Changing the conversation

Lisa Fratt, Editor, Health Imaging

This week’s highlights delivered good news for middle-aged and older men and women. The debate on prostate cancer screening, much like breast cancer screening, has reached a crescendo. Other findings should spark vibrant discussions with colleagues and patients.

Jay P. Czieki, MD, of Cleveland Clinic, and colleagues reframe the prostate cancer screening debate, acknowledging that survival is not a particularly good endpoint to measure the value of screening for a disease with a long natural history and high survival rates. But when researchers focused on metastatic disease burden, they demonstrated that screening correlated with higher metastasis-free survival rates, which in turn, may translate into lower financial costs. The findings may quiet some critics.

Women have been plagued by lower imaging specificity for the detection of obstructive coronary stenosis than men. However, a subgroup analysis of data from the ACCURACY trial showed that coronary CT angiography has comparable accuracy for both sexes in the detection of obstructive stenosis.

Meanwhile, physicians may want to consider the value of a pointed conversation with some parents about the utility of CT screening. Among children presenting to emergency departments with low risk for traumatic brain injury, parental anxiety was cited as one of the most important factors driving CT use among white children in 11.5 percent of cases. It’s not good news for the children exposed to unnecessary radiation. Nor is it good news for radiologists, as editorialist M. Denise Dowd, MD, MPH, of Children’s Mercy Hospital, Kansas City, Mo., wrote, “Overuse is a well-recognized but largely undealt with problem in U.S. healthcare. It is perhaps nowhere more clearly demonstrated than in the use of diagnostic imaging studies.”

Other less-than-welcome news arrived in the form of the American Medical Group Association's (AMGA) 2012 Medical Group Compensation and Financial Survey. AMGA reported slight drops in radiologists’ compensation, while most physicians’ income, particularly primary care specialists, trended up.

One answer to the challenges facing radiologists, according to a viewpoint in the August issue of Journal of American College of Radiology (JACR), is multisubspecialty radiology. Multisubspecialty radiologists provide more flexibility, and may better fit into future reimbursement models such as value-based payments, risk-sharing, bundled payments and accountable care.

This week, we also learned that fMRI data might predict heavy drinking in adolescence. And an economic analysis in JACR revealed just how difficult it will be for the growing number of proton therapy centers to turn a profit.

Tell us about the conversations you are having in your practices.

Lisa Fratt, editor
lfratt@healthimaging.com