Health Imaging & IT - February 2008 - (Page 41)

Another game-changer could be the results expected soon of the largest multicenter research study to compare the effectiveness of the two technologies, being conducted by the American College of Radiology Imaging Network (ACRIN). Ready for prime time When CT colonography first became a clinical option, many facilities hesitated to rush into virtual colonoscopy because the technology did not seem ready for prime time, says David Kim, MD, assistant professor of abdominal imaging at University of Wisconsin Madison Health System. The last several years have delivered improved techniques and software enhancements to make virtual colonoscopy more practical, easier to read, effective and comparable to optical colonoscopy. On the procedure side, fluid and fecal tagging makes it easier for readers to distinguish residual stool from polyps and the switch from room air to carbon dioxide allows uniform distension of the colon for better visualization. On the technology end, the advent of primary 3D display also simplifies polyp detection and aids workflow. [ syngo Colonography PEV (Polyp Enhanced Viewing) from Siemens Medical Solutions is an automated second reader tool for the visualization of lesions in the colon. ] Reimbursement: the next barrier Technology adoption is a multi-faceted process. Widespread adoption requires proof of clinical utility and adequate reimbursement. Currently, the primary barrier to widespread adoption of virtual colonography is on the payment side; the Centers for Medicare and Medicaid Services (CMS) do not mandate reimbursement for virtual colonoscopy. “Third-party payors and Medicare are being careful not to prematurely approve several of the rapidly developing new screening technologies, such as CT colonography,” explains Beth McFarland, MD, chair of the American College of Radiology (ACR) Colon Cancer Committee. The organizations look for clinical validation and standardization of a procedure prior to widespread reimbursement. Currently, physicians must use category III CPT codes for virtual colonography. These “emerging technology” codes are not assigned HealthImaging.com value, which make CT colonography nonreimbursable in most cases. (CT colonography is covered locally in some instances, mainly in the case of a failed or incomplete optical colonoscopy.) In addition, a handful of patients do pay out of pocket. Reimbursement, however, is not the only hitch, says Judy Yee, MD, chief of radiology at San Francisco Veterans Administration Medical Center in California. The U.S. lacks a critical mass of radiologists trained in CT colonography, says Yee. The next 12 to 18 months will deliver significant changes. CT colonography will shift from an emerging technology to an established procedure. One of the primary factors behind the shift is the expected release of the ACRIN II Trial results early this year. “ACRIN II should have a tremendous impact towards more generalizable validation,” says McFarland. Researchers announced results at several meetings this fall and shared that the 15-center trial demonstrates the diagnostic efficacy and interobserver consistency for clinically significant polyps. Other studies supporting screening CT colonography include the Italian IMPACT study and the Munich Colorectal Cancer Prevention trial. “In the next year or two, we’ll see a fundamental shift in how we screen for colon cancer in the country,” predicts Kim. toward cPt I Category I CPT codes are the prerequisite for national Medicare reimbursement and often provide the framework for private coverage. The ACR is working toward CPT I status for virtual colonography, and positive results from ACRIN II and other studies should provide momentum. Yee predicts that virtual colonography could gain CPT I status in 2009. “Third-party payors are waiting for ACRIN II results. The trial should make a difference and impact colorectal cancer screening recommendations in average-risk adults,” explains Yee. Other forces are gathering momentum as well. For example, Wyoming Congresswoman Barbara Cubin introduced H.R. 4879, the Virtual Screening for Cancer Act (VSCA) of 2007. The legislation is designed February 2008 | Health Imaging & IT 41 http://HealthImaging.com

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Health Imaging & IT - February 2008 Contents On the Web The Enterprise News Update Cover Story: Enterprise Image Management Makes the Grade Modality Update Special Section: Health IT: Image Management Special Section: Health IT: PCs on the Move Convention Spotlight Technology Outlook Technology Update Reader's Resource Stat Sheet

Health Imaging & IT - February 2008

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