U.S. Government to Decide on Medical Imaging Payments

The federal government, through the Centers for Medicare and Medicaid Services (CMS), will soon decide to cut payments to physicians who use and bill for medical imaging. Medical imaging is frequently used to screen and diagnose patients for a wide range of diseases including various cancers and heart diseases.

Obviously doctors and their advocates will not be pleased by this new move, as it cuts into the profitability and revenues they earn from using such technologies as MRIs and CT scans. Those siding with the doctors in this controversial move argue that such radiological technologies are a necessity in treating already-diagnosed cancer patients and that the proposed, drastic payment cuts may force them to offer fewer services and at worst, shut down some imaging-reliant practices.

The flipside of this argument, and the frame of view from which the U.S. government is presently looking at this issue, is that health care expenses are out of control and that medical imaging diagnostics and screens are potentially overused by doctors in order to generate greater fees. The government has proposed cutting up to 38% of the amount it pays to doctors participating in Medicare who use medical imaging equipment. Nearly one million doctors currently participate in Medicare.

Because of the various business and health interests in such a government move, the proposed cuts are likely to be hotly contested not only by affected doctors and related lobbies, but by business lobbies representing medical imaging equipment makers such as the large and powerful companies GE and Siemens.

The debate, however, does not concern the technology equipment itself, but rather its overuse and associated health care costs. For this reason, some propose the solution of having doctors follow proper use guidelines for imaging equipment in order to prevent overuse and unnecessary Medicare payments.

Are mammogram screenings worth the effort?

For years, doctors have told women that having a mammogram done yearly is the proper thing to do, as early screening can save your life. But are they over-endorsing the treatment?

A mammogram screens breast tissue for cancers, looking for areas where the tissue is denser than in other areas. The issue is that some women have denser breast tissue, which makes identification of tumors especially difficult. For younger women with denser tissue, it far more probable that the tumor would be missed, although it is very unlikely that they would have one in the first place. Older women, over 70 may get a tumor, but it is likely nonfatal. Studies show that the best results are gathered from women between 50 and 70, reducing the risk of death by breast cancer by 20 to 30 percent.

Dr. Formenti, the chairwoman of radiation oncology at New York University Langone Medical Center, is frustrated that people do not realize how ineffective these screenings are generally. Screenings are not as effective as we would have hoped. The results, therefore, are not as infallible as we would like or as we believe them to be. Older women, for example, who are diagnosed with tumors are forever affected psychologically, knowing that they are cancer patients.

Does that mean that screening should entirely not be done for other age groups? Some doctors would say yes, unless there is evidence in the family history of early or late set breast cancer. Not screening, however, could defeat the gains that have been made against breast cancer deaths, which have significantly dropped in recent years.

It is still the choice of individual whether a screening is worth their time, money, and discomfort. Although it may seem a complete waste, women should seriously consider the risk of ignoring the slightly flawed technology available to them. As Dr. Norton says, “Say someone fires a gun at you, and you know that there is a 30 percent chance that the bullet is a blank. Do you not still duck?”

Ultrasound + MRI = Brain Surgery!

The Magnetic Resonance Center of the University Children’s Hospital Zurich has completed ten successful non-invasive neurosurgeries. The use of an MR-guided transcranial high-intensity focused ultrasound (HIFU) did the trick.

Used for years to treat uterine fibroids and prostate cancer, the efficacy and safety of HIFU for neurosurgery was recently proven by Professors Daniel Jeanmonod and Ernst Martin. While the MR-scanner, or magnetic resonance imaging (MRI), monitors and times the surgery, the HIFU produces beams that permeate the skull, reaching the brain. Precisely defined areas of the brain focused to 3 or 4mm in diameter are then coagulated to 60⁰C for 10 to 20 seconds. The MRI continues to provide details including temperature and maps for doctors throughout the surgery. The procedures took about 7 hours to complete and were done without the use of anesthesia.

This technology can revolutionize neurosurgery. Without a single complication, the use of screening technology must be recognized as a brilliant contributor to the study and practice of medicine. Especially in an organ, such as the brain, that is so sensitive, this sonication is quite an impressive feat. Brain diseases account for one third of all chronic illnesses, ranging from ALS to stroke to Alzheimer ’s disease. We look forward to hearing about the upcoming variety of non-invasive treatments for brain diseases.

