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.
In the latest American Journal of Roentgenology, new research emerged touting follow-up protocols for CT lung cancer screening, marking the latest in a series of developments that have pushed screening into the forefront of administrative planning discussions. Other major developments were a National Lung Screening Trial (NLST) displaying mortality reduction of 20% among high-risk patients screened for lung cancer, as well as a substantial increase in CMS reimbursement for Bronchoscopy with Fiducial Markers (CPT 31626) from $723 in 2011 to $2,024 in 2012.
This collection of new tools, evidence, and reimbursement has sparked substantial interest by our hospital membership in developing lung cancer screening programs. However, the decision is not a no-brainer, and many considerations on timing, methods, and technology are required before proceeding with program development.
Lung cancer screening programs—is now the right time?
New guidelines regarding appropriate use criteria for coronary CT angiography (CCTA) have recently been published (JACC, subscription may be required) by the American College of Cardiology, in conjunction with several other cardiology and radiology organizations. Updating the guidelines from 2006, authors note the improvements in technology and clinical utilization which have led to an expansion of approved indications. The largest area of expansion includes the approval of indications for nearly all symptomatic patients with low-to-intermediate pre-test probability of coronary artery disease. The 2010 guidelines maintain that CCTA is still inappropriate to use as a screening tool in asymptomatic patients and in nearly all cases of individuals with high pre-test probability. While direct comparison with the previous 2006 guidelines is difficult due to the changes in wording and numbering of clinical scenarios, the authors contend the 2010 guidelines represent a more comprehensive set of indications for CCTA. While clinical guidelines certainly play a key role in determining how physicians will order exams, questions of how CCTA is introduced into current care pathways, procedure economics, and referral patterns play even greater roles.
Professional Societies Build Stronger Case for CCTA with Revised Appropriate Use Criteria