Position Statement: Point-of-Care Imaging in Otolaryngology
Over the past several years, point-of-care imaging has grown in response to such factors as improved patient access, the availability of prompt clinical diagnosis and treatment, and low radiation CT imaging equipment suitable for an office setting. The American Academy of Otolaryngology-Head and Neck Surgery strongly believes in the provision of high quality comprehensive care to otolaryngology patients. We maintain that point-of-care imaging represents a modality of service that is in line with the Institute of Medicines six dimensions of high quality care; care that issafe, timely, effective, efficient, equitable, and patient-centered .
The American Academy of Otolaryngology-Head and Neck Surgery strongly endorses the practice of providing patients with timely, effective, efficient, and patient-centered diagnostic imaging studies and interpretation by appropriate qualified specialists. All otolaryngologists receive training in head and neck imaging studies as part of their medical specialty training, and it is a component of the Scope of Knowledge for Board Certification.
The American Academy of Otolaryngology-Head and Neck Surgery strongly believes that patients should receive the most appropriate imaging modality to help diagnose their condition. For patients undergoing Computed Tomography (CT) imaging of the paranasal sinuses, skull base and temporal bones, both conventional CT and cone beam CT (CBCT) imaging are appropriate methods for imaging these anatomical structures. Physicians should have the discretion to determine the most appropriate imaging modality for the care of the patient. CBCT provides greater spatial resolution at a significantly lower level of radiation than a conventional CT scanner . In a study by The Lewin Group, the authors reported that the increase in office-based imaging is a factor in the reduction of the number of more costly and riskier diagnostic procedures .
The benefits to point-of-care imaging are extensive. With point-of-care CT imaging, the otolaryngologist is provided with digital 3-D images which can be reviewed in conjunction with the patient at the time of the initial office visit, which improves patient education, reduces patient anxiety, and improves patient compliance with prescribed treatment. Point-of-care imaging provides prompt diagnosis and treatment, and fewer trips to a medical center or doctors office. This results in lower costs to the patient and health plan. Prompt diagnosis and treatment also results in significantly less time away from work for the patient, which reduces employee productivity, which, in turn, negatively affects their employers, often the very entity responsible for premium payments. In short, health outcomes are improved in a safe, effective, and efficient manner.
The American Academy of Otolaryngology-Head and Neck Surgery is a founding member of the Intersocietal Accreditation Commission (IAC) - CT Division, and supports accreditation for physician s offices involved in point-of-care imaging. CBCT is an FDA approved CT Imaging modality that meets the standards required for CT accreditation by the IAC - CT Division.
Imaging studies should only be ordered when absolutely necessary in the best interest of the patient and essential for quality care. CT accreditation will help to ensure standardization, quality and safety in CT imaging. The appropriate and medically indicated diagnostic services should be reimbursed when either CT imaging modality is used. Patients will not benefit from an anticompetitive policy favoring exclusivity or monopolization of diagnostic techniques. Such a restrictive policy most likely will lead to higher cost for diagnostic imaging services, will negatively impact access to care, will reduce the quality and safety of care, and will not resolve concerns regarding the growth in the utilization of imaging studies.
1. Institute of Medicine- Six Dimensions of High Quality Care
2. Miracle, A.C., Mukherji, S.K.,Conebeam CT of the Head and Neck, Part 1: Physical Principles, AJNR 30, June-July 2009
3. The Lewin Group, Issues in the Growth of Diagnostic Imaging Services: A Case Study of Cardiac Imaging, May 2005
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.