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New study explores the significant impact of attenuation correction on downstream costs

Posted on: 09.21.17

Attenuation artifacts present a challenge when interpreting SPECT myocardial perfusion imaging (MPI) studies. Advanced technology has been able to significantly improve diagnostic accuracy through attenuation correction. A team of doctors at Hartford Hospital and the University of Connecticut explored the impact of attenuation correction on clinical decision-making and its effect on the cost of downstream testing.

The goal of the research was to determine if the use of attenuation correction reduced the need for downstream cardiac testing and thus decreased the overall cost of care. The findings of the study on the impact of attenuation correction were featured at the ASNC 2016 Annual Meeting conference in Boca Raton, FL.

Gathering data

The researchers questioned referring providers for hospital inpatients and chest pain unit patients who underwent a clinically indicated stress SPECT MPI over a 1-year period. Twenty-three different providers offered the MPI study results of 90 patients with and without attenuation correction. They were communicated via phone in a blinded, randomized manner along with the determination of whether the patient would be discharged or would remain hospitalized, and if any additional cardiac testing would be ordered. The costs for the additional downstream tests were calculated using the 2015 Medicare fee schedule

The results

The use of attenuation correction resulted in sixteen additional normal studies. Without the use of attenuation correction, an additional nine patients would have remained hospitalized at a significant total cost of $16,200. Interpretation without AC resulted in three additional echocardiograms and twelve additional cardiac catheterizations. The average excess cost per patient for downstream testing was a notable $357.

When considering a hospital patient population, the results of the study present a significant opportunity for savings. Based on the study results, a practice performing 2,500 SPECT studies annually would save the healthcare system nearly $600,000 in unnecessary tests and hospitalizations by using Attenuation Correction.

The bottom line

The results of the study demonstrated how the use of attenuation correction with stress SPECT MPI resulted in a significant reduction in downstream cardiac testing, continued hospitalization, and total cost of care.

Regarding diagnostic accuracy and confidence, the research concluded that attenuation correction is a valuable feature when it comes to SPECT MPI studies. It also proved to relieve some of the burden to the healthcare system by avoiding unnecessary costs and improving the efficiency of patient care. From a revenue perspective, hospitals and providers should also consider using their data to improve their quality scores under the new MACRA reporting since they’ll be able to demonstrate how they provide high quality, efficient care supported by technology.



Is Attenuation Shift an acceptable substitute for Attenuation Correction?

Posted on: 08.04.16

Identifying attenuation in SPECT images is a critical component of reading images with the highest clinical confidence possible. Today, some advanced nuclear cameras offer attenuation correction, which removes body artifacts and ultimately provides more uniform images. Without this feature, however, there is another alternative technique commonly used to identify attenuation.

Attenuation shift is a method which attempts to move the questionable attenuation seen in the images by repositioning the patient (i.e. from supine to prone) in order to validate its representation. The camera itself is not correcting the attenuation. It is the movement of the attenuation in the additional images that attempts to confirm its existence.

Challenges with the shift technique

During imaging, the patient is transitioned from a supine to a prone position. For Myocardial Perfusion Imaging, this changes the position of the diaphragm and the heart in relation to the camera’s detectors. Although attenuation shift is an accepted method, there are some notable challenges with this technique.

Once the patient is repositioned, the attenuation pattern may change, which leads to the question of consistency. It can be a complicated process, requiring the patient to be repositioned for additional images, and the result may not be reliable.

Attenuation exists in all images; it’s simply a question of where it is located. If the additional images show the movement of the attenuation to a different area, the reading physician may assume it is attenuation. However, the potential exists that the attenuator was not able to be moved enough to confidently come to that conclusion. By changing the patient’s position, variability is introduced, which is problematic for the process.

If your camera does not provide attenuation correction, the shift technique is an acceptable option. However attenuation correction is ultimately the best method for optimum clinical confidence and is proven to reduce the number of false positives.



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