Category: Blog

By Vijay Sekhon, MD
RDC radiologist

Are you one of the millions of Americans who has resolved to improve diet, nutrition, or fitness in 2020?  How will you know if your effort and dedication is producing the desired results?  Reno Diagnostic Centers offers state-of-the-art body fat analysis to help you with your fitness goals.  Validate the effectiveness of your lifestyle routine with the most accurate test for measuring body fat with 50+ data points in a comprehensive report, which you will be given as you leave the center.

Body fat analysis at Reno Diagnostic Centers is performed using DXA technology.  This involves the use of two different X-ray beams and an algebraic algorithm to separate the bone, fat, and lean tissues.  Special beam filtering and near-perfect spatial registration of the two X-ray attenuations if performed to produce accurate and precise body composition measurements, while providing an extremely low dose of radiation.  The dose from a single whole body DXA is roughly equivalent to the background radiation a person receives from living one day at sea level.  The body composition data obtained has implications in the treatment of metabolic conditions, musculoskeletal health, sports and fitness, as well as disease-specific indications.  Recent literature shows growing evidence that body shape and compositions are strong indicators of metabolic health and possibly overall longevity.

Measuring body fat before and after a new fitness and diet regimen has become the method of choice among professional athletes, fitness competitors, and weekend warriors, alike.  You, too, can witness the changes in your body composition, even to the level of individual body parts. This information will empower and motivate you to continue toward achieving your ideal physique.

The exam takes less than 10 minutes and is available at each of our two convenient locations.  Call today to schedule your body fat analysis.  Please feel free to inquire about group rates, as this is popular way of encouraging your peers to work together toward better health.

 

By Ron Swanger, MD, RDC radiologist

What is a CT Coronary Artery Calcium Scoring exam?
A CT coronary artery calcium scoring, also known more simply as a CT heart scan or a CorCal, has become extremely popular over the past several years. The exam is painless and quick, with the scan taking about 5 minutes to complete.

What you can expect during your exam?
Technologists attach ECG leads to the patient’s chest to coordinate image acquisition with heartbeat to reduce image motion during heart contractions, which can interfere with the quality of the images. Once the images of the heart are complete, you’re able to get dressed and carry on with your day and the images are sent to the workstation for analysis. The radiologist reviews the images and will highlight each coronary vessel for analysis. Then the radiologist will utilize computer software that will calculate the density of the calcium and measure how much calcified plaque exists in the vessels. The software creates a separate score for each vessel. When available, the software will also provide comparative analysis against your reference population. For example, your calcium score of 128.7 puts you in the 75th percentile for patients of similar sex and age.

How exactly does the radiologist score this exam?
Check out this video of an actual case being examined and scored by RDC radiologist, Dr. Swanger.

What are the benefits of knowing your Coronary Calcium Score?
The critical thing to know is that the amount of coronary artery calcium discovered correlates very closely with the amount of soft cholesterol plaque in the vessels. Calcified plaque is there for life, but soft plaque can be stabilized and potentially reversed. Unstable soft plaque can come loose and travel through the vessel  and become lodged in the narrowing point of the vessel, leading to a blockage, which ultimately can cause a heart attack. Now here is where medicine comes in. Over the past several decades, there have been tremendous advancements in cardiac medicine. When I was a kid, people either had cardiac bypass surgery or died. Today, we have all kinds of medicines available to treat cardiac disease, as well as prevent it. Statins are a class of medicine that decrease cholesterol, reduce new plaque formation, and stabilize and sometimes reverse soft plaque buildup. It’s truly a massive advancement in medical treatment of heart disease. The medicine actually prevents heart attacks. So, by knowing where your levels stand, you may be able to prevent future heart health issues and take a proactive and preventative approach to your own health care.

Does insurance cover this?
Most insurers do not currently cover CT coronary artery calcium score exams, but at Reno Diagnostic Centers, we offer this exam for $99. You need an order from your doctor, but the rest you can leave to us.

Who should get this exam?
If you are 50 years of age or older (male and female), or have a strong family history of cardiac disease, this highly effective exam is something you should seriously consider.

        

 

 

 

One of the benefits of technology in medicine is narrowing broad population guidelines to individualize care.  In breast care imaging, new technology, including computerized density assessment, mathematical cancer risk modeling, and affordable genetic testing together form a personalized breast cancer assessment and testing strategy. At the end of each breast care appointment, you will receive a handout with your specific information and further testing recommendations.

Risk assessment and Genetic testing: Through a partnership with Ambry Genetics, we now offer a family history questionnaire, cancer risk analysis, genetic testing, and if needed, genetic counseling.  The data from the questionnaire is used to calculate a lifetime breast cancer risk using the Tyrer-Cuzick model.

