Arfa Khan MD, FACR Professor of Radiology Albert Einstein College of Medicine Chief of Thoracic Radiology LIJ Medical Center, New Hyde Park, NY 11040 Chair ACR-Appropriateness Criteria Expert Chest Panel Appropriate Use of Modern Technology

Advances in Medical Technologies

Growth rate for Imaging Services (1997-2003) High-tech 12.9% Low-tech 4.5% Distribution of Imaging Services (2003) Low-tech 80% High-tech 20% 15.8% 20% MRI CAGR (%) 15% 10% 5% 0% 13.9% 11.4% 9.2% 8.3% 7.2% 2.5% NUC MED CT INT MAM US X-RAY Growth in high-tech services have made diagnostic imaging the fastest growing physician service in the United States

Projected Growth in Imaging Procedures (2000-2008) Source: Sg2 Volume of Imaging Procedures (M) Imaging service volume will continue to increase as use of high-tech procedures drive growth 281 299 323 349 374 401 430 450 471 600 2000 500 400 300 200 100 0 2001 2002 2003 2004 2005 2006 2007 2008 (9%) 122% X-RAY CT Scan 57% 133% Ultrasound MRI Projected Growth 2002-2008

SAMPLE TOPIC Clinical Condition: Low Back Pain Variant 1: Uncomplicated. No red flags. (Red flags defined in text.) Variant 2: Low velocity trauma, osteoporosis, and/or age >70 Variant 3: Suspicion of cancer, infection, or immunosuppression Variant 4: Radiculopathy Variant 5: Prior lumbar surgery Variant 6: Cauda equina syndrome

SAMPLE VARIANT TABLE Clinical Condition: Low Back Pain Variant 2: Low velocity trauma, osteoporosis, and/or age >70. Appropriateness Criteria Scale 1 2 3 4 5 6 7 8 9 1=Least appropriate 9=Most appropriate 3 MRI, lumbar spine, without and with contrast 4 NM, bone scan MRI preferred. CT useful if MRI contraindicated or unavailable. 6 CT, lumbar spine, without contrast 6 X-ray, lumbar spine 8 MRI, lumbar spine, without contrast Comments Appropriateness Rating Radiologic Procedure

Role of KEC Pool Appropriatness Criteria data from ACR and from the other high tech specialties e.g. American Society of Cardiology Advice the Ministry of Health and the appropriate professional societies in KSA Arrange a 1-2 days meeting in Madinah to discuss this topic in greater detail and develop a policy statement under the auspices of KEC

Pool Appropriatness Criteria data from ACR and from the other high tech specialties e.g. American Society of Cardiology

Advice the Ministry of Health and the appropriate professional societies in KSA

Arrange a 1-2 days meeting in Madinah to discuss this topic in greater detail and develop a policy statement under the auspices of KEC