Musculoskeletal extremity imaging jumped from 1994 to 2013 for Medicare beneficiaries

The utilization rates of four common musculoskeletal extremity imaging modalities—radiography, MRI, CT and ultrasound—increased significantly in the Medicare population over the last two decades, according to a new study by the Harvey L. Neiman Health Policy Institute.

Lead author Soterios Gyftopoulos, MD, associate professor of radiology at NYU Langone Medical Center, and colleagues analyzed Medicare Physician Procedure Summary Master Files data from 1994 to 2013, publishing their findings in the American Journal of Roentgenology.

Overall, the team found that utilization per 1,000 Medicare beneficiaries increased 43 percent over that time for radiography, 615 percent for MRI, 758 percent for CT and 500 percent for ultrasound.

“The slower growth of radiography compared with the marked growth for the other modalities is somewhat surprising given radiography's initial screening role for numerous extremity conditions, including trauma, chronic pain, and tumors,” Gyftopoulos et al. wrote. “The trajectories for CT and ultrasound suggest that these two modalities are poised to experience continuous growth in the future, whereas MRI has plateaued, remaining relatively stable since 2007, similar to findings of a recent study by Levin et al. We believe these findings reflect a shift in musculoskeletal management and patient care after the advent of advanced technologies on which physicians increasingly rely.”

The study also found that a physician’s office was the most common site for radiography, MRI and ultrasound examinations, but the most common site for CT examinations was a hospital. In addition, radiology was found to be the “dominant billing specialty” for all four modalities.

Richard Duszak, MD, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University in Atlanta, said in a prepared statement that it’s crucial for researchers to examine these utilization rates closely.

“An understanding of the utilization rates of common imaging modalities is an important first step towards determining the most cost-effective imaging strategies for patients with musculoskeletal conditions” said Duszak, a senior affiliate research fellow at the Neiman Institute and one of the study’s authors. “Our findings support observations that physicians are increasingly relying on advanced imaging to ensure that their patients with musculoskeletal diseases receive the best care.”