Radiologists savor dominant role in vascular ultrasound

At least one patch of radiology turf seems to be well under control. Radiologists perform the biggest share of vascular ultrasound studies by far, according to a new study of Medicare data.

Disputes continue in some hospitals over who should perform vascular ultrasound, said Dr. David Levin, chair of radiology at Thomas Jefferson University, at the RSNA meeting on Monday. Radiologists consider themselves the most appropriate physicians to perform the radiological study, but cardiologists, vascular surgeons, and other physicians also feel competent.

Researchers analyzed utilization of vascular ultrasound among Medicare beneficiaries between 1998 and 2003. They looked at 15 CPT codes related to vascular ultrasound, including studies of the neck and cranial arteries, extremity arteries and veins, and dialysis access drafts.

Overall utilization for all specialties grew by 35% during that time to 159.6 studies per 1000 Medicare beneficiaries.

Of the total, radiologists performed 66.1 studies per 1000 beneficiaries. In 2003, radiologists had the largest single share of vascular studies (42%), followed by surgeons (26%) and cardiologists (13%).

"Radiologists held a significantly larger share than the other physician groups," Levin said. "The findings are a pleasant surprise. The bottom line is vascular ultrasound has been and still is a win for radiologists."

All groups showed an upward trend in vascular ultrasound utilization rates, but for the most part, these increases were parallel with rather than at the expense of other physician groups. Utilization by radiologists and surgeons increased at about the same rate (35% to 37%), while cardiologists' utilization rose by 66% during the five-year period. In absolute terms, however, radiology remains way ahead of the pack.

"All physicians are showing an upward trend in utilization rates," Levin said. "Radiologists and surgeons show comparable increases. For cardiologists, the rate of increase was almost twice as high. However, radiologists are accruing new volume at a much faster rate."