A new approach to the study of diagnostic procedures in the United States

Significant changes in the medical environment in the United States pose difficult questions for small medical specialties such as nuclear medicine. How do we get our voice heard in the debates that surround the reform process? What type of information is required to demonstrate the efficacy of nuclear medicine procedures? The older measures of sensitivity and specificity do not carry the same weight in health planning circles as they do in science. Data demonstrating the impact on the outcome for the patient are preferred. American nuclear medicine has started producing outcome data. We have high hopes that we can demonstrate to health planners both the medical and economic benefits of our specialty. Cardiac procedures seem to have an excellent chance of withstanding the challenges of analysis. Some oncologic procedures such as bone imaging are likely to survive unscathed as well. However, where procedure costs are very high, and the gains marginal, such as oncologic antibody imaging, there are serious questions about how these procedures will be reviewed. Likewise, while PET systems still hold great promise, unless data showing a positive impact on medical and economic outcome can be presented, this area is also in jeopardy. Where there is little challenge to the procedure, such as lung scanning, in all likelihood the procedure will retain its current place in the diagnostic algorithm. In closing, clearly as resources become increasingly scarce in medicine, difficult choices must be made. In the past, many of these decisions were made by those with the loudest voices.(ABSTRACT TRUNCATED AT 250 WORDS)