Coding and reimbursement issues for the radiologist.

Radiologists are dependent on the proper execution of a complex administrative chain of disease and diagnosis coding and procedural coding to be properly reimbursed for the examinations they perform. The radiologist bears the ultimate responsibility for the appropriateness of these codes. However, many practicing radiologists are unaware of the critical link between the two coding systems and the systems that have developed to provide a common method of describing diseases, diagnoses, and procedures. This article is an introduction to these systems, and it emphasizes the importance of the involvement of the radiologist in coding. The inherent complexity of the reimbursement system in use is emphasized, as well as the essential role of the radiologist in complying with these often complicated and ever-changing directives.

Evaluation of a mandatory radiology resident research rotation.

RATIONALE AND OBJECTIVES: This purpose of this study was to determine if a 1-month, mandatory research rotation results in resident interest and productivity in research. MATERIALS AND METHODS: A survey composed primarily of closed-end questions was constructed to evaluate the opinions and experience of 24 residents who completed the research rotation during a 3 1/2-year period. RESULTS: All 24 residents filled out the survey. Seventeen residents did clinical projects, two did bench research, and two did projects that were socioeconomic or legal in nature. Thirteen residents presented data at a meeting, and three of these presentations won awards. Resident research projects resulted in 18 manuscripts at the time of the survey (seven published, eight in preparation, and three in revision or review). Seventeen residents thought the experience was worthwhile and the research month should be continued; two residents did not. Ten residents reported that in retrospect, they would have done the rotation even if it had not been required, and eight reported the experience increased their appreciation of the value of research in medicine. CONCLUSION: A 1-month, mandatory resident research rotation produces resident interest in research and enhances departmental research productivity.

The past 25 years in medical imaging research: a memoir.

During the past 25 years, medical imaging research has progressed in both scope and quality. Factors intrinsic to the specialty and changes occurring in medicine and society have fostered imaging research development. The advent of new, computer-based technologies that can be brought to bear on research, the increasing sophistication of researchers, and the greater availability of extramural funding have been primary factors in the promulgation of research improvements. Radiology researchers have the opportunity to play an important role in the genesis of the molecular medicine of the future. Whether they do so is dependent on whether radiologists identify necessary resources, new researchers receive appropriate training, and investigators are willing to think differently than they have in the past about the capabilities of imaging.

The RSNA-AUR-ARRS introduction to research program for 2nd year radiology residents: effect on career choice and early academic performance. Radiological Society of North America. Association of University Radiologists. American Roentgen Ray Society.

PURPOSE: To evaluate graduates of the first 5 years of the Introduction to Research program, sponsored by the Radiological Society of North America, Association of University Radiologists, and American Roentgen Ray Society, to determine if they more frequently entered and demonstrated early success in academic careers than did nonparticipants. MATERIALS AND METHODS: In 1997, the authors surveyed all 396 program participants for the 1990-1995 period and 2,047 nonparticipants who were in the same residencies as the participants during that period. Career plans, research participation, and academic achievements were compared. RESULTS: The survey was completed by 321 participants (81%) and 1,153 nonparticipants (56%). More than a third of participants thought the program had a strong effect on their initial career decision. Forty-one percent of participants who completed training (n = 192) were currently in academia versus 26% of nonparticipants (n = 676; P = .001). Of the 321 participants, 35% believed they would spend most of their careers in academia and 15% thought research would be their major focus versus 19% and 8% for the 1,153 nonparticipants (P < .001). Participants had higher levels of academic achievement earlier in their careers than did nonparticipants. CONCLUSION: The Introduction to Research program is encouraging the development of successful research careers. However, the results may be influenced by the self- or departmental selection of participants who were oriented toward research independent of program participation.

Acutely injured knee: effect of MR imaging on diagnostic and therapeutic decisions.

