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CT trends from four angles

by John W. Mitchell, Senior Correspondent | November 26, 2019
CT X-Ray
From the November 2019 issue of HealthCare Business News magazine

“At present, at least a third of those who should be screened for colorectal cancer are choosing not to get tested, contributing to a great many deaths each year,” Farley told HCB News. “Studies (in the U.S.) and abroad show virtual colonoscopy use dramatically increases screening rates.”

Unlike traditional colonoscopy, colonography does not require sedation. It is also less invasive and faster. In terms of accuracy, research in the New England Journal of Medicine has shown virtual colonoscopy is comparable to colonoscopy for average-risk patients. Studies also show that screening Medicare patients with virtual colonoscopy would cost nearly a third less than with colonoscopy. This would save up to $1.7 billion per screening cycle.

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Opposition to virtual colonoscopy screening is based on a Congressional Budget Office (CBO) “score” that Medicare availability of CTC would increase utilization. However, CBO is barred from considering the significant downstream savings as a result of catching cancer early, such as the reduced need for chemotherapy and radiation therapy, according to Farley.

“This CBO score is a challenge to passage of Medicare coverage for CTC,” he said. “It is unlikely to pass as stand-alone legislation. The best chance for passage is as part of a larger healthcare bill.”

A call for standardizing CT calibration
Interoperability in healthcare has far-reaching implications. From patient information sharing to overhauling care delivery for a value-based paradigm, getting data out of silos and across competing technologies could be a boon for providers. The same concept also holds promise for comparing CT results across different OEM scanners with the use of a universal measurement method.

“It comes down to, what is the definition supposed to be?” Dr. Zachary Levine, a physicist at the National Institutes of Standards and Technology (NIST) told HCB News. In short, Levine said, a universal calibration measurement would mean less testing to verify pathology from clinical site to site, reducing costs and making it easier for the patient. The approach was originally reported in the journal PLOS ONE in March.

"One thing I notice is that within the CT's from any given vendor, there is high precision, i.e., high repeatability. But the comparison between vendors is much worse, suggesting low accuracy, meaning that the measurements do not have a common definition," he said. "We're still using standards that were fully appropriate in 1969, but the technology has improved and we can do better."

Levine said that since March, he has received several inquiries about imaging-based measurement standardization from his peers. This includes applying the idea for more accurate proton therapy results to avoid tumor surgeries.

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