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Self-Referral of Medical Imaging Exams a Primary Factor in Six-Fold Increase to Americans' Radiation Exposure From Scans Since 1980
Date:3/3/2009

(IDTFs). Congress did recently pass the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) which requires that non-hospital imaging facilities be accredited and would establish a pilot program to measure the beneficial quality and cost effects of incorporating appropriateness criteria into the imaging ordering process. However, the appropriateness criteria pilot will not begin until sometime in 2010 while the accreditation provisions do not take effect until 2012.

Most nonradiologist providers receive little if any radiation physics or imaging training. Knowledge of the correct use of these technologies is not universal by any means. Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) are not ancillary services. The Centers for Medicare and Medicaid Services (CMS) should remove them from the list of procedures protected under the "in-office ancillary exception" to federal law which allows providers to directly profit financially from referring patients to MRI, CT, and PET scanners which they own.

CMS should also clamp down on leasing arrangements. Currently, nonradiologists can lease time in an imaging center and claim that the imaging center is now part of their practice. They then refer patients to be scanned in that imaging center during the time that they have leased. This creates a direct financial incentive to do more imaging which studies have shown significantly increases the number of scans performed and often (in regard to CT and PET) the number of patients exposed to radiation.

"The radiology community has embraced the 'ALARA' or 'as low as reasonably achievable' concept espousing that providers use only the amount of radiation necessary to obtain optimal images. Radiologists are working to lower dose and to educate elected officials, government agenc
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SOURCE American College of Radiology
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