Facility Management

Hysterectomy and myomectomy still dominate the uterine fibroid treatment options. But specialists, including gynecologists, are gradually gravitating toward minimally invasive alternatives. The pace for change may quicken when definitive long-term outcomes on uterine artery embolization are published later this year.

Ultrasound has long been a prime target in imaging turf wars because it does not employ ionizing radiation. Radiology lost cardiac ultrasound, and it is questionable that the specialty will continue to be a major player in obstetrics.

A clinical imaging study published in The New England Journal of Medicine on Sept. 16 could spark substantial new demand for full-field digital mammography.

As more physicians begin to use FDG-PET for diagnosing Alzheimer's disease, the demand for automated software systems that help interpret complex metabolic scans is increasing. Several new automated expert systems have been developed that can improve diagnostic accuracy and help assess risk for the disease.

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. But regulatory demands are not the only reason for breast centers to make the most of what information systems have to offer.

Advances in electronic image transmission have the potential to change the face of radiology. Using technology supported by PACS and radiology information systems, interpreting radiologists can provide timely services to multiple facilities while practicing "virtually" from almost any location. This capability has allowed entry of international teleradiology into the U.S. market, and it has opened the door to increased competition for interpretation contracts, even across state lines.

Digital mammography is more accurate than film in detecting cancer in women under age 50, those who have dense breasts, and in pre- and perimenopasual women, according to the long-awaited results from the Digital Mammography Screening Trial (DMIST).

PACS appears to be finally coming of age as institutions around the world increasingly recognize the benefits of electronic record keeping. The biggest providers of PACS, the film-turned-PACS vendors could expect this to be the time when they realize earnings from their decade-plus investment in this technology. But it is more complicated than that.

Thirteen years after its passage by Congress, the Mammography Quality Standards Act remains a sore subject for radiologists. While breast imagers unanimously agree that the MQSA has vastly improved mammography quality, they give the rule low marks for its cost and the burdensome details of compliance.

No doubt, the Mammography Quality Standards Act has improved the quality of breast imaging. As this month's cover story clearly establishes, long-time mammographers have seen a decided improvement in clinical practice since the MQSA was adopted in 1992.

Reimbursement for radiofrequency ablation of tumors continues to broaden, with local Medicare agencies and most major insurers covering the procedure for unresectable liver neoplasms. Palliative RFA treatment of bone metastases follows as the next most widely accepted procedure. These positions are bolstered by existing CPT codes for the treatments.

Much has happened in the year since the FDA approved the first MR-guided ultrasound device for the treatment of uterine fibroids. The pioneers of this new product area, InSightec and its imaging partner GE Healthcare, have launched initiatives to find other clinical applications. One is a pivotal trial of ExAblate 2000 for the treatment of breast fibroadenomas. Another combines two feasibility studies of the safety and efficacy of the device for ablating breast cancers and eliminating brain tumors through an intact skull.

The Centers for Medicare and Medicaid Services published today a new code that will reimburse hospitals for the use of tissue plasminogen activator, an effective thrombolytic. The shift will help hospitals recoup thousands of dollars lost each year from treating stroke patients.

Eastman Kodak will unveil a top-of-the-line, multicassette computed radiography system at this week’s meeting of the American Healthcare Radiology Administrators in San Antonio. Earlier this summer, the company unveiled a value-oriented single-cassette CR reader designed for budget-strapped hospitals, imaging centers, and physician practices.

Manufacturers and industry report a decline in the ultrasound market last year in the U.S. The market was down in 2004 about 7% to $950 million in equipment shipments, according to consolidated industry estimates. This decline came on the heels of a record year in 2003, during which vendors shipped equipment valued at just over $1 billion to U.S. customers. Backlogs for new units and upgrades from 2004 outdistanced sales by about 4%, indicating strength going into 2005.

