Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-24T21:32:21.992Z Has data issue: false hasContentIssue false
  • English
  • Français

The Relevance of Socioeconomic and Health Policy Issues to Clinical Research: The Case of MRI and Neuroradiology

Published online by Cambridge University Press:  10 March 2009

Eric B. Larson  and
Daniel L. Kent
Eric B. Larson
Affiliation:
University of Washington
Daniel L. Kent
Affiliation:
University of Washington
Get access Rights & Permissions [Opens in a new window]

Extract

Magnetic resonance imaging (MRI) is a high-cost, new technology with great potential for improving patient care. The lack of a coherent public policy for MRI, or its predecessor computed tomography (CT), has caused considerable problems. Lack of an enunciated public policy has led to inconsistent reimbursement and reimbursement levels that develop in haphazard ways. Furthermore, diffusion has been unpredictable and has led to geographical excesses and deficiencies.

Technology assessments of MRI, although numerous, have used inconsistent criteria to rate MRI's clinical efficacy. The lack of methodologically sound studies of MRI severely hampered early evaluation. This article examines these problems and suggests that the medical profession take a stronger leadership role in developing policies for expensive, promising new diagnostic technologies. The profession should promote, demand, and perform rigorous clinical evaluations of new technologies, and help develop a consensus regarding the criteria for what constitutes a clinically valuable advance in diagnostic technology.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 5 , Issue 2 , April 1989 , pp. 195 - 206
Copyright
Copyright © Cambridge University Press 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abrams, H. L., & McNeil, B. J.Computed tomography: Cost and efficacy implications. American Journal of Roentgenology, 1978, 131, 81–87.CrossRefGoogle ScholarPubMed
ACR Commission on magnetic resonance. Clinical application of magnetic resonance imaging. Chicago: American College of Radiology, 1984.Google Scholar
Ad Hoc Committee on Medical Ethics of the American College of Physicians. American College of Physicians ethics manual. Part I. History of medical ethics, the physician and the patient, the physician's relationship to other physicians, the physician and society. Annals of Internal Medicine, 1984, 101, 129–37.CrossRefGoogle Scholar
Baum, S.Physician investment in free-standing imaging centers: In opposition. American Journal of Roentgenology, 1986, 101, 129–37.Google Scholar
Bradley, W. G., Jr. Comparing costs and efficacy of MRI. American Journal of Roentgenology, 1986, 146 1307–10.CrossRefGoogle ScholarPubMed
Bradley, W. G., Jr. Magnetic resonance imaging of the central nervous system. Neurological Research, 1984, 6, 91–106.CrossRefGoogle ScholarPubMed
Bydder, G. M.Magnetic resonance imaging of the brain. Radiology Clinics in North America, 1984, 22, 779–93.CrossRefGoogle ScholarPubMed
Bydder, G. M., Niendorf, H. P., & Young, I. R.T2-dependent fast-field echo imaging in neurologic disease. Radiology 1986, 161, 131.Google Scholar
Chu, F., Cutter, D. J., Braid, M. V., Odom, P., & Perry, S.National Health Services and Practice Patterns. Survey report in magnetic resonance imaging capital and operating costs, medicare payments, and utilization rates. Washington, DC: MTPPI Press, 1986.Google Scholar
Cockshott, W. P., & Palmer, P. E.Imaging Technologies: Iconoclasts among the images. International Journal of Technology Assessment in Health Care, 1987, 3, 355–61.CrossRefGoogle ScholarPubMed
Curswell, H.Hospitals without MRI risk legal action. Diagnostic Imaging, 1987, 9, 50.Google Scholar
