RT Image Vol. 23 No. 14 July 19, 2010 : Page 15There are several reasons. Radiologists may have more comfort with an image that a tech brings them or is sent over on their PACS, versus one that they have to interact with more to produce the image. The other reason is simply reimbursement. Not only does each ultrasound pay significantly less than each MRI, but in the time it takes radiologists to do one ultra-sound, they can interpret two or three MR studies. In my opinion, that is the single major impediment to why 25 years after its introduction, MSK ultrasound is considered an emerging technology. By contrast, among non-radiologist physicians, it’s a different “ Q A story. They’re going from no cross-sectional imaging to ultrasound. They now have a tool at their disposal that they can use not only to provide better patient care but also can increase their bottom line. So for non-radiologist physicians, it’s no mystery why they’re jumping on the MSK ultrasound bandwagon. image: Should there be credentialing for MSK ultrasound? Nazarian: Yes. Through the AIUM, we’ve developed training guidelines for MSK ultrasound and we hope that that will soon lead to accreditation of practices. We believe that payers will be interested in reimbursing those who are accredited. Recently Blue Cross/Blue Shield of Illinois, Texas, Oklahoma, and New Mexico temporarily stopped paying for MSK ultrasound altogether. The reason they did that was that there was such a huge increase in utilization by non-radiologist physicians that they basically shut all of the reimbursement down. Only by a letter-writing campaign from the AIUM, others, and myself did they reverse this decision, at least temporarily. I actually have a paper accepted at the JournaloftheAmerican College of Radiology discussing how we have gotten to the point where the cheaper, most cost-effective modality is cut off from reimbursement. Q A Q A image: How will the AIUM’s training guidelines affect the use of MSK ultrasound? Nazarian: [The training guidelines will] pave the way for accreditation and then ensure patient safety, which is really our main goal. We have to make sure that the people who are using these techniques have adequate equipment, know what they’re doing, and are providing good care to their patients. image: Do you anticipate MSK ultrasound will be used more in the future? Nazarian: Absolutely. It’s definitely on a steep growth curve that’s going to continue. First of all, more and more people are seeing how integral ultrasound is to MSK diagnosis and that if you’re not providing ultrasound to your patients, you are doing them a disservice. And, as ultrasound equipment becomes smaller More and more people are seeing how integral ultrasound is to MSK diagnosis and that if you’re not providing ultrasound to your patients, you are doing them a disservice. | Levon N. Nazarian, MD ” and more affordable – many of the smaller machines have excellent imaging capabilities – you will get more diffusion of ultrasound out into the community for people who are non-traditional users, such as sports medicine physicians, orthopedists, and rheumatologists. What I’m not sure of is how much it’s going to grow among radiologists; that still remains to be seen. We are seeing some modest growth in radiologists, but the huge growth we’re seeing is among non-radiologist specialties. We sent in an abstract to the RSNA this year about this issue, and the numbers are just striking how much quicker non-radiologists’ use of MSK ultrasound is growing compared to radiologists. Q A image: What innovations have made MSK ultrasound more appealing to radiologists or other physicians? Nazarian: Over the last decade the dramatic improvements in resolution have really fueled the growth of ultrasound. The image quality is just superb, and the diagnoses we can make, some of them we couldn’t even have dreamt of making a decade ago. For the non-radiologist physician, the miniaturization and portability of the ultrasound equipment is as important as image quality. Yes, you need image quality, but it’s really the affordability and portability of the equipment that fuels the growth for non-radiologist physicians because they need to be able to take equipment to point of care from office to office, from patient room to patient room, as opposed to the classic radiologist paradigm of a big machine that you stick in the room and you bring the patient to it. Instead you bring the machine to the patient, or the playing field, or outer space. There’s an ultrasound system in the space shuttle. Q A image: What would you say to those who claim ultrasound is a mature modality with little room for advancement? Nazarian: There’s no question that there’s significant potential for advancement. I would say a couple areas, specifically for MSK would be: sonoelastography, which I think will have a great application in the MSK system to be able to tell not only what the structure looks like, but the elastic properties. I’m keenly interested in that development, and as the technology matures would like to see how we are going to be able to use that diagnostically. Ultrasound contrast agents are another one. We do not have FDA approval to use ultrasound contrast agents in this country for MSK ultrasound, but there are a host of exciting innovations we can make in diagnosis once we get FDA approval for contrast agents. |www.rt-image.com| July 19, 2010 |15| Publication List |
