Head and Neck Ultrasound Utilization Rates: 2012-2015 (original) (raw)
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The American journal of emergency medicine, 2014
To assess recent national specialty trends in the use of diagnostic ultrasound (US) services in the Emergency Department (ED) setting. We searched aggregated 1998-2012 Medicare Part B Master Files for ED diagnostic US studies, excluding cardiac and ophthalmic examinations. Studies were classified by body part and interpreting specialty. Subsequent analysis was performed for higher-volume services rendered by emergency physicians for which discrete codes were present longitudinally for complete vs limited examinations. National trends were analyzed. From 1998 to 2012, paid ED US studies interpreted by radiologists, emergency physicians, and all other physicians increased by 332% (from 221,712 to 735,858 examinations), 4454% (from 561 to 24,992), and 251% (from 26,961 to 67,787), respectively. The fraction of ED US examinations interpreted remained around 90% for radiologists, increased from 0.2% to 3% for emergency physicians, and decreased from 11% to 8% for other physicians. The fr...
Ultrasound examination of the head and neck
Ultrasound of the head and neck Chapter 1.1 Ultrasound imaging principles Ultrasound is produced by transmitting an electrical current through a piezo-electric crystal in the transducer. This current causes a vibration of the crystal, giving rise to high frequency sound waves which are above the human auditory range. For diagnostic purposes in the head and neck region 5, 7.5 and 10 MHz transducers are used. The sound waves penetrate the tissues to be examined and are reflected at interfaces of structures with different acoustic impedance. The greater the difference between the impedance of the involved tissues, the stronger will be the returning echo. The echo is picked up by the transducer, transferred into an electrical current and displayed on a screen. Fluid-filled structures with no internal tissue interfaces appear echo free on ultrasound studies. This results in a black area on the monitor. As a consequence of the low attenuation in a fluid-filled structure, an enbancement is displayed distal to the structure. Solid structures are filled with echoes and appear grey on the screen. Bone reflects rather than transmits sound, resulting in a high density reflection and a posterior acoustic shadowing. In glandular tissue sound waves are reflected from the multiple acoustic interfaces of parenchyma and stroma. Alternatively, selected portions of an examination can be captured on videotape for later reviews. The ultrasound examinations in this study were performed with an Aloka SSD-650 with UST 5 and UST 7.5 MHz transducers (manufactured by Aloka Co. Ltd., Japan) and a Philips SDR 1500 with 7.5 MHz transducer (manufactured by Philips Ultrasound Inc., Santa Ana, California, U.SA.). Chapter 1.2 Bio-effects of ultrasound Ultrasonography is in widespread use in health care because of its proven clinical utility and versatility. An ultrasound investigation is convenient and economical. As with any diagnostic investigation safety is very important in diagnostic ultrasound. In more than thirty years of clinical use there has been no adverse effect reported in diagnostic ultrasound. However, high exposure levels can modify biological structures and functions. There are two major mechanisms producing ultrasound bio-effects. respectively thermal and cavitation mechanisms. Thermal phenomena occur due to the absorption of ultrasonic energy and its conversion to heat. Cavitation involves ultrasonic interactions with small gas bubbles. The..:e bubbles can collapse violently and can produce biological effects in transient cavitation. Thermal mechanism By passing through tissues, part of the ultrasound energy is absorbed and converted into heat. In soft tissues and bone. the rise in temperature in the ultrasound beam is less than I"C Adverse effects to living mammals from increases in body temperature of I"C or less have not been reported. Serious damage may result only from prolonged elevation of the body temperature by 2.5"C or more. Cavitation mechanism The pre-existence of small, stabilized gaseous nuclei is required for acoustic cavitation. Very little is known about their location in mammalian tissues. There is no direct evidence that cavitation causes any biological effects in human subjects under diagnostic conditions. carcinoma of the upper aero-digestive tract. This is to illustrate how the use of ultrasound with cytologic examination may affect current staging. In chapter II.S the possible consequences of applying ultrasound with UGFNAB on the clinical management of patients with squamous cell carcinoma of the upper aero-digestive tract are discussed. Chapter 11.1 Metastatic neck disease; palpation versus ultrasound examination A clinical-radiographic-histopathologic prospective study.
Medicare Reimbursement Trends for Facility Performed Otolaryngology Procedures: 2000–2019
The Laryngoscope, 2020
Objective: There is a paucity of data regarding financial trends for procedural reimbursements in otolaryngology. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for the 20 most commonly billed otolaryngology procedures from 2000 to 2019. Study Design: Analysis of physician reimbursement.. Methods: The American Academy of Otolaryngology-Head and Neck Surgery database was queried to determine the 20 most performed otolaryngology procedures. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was utilized to assess each of the top 20 most utilized Current Procedural Terminology (CPT) codes in otolaryngology, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2019 U.S. dollars using changes to consumer price index. Average annual and total percentage change in reimbursement were calculated based on adjusted values for all included procedures. Results: After adjusting for inflation, the average reimbursement for the total 20 procedures decreased by 37.63% from 2000 to 2019. The greatest single mean decrease was seen in CPT code 61782 for stereotaxis procedures on the skull, meninges, and brain (−59.96%), whereas the smallest mean decrease was in CPT code 30520 for septoplasty (−1.50%). From 2000 to 2019, the adjusted reimbursement rate for the combined procedures decreased by an average of 2.33% each year. Conclusion: Medicare reimbursement for included procedures has decreased from 2000 to 2019. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons in order to assure continued access to meaningful otolaryngology care in the United States.