Dakins, D. R.By elevating standard of care, MRI raises liability concerns. Diagnostic Imaging, 1987, 9, 47–50.Google Scholar
DiMonda, R.NMR: Issues for 1985 and beyond. Chicago, IL: American Hospital Association Hospital Technology Series, Guideline Report, 1985.Google Scholar
Evens, R. G.Economic costs of nuclear magnetic resonance imaging. Journal of Computer Assisted Tomography, 1984, 8, 200–03.Google ScholarPubMed
Evens, R. G., & Evens, R. G., Jr. Economic and utilization analysis of MR Imaging units in the United States in 1987. Radiology, 1988, 166, 27–30.CrossRefGoogle ScholarPubMed
Evens, R. G., Jost, R. G., & Evens, R. G., Jr. Economic and utilization analysis of magnetic resonance imaging units in the United States in 1985. American Journal of Roentgenology, 1985, 145, 393–98.CrossRefGoogle ScholarPubMed
Evens, R. G.The diffusion of MRI in the United States: What is fact and what is speculation. American Journal of Roentgenology, 1986, 147, 856–57.CrossRefGoogle ScholarPubMed
Feeny, D.Neglected issues in the diffusion of health care technologies: The role of skills and learning. International Journal of Technology Assessment in Health Care, 1985, 1, 681–92.CrossRefGoogle ScholarPubMed
Feigenbaum, E.Public health service assessment: Magnetic resonance imaging (MRI), 1985. Health Technology Assessment Reports, 1985, No. 13. Washington, DC: DHHS.Google Scholar
Fineberg, H. V., Bauman, R., & Sosman, M.Computerized cranial tomography: Effect on diagnostic and therapeutic plans. Journal of the American Medical Association, 1977, 238, 224–27.CrossRefGoogle ScholarPubMed
Fineberg, H. V.Medical efficacy of CT. American Journal of Roentgenology, 1978, 131, 1–4.CrossRefGoogle Scholar
Finkelstein, S. N., & Gilbert, D. L.Scientific evidence and the abandonment of medical technology. Research Policy, 1985, 14, 225–33.CrossRefGoogle Scholar
Finkelstein, S. N., Isaacson, K. A., & Frighkopf, J. J.The process of evaluating medical technologies for third party coverage. International Journal of Technology Assessment in Health Care, 1984, 1, 89–102.Google ScholarPubMed
Friedmann, G., & Steinbrich, W.Integration of the new imaging procedures in clinical applications. Rongenblatter, 1985, 38, 196–204 [in German].Google Scholar
Gent, K. D. Financially successful MR in diverse settings (GE ad #49). Radiology, 1986, Sept., back cover.Google Scholar
Gerard, G., & Rossi, D. R. Nuclear magnetic resonance imaging of the brain. Hospital Practice, 1984, 143–56.CrossRefGoogle Scholar
Gerard, G., & Weisberg, L. A.MRI periventricular lesions in adults. Neurology, 1986, 36, 998.CrossRefGoogle ScholarPubMed
Green, A. M., Modic, M. T., & Steinmetz, N. D.Should you be using MR imaging? Patient Care, 1987, 21, 26–37.Google Scholar
Han, J. S., Benson, J. E., & Yoon, Y. S.Magnetic resonance imaging in the spinal column and craniovertibral junction. Radiology Clinics in North America, 1984, 22, 805–27.CrossRefGoogle ScholarPubMed
Haughton, V. M., Rimm, A. A., Sobocinski, K. A., Papke, R. A., Daniels, D. L., Williams, A. L., Lynch, R., & Levine, R.A blinded clinical comparison of MR Imaging and CT in neuroradiology. Radiology, 1986, 160, 751–55.CrossRefGoogle ScholarPubMed
Hendee, W. R., & Morgan, C. J.Magnetic resonance imaging. Part II –clinical applications. Western Journal of Medicine, 1984, 141, 638–48.Google ScholarPubMed
Hillman, A. L., & Schwartz, J. S.The diffusion of MRI: Patterns of siting and ownership in an era of changing incentives. American Journal of Roentgenology, 1986, 146, 963–69.CrossRefGoogle Scholar
