Publications & Research
We examined Medicare national coverage determinations for medical interventions to determine whether or not they have become more restrictive over time. National coverage determinations address whether particular big-ticket medical items, services, treatment procedures, and technologies can be paid for under Medicare. We found that after we adjusted for the strength of evidence and other factors known to influence the determinations of the Centers for Medicare and Medicaid Services (CMS), the evidentiary bar for coverage has risen. More recent coverage determinations (from mid-March 2008 through August 2012) were twenty times less likely to be positive than earlier coverage determinations (from February 1999 through January 2002). Furthermore, coverage during the study period was increasingly and positively associated both with the degree of consistency of favorable findings in the CMS reviewed clinical evidence and with recommendations made in clinical guidelines. Coverage policy is an important payer tool for promoting the appropriate use of medical interventions, but CMS’s rising evidence standards also raise questions about patients’ access to new technologies and about hurdles for the pharmaceutical and device industries as they attempt to bring innovations to the market.
Essential Questions for Consideration in the Design of INTERVENTIONAL X-RAY EQUIPMENT Intended for Pediatric UseJanuary 2015
This document is intended to capture the consensus reached between Image Gently (IG) and the MITA FLUOROSCOPY Interventional Working Group (IWG) to develop a position paper on a list of essential questions that should be considered in the design of INTERVENTIONAL X-RAY equipment intended for pediatric use.
This list of essential questions seeks to increase awareness of design considerations for manufacturers with a goal of improving pediatric imaging. This list is not intended to be used or interpreted as being a standard document and does not represent a list of requirements or components and hence is not appropriate for use as a checklist or other similar manner. Further, the rationales in this document represent examples of possible approaches and are not prescriptive or definitive answers. Manufacturers may have different conclusions and/or provide alternative solutions. All questions may not be applicable in all instances. It is anticipated that no manufacturer will answer affirmatively for all questions.
This work fits in the collaborative iterative process initiated in November 2012 between IG and the IWG to drive the management of radiation dose and image quality on interventional x-ray equipment used on pediatric patients. These essential questions and rationales were initiated by experienced pediatric end users and reviewed by manufacturer representatives.
99mTc is the most widely used radionuclide in nuclear medicine. The reactor stoppages that occurred in recent years illustrated the vulnerability of the availability of radiotracers for imaging. With many of the reactors due for shutdown over the next 5–10 y, alternative routes to producing the 99Mo/99mTc pair are being explored. This brief review examines how we have reached this situation and what the near and distant future holds for securing the availability of these radioisotopes.
Ultrasound images are difficult to segment due to presence of speckle noise and the boundaries of abnormal regions are also difficult to recognize due to similarity. It is important to segment the image for correct and effective diagnosis. Manual method of segmentation is good but not effective for segmentation of large data sets, due to this an automatic or computerized segmentation is motivated. An automatic region growing segmentation for ultrasound images is presented in this work. An automatic selection of seed is adopted because of time consumption, poor accuracy and need of human interaction in manual seed selection. In ultrasound images, identification of the boundaries of abnormal regions is impossible but automatic seed selection provides accurate location of abnormal regions. The proposed method outperforms the existing state-of-the-art techniques based on the texture features and visual results.
Purpose: The aim of this study was to assess the effect of applying ACR Lung-RADS in a clinical CT lung screening program on the frequency of positive and false-negative findings.
Methods: Consecutive, clinical CT lung screening examinations performed from January 2012 through May 2014 were retroactively reclassified using the new ACR Lung-RADS structured reporting system. All examinations had initially been interpreted by radiologists credentialed in structured CT lung screening reporting following the National Comprehensive Cancer Network’s Clinical Practice Guidelines in Oncology: Lung Cancer Screening (version 1.2012), which incorporated positive thresholds modeled after those in the National Lung Screening Trial. The positive rate, number of false-negative findings, and positive predictive value were recalculated using the ACR Lung-RADS-specific positive solid/part-solid nodule diameter threshold of 6 mm and nonsolid (ground-glass) threshold of 2 cm. False negatives were defined as cases reclassified as benign under ACR Lung-RADS that were diagnosed with malignancies within 12 months of the baseline examination.
Purpose: The aim of this study was to compare results of National Comprehensive Cancer Network (NCCN) high-risk group 2 with those of NCCN high-risk group 1 in a clinical CT lung screening program.
Methods: The results of consecutive clinical CT lung screening examinations performed from January 2012 through December 2013 were retrospectively reviewed. All examinations were interpreted by radiologists credentialed in structured CT lung screening reporting, following the NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screening (version 1.2012).
Applications of Justification and Optimization in Medical Imaging: Examples of Clinical Guidance for Computed Tomography Use in Emergency MedicineSeptember 2014
Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
The Medical Imaging and Technology Alliance (MITA), a division of the National Electrical Manufacturers Association (NEMA), is the leading organization and collective voice of medical imaging equipment, radiation therapy and radiopharmaceutical manufacturers, innovators and product developers. It represents companies whose sales comprise more than 90 percent of the global market for medical imaging technology including those that produce:
- Medical X-ray equipment
- Computed tomography (CT) scanners
- Nuclear imaging
- Radiation therapy equipment
- Magnetic resonance imaging (MRI)
- Imaging information systems
Medical imaging technology is manufactured by hundreds of companies with operations located throughout the United States, and is utilized in tens of thousands of hospitals, clinics, urgent care centers and physicians’ and dentists’ offices. One state, where the manufacturing of high technology equipment like medical imaging equipment is particularly important is Washington.
Usually thought of as the home of aircraft or software manufacturing since both Boeing and Microsoft are headquartered in the Seattle area, Washington is also home to 37 medical imaging technology companies. The activities performed at these sites, along with the use of medical imaging equipment and technology at over 730 hospitals, urgent care facilities and other major medical clinics and offices located throughout the state, provide over 4,520 full-time equivalent jobs in the Evergreen State. In addition, suppliers and other companies directly related to the medical imaging industry generate an additional 7,600 full time equivalent positions.