por Gus Iversen
, Editor in Chief | November 11, 2015
From the November 2015 issue of HealthCare Business News magazine
Seeing through walls with dual-energy visualization
The value of X-ray has always been its ability to look noninvasively inside the human body, but sometimes you need to see beyond structures that a normal X-ray cannot clearly see through, such as a bone. Dual-energy imaging makes that possible. “You take two automatic acquisitions, one at low energy and one at high energy,” says Edler. The result is three different perspectives: the traditional X-ray; a bone subtracted image that allows the clinician to focus on soft tissue; and a soft tissue subtracted image to look at the bone.
This can be very useful in trying to identify lung nodules because you don’t have bones obstructing the view of soft tissue. You can also better distinguish calcification. “Non-calcified could indicate a malignant nodule, calcified typically means benign,” says Edler. Philips’ Craig points out that although dual-energy imaging is very useful for certain indications, the challenge is in removing the extra dose from the equation. “Dual-energy by design requires dedicated software, and while it is a small incremental addition of dose to the protocol, it isn’t an incremental dose to the patient because it requires duplicate shots.” Today, some OEMs are meeting this need through post-processing software.
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“We [achieve dual-energy imaging] with an algorithm so you only have to take one image,” says Siemens’ Niepel. “We can also do it based on our software-based solution retrospectively.” Besides the dose advantage of this approach, he points to the economy of scale benefit of being able to use the software across an entire range of radiography equipment. For Siemens, having a wide line of radiography tools that are interchangeable and provide the same user experience is fundamental to its business strategy.
Bundled payments may favor radiography
In the U.S., health reform is changing how reimbursement works. Increasing pressure to replace fee-for-procedure billing with bundled payments — in which reimbursement is based on expected costs for clinically-defined episodes of care — will likely impact how physicians order diagnostics.
For Taber, reimbursement has been higher in the previous year than it had been in previous years. “We were nervous there would be a change with chest X-rays this past year and I was nervous we would see a big decrease because that’s a large volume of our work — but we’ve actually been holding fine.” Edler agrees that bundled payments may trigger an uptick in radiography exams, but she also thinks it may soon be time to create a reimbursement code unique to X-ray tomosynthesis. “Right now it fits as an intermediary between X-ray and CT, yet there is no dedicated reimbursement code for that.”