Opportunity knocks

It’s been said that problems are really just opportunities in disguise. If this is true, then radiology has had its share of opportunities in recent years, thanks to reimbursement cuts and other cost-control schemes targeting the specialty, fairly or unfairly, as a major driver of healthcare costs.

Among the top stories from the past week were a few more problems—excuse me, opportunities—that the medical imaging community must address.

The first comes from the realm of cardiac imaging, where shortages of technetium-99m (Tc-99m) may result in an increase in downstream testing, costs and radiation exposure. Switching to an inferior radiotracer for SPECT myocardial perfusion imaging (MPI) studies, such as thallium-201 (Tl-201), can reduce image quality and lead to more false positives.

When the Canadian Chalk River nuclear reactor in Ontario temporarily shut down in 2009, leading to a shortage of Tc-99m, the University of Ottawa Heart Institute turned to Tl-201 as a replacement. A study investigating the effects of the switch was published in Circulation: Cardiovascular Imaging, and the results showed Tl-201 use was associated with a 9.8 percent increase in downstream resource utilization. That amounted to a $74.25 cost increase per patient. If this were applied to all 9 million SPECT MPIs performed annually in North America, it would mean an additional $668 million in costs.

The Chalk River reactor is expected to close in 2016, meaning more facilities should prepare for the same challenges the University of Ottawa Heart Institute faced.

Another shortage set to affect the imaging community is a lack of helium, used for cooling MRI scanners. Congress failed to extend the Federal Helium Reserve program, which supplies 40 percent of the helium used in the U.S. If the helium reserves are not restored, the search may be on for a viable alternative for manufacturing MRI scanners.

A study this week from JAMA Pediatrics about CT-related cancers in children probably represents the best example of a problem-as-opportunity. The study, which included nearly 5 million child-years of observation from cases between 1996 and 2010, found wide variance in effective radiation doses. It estimated that 4,870 future cancers would result from the 4 million CT scans performed annually in children younger than 15 years.

So where’s the opportunity? The study also revealed that most of those cancers are preventable. If the highest 25 percent of effective doses were reduced to the median, up to 43 percent of CT-induced cancers could be prevented. If a dose reduction strategy were combined with an elimination of all inappropriately ordered scans, as many as 62 percent of radiation-related cancers could be prevented.

The opportunities are there. Will the imaging community rise to the occasion?

-Evan Godt
Senior Staff Writer – Health Imaging