The New Era of Medical Imaging
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In his Health Policy Report (June 29 issue),1 Iglehart seems to suggest that patients, payers, and physicians alike would be well served if a great effort was made by the imaging community to work together and identify new measures of quality that could define appropriate imaging. That is precisely what my colleagues and I are doing at the American College of Cardiology (ACC).
At a recent think tank composed of members of the ACC and the Duke Clinical Research Institute, multiple stakeholders made a commitment to develop standards and tools for imaging. In addition, the ACC recently released appropriateness criteria for myocardial perfusion imaging with the use of single-photon-emission computed tomography (CT). Criteria for cardiovascular CT, magnetic resonance imaging, and echocardiography are being developed.
It is indisputable that the use of medical imaging is increasing. However, the increase is fueled by many factors, including the use of imaging to enhance diagnostic accuracy and to guide therapy. At the ACC, our goal is to ensure that all appropriately trained physicians are able to perform imaging. Quality and competence are the goals underlying this effort.
Steven E. Nissen, M.D.
American College of Cardiology
Bethesda, MD 20814
References
Iglehart JK. The new era of medical imaging -- progress and pitfalls. N Engl J Med 2006;354:2822-2828.
To the Editor: Iglehart's article was a timely summary of the controversies surrounding medical imaging. However, an important clarification is needed regarding changes in the self-referral provisions for nuclear medicine.1 The statement "Medicare recently added nuclear medicine to the list of services that, starting in 2007, physicians may no longer provide in facilities they own" does not reflect the exceptions to this rule, specifically the "in-office ancillary services exception" described earlier in the article. This exception allows physicians to perform tests in their own facilities, provided that testing is part of care in that office.
Allegations regarding the impropriety of the growth of positron-emission tomography in oncology created the impetus for change by the Centers for Medicare and Medicaid Services.1 However, unexpected "nuclear fallout" could have curtailed the growth of other forms of treatment such as nuclear cardiology,2 an evidence-based3 and cost-effective4 guide to the management of heart disease that is predominantly performed in outpatient cardiology offices.
For now, the in-office ancillary services exception is intact. Its preservation is critical to the delivery of quality health care in cardiology and other specialties.
Kim A. Williams, M.D.
University of Chicago
Chicago, IL 60637
kimw@uchicago.edu
References
Rules and regulations. Fed Regist 2005;70:70265-70314.
Williams KA. Testimony March 17, 2005, before the House Ways and Means Subcommittee on Health. Washington, DC: Committee on Ways and Means, 2005. (Accessed September 19, 2006, at http://waysandmeans.house.gov/hearings.asp?formmode=view&id=2555.)
Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging -- executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-1333.
Des Prez RD, Shaw LJ, Gillespie RL, et al. Cost-effectiveness of myocardial perfusion imaging: a summary of the currently available literature. J Nucl Cardiol 2005;12:750-759.
At a recent think tank composed of members of the ACC and the Duke Clinical Research Institute, multiple stakeholders made a commitment to develop standards and tools for imaging. In addition, the ACC recently released appropriateness criteria for myocardial perfusion imaging with the use of single-photon-emission computed tomography (CT). Criteria for cardiovascular CT, magnetic resonance imaging, and echocardiography are being developed.
It is indisputable that the use of medical imaging is increasing. However, the increase is fueled by many factors, including the use of imaging to enhance diagnostic accuracy and to guide therapy. At the ACC, our goal is to ensure that all appropriately trained physicians are able to perform imaging. Quality and competence are the goals underlying this effort.
Steven E. Nissen, M.D.
American College of Cardiology
Bethesda, MD 20814
References
Iglehart JK. The new era of medical imaging -- progress and pitfalls. N Engl J Med 2006;354:2822-2828.
To the Editor: Iglehart's article was a timely summary of the controversies surrounding medical imaging. However, an important clarification is needed regarding changes in the self-referral provisions for nuclear medicine.1 The statement "Medicare recently added nuclear medicine to the list of services that, starting in 2007, physicians may no longer provide in facilities they own" does not reflect the exceptions to this rule, specifically the "in-office ancillary services exception" described earlier in the article. This exception allows physicians to perform tests in their own facilities, provided that testing is part of care in that office.
Allegations regarding the impropriety of the growth of positron-emission tomography in oncology created the impetus for change by the Centers for Medicare and Medicaid Services.1 However, unexpected "nuclear fallout" could have curtailed the growth of other forms of treatment such as nuclear cardiology,2 an evidence-based3 and cost-effective4 guide to the management of heart disease that is predominantly performed in outpatient cardiology offices.
For now, the in-office ancillary services exception is intact. Its preservation is critical to the delivery of quality health care in cardiology and other specialties.
Kim A. Williams, M.D.
University of Chicago
Chicago, IL 60637
kimw@uchicago.edu
References
Rules and regulations. Fed Regist 2005;70:70265-70314.
Williams KA. Testimony March 17, 2005, before the House Ways and Means Subcommittee on Health. Washington, DC: Committee on Ways and Means, 2005. (Accessed September 19, 2006, at http://waysandmeans.house.gov/hearings.asp?formmode=view&id=2555.)
Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging -- executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-1333.
Des Prez RD, Shaw LJ, Gillespie RL, et al. Cost-effectiveness of myocardial perfusion imaging: a summary of the currently available literature. J Nucl Cardiol 2005;12:750-759.