Is Radiology Overcoming the Commoditization Trend?

In radiology, the threat of commoditization has increased in part due to teleradiology, increased information exchange, and the development of new technologies, according to several recent reports.

Bruce I. Reiner, M.D., and Eliot L. Seigel, M.D., radiologists from the University of Maryland (College Park, USA), and authors of an article appearing in the March 2009 issue of the Journal of the American College of Radiology (JACR), reported that for radiology to avoid the commoditization trend, imaging services must be differentiated on the basis of qualitative measures--those that are reproducible and objective. Existing initiatives are in place; however, the researchers offer several recommendations for expansion, as well as opportunities to tie them to economic incentives, such as pay for performance.

The time spent interpreting computed tomography (CT) pulmonary angiographic studies is critical; death from an acute pulmonary embolism can occur in as little as one to two hours. An article in the same issue by Scott Kennedy, M.D., and colleagues evaluates the results and implications of surveys completed by radiology administrators and emergency medicine physicians at Yale (University)-New Haven Hospital (New Haven, CT, USA). The surveys were used to establish target benchmarks for optimal interpretation time, and to evaluate the impact of adding off-hours interpretation to current practice.

The investigators reported that adding only 40 hours of teleradiology coverage per week decreased turnaround time for preliminary written reports, suggesting that teleradiology can help meet quality improvement standards and ensure timely diagnosis of time-critical illnesses.

Subspecialization in radiology and radiation oncology was also the topic of an article in the March 2009 issue of the JACR by Geoffrey G. Smith, M.D., a radiologist from Casper Medical Imaging P.C. (Casper, WY, USA) and colleagues. The article is the result of a study commissioned in 2008 by past chair of the American College of Radiology (ACR; Reston, VA, USA) Board of Chancellors Arl Van Moore Jr., M.D. Responses were gathered from 1,095 professionally active radiologist ACR members and 308 radiation oncologists.

While few radiologists reported their main subspecialty as general radiology (1.5%), it accounted for 18.5% of radiologists' work time. The most frequently cited subspecialties were neuroradiology (17.1%), breast imaging or mammography (15.8%), interventional/vascular radiology (15.8%), and body imaging (11%).

In radiation oncologists, 70% reported their main subspecialties as being in body parts or organ systems. Prostate (18.9%), breast (17.7%), and head and neck (17.1%) were the most frequently cited subspecialties. Among therapeutic modalities, 12% named radiosurgery as their main subspecialty.

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University of Maryland
Yale-New Haven Hospital