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Purpose: MRI and ultrasound (US) are effective diagnostic tools to evaluate extremities. In this study, we analyze utilization trends in musculoskeletal (MSK) US and MRI from 2003 to 2015 within the Medicare population., Methods: Our data sources were the Medicare Part B Physician/Supplier Procedure Summary Master Files for 2003 to 2015. They cover all Medicare fee-for-service enrollees (37.5 million in 2015). Current Procedural Terminology codes for nonvascular, nonspine joint MRI and extremity US were selected and volumes within these codes were determined. Medicare's physician specialty codes were used to identify provider specialty. We accounted for the 2011 code change that created both complete and limited US examinations., Results: Total Medicare joint MRI volume increased from 738,509 in 2003 to 1,131,503 in 2015 (+53%), although there was little change after 2007. Radiologist MRI share in 2015 was 93%, followed by orthopedic surgeons at 5%. Total MSK US volume grew from 96,235 in 2003 to 429,695 in 2015 (+347%). Radiologists' market share of US decreased from 65% in 2003 to 37% in 2015, with nonradiologists now representing a majority of ultrasound examinations. Multiple nonradiology subspecialties also exceed radiology in volume of complete ultrasounds., Conclusion: The potential negative impact of MSK US on MSK MRI volume is likely overestimated because MRI volume has remained stable. MSK ultrasound is increasingly utilized outside radiology. If radiologists want to maintain their market share as MSK imaging leaders, more emphasis should be placed on increasing their involvement and expertise in MSK US., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether recent reimbursement cuts have resulted in a shift of outpatient MRI from private offices to hospital outpatient departments (HOPDs); and to study office MRI utilization trends among radiologists and other specialists., Methods: The Medicare Part B Physician/Supplier Procedure Summary Master Files were used. MRI codes were aggregated, and total MRI volumes from 2002 to 2012 were studied. Medicare place-of-service codes were used to identify studies performed in private offices and HOPDs and create trend lines. Specialty codes were used to categorize private office MRI users as radiologists, orthopedic surgeons, other physicians, and independent diagnostic testing facilities., Results: Medicare office and HOPD utilization of MRI (all specialties) rose rapidly from 2002 to 2006, reaching 2,727,807 in offices and 2,355,641 in HOPDs. Thereafter, office volume steadily declined, whereas HOPD volume steadily increased. By 2012, more studies were done in HOPDs than in offices. Over the entire period from 2002 and 2012, office MRI volume among radiologists increased 27%, compared with 216% among orthopedic surgeons and 124% among other physicians., Conclusions: Although the majority of Medicare outpatient MRI studies had previously been performed in private offices, recent years brought a shift, with more now being performed in HOPDs. This change will increase costs to payers, because reimbursements to HOPDs are generally higher than those to offices. Although radiologists perform the majority of MRI exams that are conducted in private offices, the rate of growth for such exams from 2002 to 2012 was considerably higher among orthopedic surgeons and other physicians than among radiologists., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: Diagnostic imaging services have been repeatedly targeted as a source of excess health care expenditure. In particular, MRI is considered a high-tech and high-cost imaging service that saw rapid increases in utilization in the early 2000s. However, the most recent trends in the utilization of MR are not known. The aim of this study was to quantify trends in MR utilization overall and by body system from 1998 to 2010 in the Medicare population., Methods: Medicare Part B data sets were obtained for 1998 to 2010 for all MR examinations performed in the Medicare population. Using Current Procedural Terminology codes, the total volume and utilization rates of all MR examinations were tabulated for each year of the study period. MR volume was then categorized by body system., Results: The utilization rate of MR examinations in the Medicare population was 73 per 1,000 beneficiaries in 1998, increased to a peak of 189 in 2008, and decreased to 183 in 2010. The compound annual growth rate from 1998 to 2008 was 10%. The utilization rate in 2010 represents a decrease of 3.1% from the 2009 utilization rate. The most frequently imaged body section in every year was the head, which accounted for 2,404,250 examinations in 2010, 37.3% of all MR examinations in that year., Conclusions: The overall MRI utilization rate sharply increased from 1998 until 2008 but then decreased in each of the next 2 years. A similar trend was noted for MR examinations performed in most body sections. These trends are likely to be the result of a number of possible causative factors., (Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: The Deficit Reduction Act of 2005 (DRA) sharply reduced technical component payments for private office magnetic resonance imaging (MRI) and computed tomographic (CT) imaging. Although radiologists have no control over referrals, nonradiologist physicians (NRPs) can potentially make up for revenue shortfalls by self-referring more examinations. The purpose of this study was therefore to compare the effects of the DRA on the in-office MRI and CT practices of radiologists and NRPs., Materials and Methods: The nationwide Medicare Part B databases for 2002 to 2007 were studied. All MRI and CT codes were selected. Using Medicare physician specialty and place-of-service codes, examinations performed in private offices by radiologists were identified and compared with those performed by NRPs. Trends in procedure volume and payments were studied. The pre-DRA compound annual growth rates for 2002 to 2006 and the post-DRA one-year rates for 2007 are reported., Results: For MRI, radiologists' private office volume increased by 8.4% yearly from 2002 to 2006 but then dropped by 2.0% in 2007. Nonradiologist physicians' office volume increased by 24.8% yearly, then increased by another 7.6% in 2007. Office MRI payments to radiologists increased by 11.2% yearly from 2002 to 2006 but then dropped by 30.1% in 2007. Nonradiologist physicians' office MRI payments increased by 25.7% yearly, then dropped by 23.5% in 2007. For CT imaging, radiologists' private office volume increased by 11.2% yearly from 2002 to 2006 but then increased by only 2.9% in 2007. Nonradiologist physicians' office volume increased by 31.8% yearly, then increased by another 18.1% in 2007. Office CT payments to radiologists increased by 13.4% yearly from 2002 to 2006 but then dropped by 5.2% in 2007. Nonradiologist physicians' office CT payments increased by 34.9% yearly, then increased by another 8.3% in 2007., Conclusion: After the DRA took effect, office MRI volume dropped among radiologists but increased among NRPs. Payments for MRI to both dropped, but the percentage decrease to radiologists was greater. Office CT volume increased slightly among radiologists but increased much more among NRPs on a percentage basis. Payments for CT imaging to radiologists dropped, but they increased to NRPs. These results suggest that NRPs may be able to ameliorate the effects of the DRA by increasing self-referral. These trends are of concern and should be scrutinized in future years.

