Journal of the American College of Radiology : JACR
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To study growth trends in the ownership of magnetic resonance imaging (MRI) examinations by nonradiologist physicians who either own the equipment outright or are involved in scan leasing arrangements. ⋯ In the private-office setting in 2005, radiologists performed most MRI examinations. However, the growth rate from 2000 to 2005 among nonradiologist physicians was far higher, 254% compared with 83% among radiologists. Because scans performed by nonradiologists through ownership or leasing are subject to self-referral, the much more rapid growth among those physicians should be of concern to policymakers and payers.
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To study trends in the utilization of the various noncardiac thoracic imaging modalities in the Medicare population in recent years and to compare the roles of radiologists and nonradiologist physicians. ⋯ The overall utilization rate of noncardiac chest imaging in recent years has increased only minimally. Within the various categories, there has been a decline in CXR utilization and a substantial decline in radionuclide scan utilization. However, there has been a considerable increase in the utilization of chest CT/CTA. Radiologists strongly predominate in all aspects of noncardiac thoracic imaging. This seems to be a pattern in which the use of a newer and better technology, CT or CTA, gradually replaces older ones and overall utilization rates remain relatively flat. One reason for this seems to be the lack of major involvement by nonradiologist physicians who might be in a position to self-refer. It is in contradistinction to cardiac imaging, in which the utilization of radionuclide scans and echocardiography has sharply increased among cardiologists. These data suggest that utilization rates in imaging might be kept under control by eliminating the opportunity for self-referral.
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Practice Guideline
ACR Appropriateness Criteria on suspected spine trauma.
The evaluation of patients with suspected spine trauma is controversial. This document addresses several pertinent issues: (1) which patients need imaging, (2) how much imaging is necessary, and (3) exactly what sort of imaging is to be performed. This subject is important, because conservative estimates indicate that more than 1 million blunt trauma patients, who have the potential for sustaining spine injuries, are seen annually in emergency departments in the United States. ⋯ Reconstructed computed tomographic images may be used from thorax-abdomen-pelvis studies of children, if they have been obtained. Magnetic resonance imaging should be the primary modality for evaluating possible spinal cord injury or compression as well as ligamentous injuries in acute cervical spine trauma. Flexion and extension radiography is best reserved for follow-up of symptomatic patients, after neck pain has subsided.