Q&A: USC Radiology Chair Ed Grant talks savings with contrast-enhanced ultrasound

Following in the footsteps of espresso and nutella, contrast-enhance ultrasound (CEUS) is crossing the pond. While it’s a common modality in Europe, U.S. doctors are relatively unfamiliar with the modality. CEUS can be a cost- and time-effective alternative to MRI or CT when visualizing the liver or the kidneys, according to Edward G. Grant, MD, chair of the USC Medical School’s Radiology Department.

Grant has been spreading the gospel of CEUS for years, and the April FDA approval of a liver-specific contrast agent will hopefully motivate clinicians to take advantage of the savings. By using contrast-enhanced ultrasound instead of CT or MRI—when it was feasible—Grant’s hospital saved over $130,000 over a 12-month period. In addition, the time to diagnosis was reduced by up to 50 percent.

Grant gave a keynote presentation on the topic at the 31st Annual Advances in Contrast Ultrasound Bubble Conference, and Radiology Business sat down with him afterwards.

Radiology Business: Could you explain why contrast-enhanced ultrasound can provide cost- and time-savings over MRI or CT?

Edward G. Grant: There’s a lot of different reasons why it can be cheaper. First, ultrasound is a cheaper exam. Let’s say a patient comes in for an ultrasound of the kidney, and you incidentally pick up a liver lesion. Depending on the situation, our clinicians will order the CEUS first. If they find something, the first thing is to order a CT or MR to confirm. But if its benign on CEUS, we are usually comfortable waiting and not going into CT or MRI. This is where the $130,000 savings comes from.

Second, the equipment is less expensive. We have three hospitals—two private and one public—and if I see a backlog of patients waiting for imaging, I want to get another scanner so I can make more money. It’s a lot easier for me to go to the administration and say ‘I need another ultrasound to accommodate the volume,' that's about $150-200,000, than ‘I need another MRI that’s $3M.'

Third, the ultrasound is faster and leads to a shorter time-to-diagnosis. In a situation where an MRI is too busy or would take too long—such as renal failure—we have to use contrast to characterize the condition. Before we used the contrast agents, the best we could do was a non-contrast ultrasound—pretty useless.

If this provides such great savings, why isn’t it more widely used?

Using contrast anywhere outside the heart was unapproved by the FDA for 25 years, and after all these years of waiting they finally approved it in April. We started doing contrast a long time ago, part of a Bracco Diagnostics trial. After we finished the trial the hepatologists and the oncologists said ‘Wait a minute, we can’t stop doing this,' so we continued to do it off-label. It’s legal to do so, but it makes it difficult to get reimbursed. Now, the hospital can get reimbursed and the American College of Radiology is creating a billing code. Some doctors wouldn’t want to use the contrast agents off-label, so I think this will lead to more widespread use.

Are there any difference in use between your public and private hospitals?

The way we practice at the county hospital is helped by the fact that you don’t have to worry as much about insurance or reimbursement at a public hospital. If the patient comes in and we see a mass, we have the advantage where we can go ahead and do the contrast study. We just order it, send the patient over, get them plugged into a contrast IV, they come back and we do the imaging on the spot.

We see a lot of fatty liver at the county hospital and the most common tumor is a hemangioma, which is impossible to see on a non-contrast ultrasound. Same with kidney lesions—we need to use contrast to characterize the growth. But as we gradually go from a fee-for-service world to a diagnostic-related grouping-based world, most hospitals are now moving toward that kind of a model.

This text was edited for clarity and space.