Purpose: The current study explores the substitution of ultrasound (US) for magnetic resonance imaging (MRI) of musculoskeletal (MSK) disorders by describing the recent use and costs of MSK imaging in the Medicare population, projecting these trends from 2006 to 2020, and estimating cost-savings involved in substituting MSK US for MSK MRI, when appropriate., Methods: The study used government-published data sets and de-identified Radiology Information System records exempt from institutional review board approval. From 1 year's MSK MRI records (n = 3,621), the proportion of cases in which US could be substituted for MRI was estimated. The use rates for 4 modalities of MSK imaging and average costs were determined from government Medicare data sets from 1996 to 2005. Regression analysis was used to project use rates from 2006 to 2020. The effect on costs of substitution was calculated., Results: For the Medicare population, although there has been a moderate overall increase (25.7%) in MSK imaging, MSK MRI has increased 353.5% from 1996 to 2005. Projected MSK imaging costs in 2020 are $3.6 billion, of which $2.0 billion will be for MRI. A study of 3,621 MSK MRI reports indicates that 45.4% of primary diagnoses and 30.6% of all diagnoses could have been made with MSK US. The substitution of MSK US for MSK MRI, when appropriate, would lead to savings of more than $6.9 billion in the period from 2006 to 2020., Conclusion: MRI MSK use has grown substantially from 1996 to 2005. The substitution of MSK US, when appropriate, would lead to large cost-savings for Medicare.

Purpose: To study growth trends in the ownership of magnetic resonance imaging (MRI) examinations by nonradiologist physicians who either own the equipment outright or are involved in scan leasing arrangements., Methods and Materials: Medicare Part B data sets from 2000 through 2005 were reviewed, and procedure codes for MRI examinations were selected. The focus was on only those procedures performed at nonhospital, private-office facilities. Using Medicare's physician specialty codes, all such studies were categorized according to the specialties of the physicians who performed them. Ownership was determined by including only those claims for global or technical-component-only reimbursement. Physicians owning or leasing MRI facilities would use one or the other of these two types of claims. Professional-component-only claims were not included. Procedure volumes and growth trends were compared among radiologists and other specialists., Results: From 2000 to 2005, private-office MRI examinations performed by radiologists increased by 83%. During the same period, private-office MRI examinations performed by nonradiologist physicians, either through owning or leasing the equipment, increased by 254%. Excluding studies performed by independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' share of the private-office MRI market rose from 11% in 2000 to 20% in 2005. The nonradiologic specialties most actively involved in performing MRI were orthopedic surgery (161,296 Medicare studies in 2005), neurology (63,363 studies), primary care (58,092 studies), internal medicine subspecialties (34,317 studies), and neurosurgery (20,712 studies)., Conclusions: In the private-office setting in 2005, radiologists performed most MRI examinations. However, the growth rate from 2000 to 2005 among nonradiologist physicians was far higher, 254% compared with 83% among radiologists. Because scans performed by nonradiologists through ownership or leasing are subject to self-referral, the much more rapid growth among those physicians should be of concern to policymakers and payers.

