Evolving Use of fMRI in Medicare Beneficiaries.

Using the Medicare Physician-Supplier Procedure Summary Master File, we evaluated the evolving use of fMRI in Medicare fee-for-service beneficiaries from 2007 through 2017. Annual use rates (per 1,000,000 enrollees) increased from 17.7 to 32.8 through 2014 and have remained static since. Radiologists have remained the dominant specialty group from 2007 to 2017 (86.4% and 88.6% of all services, respectively), and the outpatient setting has remained the dominant place of service (65.4% and 65.4%, respectively).

Strengths, Weaknesses, Opportunities, and Threats Analysis of Artificial Intelligence and Machine Learning Applications in Radiology.

Currently, the use of artificial intelligence (AI) in radiology, particularly machine learning (ML), has become a reality in clinical practice. Since the end of the last century, several ML algorithms have been introduced for a wide range of common imaging tasks, not only for diagnostic purposes but also for image acquisition and postprocessing. AI is now recognized to be a driving initiative in every aspect of radiology. There is growing evidence of the advantages of AI in radiology creating seamless imaging workflows for radiologists or even replacing radiologists. Most of the current AI methods have some internal and external disadvantages that are impeding their ultimate implementation in the clinical arena. As such, AI can be considered a portion of a business trying to be introduced in the health care market. For this reason, this review analyzes the current status of AI, and specifically ML, applied to radiology from the scope of strengths, weaknesses, opportunities, and threats (SWOT) analysis.

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply. / Health-Technology-Assessments in der Radiologie in Deutschland: Fehlende Nachfrage, fehlendes Angebot.

BACKGROUND: Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. METHOD: This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation" for inpatients and "authorization right" for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies. RESULTS: The G-BA's authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector. CONCLUSION: Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures. KEY POINTS: · HTAs should be a basic component of evidence-based radiology.. · G-BA's authority implicitly creates a paradox in terms of inventives to implement and finance HTAs.. · University hospitals and public funding institutions need to support studies that assess the benefit of radiological procedures.. CITATION FORMAT: · Winkelmann C, Neumann T, Zeidler J et al. Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply. Fortschr Röntgenstr 2019; 191: 635 - 642.

Percutaneous Vertebral Augmentation for Vertebral Compression Fractures: National Trends in the Medicare Population (2005-2015).

STUDY DESIGN: Retrospective analysis of Medicare data OBJECTIVE.: To analyze trends of vertebral augmentation in the elderly Medicare population in the context of evolving evidence and varied medical society opinions. SUMMARY OF BACKGROUND DATA: Percutaneous vertebral augmentation offers a minimally invasive therapy for vertebral compression fractures. Numerous trials have been published on this topic with mixed results. The impact of these studies and societal recommendations on physician practice patterns is not well understood. METHODS: The Centers for Medicare and Medicaid Services annual Medicare Physician Supplier Procedure Summary database was examined for kyphoplasty and vertebroplasty procedures from 2005 through 2015. Top provider specialties were determined based on annual procedural volume, and grouped into the three broad categories of radiology, surgery, and anesthesia/pain medicine. Data entries were independently analyzed by provider type, site of service, submitted charges, and reimbursement rates for interventions during the study period. RESULTS: Between 2005 and 2015 total annual claims for vertebral augmentation procedures in the Medicare population increased from 108.11% (37,133-77,276) peaking in 2008 and declining by 15.56% in 2009. Radiology is the largest provider of vertebral augmentation by specialty with declining market shares from 71% in 2005 to 43% in 2015. The frequency of vertebroplasty declined by 61.7% (35,409-13,478) from 2005 to 2015 with reduction in Medicare reimbursement. Annual volume of kyphoplasty grew by 18.3% (48,725-57,646) with significant increase in reimbursement for office-based procedures ($728.50/yr, P < 0.001, R = 0.69). CONCLUSION: The annual volume of vertebral augmentation declined in 2009 following two negative trials on vertebroplasty. Although these publications had a persistent negative impact on practice of vertebroplasty, the overall frequency of vertebral augmentation in the Medicare population has not changed significantly between 2005 and 2015. Instead, there has been a significant shift in provider practice patterns in favor of kyphoplasty in increasingly outpatient and office-based settings. LEVEL OF EVIDENCE: 3.

