Facility Management

Balancing the benefits of a procedure involving ionizing radiation against the possibility of unwanted damage is often difficult. Regulations on exposure must consider medical, economic, and ethical aspects of radiation as well as the individual and collective dose of the population.

Although neurosurgeons depend on preoperative functional MRI to map eloquent brain areas, technique standards need strengthening and reimbursement is nonexistent. The recent formation of a dedicated fMRI society is serving to galvanize interest and search for solutions to these and other issues, according to a Wednesday panel discussion.

For radiology to move into the digital arena in underserved areas around the world, financial, cultural, and technological stumbling blocks have to be removed, according to a case study presented Tuesday at the RSNA meeting.

Excluding stroke patients for thrombolysis based on an established rating of early ischemic changes on CT may not be obligatory, according to a study in the October issue of Stroke.

The Centers for Medicare and Medicaid Services has approved a new CPT code to reimburse hospitals specifically for radiofrequency ablation of kidney tumors. CMS also provided new payment classifications and higher payment rates for existing RFA-related procedures.

The Centers for Medicare and Medicaid Services has approved a new CPT code to reimburse hospitals specifically for radiofrequency ablation of kidney tumors. CMS also provided new payment classifications and higher payment rates for existing RFA-related procedures.

Tracking information about workflow, payment, and outcomes has never been more important for breast imaging centers. Some clinical and technical data collection has long been mandated by the Mammography Quality Standards Act, and new recommendations by the Institute of Medicine could require centers to step up their efforts.

The U.S. Senate last week passed a budget reconciliation bill that includes an amendment to fund a one-time ultrasound screening for abdominal aortic aneurysms.

Dr. Francis Facchini, an attending radiologist at Decatur Memorial Hospital and an assistant professor at Northwestern University’s Feinberg School of Medicine, is one of three dedicated interventional radiologists performing radiofrequency ablation and other tumor ablation procedures in the hospital’s cancer practice. He spoke to Diagnostic Imaging’s Tumor Ablation Clinic about the practical aspects of incorporating RFA into a cancer practice and what role he expects the technology to play in the future.

What does it take to incorporate radiofrequency ablation into a successful cancer practice? Time, money, and skills, to be sure, but also a shift in the way physicians think about modalities, specialties, and the disease itself. The Cancer Care Institute at Decatur Memorial Hospital in Illinois is one practice that has successfully incorporated RFA into its treatment options. Here’s how they did it.

As carotid artery stenting becomes an accepted tool for stroke prevention in appropriate patients, interventional radiologists and neuroradiologists are determining where this procedure fits into their practice. Some have already developed an active carotid artery stenting practice, but others are looking for resources to help them begin to offer this service. Consideration of many elements is required to offer a high-quality service.

Diagnostic imaging's crucial role in medical practice is affirmed by the eagerness with which referring physicians have embraced diagnostic ultrasound, MR, CT, and nuclear medicine for an ever-lengthening list of clinical roles. Evidence now suggests that referring physicians appreciate diagnostic imaging so much, for both clinical and financial reasons, that a growing number are intent on making it their own. They are using exemptions in federal antireferral law that allow them to add high-tech imaging to their menu of in-office services.

"Few radiologists understand preventive cardiology. They are enamored with less noisy pictures, and that's it. And few traditionally trained cardiologists care about coronary prevention and risk stratification of the asymptomatic person. Prevention falls to the primary-care doctor who, sadly, witnesses the specialists' apathy.

PET/CT has come a long way. Improved PET detectors with better optical response, faster electronics, and software that rapidly matches CT and PET scans have dramatically advanced the hybrids, promising whole-body exams in 15 minutes or less. Yet nothing says progress like number of slices. The CT component has marched forward from quadslice to eight-slice, then from eight to 16. Now 64-slice PET/CT is at hand.

To paraphrase Mark Twain, reports of the death of diagnostic MR spectroscopy are greatly exaggerated. CPT 76390 is considered standard of care as an effective imaging technique for the diagnosis, treatment, and monitoring of patients with brain lesions by Cigna Healthcare, a respected healthcare provider,1 though declared "investigational" by Blue Shield, Anthem, and Medicare. Radiologists and other physicians are confused and annoyed by some insurers' refusal to reimburse for their MRS services.

Radiologists' transition from reliance on axial views to 3D interpretation of multislice CT data is not a question of if, but when. The increasing data load of 16- and 64-slice scanners challenges efficiency, as does the rise in imaging volume overall. The need to interpret more cases in less time will continue to put pressure on radiologists. But users at a range of sites, from academic centers to private practice, say 3D techniques are one way to work smarter instead of harder.

Discoveries relating to the imaging of hypoxia, angiogenesis, and ligand receptors demonstrate the scientific prowess of the In vivo Cellular Molecular Imaging Center at Johns Hopkins University and justify its reputation as one of the top molecular imaging laboratories in the world.

Guaranteed profits with no financial risk: That is the lure of "per-click" leasing. The in-office imaging strategy promises to make self-referral financially safe and operationally easy to execute, according to attorney Thomas Greeson.

Digital mammography's superiority over film in cancer detection in select patients took industry watchers and researchers by surprise. While proponents hoped for a best-case scenario of a clinical draw between the two techniques, few expected digital to excel.

Exquisite images of the brain, spine, body, and joints will adorn vendors' booths at the RSNA meeting, attesting to the benefits of clinical 3T. But, unlike the many ultrahigh-field MR scans that vendors have displayed in the past, most of these 3T images will come from systems designed for everyday clinical practice.

Vendors have created CT scanners for every price point and clinical need, and medical facilities are snapping them up.

Doves like truces. A truce gives the two sides a chance to enjoy peace, if only for a short time. Maybe they’ll like it enough to stop fighting altogether, or so the thinking goes.

Doves like truces. A truce gives the two sides a chance to enjoy peace, if only for a short time. Maybe they’ll like it enough to stop fighting altogether, or so the thinking goes.

Inland Imaging center in Spokane has found a unique way to avoid the usual friction between hospitals and radiology groups by hosting a PACS for its largest partner hospital.

Virtual colonoscopy is likely to perform well in the American College of Radiology Imaging Network Trial, but the result could be a $2 billion boost in national colon cancer screening costs, according to a presentation Monday at the Sixth Annual Virtual Colonoscopy Symposium in Boston.

Clinical data are mounting to show that radiofrequency ablation of small kidney tumors is a safe, effective alternative to open or laparoscopic resection. Distinct intervention protocols and complementary techniques could further boost RFA’s efficacy and expand its application to areas previously deemed unsafe.

Radiologists have seized control of imaging to measure bone mineral density, increasing their turf by 20% in a six-year period, according to researchers from Thomas Jefferson University.

The FDA wants to alter how PET radiopharmaceuticals are regulated, though the proposed changes may not take effect until 2008.

Today's log at the imaging center shows 15 patients scheduled for different examinations. Most come with abdominal or musculoskeletal symptoms, and almost half of them are overweight. The daytime sonographer called in sick earlier, so the radiologist needs to make a tough call: Does she perform 15 ultrasound exams herself or does she shuttle everyone through to any of the CT or MR scanners available?

Dr. James H. Thrall's column "Utilization management steps onto center stage" (July, page 29) carries the subtitle "Referring physicians and radiologists must wrestle decision making back from insurers," prompting the question, Was decision making usurped or abandoned? As chief medical officer of CareCore National, one of the aggravating "1-800 programs" Thrall refers to, I present a perspective from the other side.