by
David Dennis, Contributing Reporter | November 28, 2016
From the November 2016 issue of HealthCare Business News magazine
What does this reference to the appropriateness criteria guidelines mean for radiology modalities? A drive for flexibility and blended approaches, recognizing that all these are valuable tools for the range of indications experienced.
As Tomlinson put it: “It’s not as though MR is always better than an X-ray. Sometimes the best choice is an X-ray, sometimes it’s an MR, sometimes it’s a CT, from an appropriateness perspective. Appropriateness criteria stipulate things. I would challenge the assumption that MR and CT are always better. We should first lead with the question: What is the appropriate study?
What is [the] right study on the basis of what the patient needs? That’s the first thing that challenges [the] notion that X-ray, or any other modality, will be eliminated, or take over.”
Mehta is in full agreement: “These are evidence-based decisions that are consistent with the ongoing development of the appropriate use criteria determining a path of modality which needs to be based on clinical assessments of the individual case. They may point in the direction of X-ray, but in some cases not, and therefore it must be flexible. X-rays are a very simple, low-cost, high-yield, safe method of getting an idea of what is happening from a bone perspective. You can also see some soft tissue shadows.
You can see things like alignment. You can see things like the start of arthritis, or significant arthritis. Plus, based on what you see on the X-ray, you can determine what the next best step might be, whether it is [a] digital tomosynthesis examination, or a CT scan, or an MRI, or an ultrasound. These are all very reasonable options, but you need to know what you are doing first. I agree that X-ray is here to stay. It isn’t going anywhere. But if you start there, the question you then have to ask is, ‘What is the next test after X-ray?’ What is the next go-to, and where does that fit in?”
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