The right stuff
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Lisa Fratt, Editor of Health Imaging
Comparative effectiveness research has raised the bar for clinical studies by calling for evidence on the actual effectiveness of various diagnostic or therapeutic options. Two recent studies demonstrate that advanced visualization researchers are up to the task.

For several years, cardiac CT angiography (CTA) has been promoted as a viable, and cost-saving, diagnostic alternative for patients who present to the emergency department (ED) with suspected acute coronary syndrome, a condition that costs the U.S. $12 billion in 2008.

But the model has been plagued by questions about costs and efficacy among various risk groups. Recently, researchers from the University of Washington in Seattle devised a prospective analysis of the initial costs and one-year downstream costs of CTA among low- to intermediate-risk patients, a notably tricky population.

They found that in nearly all (98.9 percent of scenarios) the costs of CTA were less than those of standard care, with $750 in per patient savings primarily derived from the difference between reimbursement for a cardiac CT study and nuclear stress test.

Similarly, a research team in Madrid sought to resolve the difficult dilemma of how to best evaluate patients who present to the ED with acute lower intestinal bleeding. Like suspected acute coronary syndrome, it’s another fairly common presentation that lacks a clear diagnostic protocol.

Current options for evaluating these patients—colonoscopy, scintigraphy and invasive angiography—are less than ideal in the ED setting. Consequently, the researchers designed a prospective study of CTA among patients presenting to the ED with acute lower intestinal bleeding.

CTA performed more than respectably, depicting or helping to exclude active or recent bleeding in 98 percent of patients, leading the authors to recommend CTA as the first diagnostic step in this patient group.

As payors and healthcare leaders attempt to rein in, yet appropriately target, imaging, studies such as these are critical. They demonstrate the right stuff: a clear, relevant question paired with a carefully designed study. In each case, the end results validate the clinical and economic value of CTA. It is the right stuff.

How is your organization leveraging the right stuff in advanced visualization to drive improvements in clinical care and economic outcomes? Let us know.

Lisa Fratt
Editor, Health Imaging