By Jim Knaub
Not long ago, converting from CR to direct DR often was not considered worth the cost premium. The improved efficiency of DR was not seen as necessary if a facility did not have the exam volume to support it and other potential DR benefits were set aside because of cost.
As the technology matures and the cost of detectors and systems gets pushed downward, new competitors have entered the field and a wider range of specialty-size detectors (such as small detectors neonatal ICU bassinets) have come on the market to handle the full range of radiography applications. Largely because of the cost, the early DR detectors were a standard larger size meant to handle a wide range of radiography exam types.
As cost decreases and competition increases, the value equation changes for X-ray equipment consumers. Given that dose reduction and value are major buzzwords in this round of health care reform, it would seem like a good time for DR expansion.
But there’s another area of potential value in DR that is being explored. Radiography techniques involving digital subtraction and X-ray tomosynthesis are available and being evaluated to ascertain where they might fit into the imaging picture. Outside of the widely known digital breast tomosynthesis—which had its own CPT codes implemented in 2015 and is not yet widely reimbursed outside of Medicare—other 3D X-ray tomosynthesis applications are being studied. The applications include chest nodules and other chest X-ray applications, knee and hip joint space quantification, olecranon and scaphoid fractures, and sinonasal examinations, according to results from a PubMed search.
How will these applications pan out? How might they supplement standard radiography? In what specific situations? Researchers are looking at how the technology, such as GE’s VolumeRad, might fit into mainstream day-to-day radiography. Of course, once the clinical utility is better defined comes the issue of how these radiography techniques might be reimbursed, and whether they will be reimbursed any differently than 2D radiographs of the same region. There’s also the matter of whether X-ray tomosynthesis might be a significant alternative to either CT scans (or cone beam CT) for some applications.
The current migration to DR opens the door to tomosynthesis and other radiography applications. It will be interesting to see how they expand into everyday imaging.
— Jim Knaub is editor of Radiology Today.