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For other articles and previous issues click here. September 5, 2005 At
the Heart of Imaging — Expect Cardiac CT to Fuel Growth At the annual meeting of the American Healthcare Radiology Administrators in San Antonio, attendees saw how cardiac imaging will fuel growth in diagnostic imaging. The real wonder of cardiac CT is a few years off, says Michael A. Silver, PhD. Silver, a consultant with Sg2, LLC, a research and consulting company based in Evanston, Ill., offered his peek into the crystal ball of medical imaging’s future at the 2005 annual meeting of the American Healthcare Radiology Administrators (AHRA) in San Antonio last month. As Silver described it, coming generations of cardiac CT systems will fuel massive growth in CT exams. The industry is working on CT systems that will provide faster temporal resolution, more slices, and reduced dose. Before long, CT scanners will be able to differentiate among different plaques and characterize them. But not just yet. “It’s still a few years away,” Silver said. Taking Off Silver also noted that CT has a head start on MRI for routine cardiac examination. “The market’s focus is on cardiac CT, not MR,” he told the AHRA audience. “Cardiac MR is five years away from being a routine business. For now, it’s an excellent follow-up tool. The change will come when MR visualizes plaque better.” As researchers and clinicians develop new standardized protocols with stronger magnets, MR and CT will find complementary roles in cardiac imaging, Silver said. The modalities have different relative strengths. CT is stronger at showing stenosis in coronary arteries and collateral circulation, while MR is better for anatomy and tissue viability. Silver also noted that the growth of noninvasive CT heart examinations will push cardiologists further into the diagnostic imaging market, increasing the competition between radiology and cardiology. It will, he believes, further the interdisciplinary nature of diagnostic imaging, at least from an administrative perspective. “Radiology administrators may well become imaging administrators,” Silver said. “More departments are going to want to be part of imaging… In some aspects, imaging may have outgrown radiology the same way the stethoscope outgrew cardiology.” The growth of cardiac CT will escalate the imaging turf war among cardiology, radiology, and orthopedics—as well as other specialties. Silver acknowledged that this evolution will be a challenge for hospital radiology departments. He suggested that hospitals’ best response to the challenge will be to take advantage of their inherent advantage in healthcare: providing the “continuity of care” that stand-alone imaging facilities can’t. “Technology isn’t the answer; executing the right technology is,” he said several times in his presentation. Clinical integration, he added, is a hospital’s “best weapon” in maintaining its strong role in the increasingly crowded imaging marketplace. Affecting PACS Silver believes electronic medical records (EMRs) are certainly part of the future, but not on a large basis until they evolve further. “EMRs are sort of at Version 1,” he said. “They are not yet true patient management tools.” He said integrated IT packages will evolve and will push EMR forward. He also mentioned that digital pathology systems
may evolve to challenge radiology as the bandwidth hog in healthcare
when digital pathology moves into the mainstream. Pathology slides
can consume 4 to 20 gigabytes per slide, according to Silver. Other Modalities Silver talked about an interesting change he believes will hit the MRI market. He sees MRI systems increasingly resembling CT machines. In an effort to create more open systems and create higher power magnets, MRI systems will use shorter magnets and patients will be drawn through the magnet’s “sweet spot” on a gantry similar to a CT system. He probably didn’t need a crystal ball to make this prediction, but Silver also forecasts huge growth for PET (particularly PET/CT) in the coming five years. In that time, PET/CT’s dominant use will be in cancer diagnosis, staging, treatment planning, and monitoring. Cardiac, neurologic, and infection detection applications all show promise, but those three will certainly lag far behind oncologic applications in clinical use. Interventional procedures will be another growth area. How many of those procedures will be done by interventional radiologists is an open question. Other specialties will compete for the emerging work in less invasive, catheter-based procedures. Ultrasound will continue to be a workhorse in diagnostic imaging, according to Silver and Sg2. Advances in handheld and volumetric ultrasound will support moderate growth over the next five years, according to the consultants’ projections. The expansion of SPECT and SPECT/CT will support modest growth in nuclear medicine in the next few years. Mammography will continue in its role, with Silver offering no strong prediction either way about the spread of digital mammography. An Sg2 report distributed to attendees did note increased Centers for Medicare & Medicaid Services reimbursement should improve the financial outlook for mammography providers. General radiography won’t show the growth of other imaging procedures, according to Sg2. Silver projected that it will take approximately 10 years for digital radiography to become the “dominant” x-ray modality. However, the change to digital won’t lead to tremendous growth in new x-ray procedures or applications; in general, the change to digital radiography will replace film-based x-rays with digital ones. Bigger Groups “Radiology groups will grow from 20- to 50-physician groups to 200- to 500-physician groups over a larger area,” Silver said, “so there will be a musculoskeletal radiologist on duty to read those studies all day. Then someone will replace that doctor at the end of the shift.” Reimbursement “Payors won’t pay for poor quality,” Silver said. “They’re going to drop that on you.” Silver said that if a radiology exam and report don’t help the referring practitioner with diagnosing or treating a patient, payors might start denying reimbursement. Silver believes the overall impact of the payor scrutiny will be lower reimbursement per imaging procedure—certainly something to consider in your future budgeting. Based on his presentation at the AHRA meeting, Silver sees growth, change, and challenge in radiology’s near future. So as Yogi Berra may put it—basically, that means more of the same, but different. — Jim Knaub is editor of Radiology Today. |
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