Patients who meet National Comprehensive Cancer guidelines for further testing are offered an educational video and onsite saliva sample collection for a 34 gene panel. Results are completed within 2-4 weeks. If positive, patients meet with a genetic counselor.

Together, the components of this program are consistent with the recent recommendations of the American Society of Breast Surgeons, and we believe will be in line with recommendations coming from major societies in the near term.

Our initial experience is summarized in the chart below.  We’ve tested over 600 patients and identified approximately 50 with genetic mutations.  Approximately 10% of patients are at a higher risk than the general population, where additional screening is proven to save lives. Identifying patients with mutations further personalizes risk for the patient and their family members.

Your guidelines for preventative breast care may change depending on the results of your risk assessment

Mammography: Tomosynthesis (3D mammography) is the baseline recommendation in recent guidelines, and recommended for normal, intermediate, and high-risk women. Compared with traditional 2D mammography, 3D mammography has increased cancer detection, decreased false positives, and has similar low radiation exposure.

Breast Density: Since February 2019, RDC has implemented automatic density quantification using Volpara software for an objective, reproducible, breast density analysis. Increased breast density is associated with an increased breast cancer risk.  Patients with dense breasts are recommended to have supplemental screening with automated breast ultrasound (ABUS).

ABUS: Recent literature demonstrates that as a supplement to mammography in dense breasts, ABUS detects an additional 4 cancers / 1000 patients. 85% of these are invasive and node negative (serious, but typically curable).

https://densebreast-info.org/

https://www.ambrygen.com/care

https://www.ambrygen.com/clinician/genetic-testing/1/oncology/cancernext-r

https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf

A radiologist is a medical doctor who plays a large role in your medical care. Radiologists are often referred to as the “doctor’s doctor” in healthcare circles. They play an integral role as a consultant to your physician by aiding them in selecting the proper medical imaging exams and interpreting the results. The results of your X-ray, CAT scan, MRI, ultrasound, mammogram, etc., are pivotal in giving your doctor an accurate diagnosis and guiding your treatment.

Radiologists are Medical Doctors

Like all other physicians, radiologists graduate from accredited medical schools and pass their board examinations for licensing. After medical school (four years) and internships (one year), they also complete a minimum four year residency. Many radiologists will then complete a fellowship following their residency. A fellowship involves an additional one or two years of training in a radiological specialty, including body imaging, breast imaging, MRI, neuroradiology, sports medicine, musculoskeletal, cardiovascular radiology and more.

Radiologist or Technologist?

Patients are often confused about a radiologist’s role in their care. Surveys show that less than 20% of patients knew that radiologists were medical doctors. 76% confused their radiologist doctor with their technologists who conducted their exam. As many as 40% of patients had no idea that radiologists played a role in patient care.

The technologists who perform your exam might be your first or only point of contact at the medical imaging center. Technologists have two to three years of training. They are not medical doctors. Rather, like the dental hygienist in the dentist’s office or the nurse assistant at the long-term care facility, radiology technologists assist the radiologist with conducting procedures.

Behind the Scenes – the steps after you finish your exam

Once your radiologist looks at the images of your scan (which in some cases, like MRI’s, may include thousands of diagnostic images), they provide a report for your referring physician. Depending on the complexity of your case, your referring physician will often review the images and consult with the radiologist and then call you with the results or schedule an appointment to go over the details and explain what your imaging study means to you and your treatment plan.

Radiologists often perform exams on patients as well. Certain procedures require radiologists to administer therapeutic or diagnostic dye injections (ex. arthrograms, angiograms). They also perform biopsies and oversee other real-time medical imaging exams.

The Expanding Role of the Radiologist in Healthcare

Your radiologist’s expertise makes them an invaluable member of your healthcare team.

Most patients require medical imaging for diagnosis at some point in their medical care.

Hopefully the next time you visit a medical imaging center or radiology department, you will have a better idea of what happens, who is involved in getting your images and reports and how the radiologist helps your doctor diagnose and manage your medical care.

I get many calls from patients frustrated because their doctor has sent over an order for their MRI, CT, ultrasound, cardiac test, or other scan and we have to schedule it out several days to accommodate for the time it takes to obtain authorization from their insurance company. Understandably, patients want to know what “authorization” is for and why it takes so long. Hopefully this article helps patients to understand this sometimes cumbersome process.

