The volume of MR imaging procedures performed in the U.S. rose by 8 percent from 2018 to 2019, to an all-time high of 42 million.

That’s the conclusion of the 2019 MR Market Outlook Report published by IMV Medical Information Division, a market research firm for the medical imaging and clinical diagnostic instruments markets. The report indicates that MR procedures rose from 39 million in 2018, reversing a nationwide slowdown in such growth that has taken place since 2004.

“They’re increasingly using MR in radiation therapy as a particular modality for treatment planning purposes,” Lorna Young, senior director of market research at IMV, told HCB News. “Then there are other things like cardiac MR and prostate MR which are very popular. With prostate, the volume of it is very small, but it’s increasingly being used. MR also doesn’t have radiation per se, like CT or X-ray.”

Initially increasing at an average annual rate of 15 percent from 1998 to 2003, MR procedures slowed by a 4 percent annual rate between 2004 and 2016. It then dipped by 8 percent to $36 million in 2017, with the report attributing a possible cause as the growing usage of appropriate use criteria (AUC) for ordering MR procedures.

Another contributor may have been a change in the reporting policy of CMS, which passed the Protecting Access to Medicare Act (PAMA) in 2014. Under PAMA, physicians must use a clinical decision support system for ordering studies pertaining to MR, CT, PET and nuclear medicine, to ensure the appropriate use of imaging resources and to curb overutilization.

Almost two-thirds of the 405 radiology and MR administrator respondents who participated in the IMV survey predict that procedure volume will increase in 2020. Part of this, according to Young, can be attributed to new applications for MR, such as prostate visualization, as well as its role in treatment planning and ability to show differences in water content of various tissues.

The findings of the report indicate a relatively stable MR market over the next three years, with 27 percent of all MR sites planning to purchase a fixed MR system, and an additional 26 percent reporting that they might. Planning for all these sites together has been relatively consistent at 53 to 57 percent.

MR systems with field strengths of 1.5 Tesla hold the majority stake in the market, comprising two-thirds of installed bases since 2007 and over 60 percent of planned MR systems. Machines with 3T magnets take up almost one fifth of the installed bases and represent one quarter of planned MR systems.

But growth in MR procedures may be hampered by decreasing reimbursement levels, health insurance preauthorization denials, reduced health plan coverage and higher out-of-pocket costs that lead to declines in patient volume for elective exams. Other challenges include appropriate use requirements, public concerns with gadolinium side effects, and local competition.

Providers are also concerned about managing operational and staffing issues that could derive from increased workloads, and face a number of logistical issues including: educating MR techs and related support personnel about MR safety, cross-training technologists across multiple locations, and screening patients appropriately for MR scanning.

“Departments need to work closely with their referring physicians so that what they refer is the right technology for the physician,” said Young. “That’s a lot of communication, standards and appropriate use criteria from the department to the referring physicians. The more they can do that, the better they can manage their patient volume and do what’s appropriate for the patient.”