President’s Message:
The ASNR Working for You
Monday, Dec. 7, 2009
The appropriate practice of neuroradiology is constantly challenged. Last spring United Healthcare made an announcement that CTA of the Head had unproven effectiveness and would not be covered as an imaging procedure. Left unchallenged, such decrees tend to spread among the payer groups faster than a glioblastoma. Fortunately, members of the ASNR Clinical Practice Committee (CPC) are well aware of the value of this procedure for our patients with cerebrovascular disease. Working with the American College of Radiology (ACR) and the Cervicocerebral CTA Guideline Committee, our CPC put together a response document to counter United Healthcare’s untenable position. Fortunately, the ASNR and ACR documented the existing efficacy data that had been ignored by United, much of it published in the AJNR by our members; some of the research supported by the Neuroradiology Education and Research (NER) Foundation of the ASNR. Based on evidence provided by our team, United Healthcare reversed their initial decision and decided to continue to cover CTA of the Head. Had we not monitored policy on a regular basis, or had we not taken the initiative, a negative outcome might well have had profound adverse consequences for patients denied these vital studies, and many of these patients might have been subjected to more invasive studies.
It is clear from this tale, that words and opinions are not enough. CMS (Centers for Medicare & Medicaid Services) and other 3rd party payers are increasingly focusing on high-level evidence, including randomized comparison studies demonstrating a positive effect on patient outcomes to justify the costs of high-tech imaging procedures. We must understand that the public justifiably expects that we will protect them from inappropriate examinations and procedures by doing the research to prove the value of these procedures before we recommend them. We have so far failed to secure reimbursement for MR spectroscopy because sufficiently rigorous scientific studies were felt to be lacking. We must be proactive and support and encourage the comparative effectiveness research required to build an evidence database, so that we are prepared for future challenges to appropriate clinical practice.
At a recent meeting of the Board of Trustees, the NER Foundation voted to directly fund comparative effectiveness research through the creation of a new grant intended specifically for this purpose. It is only through such research that we will be able to demonstrate the appropriateness of new technologies, and ensure that imaging studies and image-guided procedures that are of value are available to our patients. Support of these efforts will become ever more critical, since without it important new techniques may never come to the light of day.
As your President, and with this in mind, I urge you to make a contribution to the NER Foundation. Give whatever you can: $500, $1000, $5000 or more if you are able. As you make your commitment, judge the value of the investment you are making against the possibility that the lack of such research will lead to a future where you may be unable to care for your patients through the appropriate practice of Neuroradiology.
Donate before the end of the year to make a tax-deductible investment in the future of your radiology practice. It could turn out to be your best investment of 2009!
Happy Holidays!!
John Hesselink
ASNR President
AJNR Special Collection and Podcast Explore Radiation Exposure and CT Dose Strategies in Wake of FDA Investigation
Wednesday, Nov. 11, 2009
The safety investigation initiated last month by the US Food and Drug Administration following radiation overexposures during perfusion CT imaging highlights the importance of CT quality assurance programs. The American Journal of Neuroradiology’s latest Special Collection "Radiation Dose in Neuroradiology CT Protocols" gathers recent research and guidelines on this topic in one convenient resource. Collection Editors Max Wintermark and Michael H. Lev also hosted an accompanying half-hour podcast with Pina Sanelli and Pamela Schaefer. Their discussion addresses CT quality assurance, dose reduction strategies, clinical indicators for perfusion CT, acquisition parameters, and repeat studies.
"These unfortunate events have been front page material for the media, leading to patient anxiety and, more important, to questions regarding the use of this valuable technique. Because radiation exposure from diagnostic tests has received considerable notice—even before the recent incidents—it behooves all of us to employ our equipment judiciously," AJNR’s Editor-in-Chief Mauricio Castillo said of this controversy and the need for the timely supplemental publication and podcast.
AJNR’s Podcasts are a new feature edited by C. Douglas Phillips. Regular postings will summarize each issue's most salient articles including the Editor's and Fellow's Journal Club choices. Special Collections are released on an open-access basis to provide a comprehensive source of imaging-related articles on a single topic. Previous Collections include "Imaging Acute Stroke and its Consequences," edited by Pamela W. Schaefer and R. Gilberto González, "Acute Stroke Intervention" edited by Colin P. Derdeyn and Avi Mazumdar, and "Percutaneous Vertebroplasty" edited by Mary E. Jensen and Joshua A. Hirsch. All are available through AJNR's print-on-demand service (Brightdoc), allowing readers to order a full-color hard copy for just US $50.00, plus shipping.