Happy Holidays! Radiology Today is closing the office for the holidays beginning with Christmas Eve. Enjoy your holiday and we’ll see you after the new year.

When President Obama signed the defense appropriations bill that also included a two-month delay to the 21% cut to Medicare payments to physicians, he enabled one of Congress’ long-standing healthcare tricks: pretending to do something about a problem while not actually addressing it. While most Medicare reimbursements are tied to inflation, physician reimbursement is based on the Sutainable Growth Formula (SGF) implemented in 1998. Most years, Congress intervenes and does not allow the forumula to be implemented because it would mean significant reimbursement cuts. Stopping a 21% cut makes sense; that’s a big hit.

But it’s also a little ridiculous that Congress never addresses the underlying problem with the SGR. The American College of Radiology announcement about the President signing the bill delaying the cuts mentions that the Congress hopes to address problems with the SGR during the delay. We’ll see. Maybe there may will be some movement to address the SGR as part of the pending health reform legislation, but there will have to be something done outside of that because the two-month delay of the cuts isn’t likely to be enough time to iron out the difference between the house and senate reform bills in reconciliation.

Some Republican opposition to healthcare reforms mentions this problem. Opponents have said the savings and cost of the healthcare bills include Medicare cuts some Republicans say Congress will never carry through on implementing—like SGR-driven cuts—when push comes to shove. History suggests Republicans are right about that.

The studies surfaced earlier in the week and the mainstream media is following up on them. First, CNN reports on the Archives of Internal Medicine studies mentioned in yesterday’s entry:

And second, CNN reports on reports of patient overexposure from CT exams:

Second:

A new study published in Archives of Internal Medicine estimates that 29,000 new cancers could be related to the CT scans performed in 2007 and that exposure is higher than widely believed. It’s the latest in a string of reports highlighting concerns about increased radiation exposure to patients associated with rapid growth of CT scans.

“Further work is needed to investigate the balance of the risks and benefits from CT scan use and to assess the potential for dose or exposure reduction,” the authors from the National Cancer Institute wrote.

No one doubts the benefits CT can bring to diagnosing disease, but many in medicine also concede that not enough people—including many physicians who refer patients for scans—fully understand and implement risk/benefit analysis that should drive imaging orders.

Another study in the same journal issue found that radiation dosage varied widely between different types of CT studies and within each type of 11 routine CT scan exams studied. According to the authors, median expose ranged from 2 millisieverts for a routine head CT scan to 31 millisieverts for a multiphase scan of the abdomen and pelvis. And within each type of CT exam, the effective dose varied within and across organizations with an average 13-fold variation between highest and lowest exposure for each type of study.

“The results highlight the need for greater standardization because this is a medical safety issue,” said radiologist Rebecca Smith-Bindman, MD, in a report published on the CBS News Web site.

The radiation dose issue is not news to the imaging community, but it is an excellent example of an area where radiology can appropriately take control of this situation by developing measurable, reproducible protocols and doing everything they can so see that they are distributed and eventually enforced. Technologist organizations should have prominent role, too. Technologists actually perform the exams.

This is exactly the kind of patient-centered measurable quality that RSNA’s immediate past president, Gary Becker, MD, discussed in his President’s address at RSNA 2009. There need to be standards and widespread adherence in CT dose control, preferably driven by the imaging community rather than the regulatory community.

[These reports come from the highlighted studies press conference at RSNA 2009 on Wednesday.]

Percutaneous disc decompression treatment for painful herniated discs kept patients pain free up to two years later, standard conservative therapy only helped patients in the short run, according to a study presented Wednesday at RSNA 2009.

“Most protocols call for a minimal approach to initially treat a herniated disc,” said Alexios Kelekis, MD, PhD, assistant professor of interventional radiology at the University of Athens in Greece. “But by deflating the disc and giving the nerve root the space it needs, disc decompression solves the problem of root irritation and prevails in the long run.”

Kelekis and colleagues treated two groups of patients with herniated discs and sciatica confirmed by MRI Both groups included 17 men and 14 women complaining of back and leg pain. The mean age of patients was 36.

The condition is characterized by back and leg pain and weakness. Physicians often recommend that patients try six weeks of anti-inflammatory and pain medications before considering other treatments. Both groups in the study had tried different conservative treatments in the past without success. For the study, one group received six weeks of rigorous conservative therapy consisting of analgesics, anti-inflammatory drugs and muscle relaxants. The second group underwent percutaneous disc decompression, which is suitable only for herniated discs that are not ruptured or too compressed.

In percutaneous disc decompression, interventional radiologists puncture a bulging disc through the skin with a needle and deflate the disc by either removing some tissue or using energy to dissolve it. The outpatient procedure is performed local anesthesia, and patients are usually able to return to normal activities within 30 days.

After their treatment, patients in both groups were clinically evaluated and completed a questionnaire designed to assess pain relief, quality of life and mobility improvement at intervals of three months, 12 months and 24 months later. Both patient groups reported pain reduction and increased mobility at the three-month interval. However, one year and two years after treatment, patients who had undergone disc decompression continued to improve, while patients who received only conservative therapy reported that their pain had returned and their mobility had decreased.

“Up until 12 months following therapy, both groups of patients were doing great,” Kelekis said. “But by 12 months beyond treatment, patients who received only conservative therapy had returned to their initial pain levels.”

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