Molecular Imaging Insight - June 2008 - (Page 4)

ADDITIONAL RESOURCES: Read more on NOPR “Some fear that evidence-based medicine will be hijacked by purchasers and managers to cut the costs of healthcare,” observed David L. Sackett, MD, and colleagues more than a decade ago (British Medical Journal, Jan. 1996). “This would not only be a misuse of evidence-based medicine but suggests a fundamental misunderstanding of its financial consequences. Doctors practicing evidence-based medicine will identify and apply the most efficacious interventions to maximize the quality and quantity of life for individual patients; this may raise rather than lower the cost of their care.” A healthcare area that has seen an unprecedented surge in utilization in the recent past is that of diagnostic imaging. It is perhaps the fastest rising medical expenditure in the United States, with an annual growth rate of 9 percent, nearly one-half more than the annual increase in general medical expenditures (approximately 6 percent). As such, policy-makers and payors are increasingly demanding that evidence-based data justify the utilization of imaging procedures. Although evidence-based medicine has been the focus of work by many healthcare researchers (nearly 30,000 citations on the term are available on the National Library of Medicine’s PubMed web site), imaging has received scant attention in this arena. When it comes to scholarly research on evidence-based nuclear medicine imaging and molecular imaging, the data become clearer still with approximately 27 citations returned on these search criteria. According to Bruce E. Hillner, MD, professor and eminent university scholar in the department of internal medicine at Virginia Commonwealth University in Richmond, Va., evidence-based medicine research in molecular imaging has been hamstrung by its failure to perform prospective data collection and sufficiently randomized patients. He said this may be due to a lack of tradition in the imaging community to follow the paradigma similar model as the therapeutic community that does clinical trials. R. Edward Coleman, MD, professor of radiology and chief of the division of nuclear medicine at Duke University School of Medicine in Durham, N.C., points to a lack of funding from the same governmental and private-payor organizations that are demanding the evidence-based data. Further complicating this is the fact that the number of nuclear medicine physicians to do the research is declining. “The challenges [to conducting evidence-based medicine research in molecular imaging] are getting the funding to get the studies performed, actually getting the studies performed, getting government approval, and then getting reimbursement from the third-party payors,” Coleman noted. Meta-evidence for metabolic imaging One of the primary limitations for achieving robust evidencebased medicine studies in molecular imaging, and diagnostic imaging in general, has been a lack of prospective studies with a NOPR Delivers Evidence for Expanded PET Use in Oncology Imaging Diagnostic ﬁndings from FDG-PET imaging changed the intended care of more than one in three cancer patients, according to a study of ﬁrst-year data from the National Oncologic PET Registry (NOPR), published in May in the Journal of Clinical Oncology. NOPR was launched in May 2006 in response to the Center for Medicare and Medicaid Services’ (CMS) Coverage with Evidence policy to collect data through a clinical registry to inform the Center’s FDG-PET coverage determination decisions for currently non-covered cancer indications. The registry is comprehensive, including data from 23,000 patients. ‘‘The NOPR working group sought to measure the impact of PET findings on patient management in a manner minimally intrusive to care providers,” said Bruce E. Hillner, MD, lead author for the study and professor and eminent university scholar in the department of internal medicine at Virginia Commonwealth University in Richmond, Va. “This was critical for successfully collecting the large amount of data required for a robust analysis.” Hillner, currently chair of one of the guideline panels within the American Society of Clinical Oncology (ASCO), is also chair of the NOPR working group. NOPR is sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) and the ACR Imaging Network (ACRIN); ASCO and SNM also have played key roles in guiding the project’s development. NOPR is a prospective data registry that collects information from a PET facility, from the physician requesting a PET scan, and from the interpreting physician’s PET report for cancers not currently covered by CMS. The registry was designed to meet CMS criteria for evidence development; therefore, all patients are Medicare beneficiaries. PET studies performed on Medicare beneficiaries for CMS-approved indications in breast, cervical, colorectal, esophageal, head and neck, non-small-cell lung, and thyroid cancers, or lymphoma or melanoma are not eligible. Cancer types that Medicare currently reimburses for only through NOPR include those of the ovary, uterus, prostate, pancreas, stomach, kidney and bladder. The NOPR web site, www.cancerpetregistry.org, has 4 Molecular Imaging Insight | June 2008 MolecularImaging.net http://www.cancerpetregistry.org http://www.cancerpetregistry.org http://MolecularImaging.net

Table of Contents Feed for the Digital Edition of Molecular Imaging Insight - June 2008

Molecular Imaging Insight - June 2008 Contents NOPR: A Landmark Study Cover Story: Evidence-based Medicine Points to Wider Role for Molecular Imaging in Patient Care NOPR Delivers Evidence for Expanded PET Use in Oncology Imaging The Balancing Act Nuclear Cardiology’s Next Step Molecular Imaging Training Gaining Traction SPECT/CT’s Role in Post-Transplant Infection Imaging Clinical Study Digest : Heart Disease & Metastatic Breast, Gastric and Head & Neck Cancer

Molecular Imaging Insight - June 2008

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