PURPOSE: To assess the effect of knee magnetic resonance (MR) imaging on the diagnosis and management of acute knee injury. MATERIALS AND METHODS: Two orthopedic knee surgeons prospectively completed pre- and post-MR imaging questionnaires on 84 of 91 consecutive patients with acute knee injury. The pre- and post-MR imaging clinical diagnoses, certainty regarding these diagnoses, other diagnostic tests, and subjective impression of the usefulness of MR imaging were determined. RESULTS: Seven hundred thirty-one of 840 pre- and post-MR imaging diagnoses agreed. Agreement was lowest for medial meniscal injuries (54 of 84). Significantly fewer meniscal injuries were suspected after MR imaging (P < .05). In 60 patients, the orthopedist changed at least one of the 10 potential diagnoses after MR imaging. Clinical diagnostic certainty increased by a mean of 14% for all diagnoses. The increase in diagnostic certainty was greatest for medial meniscal injuries (30%), followed by lateral meniscal injuries (21%). The proposed management changed in 41 patients, resulting in significantly fewer arthroscopic procedures (P < .01). The post-MR imaging management plans included 37% (27 of 73) fewer arthroscopic procedures. CONCLUSION: MR imaging affects the diagnosis and management of acute knee injury by decreasing the number of arthroscopic procedures, improving clinician diagnostic certainty, and assisting in management decisions.

Medical imaging in the 21st century.

Imaging has been one of the success stories of 20th century medicine but is now under pressure from tight health-care budgets and from professional competition. The 21st century will need a very different type of radiologist, one trained not just in imaging but also in more basic disciplines and in informatics. Research in radiology will need more attention than hitherto, and the imager of tomorrow will have to defend his or her specialty against the charge of "expensive high technology" and adapt, by taking a more market-oriented approach to the added value that the specialty provides.

Acute knee trauma: how many plain film views are necessary for the initial examination?

OBJECTIVE: To determine whether anteroposterior (AP) and lateral views of the knee are equivalent to four views in acute fracture detection. DESIGN: Three musculoskeletal radiologists retrospectively interpreted the plain film knee examinations of each patient, establishing ground truth for the presence or absence of a fracture. Cases were presented to four masked senior radiology residents twice--once as a two-view study and again as a four-view study--with 4 weeks separating the two reading sessions to minimize recall bias. Sensitivity, specificity, and diagnostic performance were calculated. PATIENTS: Ninety-two patients presenting to the emergency department with acute knee trauma were evaluated with at least a four-view plain film examination. RESULTS AND CONCLUSIONS: Mean sensitivity for fracture detection using four views (85%) was significantly higher than that using two views (79%). Mean specificity and receiver operating characteristic curve areas were not significantly different using two or four views. Four views are more sensitive than AP and lateral views alone in detection of acute knee fracture.

Diagnostic efficacy of compressed digitized real-time sonography of uterine fibroids.

RATIONALE AND OBJECTIVES: The authors investigated the diagnostic efficacy of compression of real-time ultrasound (US) examinations. METHODS: Low- and high-compression recordings (9:1 and 15:1, respectively) of examinations were generated by using Joint Photographic Experts Group algorithms. Seven radiologists used a five-level response scale to answer questions about the presence, number, and location of focal fibroid tumors in 67 randomly sorted uterine examinations. The images were viewed after no, low, and high compression. Results were evaluated by using multipatient, multireader receiver operating characteristic jack-knife analysis. RESULTS: Given the reduction in the US digital video rates from 74 Mbit/sec for uncompressed images to 8 Mbit/sec for low compression and 4.7 Mbit/sec for high compression, there were no statistically significant differences in accuracy between the compression schemes. Confidence intervals suggested that the sample size was adequate. CONCLUSION: Compressed images with compression ratios of 9:1 and 15:1 were diagnostically equivalent to uncompressed images of uterine fibroid tumors.

Diagnostic imaging in 2001 - a health economics perspective.

Factors contributing to the growth and diffusion of new imaging technologies are discussed. The benefits derived from implementing and using new technologies are carefully evaluated against the associated costs to both patients and service providers. The need to invest in early scientific assessment of a new imaging technology in order to prevent wasted acquisition and utilisation later on is highlighted. Such assessment might involve evaluating the ability of the technology to improve diagnosis, positively impact on treatment plans and, above all, improve health.

The impact of ankle radiographs on the diagnosis and management of acute ankle injuries.

