Christopher Pericak and Caitlin Visek
Despite buzz at the recent ASTRO meeting about new radiation therapy technology, the ViewRay platform, we've seen a sharp falloff in chatter about this innovative technology. Our research team has spoken to several early adopters, but questions from interested buyers have been few and far between. This is somewhat unexpected, since the technology gets us closer than ever to the “holy grail” of radiation therapy: real-time adaptive treatment.
Can’t risk purchasing the ViewRay platform? Try MRI simulation.
Angiogenesis inhibitors, such as Avastin, are some of the most exciting tumor-killing drugs to emerge recently. As tumors grow larger than a few millimeters, they consume more resources and require an increased blood supply. Tumors use growth factors such as VEGF to stimulate vascular growth, or angiogenesis, to redirect blood for continued growth or metastasis. Angiogenesis inhibitors interfere with VEGF, essentially starving the tumor.
DCE-MRI: Old technique, new applications
Last week, Medicare announced it would reopen its recent reimbursement decision denying coverage for patients receiving MRIs with pacemakers, unless they are part of a clinical trial. Medicare's decision came out February 24th, just two weeks after the FDA approval of the first MRI-compatible pacemaker, the Medtronic REVO. Originally, Medicare announced that there was not enough time to adjust their decision to limit reimbursement for pacemaker patients receiving an MRI; however, they are now reopening this question and have issued a call for public comment.
Presently, hospitals implanting the REVO can receive reimbursement for implanting the pacemaker in patients, though subsequent scans will not be covered. While this is likely to change, this caveat represents one of several limitations to the new device. In addition to a premium price tag, the REVO represents first generation technology, unlike newer models already in use in Europe. First, the device will be limited to "new" pacemaker candidates only, not replacement patients. This is due to the need to implant MRI-safe leads; currently, lead removal is very risky and not part of standard pacemaker replacement procedures, therefore these patients are unlikely to undergo such an invasive procedure to upgrade to these devices. Likewise, in order to perform an MRI on a patient with one of these devices, the hospital must use a 1.5T MRI system. While 1.5T systems are standard of care for most hospitals, institutions that have adopted 3T systems will not be able to image these patients, thereby limiting potential adoption.