The American College of Radiology, the Society of Breast Imaging, and individual breast imagers have criticized a report prepared for Congress that calls for sweeping changes to the Mammography Quality Standards Act. Even though the report includes recommendations to offset financial burdens incurred by centers adopting these new measures, mammographers want to see the money first.

The recent creation of the Society for Cardiovascular Computed Tomography may give birth to a new era of cooperation among radiologists and cardiologists that might also sound the death knell for electron-beam CT.

A Florida radiologist has been named as a defendant in a whistleblower lawsuit alleging Medicare fraud though improper lease arrangements, kickbacks, and upcoding.

The political heat surrounding diagnostic imaging has gone up several degrees over the last few years. The American College of Radiology’s political action committee is now a top financial contributor among healthcare organizations. The college regularly lobbies politicians on Capitol Hill and testifies before Medicare advisory panels regarding imaging issues. Congress responded in the spring by convening a special hearing to examine and possibly revamp imaging credentialing and reimbursement.

The keys to radiologist profitability are productivity and efficiency. Outside reading arrangements that permit remote reading at a workstation can greatly assist a group's profitability because the radiologist can read more studies, enhancing productivity while remaining efficient. But the news on such opportunities is mixed. While new Centers for Medicare and Medicaid Services policy changes have opened the door to certain out-of-state reading arrangements, other outside arrangements remain questionable under the fraud and abuse laws. Of particular concern are proliferating outside arrangements for sharing CT angiography reads with cardiologists.

McKesson has signed a definitive agreement to acquire Medcon, an Israeli developer of Web-based cardiology PACS and IT. The proposed acquisition, valued at $105 million, reflects the strategy of McKesson. The IT provider is aggressively promoting integrated healthcare systems that stretch across medical specialties including radiology, gastroenterology, ophthalmology, and cardiology.

Integrating a profusion of digital healthcare information systems is central to providing efficient, high-quality healthcare, and this need spans national boundaries. To address the increasingly global task, the Integrating the Healthcare Enterprise initiative expanded to six new countries last year.

Accreditation is moving forward in some ways but backward in others. The American College of Radiology, the prime driver in the U.S., has expanded its MR accreditation process to include 3T scanners, acknowledging demands for accreditation by third-party payers and regulators and citing the increasing adoption of this technology as the reason.

Full-field digital mammography has turned into a superstar of x-ray, doubling in revenue and units shipped last year over 2003. Growth is expected to continue, although the pace may slow as the backlog of ordered systems shrank by year’s end to just 10% more than the number shipped.

Backers of a huge study examining the effect of PET on patient management face regulatory problems that threaten to delay a planned July 1 implementation of expanded Medicare Part B coverage of FDG-PET for cancer imaging.

In just seven years, computer-aided detection has become an indispensable tool for breast imaging centers. As experience accrues, CAD's role in cancer detection with mammography is evolving. Some longtime users find that initial surges in cancer detection rates eventually return to pre-CAD baselines in stable screening populations. Now the focus is on CAD's ability to find cancers at an ever earlier stage. Research is shifting toward optimizing CAD in practice and developing its potential for tumor classification.

It’s been a long time coming, but the country’s watchdogs are finally starting to bark. For as long as I can remember, legislators concerned over the well-being of U.S. citizens have focused on the makers of equipment as their primary, if not their only, concern. They worried whether equipment was safe and did what it was supposed to do, and for good reason. But, oddly, the hand-wringing in Congress and, consequently, at the FDA typically ended once those products left the loading docks.

The Institute of Medicine has recommended sweeping changes to quality standards now being applied to breast imaging facilities. If Congress, which requested the study, enacts these changes, facilities will face a substantially greater burden in collecting patient data, potentially increasing the need for information technology.

Given the high quality of FDG-PET imaging, the likelihood that other useful PET tracers will be approved for clinical applications, and the enthusiasm with which the larger radiology community has embraced PET/CT, the future of single-photon scintigraphy in diagnostic imaging is a relevant discussion for nuclear medicine and radiology departments. Decisions have to be made about the allocation of funds, space, and physician training.