RATIONALE AND OBJECTIVES: We assessed the impact of ankle radiographs on referring physicians' diagnoses and treatment of acute ankle injuries. METHODS: Twenty emergency department physicians prospectively completed questionnaires before and after radiography on 101 patients with acute trauma receiving ankle radiographs. The questionnaires asked physicians to estimate the probability (0-100%) of their most likely diagnosis before and after receiving the radiographic information. We also asked their anticipated and final treatment plans. We calculated the mean gain in diagnostic confidence percentage and the proportion of patients with changed initial diagnoses or anticipated management. RESULTS: The mean gain in diagnostic certainty from ankle radiographs was 34% (95% confidence interval [CI] = 28-40%). Ankle radiographs changed physicians' initial diagnoses in 37% (95% CI = 28-47%) of the patients. Immediate clinical management changed in 30% (95% CI = 22-40%) of the patients. CONCLUSION: Plain ankle radiographs have considerable impact on referring physicians' diagnoses and treatment of acute ankle trauma.

Specificity of MR angiography as a confirmatory test of carotid artery stenosis.

PURPOSE: To estimate from available literature the specificity (true-negative rate) of MR angiography for detecting severe carotid artery stenoses when applied as a confirmatory test after screening with duplex Doppler sonography. METHODS: We reviewed the pertinent MR angiographic literature published between 1990 and 1994 and recalculated the specificity of MR angiography after deleting from the database results for normal vessels and for vessels with mild and moderate stenoses, since the study of these vessels is not germane to an exploration of the utility of MR angiography as a confirmatory test. RESULTS: Seventeen articles provided data for our analysis. We divided vessels into four categories on the basis of data supplied within each article. Seven of the articles provided data that could be configured to match the categories used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). In one study, the criterion of severe stenosis was more than 70% construction, but the moderate category was limited to stenoses of 50% to 69%. The remaining series defined severe stenoses as more than 80% (four series), more than 75% (two series), or more than 60% (three series) constriction. The stated specificity of MR angiography ranged from 64% to 100%. Before revision, 15 of 17 articles had stated specificity values above 75%. Our recalculated values ranged from 18% to 100%. Only seven of 17 studies would have had MR angiographic specificity of greater than 75%. Nine of 17 articles would have had specificities of less than 60%. For all articles specifically identifying vessels with false-positive findings at sonography, the specificity of MR angiography was 16%. CONCLUSION: To base specificity values for MR angiography as a confirmatory test of carotid artery stenosis on studies that include nondiseased vessels incurs spectrum bias. The actual specificity for MR angiography as a confirmatory test remains unknown, but it is lower than that reported in the literature.

1995 AUR Memorial Award. Gamma knife irradiation-induced changes in the normal rat brain studied with 1H magnetic resonance spectroscopy and imaging.

RATIONALE AND OBJECTIVES: The pathogenesis of brain injury following radiosurgery is poorly understood. To better elucidate the relationship between blood-brain barrier disruption and metabolic derangements, we used magnetic resonance (MR) imaging and 1H MR spectroscopy to detect early changes from focused single-fraction, high-dose irradiation injury in rat brains. METHODS: Using the Leksell gamma knife, we irradiated the frontoparietal cortex of 11 male Wistar rats with a single dose of 120 Gy. Four weeks later, we sequentially performed water-suppressed 1H MR spectroscopy and gadopentetate dimeglumine-enhanced T1-weighted MR imaging. Metabolic maps were created of n-acetylaspartate (NAA), creatine and choline (Cr/Cho), and lactate from the MR spectroscopy data set. Detection of irradiation injury among the tested modalities was assessed by receiver operating characteristic analysis and by quantitative signal intensity changes. Pathologic confirmation of irradiation damage was obtained in all rats. RESULTS: Gadopentetate dimeglumine-enhanced T1-weighted MR imaging was the only imaging modality that detected statistically significant signal intensity changes (p < .05). No reproducible changes in the metabolites of interest could be detected by 1H MR spectroscopy. CONCLUSION: In our animal model, blood-brain barrier disruption was a reproducible, integral finding of single-fraction, high-dose irradiation injury. No reproducible metabolic derangements of ischemia or necrosis were detected by 1H MR spectroscopy, possibly because of dose-latency effects or sensitivity issues.