The Data Dilemma
Data are the heart of medicine, science and business; yet for all of the value they deliver, data remain woefully elusive. Several of this week’s top stories illustrate various aspects of the data dilemma.

Current practice guidelines for breast MR, for example, recommend its use among women with newly diagnosed breast cancer. Implicit in the recommendation is that use of the modality will impact outcomes. However, when a team of researchers from East Carolina University in Greenville, N.C., undertook a retrospective analysis of surgical outcomes among women undergoing pre-operative breast MR, they found imaging did not affect the re-operation rate.

In another breast imaging study, researchers determined that many mammographers do not understand gaps in their own performance and cannot provide an accurate estimate of quality measures such as recall, false-positive and cancer detection rates and positive predictive value of biopsy recommendation. Radiologists who do not understand their own performance gaps and need for improvement may be less likely to benefit from quality improvement interventions.

A meta-analysis of the Canadian Head CT Rule, a clinical prediction rule that targets neuroimaging in the emergency department, found that the rule is sensitive and specific. However, data about its effect on utilization are inconclusive, as some have linked use of the rule with an increase in imaging.

In regulatory news, the FDA approved the first automated breast ultrasound screening system for women with dense breasts. Will the approval mark the beginning of the end of the current hodge podge, state-by-state approach to screening women with dense breasts? A handful of states have enacted breast density legislation. Some require mammographers to notify women of their breast density; others require insurers to cover adjunctive screening for these women. Many are silent on the subject.

Finally, in another development that may foreshadow the future of risk-stratified, personalized medicine, Israeli researchers reported that breath testing could be used to discriminate between benign and malignant pulmonary nodules. If such findings are validated, the test could inform decision-making about follow-up procedures for patients whose chest CT screening exams show nodules.  

If these items have not quenched your appetite for data, check out “Prostate Cancer: In the Eye of the Storm,” in the September/October issue of Health Imaging.

How is your practice leveraging data to improve clinical and business outcomes? Please let us know.

Lisa Fratt, editor