Hillman, B. J., Neu, C. R., Winkler, J. D., Aroesty, J., Rettig, R. A., & Williams, A. P.Diffusion of magnetic resonance imaging into clinical practice. The Rand Corporation (R-3392-HHS), 1986.Google Scholar
Hillman, B. J., Neu, C. R., Winkler, J. D., Aroesty, J., Rettig, R. A., & Williams, A. P.Diffusion of magnetic resonance imaging scanners in a changing U.S. health care environment: Acquirers considerations and actions. International Journal of Technology Assessment in Health Care, 1987, 3, 545–59.CrossRefGoogle Scholar
Hillman, B. J., Winkler, J. D., Phelps, C. E., Aroesty, J., & Williams, A. P.Adoption and diffusion of a new imaging technology: A magnetic resonance imaging prospective. American Journal of Roentgenology, 1984, 143, 913–17.CrossRefGoogle Scholar
Huk, W. J., & Gademann, G.Magnetic resonance imaging (MRI): Method and early clinical experiences in diseases of the central nervous system. Neurosurgery Review, 1984, 7, 259–80.CrossRefGoogle ScholarPubMed
Johnston, D. L., Liu, P., Wismer, G. L., et al. Magnetic resonance imaging: Present and future applications. Canadian Medical Association Journal, 1985, 132, 765–77.Google ScholarPubMed
Kent, D. L., & Larson, E. B.Magnetic resonance imaging of the brain and spine. Annals of Internal Medicine, 1988, 108, 474–76.CrossRefGoogle ScholarPubMed
Kent, D. L., & Larson, E. B.Will history repeat itself? Declining sensitivity of magnetic resonance imaging. Clinical Research, 1987, 35, 350A.Google Scholar
Kucharczyk, W., Brandt-Zawadski, M., Norman, D., & Newton, T. H.Magnetic resonance imaging of the central nervous system–an update. Western Journal of Medicine, 1985, 142, 54–62.Google ScholarPubMed
Kucharczyk, W., Davis, D. O., Kelly, W. M., Norman, D., & Newton, T. H.Pituitary adenomas: High-resolution MR imaging at l.5T. Radiology, 1986, 161, 761.CrossRefGoogle Scholar
Lechky, D.An NMR for your office–for $600,000. Medical Tribune, 1984, 25, 18–19.Google Scholar
Loop, J. W., & Lusted, L. B.Special Report: American College of Radiology diagnostic efficacy studies. American Journal of Roetgenology, 1978, 31, 173–97.CrossRefGoogle Scholar
Lusted, L. B. American College of Radiology study of the efficacy of diagnostic radiologic procedures: Final report on diagnostic efficacy. Chicago: American College of Radiology, 1977.Google Scholar
McNeil, B. J., & Abrams, H. L. Economic considerations. In Margulis, A. R., Higgins, C. B., Kaufman, L., & Crooks, L. E. (eds.), Clinical magnetic resonance imaging. San Francisco: Radiology Research and Education Foundation, 1983, 101–34.Google Scholar
Meaney, T. F.Magnetic resonance without nuclear. Radiology, 1984, 150, 277.CrossRefGoogle ScholarPubMed
Medicare Carriers Manual. Coverage issues in diagnostic services 50–13; and Medicare Coverage Manual: Reasonable charges 5246−2. 11 5–81; 1985.Google Scholar
Modic, M. T., Masaryk, T., Boumphrey, F., et al. Lumbar herniated disk disease and canal stenosis: Prospective evaluation by surface coil MR, CT, and myelography. American Journal of Neuroradiology, 1986, 7, 709–17.Google Scholar
Modic, M. T., Masaryk, T. J., Mulopulos, G. P., Bundschuh, C., Han, J. S., & Bolhman, H. Cervical radiculopathy: Prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Radiology, 1986, 161–753.CrossRefGoogle Scholar
Ormerod, I. E., Bronstein, A.Rudge, P., et al. Magnetic resonance imaging in clinically isolated lesions of the brain. Journal of Neurology, Neurosurgery and Psychiatry, 1986, 49, 737–43.CrossRefGoogle ScholarPubMed
Panzer, R. J., Kido, D. K., & Hindmarsh, T. A methodologic assessment of studies comparing magnetic resonance imaging and computed tomography of the brain. Acta Radiologica, Suppl. 2, 1986.Google Scholar
