Cardiovascular Imaging Survey: Who Does What?

In the February issue of the American Journal of Roentgenology, results were published of a survey of noninvasive cardiovascular imaging in the United States, its importance to the practice of radiology, and the percentages of studies performed by radiologists versus other types of physicians.

David C. Levin, MD, of Thomas Jefferson University Hospital, Philadelphia, and colleagues used the national 1998 Medicare Part B database to review all of its noninvasive diagnostic imaging studies, nearly 109 million, and reduced the more than 19 million cardiovascular procedures to five categories: cardiac MRI, MR angiography, cardiovascular nuclear medicine, vascular sonography, and echocardiography, which accounted for 63.4% of the studies.

Cardiologists conducted 61.5% of the cardiovascular studies, largely because of their dominance in echocardiography (they performed 79.8%), while radiologists conducted 16.7%, surgeons 4.8%, and other physicians 16.9%. Radiologists performed most of the cardiac MRI and MR angiography (85.7% and 95.3%, respectively, but these procedures comprised only 1% of the total), 37.8% of cardiovascular nuclear medicine, and 44.8% of vascular sonography. Even more important is the fact that cardiovascular imaging accounted for 33.6% of all Part B reimbursements for noninvasive diagnostic imaging for an approximate total of $1.7 billion.

One limitation of the data is that it underestimates the role of radiology because conventional chest radiography was not included, the authors acknowledged. The survey also included data on diagnostic cardiac catheterizations in the expectation that noninvasive CT and MRI might replace many of these procedures in the future. The survey was performed under the auspices of the Committee for Cardiovascular Imaging formed in 1999 by the American Board of Radiology, the American College of Radiology, the American Roentgen Ray Society, and the Radiological Society of North America.

-Linda Litchfield

FDG-PET Fee Updated, Indications Broadened

The Centers for Medicare & Medicaid Services (CMS) has raised the previously announced coverage for FDG-PET procedures from $1,375 to $1,850. Although the  announced reimbursement level of $1,375 has not technically been changed, CMS has added separate coverage for FDG at $475,  34.5% higher than the previous rate.

CMS also recently announced its decision to reimburse for FDG-PET scans for staging breast cancer patients with distant metastasis or restaging patients with locoregional recurrence or metastasis, and to monitor treatment response. Previously, the agency had announced it would soon reimburse for PET imaging as an initial diagnostic study for determining myocardial viability in patients with ischemic heart disease.

Cryoplasty May Deter Reclogging of Arteries

Cryoplasty, a new type of angioplasty that uses nitrous oxide to freeze plaque and unclog arteries, could also prevent reclogging, according to results of a study presented at the 14th Annual International Symposium on Endovascular Therapy (ISET), held in late January in Miami Beach, Fla.

The process gently freezes and opens up blocked heart and leg arteries, and does not appear to cause scarring or reclogging, as normal angioplasty sometimes does. "Angioplasty is far less invasive than bypass surgery in treating clogged arteries, but half the time, the blood vessels reclog," said cryoplasty inventor James Joye, DO, director of peripheral vascular interventions at The Cardiovascular Institute at El Camino Hospital, Mountain View, Calif. "Our preliminary research with cryoplasty is very promising."

In cryoplasty, a small balloon is threaded to a clogged artery and filled with nitrous oxide. The pressurized liquid expands and becomes a gas, causing it to reach subzero temperatures. This cooling prompts apoptosis, a natural programmed cell death that is less traumatic than standard balloon angioplasty.

The FDA has approved a 20-center Phase I feasibility trial using the process to treat clogged coronary arteries, with results expected in the spring. Another Phase I trial using cryoplasty to treat clogged leg arteries is also under way. The Phase II efficacy trial is scheduled to begin this summer.

SCVIR To Vote on Name Change

The members of the Society of Cardiovascular and Interventional Radiology (SCVIR), Fairfax, Va, will decide whether to drop "Cardiovascular" from the society's name when it convenes for its annual scientific meeting, "Charting a New Course for IR," in Baltimore, April 6-11.

Part of the society's new strategic plan is a broad, sweeping communication and educational effort, including advertising to SCVIR members, industry partners, and the general public, intended to make interventional radiology more competitive through training and practice.

The organization will begin a national public educational campaign later this month on uterine fibroid embolization treatment. The print public service announcements will run in consumer publications, newspapers, and medical journals.

Industry News

Swissray International, Elmsford, NY, has been awarded the Market Penetration Leadership Award by Frost & Sullivan for capturing a 47.7% share of the direct digital radiography equipment market. The report also predicts a compound annual growth rate for the digital radiography market of 29.5% between 2000 and 2007... The Mammography Institute , Galveston, Tex, is launching MammAlert, a mammography notification system designed to remind women nationwide to schedule an annual screening mammogram... AccuImage Diagnostics Corp , South San Francisco, has signed an agreement with VirtuRad, Phoenix, to provide stitching capability for orthopedic applications of computed radiography image processing software for  VirtuRad's fee-for-service and leasing digital radiology programs... Med-XS Solutions , a Mentor, Ohio-based asset management company for excess medical equipment, has purchased Neoforma GAR General Asset Recovery, a medical equipmentauction business, from Neoforma.