Some Dark Clouds on the Medical Imaging Horizon

It has been suggested that one of the reasons that Siemens and GE have acquired a number of IVD companies lately, thereby extending their reach in diagnostic medicine, is that demand for medical imaging equipment is softening. Their hedge has been prompted, in part, because insurance companies and Medicare are taking a harder look at the rising cost of imaging procedures. A recent article (see: Cranking Up the Volume) addressed this issue. Below is an excerpt from it with boldface emphasis mine: 

One reason medical costs are getting way out of control: GE employs too many good salesmen....But a year ago Medicare cut the price it pays for imaging, so [one radiologist] gets paid 15% to 50% less for each order, depending on the type of scan....[The radiologist] was forced to take a 20% salary cut. Now his ...practice is holding off on buying new machines and stretching the old machines' life span to five years.... But what's bad for the radiologist and all the big companies selling him new equipment--General Electric, Siemens...and Philips--is good for everyone who foots the bill. Imaging accounts for only 5% of the $2 trillion in U.S. medical spending, but it has been the fastest-growing component of health care inflation in recent years, climbing 20% annually until last year. Scans (excluding old-fashioned X rays) per thousand insured people went from 85 to 234 in the U.S. since 1999 ....Expensive fact: Pittsburgh has more MRI machines than Canada. Now comes a scientific backlash to the imaging boom. A recent study by two Columbia University researchers ...argued that the overuse of CT scanning is adding up to dangerous levels of radiation exposure, especially in kids. Another risk is needless panic. A study from the National Institutes of Health found that 17% of patients getting tested for cancer had at least one false positive chest X ray over a four-year period, and 8% of women had at least one false positive ultrasound for ovarian cancer.

I believe that it's time to get back to basics in diagnostics as described in my recent post which advocated the right test for the right patient at the right time. In this note, I recommended the use of algorithms for guiding clinicians about what lab tests to select to quickly and efficiently arrive at the correct diagnosis. Just substitute the term guidelines for algorithms in the note and you will understand the larger picture. Although one can pejoratively refer to such guidelines as cook-book medicine, I prefer the phrase appropriate healthcare delivery to describe their use.

We will increasingly turn to the sophisticated multiplex biomarker panels that are  coming to market for disease monitoring and screening as a safer and less expensive alternative to medical imaging. Put another way, I favor an initial workup with lab tests followed by carefully selected imaging studies. However, everyone need to fully understand that any diagnostic procedure is associated with both false positive and negative results. It falls to the astute clinician to ameliorate these risks with an optimal testing ordering strategy and by careful integration and analysis of test results.

:: Update on March 11, 2008, @9:36 a.m.

For additional reading about the use of CT scans for screening for lung cancer, see:  Cancer Screening, CT Scans, and Patent Applications.