Reuse and reduce: abdominal CT, lumbar spine MRI, and a potential 1.2 to 3.4 billion dollars in cost savings

Anatomical and Micro-CT measurement analysis of ocular volume and intraocular volume in adult Bama Miniature pigs, New Zealand rabbits, and Sprague-Dawley rats

AIM

Utilizing a combination of micro-computed tomography (micro-CT) and anatomical techniques for the volumetric assessment of the eyeball and its constituents in Bama Miniature Pigs, New Zealand rabbits, and Sprague-Dawley(SD) rats.

METHOD

Six Bama Miniature pigs, New Zealand rabbits, and SD rats were enrolled in the study. Micro-CT and gross volumetric estimation of ocular volume were employed to acquire data on ocular volume, anterior chamber volume, lens volume, and vitreous cavity volume for each eye.

RESULTS

The eyeball volume of pigs ranges from approximately 5.36 ± 0.27 to 5.55 ± 0.28 ml, the lens volume from approximately 0.33 ± 0.02 to 0.37 ± 0.06 ml, the anterior chamber volume from approximately 0.19 ± 0.05 to 0.28 ± 0.04 ml, and the vitreous volume is approximately 3.20 ± 0.18 ml. For rabbits, the eye volume, lens volume, anterior chamber volume, and vitreous volume range from approximately 3.02 ± 0.24 to 3.04 ± 0.24 ml, 0.41 ± 0.02 to 0.44 ± 0.02 ml, 0.23 ± 0.04 to 0.26 ± 0.05 ml, and 1.54 ± 0.14 ml, respectively. In SD rats, the volumes are 0.14 ± 0.02 to 0.15 ± 0.01 ml for the eyeball, 0.03 ± 0.00 to 0.03 ± 0.00 ml for the lens, 0.01 ± 0.00 to 0.01 ± 0.01 ml for the anterior chamber, and 0.04 ± 0.01 ml for the vitreous volume.

CONCLUSION

The integration of micro-CT and gross volumetric estimation of ocular volume proves effective in determining the eyeball volume in Bama Miniature Pigs, New Zealand rabbits, and SD rats. Understanding the volume distinctions within the eyeballs and their components among these experimental animals can lay the groundwork for ophthalmology-related drug research.

Cost of Low-Value Imaging Worldwide: A Systematic Review

BACKGROUND AND OBJECTIVE

Imaging with low or no benefit for the patient undermines the quality of care and amounts to vast opportunity costs. More than 3.6 billion imaging examinations are performed annually, and about 20-50% of these are of low value. This study aimed to synthesize knowledge of the costs of low-value imaging worldwide.

METHODS

This systematic review was based on the PRISMA statement. The database search was developed in Medline and further adapted to Embase-Ovid, Cochrane Library, and Scopus. Primary empirical studies assessing the costs of low-value diagnostic imaging were included if published between 2012 and March 2022. Studies designed as randomized controlled trials, non-randomized trials, cohort studies, cross-sectional studies, descriptive studies, cost analysis, cost-effectiveness analysis, and mixed-methods studies were eligible. The analysis was descriptive.

RESULTS

Of 5,567 records identified, 106 were included. Most of the studies included were conducted in the USA (n = 76), and a hospital or medical center was the most common setting (n = 82). Thirty-eight of the included studies calculated the costs of multiple imaging modalities; in studies with only one imaging modality included, conventional radiography was the most common (n = 32). Aggregated costs for low-value examinations amounts to billions of dollars per year globally. Initiatives to reduce low-value imaging may reduce costs by up to 95% without harming patients.

CONCLUSIONS

This study is the first systematic review of the cost of low-value imaging worldwide, documenting a high potential for cost reduction. Given the universal challenges with resource allocation, the large amount used for low-value imaging represents a vast opportunity cost and offers great potential to improve the quality and efficiency of care.

Achieving Value in Spine Surgery: 10 Major Cost Contributors

STUDY DESIGN

Narrative Review.

OBJECTIVES

The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement.

METHODS

We present a narrative review of the literature regarding 10 features in spine surgery which are characterized by substantial disproportionate costs and minimal-if any-clear benefit. Discussion items were generated from a service-wide poll; topics mentioned with great frequency or emphasis were considered. Items are not listed in hierarchical order, nor is the list comprehensive.

RESULTS

We describe the cost and clinical data for the following 10 items: Over-referral, Over-imaging & Overdiagnosis; Advanced Imaging for Low Back Pain; Advanced imaging for C-Spine Clearance; Advanced Imaging for Other Spinal Trauma; Neuromonitoring for Cervical Spine; Neuromonitoring for Lumbar Spine/Single-Level Surgery; Bracing & Spinal Orthotics; Biologics; Robotic Assistance; Unnecessary perioperative testing.

CONCLUSIONS

In the pursuit of value in spine surgery we must define what quality is, and what costs we are willing to pay for each theoretical unit of quality. We illustrate 10 areas for future research and quality improvement initiatives, which are at present overpriced and underbeneficial.

Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided

Evidence-based contemporary spinal rehabilitation often requires radiography. Use of radiography (X-rays or computed tomography scans) should not be feared, avoided, or have their exposures lessened to decrease patient dose possibly jeopardizing image quality. This is because all fears of radiation exposures from medical diagnostic imaging are based on complete fabrication of health risks based on an outdated, invalid linear model that has simply been propagated for decades. We present 7 main arguments for continued use of radiography for routine use in spinal rehabilitation: (1) the linear no-threshold model for radiation risk estimates is invalid for low-dose exposures; (2) low-dose radiation enhances health via the body's adaptive response mechanisms (ie, radiation hormesis); (3) an X-ray with low-dose radiation only induces 1 one-millionth the amount of cellular damage as compared to breathing air for a day; (4) radiography is below inescapable natural annual background radiation levels; (5) radiophobia stems from unwarranted fears and false beliefs; (6) radiography use leads to better patient outcomes; (7) the risk to benefit ratio is always beneficial for routine radiography. Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice.