New European imaging studyun covers radiology trends

July 13, 1994

X-ray is common for neuro imaging in France A new study of imaging procedures in Europe concludes that high-techradiology is considerably less prominent in European health carethan it is in the U.S. Physicians in Germany, Italy, France and

X-ray is common for neuro imaging in France

A new study of imaging procedures in Europe concludes that high-techradiology is considerably less prominent in European health carethan it is in the U.S.

Physicians in Germany, Italy, France and the U.K. -- the fourcountries covered in the study -- are about four times less likelythan their U.S. counterparts to use MRI, according to the study.These countries use CT about half as often, said Paul Ferris,a principal with Arlington Medical Resources in Devon, PA, whichconducted the study.

Entitled Euro-Image, AMR's effort is the first multi-countrystudy of diagnostic imaging utilization undertaken in Europe.Euro-Image covers procedural volumes and contrast agent consumptiontrends in the fourth quarter of 1993 for conventional x-ray, CT,cardiac catheterization laboratories, MRI, ultrasound and nuclearmedicine. The study included hospitals and non-hospital facilities.

Euro-Image may be the most ambitious survey of its kind everattempted in Europe, according to Ferris.

"To my knowledge, nothing on this scale has been donebefore in terms of looking at all the modalities across thesefour countries," he said.

AMR plans to audit Europe in the second and fourth quartersof every year to establish utilization trends over time for itsequipment vendor and pharmaceutical company clients. Euro-Imageanalyzes diagnostic imaging use by facility type, modality, anatomicregion, patient demographics, contrast volume, brand use, referring-physicianspecialty and disease classification.

Future audits will be expanded for additional measurement ofdiagnostic ultrasound utilization. The company also plans to addSpain and Switzerland to the auditing service before long, Ferrissaid.

The number of health-care institutions participating in thestudy varied between countries and among modalities, he said.As few as 25 facilities audited their experience with the lessfrequently used modalities, while about 100 hospitals and clinicscontributed data for the more commonly used modalities. The samplewas statistically extrapolated to describe conditions for thecountry as a whole.

The audit found Germany was by far the greatest consumer ofconventional x-ray procedures. Slightly over 11 million x-rayprocedures were performed in Germany in the fourth quarter of1993. Eight million such procedures were conducted in France,seven million in Italy and four million in the U.K.

Ferris, who has monitored U.S. imaging procedure trends since1990, was surprised by variations in European utilization. Thepopularity of MRI breast imaging in Germany was unexpected, forexample. The audit found that more MR mammography exams are undergoneby the 80 million citizens of Germany than by the 250 millionpeople in the U.S. Psychological and economic factors accountfor this variation, according to Ferris.

"It turns out that German women fear anything associatedwith x-rays, so there's big business in doing breast screeningin Germany with MRI magnets. It's a very profitable procedurefor independent radiologists there to perform," he saidIodine-123nuclear studies are also far more popular in Germany than elsewherein Europe and the U.S. Dietary differences explain this variation,Ferris said.

"Through conversations with clinicians, we learned thatthere is apparently a deficiency of iodine in the German diet,so eight of 10 Germans have a nuclear thyroid scan done sometimeduring their lives," he said.

In France, x-ray is by far the most commonly used imaging modalityfor head/brain procedures. The AMR audit estimated that 578,000x-ray studies of the head and brain were performed in the finalthree months of 1993. CT ranked second in terms of frequency ofuse with 214,000 scans. About 112,000 ultrasound and 27,000 MRIprocedures involving the head or brain were performed.

The survey identifies a higher than expected concentrationof MRI systems per capita in Italy. MRI utilization is low, however,although there is a trend favoring specialized clinics for jointand extremity applications, Ferris said.

A relatively large number of obstetrical ultrasound proceduresare performed in U.K. hospitals, he noted.

"That's a function of the health-care system," Ferrissaid. "Private practice ob/gyn clinics handle the bulk ofthese procedures in Germany, France and Italy. In the U.K., theyare mainly done hospitals."