A new breed of Web-savvy, health-conscious imaging consumers have fueled the growth of self-referred imaging centers in the U.S., say researchers from the Yale University School of Medicine. The number of self-referred body imaging centers in the U.S. nearly doubled between 2001 and 2003, though the market may be showing signs of saturation, they concluded from an Internet survey.
Centers continue to be located in wealthier areas; however, the demographics of the center locations more closely reflect that of the U.S. population as a whole in 2003 compared to 2001. And overall, centers are becoming less coastal and more widely dispersed throughout the U.S., especially in the Midwest.
"The utility, cost-effectiveness, impact and safety of self-referred body imaging (SRBI) are subjects of major controversy," wrote Drs. Grace Kalish; Mythreyi Bhargavan, Ph.D.; and colleagues in the November issue of Radiology. "Proponents of whole-body screening argue that the potential risks are largely outweighed by benefits, which include early detection of cancer or coronary disease. Although several success stories have been the focus of much media attention, the medical community has not provided validated evidence in support of whole-body as a screening modality" (November 2004, Vol. 233:2, pp. 353-365).
That was then
Aiming to assess the current state of imaging centers in the U.S., the Yale team from New Haven, CT, repeated broad swaths of a 2001 study by Dr. Julie Illes and colleagues from Stanford University in Stanford, CA.
The Stanford group had conducted an empirical analysis of self-referred whole-body CT to determine the geographic and demographic profile of centers, types of services and modalities, costs, and procedures for reporting results (Radiology, August 2003, Vol. 228:2, pp. 346-351).
They reported 88 self-referred CT screening centers that were spread across the U.S., but concentrated on both coasts. The population centers where they were located were dominated by European Americans (p < 0.05), as well as individuals of higher education (p < 0.05) and socioeconomic status (p < 0.5). In all, 47 centers performed whole-body screening, most frequently heart and lung examinations with CT, with highly variable standards for reporting results, the Stanford team reported.
"The geographic distribution of the centers suggests target populations of educated health-conscious consumers who can assume high out-of-pocket costs," Illes and colleagues concluded. "Guidelines developed from within the profession and further research are needed to ensure that benefits of these services outweigh risks to individuals and the healthcare system."
This is a year ago
Hoping to gauge changes in the industry since 2001, the Yale team conducted an Internet search in March 2003 using Google and Yahoo Internet engines, searching for commonly used terms such as "full body scan," "whole body scan," "preventive imaging," and "radiological scanning" (without the limiting quotation marks, however).
They categorized the results by geographic area and categorized the centers as hospitals, general outpatient facilities, or self-referral-based imaging centers (SRBIs). Services offered at SRBIs were categorized as full-body (without head), heart, lung, abdomen and/or pelvis, or virtual colonoscopy.
The group found 161 SRBI centers across 31 states and Washington, DC, with the greatest numbers in California (n = 44, 27%) and Florida (n = 13, 8%). The West led the pack geographically with 62 centers (39%), while the Northeastern states had the fewest centers (n = 22, 14%). Based on population, however, Arizona led with 17.5 centers per 10 million inhabitants, followed by California with 13 centers per 10 million, and then Maryland and Washington, DC, with a combined 11.9 centers per 10 million residents.
Two-thirds of the centers (107/161, 66%) were SRBI centers exclusively, while 10 (6%) were comprehensive screening centers, 17 (11%) were hospitals, and 28 (17%) were diagnostic imaging centers.
The range of services broadened between 2001 and 2003. "The percentages of centers that offer heart, lung, and whole-body scanning and virtual colonoscopy increased from 70% to 94%, 58% to 78%, 53% to 84%, and 40% to 55%, respectively," the authors wrote. This could suggest some saturation in the market, they stated.
"Indeed, it has recently been reported that exclusive SRBI centers are beginning to scale back services or shut down completely, a development that indicates the beginning of a downturn from the earlier peak of the industry," they wrote (Callahan P, Wall Street Journal, September 2003).
Heart scanning was the most commonly offered exam by SRBIs in 2003 (n = 152, 94%), followed by lung scanning (n = 126, 78%), and virtual colonoscopy (n = 88, 55%). Fewer than half of SRBI centers offered abdominal/pelvic or head scanning (n = 33, 20%; n = 25, 16%; respectively). Western centers were likelier to offer head CT and virtual colonoscopy.
Compared to 2001, the racial demographics of center localities compared to the U.S. average edged closer in 2003 for whites (76% versus 77.1%, respectively) and Hispanics (11.5% versus 12.5%). However, blacks (8.8% versus 12.9%) and Native Americans (0.6% versus 1.5%) were underrepresented in the center communities, while Asians (7.0% versus 4.2%) were overrepresented in 2003. Still, the authors cautioned that data from the 2000 U.S. census was used to determine the demographic characteristics of SRBI localities in 2003, while the 2001 study team had only 1990 census data available.
In 2003, fewer SRBI centers were hospitals (11%) and general diagnostic imaging centers (17%) than in 2001 (49% combined), the authors stated.
"This may be a reflection of the lack of support given to whole-body imaging by the medical community. Indeed, the hospital-based centers identified in this study offered fewer screening examinations other than those for coronary calcium scoring," they wrote.
In fact, the total number of SRBI centers that were part of outpatient imaging centers or hospitals (n = 45) remained unchanged between 2001 and 2003, suggesting that higher-profile centers may be uneasy about offering self-referred screening until the benefits are validated in long-term studies, which may not be available for another decade.
As a fair compromise between caution and the potential benefits of screening, two letters to Radiology in 2003 endorsed the use of informed consent to provide information to the patient in regard to the risks and benefits of CT screening, the authors noted (Radiology, Vol. 226, pp. 633-634, and Vol. 228, pp. 901-902).
The number of self-referred screening centers has grown in recent years, though a wider geographic distribution of centers and diminishing racial gaps demonstrate a potential saturation of the market, the authors concluded.
"If organ-specific CT scanning is approved by the medical community as a valid screening tool, coverage of these services by insurance companies will increase, and may lead to a decline of the whole-body SRBI industry, they wrote. Last, if the American College of Radiology and other medical organizations revise their policies to adopt the informed-consent approach such that SRBI centers also follow this approach, patients may be deterred from seeking SRBI because of the reality of false-positive results and the attendant costs of follow-up tests."
By Eric Barnes
AuntMinnie.com staff writer
November 17, 2004
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