The Benefits Outweigh the Risks

The dangers of medical imaging (including CT scans) are widely publicized. In fact, a recent report by the National Council on Radiation Protection and Measurement argued that medical imaging exposes Americans to seven times more radiation than in 1980.

The society of Nuclear Medicine (SNM) works to promote the values of nuclear molecular imaging, and provides meetings and networking for thousands of people in the medical community. This article (http://www.medicalnewstoday.com/articles/141423.php) was published in March 2009 shortly after a damning paper was published, that detailed the negative effects of radiation in medical imaging. Here, we are told about the benefits of imaging. The main purpose of imaging is to provide diagnostic treatment that could help in the treatment of an illness. The president of SNM spoke out for the benefits of medical imaging, and it is hard to ignore his points.

He points out that medical imaging caused treatment to change in one out of three patients that undergo some form of imaging. This has massive implications in terms of the specificity of treatments, as well as targeting a disease earlier in its development. Another crucial benefit is that medical imaging can decrease the need for exploratory surgery - this would reduce risks of open surgery, such as infection.

When considering the risks of imaging, it is important to realize much of the risk can come from human error in the operation of imaging equipment. Indeed ensuring that all technicians have been fully trained can make a major improvement in the quality of medical imaging. This is unfortunately not always the case.

While it is true that medical imaging does involve exposure to radiation, we must remember that most medical procedures involve risk. This brings up one of the most important realizations about medical imaging; that it is a medical procedure. This means that like any other procedure, there are risks and benefits. Therefore the debate should not be whether or not there are risks, but do the risks outweigh the benefits? The information in this article would definitely suggest that the answer is no.

Sustainability of Medical Imaging

The role of radiation exposure, even at minimal amounts, is still controversial among many physicians. Nonetheless the amount of medical radiation humans receive has been increase exponentially in recent years. According to “Sustainability of Medical Imaging,” medical radiation increased from roughly one fifth of natural radiation in 1987 to nearly 100% by 1997. Though the amount of radiation, on average, from medical procedures remains beneath the limit of roughly 50 mSv/year, it is often difficult to predict what occurs with such low levels of exposure.

Varying theories exist for such minimal levels ranging from the hormesis theory, which asserts that a little radiation is actually beneficial, to contradicting theories that accuse modern radiation dosage limits of being severe underestimates of toxic levels. Adding to this controversy is the fact that many modern physicians are under more pressure to perform more medical imaging in order to ensure that they have exhausted every possible option and thus prevent any legal action. Likewise modern patients are more informed and demand more examinations in order to feel they are getting the best treatment possible. Taking all these factors into account will be vital to the future of medical imaging. Moving forward we must implement rigorous laws to defend high levels of safety for individuals.

The Physics of Medical Imaging

With so much of modern medicine depending on medical imaging, it is important for us to gain a basic understanding of how the technology works. From X-rays to MRIs, medical imaging plays an important role in both preventative and diagnostic medicine.

In this article, “The Essential Physics of Medical Imaging,” the researchers discuss how these images are produced. The paper delves deep into the science behind modern imaging technologies and gives insight into how these technologies were discovered. For example magnetic resonance imaging (MRI) hinges on the fact that hydrogen nuclei in the water molecules in our body will align themselves given a strong magnetic field. All atoms have a quantum mechanical property of spin. When the spin in an atom is not balanced internally, the nuclei have a non-zero spin and a magnetic moment. This magnetic moment will align in a magnetic field in a similar fashion as a compass aligns with the Earth’s field. By interpreting these signals, radiologists can form an image that is essentially a cross section of the region of interest. The images produced offer a stark contrast between the soft tissues and are extremely useful in parts of the body where soft tissue dominate such as the brain, the musculoskeletal and the cardiovascular system.

A basic understanding of this technology is essential for us to understand before delving into the issues, debates, and other related technologies of medical imaging. Imaging is a powerful advancement in biotechnology that helps us screen patients for various diseases and assess other disorders and injuries and factors heavily into government and private health care expenditures.