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Interest in performing dosimetry for clinical radiopharmaceutical therapy procedures has grown in recent years. Several approved therapies include dosimetry in the Food and Drug Administration-approved label instructions, and other therapies are best used under a patient-tailored paradigm. This paper, which is a product of the Society of Nuclear Medicine and Molecular Imaging Dosimetry Task Force, presents motivations and general workflows for radiopharmaceutical therapy dosimetry, as well as existing strategies for obtaining reimbursement for clinical activities related to dosimetry. Several specific patient examples are provided, including suggested codes for reimbursement. In addition to current reimbursement approaches, key dosimetry services that are not supported under the current coding structure are presented and suggested as areas of focus in the coming years., (© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)

Rationale and Objectives: The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology., Materials and Methods: Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies., Results: In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined., Conclusion: Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated., (Copyright © 2019 Academic Radiology. Published by Elsevier Inc. All rights reserved.)

The outcomes of a 2011 Medical Imaging & Technology Alliance (MITA) conference helped shape considerations about what might be the most appropriate pathways for the regulatory and payment considerations of new PET radiopharmaceuticals. As follow-up to that conference, MITA convened a second conference of stakeholders to advise payers on what might be acceptable endpoints for clinical trials to support the coverage of novel PET agents. The conference involved experts on imaging and clinical research, providers of PET services, as well as representatives of interested medical societies, the PET industry, and the regulatory and payer communities. The principal outcome of their deliberations was that it was unrealistic to expect trials of new PET radiopharmaceuticals to directly demonstrate a health benefit. Rather, intermediate outcomes, such as a positive change in patient management, would be more efficient and appropriate., (Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Medical procedures that use ionizing radiation have grown rapidly in volume over the last two decades and constitute a substantial portion of the collective radiation doses to the U.S. population. The purpose of this study is to describe the components of this growth. Summarized claims data from Medicare are used to describe trends for the period 1986-2005; supplemental data from other payers and surveys are used for verification and to describe age distributions of those who have these procedures. A notable trend is the rapid growth of CT and nuclear medicine, with CT volume per fee-for-service Medicare enrollee growing, on average, at 8% per y and nuclear medicine at 7% per y during the period 1986-2005. Cardiac procedures-nuclear medicine and interventional radiology-grew at over 15% per y per fee-for-service enrollee during the same period. The share of nuclear medicine procedures performed in physician offices increased from 10% in 1986 to 55% in 2005; the share of CT in the emergency room increased from 3% in 1992 to 17% in 2005. With this expansion in imaging volumes across practice settings, there is an increased need for radiation safety education of ordering physicians, imaging physicians, and patients, so that adequate consideration is given to radiation risk when determining the appropriateness of a prescribed procedure.

Purpose: This study examined financial data reported by Florida hospitals concerning costs, charges, and revenues related to imaging services., Methods: Financial reports to the Florida Hospital Uniform Reporting System by all licensed acute care facilities for fiscal year 2002 were used to calculate four financial indices on a per procedure basis. These included charge, net revenue, operating expense (variable cost), and contribution margin. Analysis, stratified by cost center (imaging modality), tested the effects of bed size, ownership, teaching status, and urban or rural status on the four indices., Results: The mean operating expense and charge per procedure were as follows: computed tomography (CT): $51 and $1565; x-ray and ultrasound: $55 and $410; nuclear medicine (NM): $135 and $1138; and magnetic resonance imaging (MRI): $165 and $2048. With all four modalities, for-profit hospitals had higher charges than not-for-profit and public facilities. Excepting NM, however, the difference by ownership disappeared when considering net revenue. Operating expense did not differ by ownership type or bed size., Conclusions: Operating expense (variable cost) per procedure is considerably lower for CT than for MRI. Consequently, when diagnostically equivalent, CT is preferable to MRI in terms of costs for hospitals. If the cost structure of nonhospital imaging is at all similar to hospitals, the profit potential for performing CT and MRI seems to be substantial, which has relevance to the issue of imaging self-referral.

More than a decade of dramatic changes in US and global health care has affected the practice of and payment for nuclear cardiology services. The clear diagnostic and prognostic power of nuclear cardiology procedures to detect coronary artery disease and predict patient outcomes has resulted in the rapid growth of these procedures in clinical practice. This has focused the attention of public and private payers on the high use of medical resources required to carry out nuclear cardiology testing. Two recent, major multicenter trials, one in the United States and another in Europe, have demonstrated the cost effectiveness of stress myocardial perfusion imaging strategies compared with coronary angiography in patients with known or suspected coronary artery disease, across the spectrum of pretest risks and both sexes. These studies, and more extensive data from more than 10 years of decision analysis, have reinforced the value of nuclear cardiology in modern cardiovascular health care. Future challenges will include assurance of provider and laboratory quality in the burgeoning outpatient imaging centers across the country, and wider acceptance by payers and expert panels of the evidence supporting the cost effectiveness of nuclear cardiology in most clinical settings.

Noninvasive testing in cardiology may be used to control the initial diagnostic costs as well as to limit expensive testing to only those at highest risk. Outcome data may be used to profile accuracy for individual laboratories to assure quality of the nuclear test data in altering patient management.