The Changing Fortunes of CT Imaging

by: Wayne Webster

In the past year several significant institutions from California to Alabama reported over dosing patients when performing CT Brain Perfusion studies. These radiation doses were unfortunate for the patient and resulted in negative outcomes. The effect these failures may have on the future use of CT is unknown but could be far reaching when combined with health care reform and the slow economy. 

This release of information comes on the heels of several articles about the effects of X-ray radiation from CT scanning and how it may add new cancer cases into our population. In a recent volume of the Archives of Internal Medicine it was reported that since 1980 we’ve gone from 3 million CT scans annually to 70 million in 2007. The same authors are projecting tens of thousands of new cancer cases will be a direct effect of the increased use of CT scanning in the general population. Why has the dose increased and why have we increased the usage of CT scanning?

Upon analysis I find the answer to be straight forward. Productivity entered the diagnostic imaging lexicon about two decades ago. And when it did there was great interest in shortening the scan time. Most understand that shortened scan time comes as a result of increasing the dose. In nuclear medicine we give more millicuries. In MRI we use a higher magnetic field and in CT we increase the power of the X-ray generator.

As the annual number of scans being performed increased there was a need for more CT scanners. The increased number of CT scanners made it possible to scan more patients. Simultaneously with the increase in patient scans reimbursement was decreasing. To counter the lower reimbursement the owners of CT scanners had to see more patients each day of scanning, thus the need for faster throughput. Faster throughput required more powerful CTs. Are you starting to see a pattern develop?

Now here we are in 2010 with concerns about the dose we’re administering to patients, the number of patients being scanned and how we may be adding to the cancer problem as we try to fight it. On top of everything those offering CT scanning are also focused on profitability. It’s a real dilemma.

Logic says do fewer scans and reduce the radiation dose to the population and concurrently reduce the contribution to the cost of health care. But if you’ve invested in equipment, have declining reimbursement and need to pay bills can you really recommend that a person not have a CT scan? The number of CT articles on Aunt Minnie over the past year, almost 900, suggests there is a trend toward more CT scanning rather than less.

I think we’d all agree CT is a valuable diagnostic tool. But with the knowledge that its use may also contribute to the number of cancer cases, with reduced reimbursement and a desire to restructure our Health Care System by the Government, maybe this could be a good time to rethink CTs application in diagnostic medicine.

CT and its high utility within our population will certainly make it visible to regulators. I think we’re already seeing the effect of these many concerns as centers delay the purchase of new CT scanners and extend the life of those in place. In such a market how does a seller cope?

The economy and concern about reimbursement has many end users seeking new and more novel service proposals from the OEMs and ISOs in their geographic area. When they need to add or replace a CT they are focused on price. In the world of refurbished equipment they can usually get price and performance. It’s a difficult pill to swallow for those with strong ties to their OEM vendors but the bonds are breaking as annual budget reductions become reality.

Where this all ends up is anyone’s guess. I suspect that five years from now the medical imaging landscape will have changed dramatically. The question for most vendors of service and new or used product is not whether there will be a medical imaging market but whether any particular vendor can adjust his business model in order to continue participating in the marketplace.

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