Are providers at the tipping point with CT?
Are providers at the tipping point with CT?
With the dramatic increases in the use of CT in recent years, people are questioning whether all these tests are really necessary or whether they are just driving up health care expenses. Consumer Reports highlighted 10 tests and treatments that the magazine said were overused, and three of them — whole-body scans, high-tech (CT) angiography, and virtual colonoscopy — involve CT.
Such concerns have generated heated reaction among industry experts and clinicians, many of whom believe that while there are legal and other non-clinical pressures in the health care system driving the use of imaging, blanket statements about overused tests or simple lists such as the one that appeared in Consumer Reports can dissuade people from undergoing procedures that are medically indicated.
With respect to CT angiography, some experts strongly disagree with the contention that the test is overused, including Claudio Smuclovisky, MD, director of the Cardiovascular Institute at South Florida Medical Imaging in Boca Raton, FL. "CT angiography demonstrates much more than the standard coronary angiogram, so the value of this test is enormous, and it is being underutilized," says Smuclovisky, who points out that 40% of the population will develop heart disease. "This is such an important technology that I predict in the future it will become as prevalent as screening mammography or colonoscopy."
Conversely, there is wide agreement in the radiologic community that there is no medical case to be made for whole-body CT scans, and these tests are therefore ill-advised considering that they expose patients to radiation needlessly. However, vendors tell Healthcare Imaging Update that there is little evidence that whole-body scanning is being particularly overused, as the practice has fallen off sharply in recent years. Peter Kingma, vice president of the CT division at Malvern, PA-based Siemens Medical Solutions, says, "The marketplace has moved steadily away from this, probably because there was not a high level of acceptance in terms of what you get as a clinical outcome versus the dose [of radiation] that you expose certain segments of the population to. We have had very little in the way of requests from the marketplace for systems that would do this."
The jury is still out on virtual colonoscopy or CT colonography (CTC), although it generally receives much higher marks from radiologists who perform the procedure than from gastroenterologists who tend to be more comfortable with colonoscopy. "It is a superb test that has been validated," stresses Smuclovisky of CTC. However, while his imaging center does perform CT colonography, there is little evidence that the test is being overused because, in most cases, insurance carriers do not yet reimburse for the procedure.
Robb Young, senior manager of the CT Business Unit for Tustin, CA-based Toshiba Medical Systems, agrees and notes that while newer studies indicate that the test shows promise and potentially could boost the colorectal screening rate, there is little impetus for imaging centers to offer the procedure on a larger scale until there is better reimbursement and until specialists show more interest in CTC. "Cardiac CT has moved very quickly to getting more reimbursement, and part of that is because cardiologists have a great interest in imaging. The difference with CTC is that gastroenterologists have not been as excited about using it," says Young. "The reality is: If the specialist isn't interested in it, it is very hard for that application to take effect."
With the dramatic increases in the use of CT in recent years, people are questioning whether all these tests are really necessary or whether they are just driving up health care expenses.Subscribe Now for Access
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