Differentiate your practice: Couple advanced visualization software with multislice CT technology

By Stephen M. Bravo, MD
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Private Practice


Private radiology practices have watched their computed tomography (CT) revenues steadily erode over the past several years, thanks in large part to the bundling of different CPT codes by the Centers for Medicare and Medicaid Services (CMS), associated drops in reimbursement per CPT code, and an overall drop in CT utilization driven largely by adverse press coverage of ionizing radiation, especially with respect to the pediatric population. Indeed, CT examinations have been greatly supplanted by ultrasonography and MRI.

Nevertheless, the growing sophistication of advanced visualization (AV) software has allowed us to reinvigorate our CT services. While standard CT exams of the chest, abdomen and pelvis, brain, and sinuses have remained stagnant, advanced CT examinations such as CT coronary arteriography, neurovascular CT arteriography, and peripheral vascular CT arteriography have increased significantly with growing acceptance of these procedures by both the lay public and our referring physicians. Lung cancer screening with low-dose CT will also become increasingly important in the future.

The adoption of AV tools in conjunction with multislice CT has helped us to become much more proficient at delivering these more sophisticated CT applications. At Sand Lake Imaging, we combine 64-slice CT with the Siemens syngo.via AV software package, which permits rapid image manipulation. Indeed, images are transferred directly from the CT to the syngo.via AV server, where manipulation is performed by the CT technologist, who then forwards the images on to our PACS, permitting complete integration of raw data with the reconstructed images. The raw data, moreover, confers on the radiologist the ability to further manipulate the images as necessary.

These tools have markedly increased our ability to process these more-sophisticated examinations. Previously, evaluating these studies had been hampered by the significant amounts of time required by technologists to present images in a format acceptable to the reading radiologist. Today, coronary CTA reconstructions have dropped from 50 minutes to 10 minutes; CTA runoff and neurovascular arteriography raw data manipulation have dropped from 30 minutes to 10 minutes—thanks largely to automatic vessel tracing capabilities and a far more robust bone-removal software algorithm, which in turn have resulted in far more rapid turnaround from exam completion to presentation to the radiologist. The software’s ease of use has also increased radiologist productivity, leading to increased volume of these types of examinations without hurting the quality of service provided to our referring doctors.

Combining AV software with multislice CT has also significantly increased our diagnostic accuracy. Quantification application software embedded within the software permits reproducible, accurate, objective data measurement, allowing for far greater accuracy in delineating arterial stenoses and making other measurements. Anecdotal data from our referring physicians in fact demonstrates increased concordance of our results with the gold standard of catheter-directed arteriography. This increased accuracy, in turn, has yielded greater acceptance among referring doctors of the validity and efficiency of this diagnostic imaging tool, and they, in turn, have significantly increased their ordering patterns, resulting in higher utilization of these examinations.

Since installing AV software in November 2012, we have witnessed a 300 percent increase in coronary CT arteriography, a 150 percent increase in neurovascular CT arteriography, and a 100 percent increase in peripheral vascular CT arteriography. At the same time, iterative reconstruction algorithms have allowed us to reduce ionizing radiation to levels far below the accepted standards for safe imaging.

The AV-centric pathway of data dissemination has also allowed us to deliver information in a more clinically applicable format easily understood by our referring doctors, increasing their acceptance of the information’s clinical utility. In addition, patients get readily available access to the images, which reportedly provides them with greater understanding and acceptance of planned procedures. For us, this has yielded a successful cooperation among patients, referring doctors and ourselves which significantly improves healthcare delivery.

With implementation of the Affordable Care Act (ACA), preventive medicine has become more important. As AV provides a detailed look into areas of suspected disease in high-risk populations, potentially enabling physicians to accurately monitor and diagnose pathology much more efficiently and earlier, we believe the technology will play an especially major role in the future of lung cancer screening.

The American Lung Association, the American Cancer Society, and the National Comprehensive Cancer Network have all recently recommended low-dose CT screening for high-risk patients; the American College of Radiology has also adopted a certification for low-dose lung cancer screening centers. It is our hope that the CMS will soon approve these scans for reimbursement. With its ability to delineate volumetric size of nodules, we believe AV will be increasingly important to providing appropriate screening, likely altering patient care pathways and inevitably reducing patient exposure to radiation by eliminating unnecessary procedures.

Ultimately, we believe that AV tools can not only help to improve patient outcomes and overall healthcare delivery—fundamental elements of accountable care—but can also help position imaging practices for future success.

By coupling AV software tools with multislice CT, your imaging practice can significantly offset declines in CT volume, define itself as one of excellence and accuracy in performing advanced CT applications, and help to ensure it is properly positioned for success in the coming new era of preventive and value-based medicine.

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July 04, 2014
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