by
David Dennis, Contributing Reporter | November 28, 2016
From the November 2016 issue of HealthCare Business News magazine
And these ease-of-positioning factors apply in particular to the use of X-ray, especially fluoroscopy, in the operating room. “Another capacity where X-ray is going to hold is in the OR,” observed Jung. “Fluoro via C-arm is the best way to do many exams. This will continue to provide it with a fair amount of volume.”
A shift in the use of fluoroscopy
Regarding fluoroscopy, there are some indications that use may be shifting. “Use of fluoroscopy at our hospital has been declining,” noted Hellwig. “We have a stroke center and we still conduct barium swallow exams to evaluate stroke patients before discharging them. It’s also used to evaluate urinary systems and for fertility testing. But in areas where fluoroscopy is used, it makes sense to purchase a radiography/fluoroscopy system so you have the best of both worlds.”
Tomlinson also observes that “MR has become able to pick up some of the fluoroscopy studies. That’s because it gives you more information to better diagnose. So there is some movement away there.” But while acknowledging “some shifting of modalities,” he “rejects the notion that X-ray and fluoro are no longer useful.”
Further application of tomosynthesis
According to Dr. Samir Mehta, associate professor of orthopaedic surgery and chief of the Orthopaedic Trauma Service at the Hospital of the University of Pennsylvania, “If there are any areas where basic X-ray may be superseded to a degree, one may be by tomosynthesis. Of course, it won’t replace X-ray, but tomosynthesis is increasingly useful for subspecialists in particular. If I have a patient with pelvic issues, I may be inclined to forego the plain X-ray and get the tomosynthesis examination because I get the X-ray ‘plus.’ ”
With tomosynthesis, Mehta adds, “I am not increasing my costs significantly and I am getting a tremendous amount of information. In some ways I’m doing away with the next exam, which in the pelvis situation might be a CT scan. The digital tomosynthesis gives me as much information as a CT would for certain conditions.” So while we will always have X-ray, said Mehta, “this is one example of a situation where we could go right to tomosynthesis.”
CT usage continues to encroach on basic X-ray
“The general category of abdominal pain is just one area where CT is better, because technology has evolved,” says Silva. “One example might be kidney stones. Years ago you might do an X-ray and an IVP or a pyelogram. Now, if a patient comes in with clinical suspicion, you are probably going to do a CT scan or a CT urogram, which results in a 3-D reconstructions/virtual view, which is a very good new exam. That’s an example of where, in 2016, there is a different diagnostic algorithm than we might have seen in 1986.”
