Word: radiologist
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...years, the gap between cost and reimbursement has only grown wider. Today the Medicare rate for a mammogram stands at about $69, yet the cost incurred by the imaging centers can run anywhere from $100 to $150. "We're basically operating a charity," says Dr. Mark Dennis, a radiologist at the Sally Jobe Breast Center in Englewood, Colo., whose six clinics performed more than 50,000 mammograms last year and reportedly lost $120,000, most of it on mammograms. "We can afford to keep our doors open only because our mammography sites perform other types of services as well...
With the benefit of hindsight, another radiologist--say, one hired by a patient's lawyer--might very well be able to pick out the trace of an incipient malignancy on a mammogram that was previously marked clean. But that's hardly a fair test, say most practitioners. "You can't expect people to go into a field knowing they could be pulled into court for 10% of the cancer patients that they see," says Dr. David Dershaw, director of breast imaging at Memorial Sloan-Kettering in New York City. Indeed, the number of applicants for Sloan-Kettering's five training...
...solution that hasn't received a lot of attention so far is to have part of the radiologist's job performed by technicians--or even computers. There are some data suggesting that technicians can be trained to read the mammograms as reliably as physicians, though at a slower rate. Radiologists already use sophisticated computer programs to improve their ability to detect tumors. No one is ready, however, to stake the lives of millions of women on mammographers who are not doctors...
...should parents and pediatricians react to the reports? Medical common sense should prevail, says pediatric radiologist Dr. Michael DiPietro of the C. S. Mott Children's Hospital at the University of Michigan in Ann Arbor. "If alarm prevents people from having tests done that really need to be done, then the chances of harm from that are much greater than the chances of harm from the radiation. The concerns raised by this study should highlight, however, the need for these tests being ordered appropriately, done correctly and interpreted correctly in order to get the maximum information from the minimum...
First the CAT scan picks up suspicious-looking lesions in the lungs. Then a radiologist determines whether those nodules warrant further investigation. Most of the time, that means waiting a couple of weeks or months to see if they grow (only 1 out of 10 lesions is cancerous). Sometimes it means undergoing a biopsy. "We found that people were willing to wait," Henschke says, in order to avoid potential complications from unnecessary surgery. The still experimental scan costs $300 and is so far available only in New York City, Rochester, Minn., and Tampa, Fla. But if it becomes the next...