Journal of the American College of Radiology, 2004
Purpose: To ascertain changes in the utilization rates of diagnostic ultrasound among radiologists, cardiologists, and other physicians in recent years. Methods and Materials: The nationwide Medicare Part B databases for 1993 and 2001 were searched in all ultrasound Current Procedural Terminology 4 codes, except for ophthalmic ultrasound and supervision and interpretation codes. Ultrasound examinations were categorized as general, vascular, breast, obstetric (very low in the Medicare population), and echocardiography. Using the Medicare physician specialty codes, utilization rates per thousand Medicare beneficiaries per year were calculated for radiologists, cardiologists, and other physicians for all codes in the five aforementioned categories. Results: Radiologists performed 24% of all ultrasound examinations in 2001. The overall utilization rate of ultrasound examinations among radiologists increased from 132.9 per thousand Medicare beneficiaries in 1993 to 166.3 in 2001, a 25% increase. Among cardiologists, the rate increased from 190.3 in 1993 to 356.1 in 2001, an 87% increase. The vast bulk of these examinations were echocardiograms, but cardiologists also had some involvement in vascular ultrasound. Among other physicians, the rate increased from 116.9 in 1993 to 167.0 in 2001, a 43% increase. The areas of greatest involvement by these other physicians were echocardiography, vascular ultrasound, and general ultrasound. Of the five ultrasound categories, echocardiography had by far the highest volume. Conclusion: Nonradiologist physicians utilize ultrasound at much higher rates than radiologists, primarily reflecting the influence of echocardiography. Between 1993 and 2001, the ultrasound utilization rate grew over 3 times as rapidly among cardiologists as among radiologists; the rate among other physicians grew almost twice as rapidly as it did among radiologists. This raises the concern that self-referral may be leading to higher utilization and costs.
Three-dimensional ultrasound evaluation in the head and neck
Otolaryngology - Head and Neck Surgery, 1998
We evaluated the use of a novel three-dimensional ultrasound imaging device in patients with various head and neck lesions. The investigated system was found to be a valuable adjunct to conventional ultrasound in head and neck evaluations. A disadvantage of the three-dimensional system was the need for expensive technical equipment.
Background Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice.Methods This is a quantitative study, analyzing fifteen years of billing data from 213 GPs in Central Switzerland, and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM).Results According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients <65 years, and those with only on...
Role of Anterior Neck Soft Tissue Quantifications by Ultrasound in Predicting Difficult Laryngoscopy
Background: The aim of this study was to determine if ultrasound (US) measurements of anterior neck soft tissue thickness at hyoid bone (DSHB), thyrohyoid membrane (DSEM), and anterior commissure (DSAC) levels can be used to predict difficult laryngoscopy. Material/Methods: We included 203 patients age 20–65 years scheduled to undergo general anesthesia in this prospective observational study. Correlation analysis and receiver operating characteristic curve (ROC) analysis were used to determine the roles of screening tests [interincisor gap (IIG), thyromental distance (TMD), modified Mallampati score (MMS)] and US measurements (DSHB, DSEM, DSAC) in predicting difficult laryngoscopy. Results: There were 28 out of 203 patients categorized as difficult laryngoscopy. DSHB, DSEM, DSAC, and MMS were greater in the difficult laryngoscopy group (P<0.0001). There was a strong positive correlation between DSEM and DSHB (r=0.74); moderate positive correlations between DSEM and DSAC (r=0.60), DSHB and DSAC (r=0.69); small positive correlations between MMS and DSHB (r=0.32), MMS and DSEM (r=0.27), MMS and DSAC (r=0.32), all P values £0.0001; very small positive correlation between TMD and IIG (r=0.18, P=0.0089); small negative correlation between IIG and MMS (r=–0.27, P=0.0001); and very small negative correlations between MMS and TMD (r=–0.20, P=0.004), IIG and DSAC (r=–0.18, P=0.011), IIG and DSHB (r=–0.15, P=0.034). The areas under the ROC curve (AUCs) of MMS, DSHB, DSEM, and DSAC were significantly larger compared with the reference line (P<0.0001). Conclusions: Anterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior com-missure levels are independent predictors of difficult laryngoscopy. Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy. 2343 Indexed in: [Current Contents/Clinical Medicine] [SCI Expanded] [ISI Alerting System] [ISI Journals Master List] [Index Medicus/MEDLINE] [EMBASE/Excerpta Medica] [Chemical Abstracts/CAS] [Index Copernicus]