Abstract
An image that is not perceived and interpreted can have no positive impact on health care. In this article, the authors review publicly available data and the published literature concerning the unitary event of the perception and interpretation of medical images. Their review shows that this event occurs as frequently as do major medical, public health, and public safety events in the United States; constitutes a significant economic activity; and makes up a significant portion of hospital-based health care in the United States. Yet despite its central importance to the economy and to health care, the authors' analysis found that research in the perception and interpretation of medical images has been awarded minimal support by National Institutes of Health extramural funding: fewer than 5% of all National Institutes of Health-funded grants related to radiology during the 10-year period from 1994 to 2003 focused on human perception and interpretation. The increased funding of medical image perception and interpretation research could lead to important improvements in overall health care thanks to the pervasive and vital role imaging plays in modern medicine.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 409-412 |
| Number of pages | 4 |
| Journal | Journal of the American College of Radiology |
| Volume | 3 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2006 |
Keywords
- Perception
- finance of health care
- health care costs
- interpretation of medical images
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
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In: Journal of the American College of Radiology, Vol. 3, No. 6, 06.2006, p. 409-412.
Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - The Place of Medical Image Perception in 21st-Century Health Care
AU - Beam, Craig A.
AU - Krupinski, Elizabeth A.
AU - Kundel, Harold L.
AU - Sickles, Edward A.
AU - Wagner, Robert F.
N1 - Funding Information: Although we all might informally appreciate the pervasive role of imaging technology in modern medicine, the true magnitude of the unitary act of the perception and interpretation of medical images is less appreciated. Obviously, an image that is not perceived and interpreted can have no positive impact on health care. Hence, the intelligence that perceives and interprets an image (the reader, radiologist, or interpreting physician) is vital to actualizing the data generated by the image into an effect in health care. The data in obtained from the Centers for Medicare and Medicaid Services [ Figures 1 to 3 , 1 ], illustrate the central importance of the perception and interpretation of medical images (and thus of the vital importance of humans) in modern health care. Figure 1 reminds us that national health expenditures in general constitute a significant portion of the gross domestic product: approximately 13% in 2000. Figure 2 shows that Medicare expenditures, and hence our analysis of Medicare Part B, the portion of Medicare paying for physician services, represent a significant portion of health care expenditures in the United States. In 2000, Medicare expenditures accounted for 17% of national health care expenditures ($221 billion of the $1.3 trillion spent on health in the United States). Using data from the Centers for Medicare and Medicaid Services, we classified charges into 3 categories within the allowable Part B charges: “image interpretation tasks” performed by radiologists, “nonimage interpretation tasks,” and “required nonphysician tasks.” Image interpretation tasks included the activities required for image perception and interpretation. The allowed charges were the percentage of all physician-allowed and supplier-allowed charges submitted to Part B carriers. Allowed charges were aggregated by procedure code. The leading procedure codes (n = 77) included radiologic examinations performed with radiography, computed tomography, magnetic resonance, and ultrasound, at approximately 49% of the allowed charges [ 2 ]. The result of our classification is presented in Figure 3 . On the basis of our categorization, we estimated that image perception and interpretation tasks accounted for 8% of all Part B charges in 2000. In addition, comparing the 2 categories of physician-related tasks, we estimated that image perception and interpretation activities alone accounted for 42% (8%/[8% + 11%]) of all physician-related Medicare Part B charges in 2000. Finally, on the basis of the summary data for leading procedure codes, we observed that in 2000, Medicare paid more than $5.5 billion in care related to the perception and interpretation of images by physicians. Remembering that total Medicare expenditures account for only a part of total US health care expenditures, we then estimated that of the $1.3 trillion spent on health care in the United States in 2000, at least 0.4% ($5.5 billion of $1.3 trillion) was spent on the activity of image interpretation. Because national US health care expenditures constituted approximately 13% of the gross domestic product in 2000 ( Figure 1 ), we also concluded that from an economics perspective, image perception and interpretation tasks constituted at least 0.05% (0.4% of 13%) of the GDP in 2000. These economic conclusions reflect differences in allowable costs per procedure as well as frequency of those procedures. To gain an appreciation for the relative frequency of the act of “medical image interpretation,” we summarize below estimates from several other publicly available data sources. The Healthcare Cost Utilization Project, sponsored by the Agency for Healthcare Research and Quality, brings together data collected by state data organizations, hospital associations, private data organizations, and the federal government to create a national information resource of discharge-level health care data. We accessed the Healthcare Cost Utilization Project data on national statistics for 2002 using the web-based software tool HCUPnet provided at the Healthcare Cost Utilization Project Web site ( summarizes the result of our classification and shows that imaging-based procedures accounted for more than 40% of all hospital procedures reported in the discharge reports. Hence, we concluded that the event of the perception and interpretation of medical images constitutes a significant portion of hospital-based health