Cost-Effectiveness Analysis: An Overview of Key Concepts, Recommendations, Controversies, and Pitfalls.

The field of radiology has witnessed a burst of technological advances that improve diagnostic quality, reduce harm to patients, support clinical needs, and better serve larger more diverse patient populations. One of the critical challenges with these advances is proving that value outweighs the cost. The use of cutting-edge technology is often expensive, and the reality is that our society cannot afford all the screening and diagnostic tests that are being developed. At the societal level, we need tools to help us decide which health programs should be funded. Therefore, decision makers are increasingly looking toward scientific methods to compare health technologies in order to improve allocation of resources. One of such methods is cost-effectiveness analysis. In this article, we review key features of cost-effectiveness analysis and its specific issues as they relate to radiology.

Litigation claims in relation to radiology: what can we learn?

AIM: To analyse data provided by the National Health Service Litigation Authority (NHSLA) to establish common and/or reoccurring themes or trends, and use these established learning points to reduce the possibility of such claims in the future. MATERIALS AND METHODS: Data provided by the NHSLA under the Freedom of Information Act for settled claims against radiology between 1995 and 2014 were analysed for common themes. RESULTS: Seven hundred and ninety-one settled claims were recorded by the NHSLA between 1995 and 2014 where radiology was implicated as the primary specialty at fault. Alleged missed or delayed diagnosis of a tumour accounted for almost a third of claims. Eight percent of claims related to interventional radiology. Almost 10% of claims (n=75) were settled due to an injury whilst in the radiology department, with almost a third of these due to a fall in the department. CONCLUSION: "To err is human", but by analysing NHSLA claims related to radiology, thematic analysis and discussion regarding these cases can be highlighted, and hopefully, to mitigate these risks and thus reduce liability in the future.

2017 Presidential Address: Staying Ahead of the Curve.

The practice of the radiological sciences has always been dynamic. From economics and payment policy to imaging appropriateness, the ACR has led the way in keeping our specialty ahead of the curve. However, being ahead of the curve is a fragile place, and constant diligence is needed to remain there. There will always be major changes on our horizon, and the ACR will be there to empower us to adapt to change.

National Trends in the Utilization of Skeletal Radiography From 2003 to 2015.

PURPOSE: Examine recent trends in the use of skeletal radiography and assess the roles of various nonradiologic specialties in the interpretations. METHODS: Medicare Part B fee-for-service claims data files from 2003 to 2015 were analyzed for all Current Procedural Terminology, version 4 (CPT-4) procedure codes related to skeletal radiography. The files provide examination volume, and we calculated utilization rates per 1,000 Medicare beneficiaries. Medicare's physician specialty codes were used to determine the specialties of the providers. Total utilization rate trends were analyzed, as well as those for radiologists and nonradiologists. We determined which nonradiologist specialties were the highest users of skeletal radiography. Medicare place-of-service codes were used to identify the locations where the services were provided. RESULTS: The total utilization rate per 1,000 of skeletal radiography within the Medicare population increased 9.5% from 2003 to 2015. The utilization rate for radiologists increased 5.5% from 2003 to 2015 versus 11.1% for nonradiologists as a group. Among nonradiologist specialties in all health care settings over the study period, orthopedic surgeons increased 10.6%, chiropractors and podiatrists together increased 14.4%, nonphysician providers (primarily nurse practitioners and physician assistants) increased 441%, and primary care physicians' rate decreased 33.5%. Although radiologists do almost all skeletal radiography interpretation in hospital settings, nonradiologists do the majority in private offices. There has been strong growth in skeletal radiography in emergency departments, but a substantial drop in inpatient settings. CONCLUSIONS: The utilization of skeletal radiography has increased more rapidly among nonradiologists than among radiologists. This raises concerns about self-referral and quality.

Teaching Radiology Trainees From the Perspective of a Millennial.

The millennial generation consists of today's medical students, radiology residents, fellows, and junior staff. Millennials' comfort with immersive technology, high expectations for success, and desire for constant feedback differentiate them from previous generations. Drawing from an author's experiences through radiology residency and fellowship as a millennial, from published literature, and from the mentorship of a long-time radiology educator, this article explores educational strategies that embrace these characteristics to engage today's youngest generation both in and out of the reading room.

