ABSTRACT
Neuroimaging is an integral and indispensable part of every neurologist's practice.
As neuroimaging now becomes a formal neurological subspecialty, through the United
Council of Neurologic Subspecialties, the entire concept of “neurologist as neuroimager”
is undergoing a detailed examination and emphasis at all levels of neurological training
and endeavor. This article summarizes historical aspects and current trends involved
with the political, academic, and practical neuroimaging issues encountered by the
clinical neurologist. Reference is made to rationale for organ system specialty imaging;
support organizations; imaging utilization and appropriateness guidelines; medical
specialist competition, self-referral and turf matters; practice domain prerogatives;
legislative challenges; and educational and advocacy concerns.
KEYWORDS
Neuroimaging - neurologist neuroimager - MRI - American Society of Neuroimaging
REFERENCES
- 1
Atlas S W.
Embracing subspecialization: the key to the survival of radiology.
J Am Coll Radiol.
2007;
4
752-753
- 2
Ellenberger C, Greenberg J.
Do neurologists have a future in neuroimaging?.
Neurology.
1998;
50
1516-1517
- 3
Adair J C, Rudnicki S, Boudreau E et al..
Survey of training programs' means for promoting neurology and attracting trainees.
Neurology.
2006;
67
936-939
- 4
Preston W G.
Survey of training programs' means for promoting neurology and attracting trainees.
Neurology.
2007;
68
1324
- 5
Brillman J, Kasdan R, Wechsler L.
The neurologist as neuroimager.
Neurology.
1997;
48
303-306
- 6
Oldendorf W H.
The quest for an image of the brain: a brief historical and technical review of brain
imaging techniques.
Neurology.
1978;
28
517-533
- 7
Masdeu J C.
Will subspecialty certification change your view of neuroimaging?.
Practical Neurology.
2006;
3
40-43
- 8 American Society of Neuroimaging .Fellowships, Tutorials and Seminars in Neuroimaging. Available at: http://www.asnweb.org/clientuploads/Fellowshipupload2007.pdf Accessed December 15, 2007
- 9
Gomez C, Kinkel P, Masdeu J et al..
American Academy of Neurology guidelines for credentialing in neuroimaging. Report
from the task force on updating guidelines for credentialing in neuroimaging.
Neurology.
1997;
49
1734-1737
- 10
Masdeu J C.
American Academy of Neurology Neuroimaging Training Guidelines. The AAN Workshop on
Neuroimaging Training.
Neurology.
1997;
49
1738-1740
- 11
Bakshi R.
Neuroimaging curriculum for neurology trainees: report from the neuroimaging section
of the AAN.
J Neuroimaging.
2003;
13
215-217
- 12
Igelhart J K.
The new era of medical imaging—progress and pitfalls.
N Engl J Med.
2006;
354
2822-2828
- 13 Testimony before the subcommittee on health of the house committee on ways and
means. Available at: http://waysandmeans.house.gov/hearings.asp?formmode=view&id=2555 Accessed August 14, 2008
- 14 House Ways and Means Committee. Statement of the Coalition for Patient-Centered
Imaging on the current use of imaging technology in medical practice. Available at: http://waysandmeans.house.gov/hearings.asp?formmode=printfriendly&id=3076 Accessed August 14, 2008
- 15 Abelson R, An M. R.I. machine for every doctor? Someone has to pay. New York Times,
March 13, 2004. Available at: http://query.nytimes.com/gst/fullpage.html?res=9C04E0D7113EF930A25750C0A9629C8B63&sec=&spon=&pagewanted=print Accessed February 28, 2008
- 16 Armstrong D. MRI and CT centers offer doctors way to profit on scans. The Wall
Street Journal, May 2, 2005. Available at: http://online.wsj.com/article/SB111498587452921637.html Accessed February 28, 2008
- 17 Miller M. Hearing on Managing the Use of Imaging Services. Testimony March 17,
2005, before the House Ways and Means Subcommittee on Health. Washington, DC; Available at: http://www.medpac.gov/publications/congressional_reports/Mar05 Accessed December 15, 2007
- 18 Johnson (Hon.) N, Stark (Hon.) F. Hearing on Managing the Use of Imaging Services.
Testimony March 17, 2005, before the House Ways and Means Subcommittee on Health. Washington,
D.C.; Available at: http://www.medpac.gov/publications/congressional_reports/Mar05 Accessed December 15, 2007
- 19
Hillman B J, Olson G T, Sunshine J H.
Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare
population.
JAMA.
1992;
268
2050-2054
- 20
Kouri B E, Parsons R G, Hillel R.
Physician self-referral for diagnostic imaging: review of the empiric literature.
AJR Am J Roentgenol.
2002;
179
843-850
- 21
Levin D C, Rao V M, Bree R L et al..
Turf battles in radiology: how individual radiologists can respond to the challenge.
Radiology.
1998;
209
330-334
- 22
Levin D C, Rao V M.
Turf wars in radiology: the overutilization of imaging resulting from self-referral.
J Am Coll Radiol.
2004;
1
169-172
- 23
Patti J A.
The economic environment of 2006: how safe is your practice and what you can do to
protect it.
J Am Coll Radiol.
2007;
4
97-101
- 24
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for
Calendar Year 2006; Final Rule.
Federal Register.
2005;
70
70116-70476
- 25
Moser J W.
The deficit reduction act of 2005: policy, politics, and impact on radiologists.
J Am Coll Radiol.
2006;
3
744-750
- 26 American Medical Association .Current Policy Statement. D-385.974: Freedom of practice
in medical imaging. http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/DIR/D-385.974.HTM Accessed August 14, 2008
- 27 American Medical Association .Resolution 208 (A-08): Fairness in medical imaging
interpretation. Adopted by the House of Delegates (Reference Committee B). Available at: http://www.ama-assn.org/ama1/pub/upload/mm/471/annotatedb.doc Accessed August 14, 2008
- 28 Borgstede J, Williams K. Hearing on Managing the Use of Imaging Services. Testimony
March 17, 2005, before the House Ways and Means Subcommittee on Health. Washington,
DC; Available at: http://www.medpac.gov/publications/congressional_reports/Mar05 Accessed December 15, 2007
- 29
Hutchinson M, Chawluk J, Gomez C et al..
Self-referral of imaging does not imply over-utilization.
J Neuroimaging.
, In press
- 30 Preston W, Morariu M. Palatucci Advocacy Leadership Forum Neuroimaging Projects,
2006 and 2007. http://Available at: www.aan.com/advocacy/issues/?event=home.showIssue&id=24 Accessed August 14, 2008
- 31 American Academy of Neurology Professional Association .Position statement on principles
of neuroimaging training, guidelines, and practice. Available at: http://www.aan.com/advocacy/issues/tools/99.pdf Accessed August 14, 2008
William G PrestonM.D.
Associate Clinical Professor of Neurology, University of California, Irvine School
of Medicine
Saddleback Valley Neuroscience Medical Group, Neurophysiologic Laboratory and Research
Organization, 23961 Calle de la Magdalena, #317, Laguna Hills, CA 92653
Email: wpreston@aol.com