20 Dec CR: Here to stay

Advance for Imaging and Radiation Oncology | December 13 – Apart from the domestic economic crisis, U.S. health care has suffered through decades of steeply rising costs. National agencies are tamping down the rapid increase in the volume and cost of advanced imaging exams. The Deficit Reduction Act of 2005 (DRA) capped costs of advanced imaging exams at hospital outpatient rates. And more recently, we’ve heard debate over whether the utilization factor of advanced imaging technologies should exceed 50 percent–the rate used to calculate reimbursement.

Rather than replace existing exams, advanced imaging exams add to volume¹–a finding relevant to plain radiography since that volume still outstrips ultrasound, CT or MRI at most imaging facilities. Indeed, it accounts for roughly 50 percent of the overall radiology volume at most community hospitals and for 75 percent of medical imaging exams worldwide.²

Understanding CR and DR

Plain radiography isn’t going away–and it has its merits. Historically a low-cost technology, it’s widely available, has a relatively low dose and is recommended as an initial test in many trauma, chest and extremity applications. Digital radiography (DR) arrived in the mid-1980s when computed radiography (CR) debuted. Demonstrating value, CR replaced film with a reusable phosphor plate, and the CR reader supplanted the wet film processor. The CR reader scanned and erased the exposed phosphor plate, making a digital radiograph available for printing to a dry film printer and storing to a PACS. CR not only eliminated wet film chemistry and silver recovery but it reduced retakes and eliminated lost films. PACS improved accountability and exam accessibility, and enabled electronic storage and transmission as well as soft-copy reading. Owing to such notable value, most domestic facilities transitioned to CR for plain radiographic exams (with the exception of film-based mammography).

Over the past decade, manufacturers introduced DR systems with flat-panel detectors. While CR maintains the workflow associated with film, DR removes the need for the technologist to handle the imaging detector. The DR detector essentially becomes an integral electronic part of the imaging system, increasing exam speed and throughput. One major problem with DR, however, has been cost; a single DR system is essentially an expensive one-on-one replacement for an analog radiographic system. Some early DR systems also lacked the flexibility required for imaging (e.g., cross-table exams), but many systems have addressed those shortcomings.

DR will establish itself once its price drops to a point where facilities can extract value in adopting it. Two to three times more expensive than the analog radiographic system used with a CR reader, DR is reimbursed at the same rate as a film or CR exam. Facilities should review how far they can stretch their existing investment in technology, as long as it’s meeting clinical and operational needs. If CR has facilitated a transition to digital imaging and PACS–and, hopefully, provided a stepping stone to the electronic health record (EHR)–must facilities abandon CR for DR?

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