David C. Levin MD, Presenter: Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Andrea J. Frangos MPH, Abstract Co-Author: Nothing to Disclose

Jonathan H. Sunshine PhD, Abstract Co-Author: Nothing to Disclose

CCTA is a relatively new technique that has attracted wide attention and some controversy over when and how it should be used. Our purpose was to study recent utilization trends of this technique, compared with those of MPI, a competing technique.

The nationwide Medicare Part B databases for 2006-2008 were studied; 2006 was the first year CPT codes were available for CCTA. Utilization rates for CCTA and MPI per 100,000 Medicare beneficiaries and year over year percent changes were calculated. Using Medicare’s physician specialty codes, studies done by radiologists and cardiologists were identified and these trends were also compared.

In 2006, a total of 99 CCTAs per 100,000 were performed, rising to 210 in 2007 (+112%) but then dropping to 194 in 2008 (-8%). By comparison, in 2006 a total of 8753 MPIs per 100,000 were performed, dropping to 8548 in 2007 (-2%), then dropping again to 8467 in 2008 (-1%). The CCTA rates per 100,000 among radiologists were 31 in 2006, 67 in 2007 (+116%), and 60 in 2008 (-10%). The CCTA rates among cardiologists were 59 in 2006, 126 in 2007 (+114%), and 119 in 2008 (-6%). The MPI rates per 100,000 among radiologists were 1906 in 2006, 1736 in 2007 (-9%), and 1601 in 2008 (-8%). Among cardiologists, the MPI rates were 6168 in 2006, 6174 in 2007 (+0%), and 6228 in 2008(+1%).

Despite the great promise offered by CCTA and the widespread attention it has received, there was a surprising drop in its utilization rate in 2008. This is highly unusual for promising new technology and there are probably several reasons for it. The drop occurred among both radiologists and cardiologists. There was also a slight reduction in overall MPI utilization in both 2007 and 2008. This reduction was much more pronounced among radiologists, whereas among cardiologists the rate remained essentially flat. In 2008, approximately 44 times as many MPIs as CCTAs were performed. Given that CCTA provides different, and in many ways better, information than MPI in patients with suspected coronary disease, it appears that CCTA is being underutilized in the Medicare population.

not applicable

Levin, D, Rao, V, Parker, L, Frangos, A, Sunshine, J, The Surprising Drop in Utilization of Coronary CT Angiography (CCTA) Compared with Radionuclide Myocardial Perfusion Imaging (MPI).  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003078.html