Many health plans require a prior authorization (PA) for certain medical imaging, pharmaceuticals, surgeries or equipment. It is also a health plan cost-control process requiring providers to obtain approval before performing a service to qualify for payment. The process varies from insurers, but typically requires the ordering physician staff or healthcare facility to contact the insurer with information about the requested service and complete a series of questions online, via telephone or fax, ultimately allowing the insurer to determine the “medical necessity” of the ordered service. If the insurer deems the service or product to be medically necessary, they will provide an authorization (typically in the form of a number) that indicates the service will be covered under the terms of the patient’s health care plan.

The American Medical Association (AMA) reports that nearly 60% of physician practices wait at least one business day for authorization with 26% of them waiting about three business days for the approval/denial for the requested service. Of the 1,000 physicians surveyed, 72% of PAs are approved on the initial request and 7% of them are approved on appeal, also known as going “peer to peer.” This means that the ordering physician must personally speak to the medical director of the health plan. As you may imagine, this further delays the authorization process due to scheduling conflicts and the availability of the parties to speak with each other.

If the service is not authorized, the health plan will not have an obligation to process the claim under its terms and conditions and the cost of the service could become the responsibility of the patient. Most patients do not want to pay out of pocket for their service, so having the authorization is very important. Patients can always opt to have the service without the authorization, which can be risky if the cost of the service is not fully understood. In this case, most providers of the service will require the patient to sign a notice stating that they understand their insurance has not provided authorization for the ordered service and responsibility for full payment will become the responsibility of the patient.

Not only is this process frustrating for the patient, it can be time consuming and difficult for physician practices – significantly increasing the costs to the practice and overall operations. According to the AMA, approximately 75% of physician offices surveyed describe the burden associated with obtaining authorizations to be “high” to “extremely high” on their practice and 60% of those offices spend over 10 hours per week working through the required process.

New technology and evolving payment models may offer relief for providers and patients that are fed up with the current process. Healthcare advocacy groups have been highly vocal about the frustrations and are working toward industry-focused technology that supports more collaboration between insurers and providers, but this will take time – some say up to five more years.

My best advice to patients until this process is more advanced is to ask your doctor if the requested service requires PA and about how long that typically takes so your expectations for the required service are realistic.

Comparing prices for healthcare services can be time-consuming and frustrating. Now it’s easier than it used to be, if you know how to shop.

Common procedures like MRIs, ultrasound, mammography, and colonoscopies can be scheduled in advance and are the most “shoppable.” Start by asking your doctor for the specific name of the exam (being sure to ask if it is with, without, or with and without contrast), or ask for the exam code, which is used for billing purposes. Make sure you understand why the test or procedure is being ordered, which can affect the cost. A colonoscopy, for example, could cost an insured patient anywhere from $0 to $10,000 out of pocket, depending on whether it’s considered “screening” or “diagnostic,” where it’s performed, and whether the facility and/or the physician are in-network.

Most insurers now have online tools that let plan members see how their out-of-pocket costs night vary for the same service at different in-network providers. Some insurers’ tools are cumbersome, and most caution that the amounts listed are just estimates that could change without notice. This is because each facility can be contracted with the same payor for different rates. For example, your Aetna plan will most likely pay a higher rate for hospital based services than an outpatient facility. This, in turn, impacts your out of pocket costs (especially for those in a high-deductible based plan).

Paying Cash

Many providers offer cash or “self-pay” rates that may be lower than what you would pay using your insurance. Insurers’ cost-estimator tools typically don’t give you this information, so you’ll have to call the facility and ask for the cash-pay price. Be sure to ask if ALL fees are included in the estimate (i.e. physician and/or drug fees.

Stand-alone imaging centers, outpatient surgery centers and urgent-care clinics are generally much less expensive than hospitals, and offer lower cash rates to patients who pay at the time of service. Some will look up your coverage, so you can compare the cash price they are offering to the out-of-pocket amount you would owe using your insurance.

Hospitals also offer self-pay rates, though their policies vary widely. Most offer discounts of 20 percent to 80 per cent off their “charges”, but “charges” are often highly inflated list prices that providers work from when negotiating actual fees with insurance companies. Deeper discounts may be available to those who qualify for financial aid, so it pays to call the provider or hospital’s financial-services department and ask.

Consumers seeking to compare cash prices for medical services can now turn to a growing number of websites for help, unfortunately they haven’t been fully developed for northern Nevada as of yet.

High Cost ≠ High Quality

Assessing how providers compare in quality is also important, although that information can be difficult to find. Now that prices are more transparent to customers and patients, people want to know, is that $6.000 MRI so much better than a $600 one with the same billing code two blocks away? Ask your doctor, and if you don’t get a satisfactory answer, take your healthcare into your own hands ind call the facilities directly.