Purpose: There is considerable conflict between radiologists and cardiologists over who has the experience and knowledge to perform computed tomography (CT) and magnetic resonance imaging (MRI) of the cardiovascular (CV) system. The purpose of this study was to determine the relative roles of the different specialties in these procedures., Method and Materials: The nationwide 2003 Medicare Physician Supplier Procedure Summary Master Files were used to study all 8 codes for CT angiography and all 12 codes for magnetic resonance angiography and MRI of the heart. The database provides information on the number of studies performed in each code and the specialties of the physician providers. All professional component and global claims were tabulated, but technical-component-only claims were excluded because that would have led to double counting studies., Results: In 2003, in the Medicare fee-for-service population, a total of 266,142 CV CT studies were performed. Radiologists performed 257,581 (96.8%), and cardiologists performed 1,246 (0.5%). Primary care physicians (PCPs) and radiation oncologists each performed more of these studies than cardiologists: 1,879 and 1,389, respectively. Independent diagnostic testing facilities (IDTFs) and multispecialty groups together performed 2,398 (0.9%); although Medicare lists each of them as a medical "specialty," the actual specialty of a provider cannot be determined. A total of 110,743 CV MRI studies were performed. Radiologists did 100,788 (91.0%), and cardiologists did 3,257 (2.9%). In addition, IDTFs and multispecialty groups together performed 4,644, PCPs 753, and radiation oncologists 537., Conclusion: Cardiologists had only minimal roles in CV CT and MRI in 2003. Their procedure volume was so small that it raises a question as to whether they could be gaining meaningful experience or providing meaningful training to fellows. Radiologists strongly dominated in the use of these modalities for imaging CV structures.

Purpose: The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses., Patients and Methods: Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study., Results: A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective., Conclusions: 1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies., (Copyright 2003 American Association of Oral and Maxillofacial Surgeons)

Technologic advances in MR imaging have had a decisive effect on the capacity of investigators to image the TMJ. This article provides a description of the normal anatomy and function of this joint. emphasizing the key imaging findings of internal derangement. A reading algorithm is given to achieve a systematic approach to the interpretation of a temporomandibular MR imaging study. Finally, a summary of key imaging findings of other miscellaneous pathologic processes involving this joint is provided.

The utilization rate of advanced diagnostic imaging (magnetic resonance imaging, computed tomography, and nuclear medicine) in Medicare outpatients rose 72.7 percent between 2000 and 2005, sparking concern among policymakers. However, analysis of discretionary use of these exams indicates that their use largely stabilized after 2005. Some have credited the Deficit Reduction Act of 2005, which sharply reduced reimbursements for advanced imaging done in physicians' offices. But the fact that the leveling was more pronounced in hospital outpatient facilities than in physicians' offices indicates that the explanation lies elsewhere. More likely, there has been a change in physicians' ordering patterns, possibly due to the influence of radiology business management companies (RBM5) and imaging guidelines promulgated by specialty societies. [ABSTRACT FROM AUTHOR]

Presents quizzes on the diagnosis of different diseases as revealed by computed tomographic scan and magnetic resonance imaging.

Objective: To evaluate magnetic resonance imaging (MRI) scans for enhancement of inner ear structures of patients with sensorineural hearing loss and documented antibodies to the 68-kd inner ear antigen. Study Design: Retrospective case review with reexamination of MRI scans. Setting: Outpatient office. Patients: Thirty-five patients with autoimmune sensorineural hearing loss defined by audiograms documenting a sensorineural hearing deficit in one or both ears and the presence of an anti–inner ear antibody (68-kd band) in serum samples who underwent precontrast and postcontrast T1-weighted axial and coronal MRI scans of the inner ear, which were performed concurrently with the hearing loss. Interventions: Diagnostic. Main Outcome Measures: Frequency and intensity of cochlear enhancement on MRI scans. Results: One patient demonstrated +2 cochlear enhancement. However, that finding was thought to represent postoperative inflammatory change. Conclusion: No correlation was found between the presence of antibodies to inner ear antigen in patients with hearing loss and cochlear enhancement on MRI scans. [ABSTRACT FROM AUTHOR]

Imaging is an important cost driver in health care, and its use grew rapidly in the early 2000s. Several studies toward the end of the decade suggested that a leveling off was beginning to occur. In this study we examined more recent data to determine whether the slowdown had continued. Our data sources were the nationwide Medicare Part B databases for the period 2001-14. We calculated utilization rates per 1,000 enrollees for all advanced imaging modalities. We also calculated professional component relative value unit (RVU) rates per 1,000 beneficiaries for all imaging modalities, as RVU values provide a measure of complexity of imaging services and may in some ways be a better reflection of the amount of work involved in imaging. We found that utilization rates and RVU rates grew substantially until 2008 and 2009, respectively, and then began to drop. The downward trend in both rates persisted through 2014. Federal policies appear to have achieved the desired effect of ending the rapid growth of imaging that had been seen in earlier years. [ABSTRACT FROM AUTHOR]