The Value of Using Ultrasound First for Musculoskeletal Imaging
Clinical evidence and research supports using ultrasound as the first diagnostic test for numerous musculoskeletal (MSK) conditions. Diagnostic ultrasound offers a number of important advantages compared to computed tomography (CT) and magnetic resonance imaging (MRI), in terms of safety and effectiveness. Diagnostic ultrasound is noninvasive and offers real-time imaging, allowing for examinations of structures at rest and in motion. This ability to capture the movement of musculoskeletal components differentiates it from other imaging modalities and can permit more accurate diagnoses. Other advantages for your patient include its portability, which allows for point-of-care application and interpretation.
Yet, for a variety of reasons, healthcare providers have gravitated toward more expensive imaging modalities over time. Use of such imaging modalities as CT and MRI instead of lower-cost alternatives, such as ultrasound, may not ensure better outcomes and it also increases the cost to the healthcare system and the cost to your patient.
A Cost-Effective, Lower-Risk Approach
In 2009 alone, CT and MRI accounted for 95% of Medicare allowed charges for all extremity imaging. Only 5% was for ultrasound, which is cost-effective and avoids the inherent risk of radiation exposure. Using a lower cost and a safer approach to imaging would make clinical sense for many conditions without compromising care. An article by Parker et al., published in 2008, indicates that the substitution of MSK ultrasound for MSK MRI, when appropriate, would lead to savings to Medicare of more than $6.9 billion in the period from 2006 to 2020.1
A report by KNG Health Consulting LLC2 found that if ultrasound was used first in a diagnostic algorithm, our nation’s health care system and your patients could realize significant cost savings. KNG’s examination of 2009 Medicare data showed that if ultrasound was used first in diagnosing 30% of rotator cuff injuries instead of MRI or CT, the savings would have exceeded $31 million. Using ultrasound first in 30% of ankle injuries would have saved approximately
And if ultrasound was used first in 70% of the diagnostic evaluations for all both conditions—rotator cuff and ankle injuries—the combined savings to Medicare would have added up to more than $91 million.
1 Parker, et al. Musculoskeletal imaging: Medicare use, costs, and potential for cost substitution. Journal of American College of Radiology. 2008: 182:188.
2 Koenig L, Ruiz D, Cornejo A. Potential cost savings from the use of diagnostic ultrasound in the Medicare population. KNG Health Consulting LLC, 2011. Prepared for SonoSite, Inc.
Selected Additional References
Smith TO, Back T, Toms AP, Hing CB. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis. Clin Radiol. 2011; 5 (ePub).
Rogers CJ, Cianca J. Musculoskeletal ultrasound of the ankle and foot. Phys Med Rehabil Clin N Am. 2010;21(3):549-57.
Allison SJ, Nazarian LN.Musculoskeletal ultrasound: evaluation of ankle tendons and ligaments. CAJR Am J Roentgenol. 2010;194(6):W514.
Morvan G, Busson J, Wybier M, Mathieu P. Ultrasound of the ankle. Eur J Ultrasound. 2001;14(1):73-82.
Swen WA, Jacobs JWG, Algra PR. Sonography and magnetic resonance imaging equivalent for the assessment of full-thickness rotator cuff tears. Arthritis Rheum. 1999;42:2231-2238.