Paushter, D. M., et al. Magnetic resonance principles and applications. Medical Clinics of North America, 1984, 68, 1393–1421.CrossRefGoogle Scholar
Prospective Payment Assessment Commission. Report and recommendations to the Secretary, U.S. Department of Health and Human Services, 04 1, 1986.Google Scholar
Ransahoff, D. F., & Feinstein, A. R.Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. New England Journal of Medicine, 1978, 299, 926–30.CrossRefGoogle Scholar
Reese, L.Cost analysis of magnetic resonance imaging at St. Joseph's Health Center in London. Canadian Medical Association Journal, 1987, 136, 497–501.Google Scholar
Relman, A. S.Dealing with conflicts of interest. New England Journal of Medicine, 1986, 313, 749–51.CrossRefGoogle Scholar
Revicki, D. Nuclear magnetic resonance imaging: Information synthesis on clinical applications and cost considerations. Washington, DC: Health Services Research and Development Service, Veterans Administration, 04, 1986.Google Scholar
Salgado, E. D., Weinstein, M., Furlan, A. L., Modic, M. T., Beck, G. J., Estes, M., Awad, I., Little, J. R.Proton magnetic resonance imaging in ischemia cerebrovascular disease. Annals of Neurology, 1986, 20, 502.CrossRefGoogle Scholar
Schwartz, J. S., Ball, J. R., & Moser, R. H.Safety, efficacy and effectiveness of clinical practices: A new initiative (editorial). Annals of Internal Medicine, 1982, 96, 246–47.CrossRefGoogle Scholar
Schwartz, J. S. Evaluating diagnostic technologies. In Institute of Medicine, Assessing Medical Technologies. Washington, DC: National Academy Press, 1985, 80–89.Google Scholar
Shapiro, S. H., & Wyman, S. M.CAT fever. New England Journal of Medicine, 1976, 131, 1–4.Google Scholar
Stason, W. B., & Localio, A. R. Magnetic resonance imaging: Clinical efficacy, costs and policy considerations. Document prepared for Health Benefits Management Division, Blue Cross and Blue Shield Association, 02 1985.Google Scholar
Steinberg, E., Anderson, G., Steinwachs, D., Erickson, J., Fahey, M., & Hynes, D. Financing magnetic resonance imaging in an era of prospective payment: Issues and options. The Health Industry Manufacturers Association, 06 1986.Google Scholar
Steinberg, E. P., & Cohen, A. B. Health technology case study 27: Nuclear magnetic resonance imaging technology: A clinical, industrial, and policy analysis. Washington, DC: U.S. Congress, Office of Technology Assessment, OTA-HCS-27, 09 1984.Google Scholar
Steinberg, E. P., & Evens, R. G.The economics of MRI. American Journal of Roentgenology, 1987, 149, 747–49.Google Scholar
Steinberg, E. P., Sisk, J. E., & Locke, K. E.The diffusion of magnetic resonance imagers in the United States and worldwide. International Journal of Technology Assessment in Health Care, 1985, 1, 499–514.CrossRefGoogle ScholarPubMed
Steinberg, E. R., Sisk, J. E., & Locke, K. E.X-ray CT and magnetic resonance imagers: Diffusion patterns and policy issues. New England Journal of Medicine, 1985, 313, 859–64.Google ScholarPubMed
Steinberg, E. P. The status of MRI in 1986: Rates of adoption in the United States and worldwide. American Journal of Roentgenology, 1986, 147, 453–55.CrossRefGoogle ScholarPubMed
Steiner, R. E.Present and future clinical position of magnetic resonance imaging. Magnetic Resonance in Medicine, 1987, 3, 473–90.CrossRefGoogle Scholar
Zeman, R. K., & Elliott, L. P.Physician investment in free-standing imaging centers: In defense. American Journal of Roentgenology, 1986, 147, 414–16.CrossRefGoogle ScholarPubMed
Zimmerman, R. D., Fleming, C. A., Lee, B.C., Saint-Louis, L.A., & Deck, M. D.Periventricular hyperintensity as seen by magnetic resonance: Prevalence and significance. American Journal of Roentgenology, 1986, 146, 443–50.CrossRefGoogle Scholar