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A recent Health Affairs article examined the challenges in determining how high tech medical imaging adds value to our healthcare. The article showed that in the U.S. there has been rapid expansion of the number of Radiology centers which is associated with an increase in use of Radiology imaging such as MRI, CT and PET scans.

MRI data points:

• There are over 7000 imaging centers in the U.S.
• That do 26 million MRI test each year
• At a cost of $18 billion

Although measuring both the tangible cost savings and the intangible benefits is enormously challenging, Radiology touches on nearly every major medical condition, has become an indespensible tool in treatment and diagnosis, accelerating the speed at which doctors can gather information and help them develop precise treatment plans.

Advances in Radiology have also reduced the need for invasive exams. These new Radiology tests are more comfortable, generate less patient anxiety and require shorter recovery times.

For example, CT Angiograms are increasingly replacing the need for catheter angiograms. Catheter angiograms require puncturing a major vessel in the groin area (femoral artery) to inject the contrast/dye. Whereas, during a CT Angiogram the contrast is given through an IV. Virtual colonoscopy, which uses a CT scanner, is being refined to supplant traditional invasive colonoscopy which uses a long tube to examine the colon.

PET (Positron Emission Tomography) scans have gained wide spread adoption among oncologists. They stage and monitor treatment of a variety of cancers. PET scans can detect small "islands" of cancer cells that are not picked up by MRI and CT scans.

As Radiology technology advances, we'll see the availability of high tech medical imaging become widespread. The time to diagnose disease will become shorter and treatment plans will be personalized for each patient.

What are your thoughts? Can you think of any other benefits? Please leave your comments below.

Colonoscopy is a test that is used to evaluate the colon (aka the large bowel). It is one of many tests that can detect colon cancer and is used to look for the source of bleeding in patients who have blood in their stool. The American Cancer Society has published its colon screening recommendations.

Traditional or conventional colonoscopy uses a flexible scope with a fiberoptic camera to look at the inner surface of the colon. The camera is connected to an external monitor which your GI doctor uses to guide the camera and look for polyps or other lesions. Using a small cutting device at the end of the tube, if any polyps are found, they can be removed and sent to a pathologist to determine if the polyp is benign or cancerous. As this is an invasive procedure, patients are sedated for the test, and there is some risk of injury to the colon from the tube. Also, on occassion, the colonscopy will "fail." That is, the tube is unable to reach the end of the colon because of its length or is blocked by the colon's many turns and folds.

3D or virutal colonoscopy is a relatively new way to evaluate the colon. Instead of using a camera, a CT scanner takes numerous images and creates a 3D model of the inside lining of the colon. A Radiologist interprets the 3D images on a computer workstation and reports the findings to your doctor. Virtual colonscopy can also detect polyps, masses and any irreguarilities in the lining of the colon. However, unlike traditional colonscopy, if any polyps are seen, there is no way to biopsy the polyps directly. Virtual colonoscopy may not detect small polyps though more powerful CT scanners and computer software will likely make this a non-issue in the near future.

Here's a comparison summary:

Virtual Colonscopy:

• Uses a CT scanner
• Takes 30 minutes to do
• No sedation needed
• Not covered by insurance
• Not able to do biopsy
• Radiation exposure
• May miss small polyps

Conventional Colonoscopy

• Uses a flexible tube with a camera
• Takes 1-2 hours to do
• Need to be sedated for test
• Covered by insurance
• Can biopsy polyps
• May not reach end of colon
• Risk of colon puncture
  

So how much do virtual colonscopies cost? Very few insurance plans cover virtual colonoscopies. A recent Wall Street Journal article featuring virtual colonoscopy revealed a wide range in prices among Radiology providers (you'll need a subscription to access the article). Prices varied from $500 to $1500.

Do you know of any other centers in your area that offer this test? We'd be happy to add them to our list of providers. Looking forward to hearing from you. Please leave your comments below.