Health Imaging & IT - January 2009 - (Page 18)

RSNA 2008 In Review RSNA 2008 IN-Depth @ RSNA360.HealthImaging.com FDG pet/Ct brings accuracy to staging, restaging of prostate cancer FDG PET/CT may add significant value in patients with prostate cancer by accurately identifying primary lesions and/or metastases at initial staging and detecting recurrent disease according to research by Nghi C. Nguyen, MD, PhD, of St. Louis University in Missouri. “FDG PET/CT may add significant value in patients with prostate cancer by accurately identifying primary lesions and/or metastases in 48 percent at initial staging, detecting recurrent disease in PSA+ patients in 42 percent as well as incidentally diagnosing a second primary in at least 2 percent,” the authors concluded. Needed: Nuclear medicine advanced associates Nuclear medicine has grown tremendously in the last 15 years, creating the need for a new clinical specialty—nuclear medicine advanced associates, said David Gilmore, from Beth Israel Deaconess Medical Center in Boston. The new title—nuclear medicine advanced associate—represents an advanced practice level. The master’s degree program is designed to prep participants to serve as a physician extender with duties ranging from radiopharmaceutical administration, performing stress tests and ordering complementary exams to clinical leadership. The initial program is a collaboration among University of Arkansas School for Medical Sciences, St. Louis University and University of Missouri. the BuSINeSS oF ImAGING Ct: Doing more but getting less; Rads recommend fewer procedures over time Despite continuing technical advances and increased use of CT in clinical practice, the diagnostic yield of CT exams has actually decreased over the past decade, according to data from a Natural Language Processing program, Leximer, developed at Massachusetts General Hospital in Boston, that was used to analyze reports of all CT exams performed at the institution from 1996 to 2005. Pragya Dang, MBBS, reported that the group found there was a 14 percent growth in volume of CT exams, which outpaced the increase in recommendation rates for further imaging studies in the radiologist’s report (13.6 percent to 19.6 percent, increasing by 0.5 percent per year). “Over this time, the rate of findings in radiology reports changed from 79.5 percent to 75.4 percent, decreasing at a rate of 0.6 percent per year,” Dang said. The researchers found that recommendation rates increased for all radiology specialties; however, finding rates decreased for all radiology sub-specialties, except neuroradiology. Using the same system, researchers also found that the longer a radiologist is in practice, the lower his or her rate of requests for additional diagnostic imaging procedures. A decrease in recommendation rates was observed with an increase in years of experience of radiologists in abdominal imaging, neuroradiology, thoracic and musculoskeletal radiology. next two years. The hospital launched decision support in 2004, requiring ordering physicians to enter indications and demographics for imaging studies. Dang reported a decrease in CT volume growth and the growth rate after implementing decision support. The quarterly CT growth rate declined from 3.1 percent to 0.2 percent. She attributed the results to two factors: the gatekeeper effect and the educational effect. on the (far) horizon: pay for performance at a glance “Pay for performance (P4P) is here for the long haul,” commented Kimberly Applegate, MD, from Indiana University Riley Hospital for Children in Indianapolis. “The good news for radiologists is that the specialty is not yet in the crosshairs, which gives the profession time to prepare.” Only a handful of the approved metrics apply to radiology. Consequently, radiologists face a slightly different mandate than their clinical colleagues. P4P will drive better integration with clinical colleagues, resulting in “IT infrastructure for better reporting,” predicted Applegate. She highlighted upcoming priorities on the P4P agenda, including coordination of care, transition, communication and planning. Smart facilities will invest in systems and processes that tackle target metrics and related objectives like communication and clinical coordination. Early studies hint at some troubling outcomes. Surveys of peer-reviewed studies show mixed results, said Bibb Allen, MD, chair of the American College of Radiology’s commission on economics. Studies have not yet established a link between P4P and improved patient outcomes, and some indicate that P4P could limit access to care. In addition to producing less than stellar clinical outcomes, P4P has not yet benefitted participating physicians. “Nearly half of all overall eligible bonus funds are left on the table,” Allen noted. Next year could see better results for radiologists as two more measures are reportable, and the Medicare bonus will increase from 1.5 to 2 percent. Cpoe and strategies for taming the Ct growth beast Massachusetts General Hospital (MGH) in Boston has contained growth in outpatient CT imaging volume by basing its CT-diet regimen on computerized radiology order entry with decision support. “Computerized radiology order entry with decision support is an effective way to reduce the image intensity creep,” said Dang (see reference above). MGH introduced web-based computer order entry in 2001 and rolled the system out across the entire outpatient physician population over the 18 Health Imaging & IT | January 2009 HealthImaging.com http://RSNA360.HealthImaging.com http://www.HealthImaging.com

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Health Imaging & IT - January 2009 Contents The Enterprise News Update DR Breathes New Life into Radiography Radiology in the Spotlight Educational Sessions Keynote Addresses Tech Trends on the Exhibit Floor Imaging Tools Managing Technology People & Technology Reader's Resource

Health Imaging & IT - January 2009

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