care in the United States. On the basis of the number of examinations performed in 2001, medical perception and interpretation events occurred at a rate of more than 1 per second. Mammography alone contributed 6 million events for non-HMO Medicare beneficiaries [ http://www.ahrq.gov/data/hcup/ ). The data set we accessed contained weighted national estimates from the Nationwide Inpatient Sample, containing data on primary and secondary procedures per hospital stay from typical claims or discharge abstracts from nearly 1,000 community hospitals in 33 states. Using HCUPnet, we obtained a listing of all procedures ranked in order of frequency. We then manually classified each of the categories into whether or not they involved image interpretation as part of the procedure. Figure 4 3 ], or at least 1 medical image perception and interpretation event every 5 seconds in the United States. Another way to gauge the frequency of image perception and interpretation events is to compare the (minimum) 6 million mammogram interpretation events per year in the United States with other common medical procedures and events ( For example, the American Heart Association ( Table 1 ). http://www.americanheart.org ) reported 519,000 cardiac revascularizations in 2002. There were also approximately 686,000 “total open-heart procedures” in that year. Obviously, the number of medical image perception and interpretation tasks in the United States greatly outnumbered both of these procedures combined. A public health event that occurs at a similar frequency to mammographic perceptions and interpretations is car accidents. In 2002, there were approximately 6.4 million car accidents [ 4 ]. In sum, the event of the perception and interpretation of medical images occurs as frequently as do major medical, public health, and public safety events in the United States. Despite its central importance, research in the perception and interpretation of medical images is minimally supported by National Institutes of Health (NIH) extramural funding in the United States. summarizes NIH extramural funding of radiology from 1994 to 2003. We evaluated the NIH-maintained Computer Retrieval of Information on Scientific Projects database [ Figure 5 5 ], containing information about all NIH-funded grants awarded from 1994 to 2003, with regard to the funding of perception and display research. We queried the database for grants having any of the terms radiology , imaging , and display as a keyword or text word in the abstract. The initial search netted 1,232 funded grants. We then deleted 802 grants that, on the basis of their grant identification numbers, were intramurally funded grants and grants that used animals or were for the development of molecular imaging. We then manually reviewed the abstracts of the remaining 430 grants and classified them into the categories shown in Table 2 . We were able to classify fewer than 5% (21 of 430) of NIH-funded studies in radiology during that period as primarily studying human observers (as indicated by studies of interpreter error or variation). This count included 7 grants related to computer-aided detection that were focused on reducing human error and aiding human interpretation. Most NIH-funded grants (56%) were for technology development. In sum, the number of grants specific to the perception and interpretation of medical images accounted for no more than 5% of the total number of the extramural grants funded by the NIH in radiology during the 10-year period from 1994 to 2003.
PY - 2006/6
Y1 - 2006/6
N2 - An image that is not perceived and interpreted can have no positive impact on health care. In this article, the authors review publicly available data and the published literature concerning the unitary event of the perception and interpretation of medical images. Their review shows that this event occurs as frequently as do major medical, public health, and public safety events in the United States; constitutes a significant economic activity; and makes up a significant portion of hospital-based health care in the United States. Yet despite its central importance to the economy and to health care, the authors' analysis found that research in the perception and interpretation of medical images has been awarded minimal support by National Institutes of Health extramural funding: fewer than 5% of all National Institutes of Health-funded grants related to radiology during the 10-year period from 1994 to 2003 focused on human perception and interpretation. The increased funding of medical image perception and interpretation research could lead to important improvements in overall health care thanks to the pervasive and vital role imaging plays in modern medicine.
AB - An image that is not perceived and interpreted can have no positive impact on health care. In this article, the authors review publicly available data and the published literature concerning the unitary event of the perception and interpretation of medical images. Their review shows that this event occurs as frequently as do major medical, public health, and public safety events in the United States; constitutes a significant economic activity; and makes up a significant portion of hospital-based health care in the United States. Yet despite its central importance to the economy and to health care, the authors' analysis found that research in the perception and interpretation of medical images has been awarded minimal support by National Institutes of Health extramural funding: fewer than 5% of all National Institutes of Health-funded grants related to radiology during the 10-year period from 1994 to 2003 focused on human perception and interpretation. The increased funding of medical image perception and interpretation research could lead to important improvements in overall health care thanks to the pervasive and vital role imaging plays in modern medicine.
KW - Perception
KW - finance of health care
KW - health care costs
KW - interpretation of medical images
UR - http://www.scopus.com/inward/record.url?scp=84928096149&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84928096149&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2006.02.029
DO - 10.1016/j.jacr.2006.02.029
M3 - Article
AN - SCOPUS:84928096149
SN - 1546-1440
VL - 3
SP - 409
EP - 412
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 6
ER -