group includes one part-time and two full-time interventional radiologists, as well as medical oncologists, radiation oncologists, surgeons, and other specialists.

Larry Dentice wants to take Toshiba America Medical Systems to the next level. TAMS is coming off a stellar year during which sales rose 25%, but to continue that growth the company must make some refinements, according to its new general manager.

Teleradiology has apparently come of age. Imaging examinations can be sent via high-speed connections to anywhere in the world, at increasingly low cost. Teleradiology also appears to be a profitable business. Take, for example, the services emerging to cover the night shift for U.S. radiologists. Teleradiology Solutions and TeleDiagnosys Services are just two of the many enterprises in the field, both offering this service from a base in India.

Efficiency is driving the IT market, and brokerless information exchange is driving efficiency at institutions deploying IT products from Misys Healthcare Systems.

Diagnostic radiologists are the most important physicians patients will never meet. They are the M.D. equivalent of pharmacists, taking orders from attending physicians and filling orders, hovering in the shadows of medical care, and observing what’s going on but not participating.

Demand dropped for gamma cameras in 2005, while it boomed for PET/CT. Trends driving this teeter-totter market, which links these two related but very different modalities, are continuing but moderating, according to industry sources.

Congressional moves to cut Medicare payments for outpatient imaging procedures tops the list of what worries executives at Toshiba America Medical Systems. But reimbursement problems won’t stop the company from developing and promoting new imaging technologies.

Yale University researchers have introduced an endovascular technique that takes up a notch the embolization of the varicose veins that cause varicoceles and chronic pelvic pain.

A new CPT code set to take effect July 1 might serve as an added incentive for the purchase of computer-aided detection systems for breast MR. But Confirma, the leader in MR CAD, isn’t counting on it to boost sales.

Diagnostic radiologists are the most important physicians patients will never meet. They are the M.D. equivalent of pharmacists, taking orders from attending physicians and filling orders, hovering in the shadows of medical care, and observing what’s going on but not participating.

Optical imaging may soon enter the medical mainstream with a handheld device that developers say will help providers of emergency care quickly diagnose brain hematomas.

An electronic form of brachytherapy could propel radiotherapy beyond oncology clinics and into radiology departments and possibly even imaging centers.

Patients often ask sonographer Cynthia Rapp just what it takes to perform ultrasound. Her frank response about the necessary qualifications sometimes comes as a surprise.

Convincing evidence suggests that, as suspected, managed care companies lack the ability to properly adjudicate claims and pay the contracted amount for services rendered.

While clinical data supporting the effectiveness of tumor ablation is growing, educational opportunities for physicians who want to learn new techniques or get tips on developing a tumor ablation practice lag behind. Some training is available through CME courses, industry society events, vendor education, and informal arrangements with luminaries, but large-scale, organized training regimens do not yet exist.

No better way exists than functional MRI to plot the intricate neural pathways of the brain. Neurosurgeons regularly call on this technique to plan surgical routes around eloquent brain areas, yet fMRI’s potential has remained untapped, largely due to benign neglect on the part of developers and third-party payers. The recent formation of a society dedicated to fMRI might change that situation.

Any reputation for excellence that Roxborough Memorial Hospital in Philadelphia might have tends to be eclipsed by its larger academic neighbors. Dr. Robert Worthington-Kirsch, however, wouldn't trade the small-town flavor of Roxborough Memorial for the publish-or-perish world of academic centers. It helps that he doesn't need to, as he is one of a handful of successful solo interventional radiology practitioners in the nation.

Convincing evidence suggests that, as suspected, managed care companies lack the ability to properly adjudicate claims and pay the contracted amount for services rendered. As a result, every radiology practice must routinely verify managed care payment compliance by tracking and reporting third-party payment practices.

Although musculoskeletal radiologists have long debated the relative roles of MRI and ultrasound in imaging shoulder injuries, they have reached consensus on a number of diagnostic algorithms. But the proliferation of inexpensive, low-end compact ultrasound systems has introduced a new controversy.

Hot on the heels of a successful 3D workstation face-off at last year's meeting, the Society for Computed Body Tomography and Magnetic Resonance this year has invited PACS vendors to submit their systems for what will be the first ever PACS showdown.

The adoption of new imaging technologies presents multiple challenges to hospitals, radiologists, cardiologists, payers, and vendors. Sixty-four-slice CT, which has enabled the clinical evolution and market adoption of coronary CT angiography, is not a disruptive technology. But CCTA is, as evidenced by questions raised about its clinical impact and the push for new credentialing standards by organizations.

The American College of Radiology and the American College of Cardiology called a truce in their turf battle over cardiac CT to jointly write a document intended to help local Medicare insurers set the terms for the acceptance and coverage of cardiac CT procedures.

Before considering revascularization procedures, surgeons want proof of ischemia. While catheter angiography has value in assessing lesions associated with coronary artery disease, it cannot assess the associated ischemia. PET imaging is increasingly being used to provide that information. With the rise of multislice CT angiography as a first-line test for patients with suspected CAD, researchers have set their sights on integrated PET/CT for combined acquisition of coronary anatomy and perfusion.