It’s time to get mad as hell

September 24, 2009
Greg Freiherr

It’s the kind of research that radiology needs: a study performed at the University of Southern California Keck School of Medicine that documents enormous cost savings from the use of an image-guided procedure.

It's the kind of research that radiology needs: a study performed at the University of Southern California Keck School of Medicine that documents enormous cost savings from the use of an image-guided procedure.

The research, which will be published in the October issue of the American Journal of Roentgenology, shows that draining excess fluid from around the heart following cardiac surgery can be done through a tube under CT guidance at a cost savings of 89% over widely practiced surgical drainage. The results, publicly released Sept. 21, show that CT-guided tube pericardiostomy is just as effective as surgery, but requires no patient recovery time, consumes fewer hospital resources, and costs only $769.15 compared with $6952.52 for a surgical drainage.

The potential impact of this study is huge. Pericardial effusion occurs in as many as 85% of patients following cardiovascular surgery. Conservative estimates put the number of these procedures at well over 200,000 in the U.S. alone. So…$6000 here, $6000 there times a couple hundred thousand and pretty soon you're talking some real money. But that's not the half of it.

The facts surrounding CT-guided tube pericardiostomy support what the radiology community has taken for granted for decades: that imaging in general, and as it is applied in minimally invasive procedures in particular, cut the cost of care while improving patient care. We take this as a given, a self-evident truth. Well, guess what? It isn't self-evident to everyone. It only becomes evident-and indisputable-when we demonstrate it is. When, for example, researchers show that pericardiostomy under CT guidance saves more than $6000 per procedure.

Who is going to argue that surgical drainage should be done? Not the hospitals or the third party payers. And not the patients who can avoid general anesthesia and major surgery, as well as a stint in the recovery room.

This is the kind of research that radiology needs now and every day in the future. We have to prove cost savings, better resource management, and improved patient care. We need to tally every proof, put each in context, sum them up, and recalculate as more are added.

It's time we got as mad as Howard Beale, the anchorman in the 1976 movie Network who railed about a sour economy, crime, and pollution (http://www.youtube.com/watch?v=dib2-HBsF08). We have to tell the world how much medical imaging saves in this case and that. Hammer home that these are just examples of what is going on in the big picture. Then prove that argument over and over with each successive research project.

It's time people outside radiology stop seeing radiology as a cost center and we stop accepting their lunacy. Radiology is not a cost center. It is a cost-saving center.

"I want you to get up right now, go to your windows and stick your heads out and yell, "I'm as mad as hell, and I'm not going to take it anymore," Beale said from his Network anchor desk.

Sounds like a pretty good idea, metaphorically speaking, of course.