Although the rate of advanced oncological imaging in specialized, academic cancer centers has increased over the past 15 years, most of these exams continue to be read by radiologists in other practice settings who may not have specific expertise, according to a study published July 5 in the Journal of the American College of Radiology.
The findings beg the question of whether community practice radiologists reading advanced imaging exams for oncology have the support they need, and whether more work needs to be done to make oncology imaging consistent across practice types and locations, wrote a team led by Dr. Andrew Rosenkrantz of NYU Langone in New York City.
"We ... found that radiologists' exposure to oncologic imaging varied significantly across practice settings, lending further weight to existing concerns about the need to broaden access to cancer imaging expertise," the group wrote.
The complexity of oncologic imaging has increased in the past few decades, but only about a fifth of U.S. counties have radiologists with subspecialty expertise in any area of imaging, much less oncology, Rosenkrantz and colleagues noted. To explore advanced oncologic imaging trends in the U.S., Rosenkrantz's group used U.S. Centers for Medicare and Medicaid (CMS) claims data from 2004 and 2016, identifying all noninvasive diagnostic imaging exams, subcategorizing advanced exams such as CT, MRI, PET/CT, and tracking oncologic imaging exams by location. Both the 2004 and 2016 data samples included 5 million diagnostic imaging exams; in 2004, 1.2 million were advanced imaging and in 2016, 1.5 million were advanced.
Among all imaging exams performed, oncologic imaging increased over the study timeframe, although advanced imaging actually decreased between the two study time periods. As for imaging service location, oncologic imaging increased dramatically in academic practices, from 18.8% to 34.1% -- yet the majority of this imaging (65.9%) continued to be performed outside of academia.
| Oncologic imaging incidence and location | ||
| Characteristic | 2004 | 2016 |
| Share of oncologic imaging of all imaging | 3.9% | 4.3% |
| Share of oncologic imaging out of all advanced imaging | 10.8% | 9.5% |
| Advanced oncologic imaging in academic practices | 18.8% | 34.1% |
| Advanced oncologic imaging by other locations | ||
| Hospital outpatient | 58.1% | 58% |
| Physician office | 25.9% | 23.9% |
The findings point to the need for more support of non-academic practice radiologists, according to the authors.
"[Such] progressive concentration of oncologic imaging at academic centers signals a potential worsening of disparities in radiologists' exposure to, and familiarity with, such examinations, and consequently growing challenges in maintaining high-quality oncologic imaging services throughout the full breadth of radiology practices," they wrote.
How can this be done? Rosenkrantz and colleagues offered a number of ideas, including establishing second-opinion networks via teleradiology, telementoring and coaching, peer learning, and fellowships.
"Action is urgently needed to disseminate the current expertise at cancer centers and major academic institutions to community and smaller radiology practices that may have very low oncologic imaging exposure," they concluded.
