Recent Trends in Utilization Rates of Noncardiac Thoracic Imaging: An Example of How Imaging Growth Might Be Controlled

doi:10.1016/j.jacr.2007.06.010

Journal of the American College of Radiology

Volume 4, Issue 12, December 2007, Pages 886-889

https://doi.org/10.1016/j.jacr.2007.06.010 Get rights and content

Purposes

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.

Materials and Methods

The Medicare Part B databases for 1996 through 2005 were reviewed. All Current Procedural Terminology^®, Fourth Edition, codes pertaining to noninvasive imaging of noncardiac thoracic structures were selected and grouped into 5 categories: chest radiography (CXR), chest computed tomography (CT)/computed tomographic angiography (CTA), noncardiac radionuclide scans, ultrasound, and magnetic resonance imaging/magnetic resonance angiography. Utilization rates per 1,000 Medicare beneficiaries were calculated. Medicare physician specialty codes were used to ascertain utilization by radiologists compared with nonradiologist physicians. Trends over the 9-year period were studied.

Results

In 1996, a total of 1,044.1 noncardiac thoracic imaging examinations were performed per 1,000 Medicare beneficiaries, increasing to 1,051.6 in 2005 (+1%). In the largest category, CXR, the utilization rate dropped from 995.2 in 1996 to 941.5 in 2005 (−5%). The radionuclide scan utilization rate also dropped, from 16.9 in 1996 to 8.3 in 2005 (−51%). By contrast, the chest CT/CTA utilization rate increased from 30.9 in 1996 to 99.7 in 2005 (+223%). The use of magnetic resonance imaging/magnetic resonance angiography and ultrasound in the thorax was minimal. In 2005, radiologists performed 91% of CXR studies, 97% of chest CT/CTA studies, and 94% of noncardiac chest radionuclide scans.

Conclusions

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.

Section snippets

Materials and Methods

Our data source was the Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary Master Files for 1996 through 2005. These are the summary tables for the nationwide Medicare Part B data sets for all beneficiaries in the Medicare fee-for-service program. We determined the number of beneficiaries in this program each year from the Medicare State County file. The master files provide data on each code in the Current Procedural Terminology^®, Fourth Edition, manual. These data

Results

Table 1 shows the changes in utilization rates per 1,000 Medicare beneficiaries within the 5 imaging categories between 1996 and 2005. Among all 3 of the aforementioned provider classes combined (shown in the first 2 data columns), the overall utilization rate increased from 1,044.1 per 1,000 in 1996 to 1,051.6 per 1,000 in 2005, a 1% increase. During those years, the CXR utilization rate dropped from 995.2 to 941.5 (−5%), and the radionuclide scan rate dropped from 16.9 to 8.3 (−51%). At the

Discussion

There was almost no change in the overall utilization rate of noncardiac thoracic imaging between 1996 and 2005. The recognition of the increased value of CT in the diagnosis of pulmonary emboli and other chest diseases has resulted in a rapid rise in the utilization of that technique. However, it has been largely offset by a concomitant drop in the utilization of CXR and radionuclide scans, a good example of a newer and better technology substituting for older technologies. It should of course

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Citation Excerpt :
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Citation Excerpt :
As noted above, CTA grew progressively and rapidly, but nuclear scanning gradually declined from 11 to 6. A previous study showed that between 1996 and 2005, there was almost no change in the overall utilization of noncardiac thoracic imaging [8]. The present study demonstrates a substantially different trend.
To analyze recent trends in utilization of the various noncardiac thoracic imaging modalities in the Medicare population.
The Medicare Part B databases for 2002 through 2014 were reviewed. All CPT codes pertaining to noninvasive imaging of the thorax were selected and grouped into seven categories: x-ray, CT, computed tomographic angiography (CTA), nuclear scans (noncardiac), MRI, MR angiography, and ultrasound. Yearly utilization rates per 1,000 Medicare beneficiaries were calculated. Medicare physician specialty codes were used to determine how many studies were performed by radiologists versus nonradiologist physicians.
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The data sources were the Medicare Part B Physician/Supplier Procedure Summary Master Files for 2001 to 2011. The 3 Current Procedural Terminology codes for thoracic CT (with contrast, without contrast, and without plus with contrast) were selected. Utilization rates per 1,000 beneficiaries and the percentage that were combined scans were calculated.
The utilization rate of combined scans increased from 2001 through 2006, remained steady in 2007, but then decreased sharply thereafter. The compound annual rate of change from 2007 to 2011 was −10.4%. From 2001 through 2006, combined thoracic CT scans constituted 6.0% to 6.1% of all thoracic CT scans. However, from 2006 to 2011, this percentage progressively declined, reaching a low of 4.2% in 2011.
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This study demonstrates that radiologists play an increasingly important role in thoracic diagnosis. Radiologists perform the vast bulk of thoracic CT scans [1] and percutaneous thoracic biopsies. The latter is the only 1 of the 3 types of thoracic biopsies that are increasing in use (Fig. 3).
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: This study was supported in part by a grant from the American College of Radiology, Reston, Virginia.

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Regular articleRecent Trends in Utilization Rates of Noncardiac Thoracic Imaging: An Example of How Imaging Growth Might Be Controlled

Purposes

Materials and Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

J Am Coll Radiol

J Am Coll Radiol

J Am Coll Radiol

Regular article
Recent Trends in Utilization Rates of Noncardiac Thoracic Imaging: An Example of How Imaging Growth Might Be Controlled