Bridging the Gap: Identifying Global Trends in Gender Disparity Among the Radiology Physician Workforce.

RATIONALE AND OBJECTIVES: Women make up half of American medical school graduates, but remain underrepresented among radiologists. This study sought to determine whether workforce gender disparities exist in other countries, and to identify any country-specific indices associated with increased female representation. MATERIALS AND METHODS: In this cross-sectional study, 95 professional radiology organizations in 75 countries were contacted via email to provide membership statistics, including proportion of female members, female members aged 35 or under, and women in society leadership positions. Country-specific metrics collected included gross domestic product, Gini index, percent female medical school enrollment, and Gender Development Index for the purposes of univariate multiple regression analysis. RESULTS: Twenty-nine organizations provided data on 184,888 radiologists, representing 26 countries from Europe (n = 12), North America (n = 2), Central/South America (n = 6), Oceania (n = 2), Asia (n = 3), and Africa (n = 1) for a response rate of 34.7% (26/75). Globally, 33.5% of radiologists are female. Women constitute a higher proportion of younger radiologists, with 48.5% of radiologists aged 35 or under being female. Female representation in radiology is lowest in the United States (27.2%), highest in Thailand (85.0%), and most variable in Europe (mean 40.1%, range 28.8%-68.9%). The proportion of female radiologists was positively associated with a country's Gender Development Index (P = .006), percent female medical student enrollment (P = .001), and Gini index (P = .002), and negatively associated with gross domestic product (P = .03). CONCLUSIONS: Women are underrepresented in radiology globally, most notably in the United States. Countries with greater representation of women had higher gender equality and percent female medical school enrollment, suggesting these factors may play a role in the gender gap.

2017 Annual Meeting of the American College of Radiology-Moreton Lecture: Forecasting the Futures of Radiology.

PURPOSE: The traditional forces of change in health care are no longer working as they did in the past. Political gridlock has destroyed Washington's ability to create sensible policy for reforming the medical marketplace, creating chaos for providers. Fortunately, chaos creates opportunity. The idea of creating one's future has never been more relevant and necessary. MATERIALS AND METHODS: Predicting-the science of extrapolating future values from historical data-is not a valid method for looking ahead when causal relationships that explained change in the past are themselves being redefined (the current situation). Forecasting-the art of estimating probabilities of possibilities-is the appropriate method for anticipating futures when causality is being redefined. With its focus on identifying a range of possibilities, forecasting identifies many different outcomes that are simultaneously possible for radiology. RESULTS: Health care's new climate is being shaped by four defining trends: 1) revolution in biological science that is shifting caregivers' mission from acute care to disease management; 2) proliferation of information and communications technologies that are transforming the way care is delivered; 3) end of economic growth in the medical marketplace that is reshaping demand for care; and 4) political dysfunction that forces caregivers and their business partners to develop successful futures on their own. CONCLUSIONS: Radiology 3.0 is nicely aligned with the transformational trends. Staying focused on implementing Radiology 3.0 is supported as the optimal strategy for creating the profession's futures. Diagnostic convergence, establishing a unified diagnostic science with laboratory medicine, is proposed as a complementary initiative.

2017 ACR Annual Meeting Open-Microphone Session: Navigating the Landscape of Changing Practice Models: Private Practice, Corporate Radiology, and Enterprise Systems.

Many practice groups are considering adopting new practice models, primarily to secure their practices by adapting to new payment models, government compliance and regulation, and increasing IT and infrastructure costs. As we move toward value-based care and capitation, the value equation (value = quality/cost) will lead us to also compete on cost to improve value. No matter what payment models ultimately dominate, we need to be prepared to lead in a value-based care environment. Measures of value will either be defined by radiologists or imposed by outside entities. It is critical to our continued success that practices and practice leaders continue to fully and strongly support the ACR to avoid the possibility of a decline in membership that may accompany a lack of practice engagement. Consolidation appears inevitable, but with the help of the ACR, radiologists should have a vibrant future if investments are made now in determining appropriate radiology-specific value measures that are meaningful in consolidated health care environments.