Health Insurers and Medical-Imaging Policy - A Work in Progress

New England Journal of Medicine (Impact Factor: 55.87). 04/2009; 360(10):1030-7. DOI: 10.1056/NEJMhpr0808703
Source: PubMed
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    • "Not surprisingly, the radiation exposure has increased in trauma patients over time. On the other hand, imaging has been the highest rate of growth among all healthcare services cost between 2000 and 2006, increasing at 17% per year.9 Thus, unnecessary exposure to ionizing radiation by overuse of head CT has raised concerns for patients, health care providers and regulators. "
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    ABSTRACT: Objective: Computed tomography (CT) scan has been an increasingly essential diagnostic tool for emergency physicians (EPs) to triage emergency patients. Canadian computed tomography Head Rule (CCHR) had been established and widely used to spare patients with mild head injury from unnecessary radiation. However, the awareness of CCHR and its actual utilization among Chinese EPs were unknown. This survey was to investigate the awareness and use of CCHR and their associated characteristics among Chinese EPs. Methods: Questionnaire was randomly sent to EPs from different Chinese hospitals. Surveyed EPs were asked how well they know about the CCHR and how often they use the CCHR to guide head CT use. Association between the awareness and utilization of CCHR and the physicians’ characteristics were analyzed using repeated-measures logistic regression. Results: About 41.7% of the total 247 responders noted they “very familiar” or “somewhat familiar” with CCHR while the utilization rate was 24.7%. With respect to the most important underlying barriers for the use of CCHR, approximate half (48.5%) cited “fear of malpractice” as the leading cause. “Received specific training regarding radiation dose of CT” was the significant predicting factor both for the awareness (OR 5.87; 95% CI, 3.08-11.21) and the use (OR 6.10, 95% CI, 2.91-12.80) of CCHR. Conclusions: Fear of malpractice and lack of radiation risk knowledge were two main barriers to apply CCHR in the request of CT for patients with mild head injury. Furthermore, EPs with specific training about radiation risk of CT were more likely to know and use of CCHR.
    Pakistan Journal of Medical Sciences Online 07/2013; 29(4):951-6. DOI:10.12669/pjms.294.3469 · 0.23 Impact Factor
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    • "Medical imaging plays an important role in patients' care and is continuously being used in managing health and disease [2], [3]. For example, it is used in prevention, early detection of disease, choosing an optimal treatment, during surgical interventions, monitoring of treatment effects, etc. [3]. "
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    ABSTRACT: Medical imaging plays an important role in patients' care and is continuously being used in managing health and disease. To obtain the maximum benefit from this rapidly developing technology, further research is needed. Ideally, this research should be done in a patient-safe and environment-friendly manner; for example, on phantoms. The goal of this work was to develop a protocol and manufacture a multimodal liver phantom that is suitable for ultrasound, computed tomography, and magnetic resonance imaging modalities. The proposed phantom consists of three types of mimicked soft tissues: liver parenchyma, tumors, and portal veins, that are made of six ingredients: candle gel, sephadex®, agarose, glycerol, distilled water, and silicone string. The entire procedure is advantageous, since preparation of the phantom is simple, rather cost-effective, and reasonably quick - it takes around 2 days. Besides, most of the phantom's parts can be reused to manufacture a new phantom. Comparison of ultrasound images of real patient's liver and the developed phantom shows that the phantom's liver tissue and its structures are well simulated.
    PLoS ONE 05/2013; 8(5):e64180. DOI:10.1371/journal.pone.0064180 · 3.23 Impact Factor
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    • "This IPD meta-analysis also holds the potential to analyze and compare the predictive value of cardiac CT and CCA for subsequent major adverse cardiovascular events. Finally, the CoMe-CCT may facilitate the adequate selection of patients for cardiac CT by estimating the pretest likelihood for disease and predicting the diagnostic performance for individual patients that should ultimately help to avoid unnecessary examinations and thus decrease the use of scarce health care resources in the future [40]. "
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    ABSTRACT: Coronary computed tomography angiography has become the foremost noninvasive imaging modality of the coronary arteries and is used as an alternative to the reference standard, conventional coronary angiography, for direct visualization and detection of coronary artery stenoses in patients with suspected coronary artery disease. Nevertheless, there is considerable debate regarding the optimal target population to maximize clinical performance and patient benefit. The most obvious indication for noninvasive coronary computed tomography angiography in patients with suspected coronary artery disease would be to reliably exclude significant stenosis and, thus, avoid unnecessary invasive conventional coronary angiography. To do this, a test should have, at clinically appropriate pretest likelihoods, minimal false-negative outcomes resulting in a high negative predictive value. However, little is known about the influence of patient characteristics on the clinical predictive values of coronary computed tomography angiography. Previous regular systematic reviews and meta-analyses had to rely on limited summary patient cohort data offered by primary studies. Performing an individual patient data meta-analysis will enable a much more detailed and powerful analysis and thus increase representativeness and generalizability of the results. The individual patient data meta-analysis is registered with the PROSPERO database (CoMe-CCT, CRD42012002780). The analysis will include individual patient data from published and unpublished prospective diagnostic accuracy studies comparing coronary computed tomography angiography with conventional coronary angiography. These studies will be identified performing a systematic search in several electronic databases. Corresponding authors will be contacted and asked to provide obligatory and additional data. Risk factors, previous test results and symptoms of individual patients will be used to estimate the pretest likelihood of coronary artery disease. A bivariate random-effects model will be used to calculate pooled mean negative and positive predictive values as well as sensitivity and specificity. The primary outcome of interest will be positive and negative predictive values of coronary computed tomography angiography for the presence of coronary artery disease as a function of pretest likelihood of coronary artery disease, analyzed by meta-regression. As a secondary endpoint, factors that may influence the diagnostic performance and clinical value of computed tomography, such as heart rate and body mass index of patients, number of detector rows, and administration of beta blockade and nitroglycerin, will be investigated by integrating them as further covariates into the bivariate random-effects model. This collaborative individual patient data meta-analysis should provide answers to the pivotal question of which patients benefit most from noninvasive coronary computed tomography angiography and thus help to adequately select the right patients for this test.
    Systematic Reviews 02/2013; 2(1):13. DOI:10.1186/2046-4053-2-13
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