The Future of Medicine

Medical Imaging & Technology Alliance

Over the last thousand years, medical imaging is one of the top developments to have “changed the face of clinical medicine,” the New England Journal of Medicine reports. “In less than a generation, medical imaging has turned the practice of medicine upside down,” adds Dr. Gail Rodriguez, Executive Director of MITA. And yet, few people recognize the enormous positive impact this life changing technology has on healthcare.
MITA (Medical Imaging & Technology Alliance) is hoping to change that. “My goal for MITA is to help the world see the value of imaging,” Dr. Rodriguez explains. “We need policy makers to have an appreciation for how important this is. Literally, surgeons could not do their job, cardiologists could not do their job, oncologists could not do their job without these very precise, accurate, imaging modalities. It has added a disproportionate value to patient care.”

The Washington, DC based trade organization, which is a division of the National Electrical Manufacturers Association (NEMA), is the leading voice for imaging equipment, radiation therapy and radiopharmaceutical manufacturers, innovators and product developers. The organization provides leadership on legislative and regulatory issues, advocating for fair legislative and regulatory proposals that will encourage innovation and investment in research and development. Through NEMA, MITA is also a respected leader in the development of important standards for medical imaging and radiation therapy equipment.

Imaging Forward Campaign
Ground breaking diagnostic imaging – including CT scans, PET scans, nuclear medicine scans, and MRI scans – have been a tremendous success, allowing physicians to diagnose diseases earlier and monitor treatment far better than anyone could imagine just a few years ago. “I think there is widespread recognition among the [imaging and radiology] community that diagnostic imaging has revolutionized the practice of medicine,” Dr. Rodriguez says. “It is one of the most important benefits to the practice of medicine. It has just been so innovative in such a short period of time.”

Unfortunately, not everyone has gotten the memo. “I think what the imaging community hasn’t done well is to share that information with others,” Dr. Rodriguez admits. “Companies are spending extraordinary amounts of money to develop technologies that will detect disease sooner, that will be more accurate, that will be safer, that will be less invasive; all the things that are important for patient care. But they are doing it quietly.”

Indeed, “There were a lot of misconceptions in the 2000s about imaging; that it was over utilized, defensive medicine, that it was just [about] money making,” Dr. Rodriguez recalls. “There was this notion that everybody was getting imaging, that people were getting it when they didn’t need it. And I think that one of the reasons that some people believed that is because we were not doing a good job of [sharing] the evidentiary base that demonstrates that there is a reason why doctors rely on these technologies. It is because it helps them practice medicine better.”

MITA has launched the Imaging Forward campaign to educate policy makers and the public about the importance of diagnostic imaging. “We are trying to show just how dramatic the evidence is that supports the use of imaging across multiple disease bases,” Dr. Rodriguez explains. “And we are also trying to show from a patient’s perspective why the data is meaningful. We have a whole slew of educational resources and videos that pull that all together. We are not copyrighting them. We really hope that our imaging partners will [utilize these resources] and make as much noise as we are trying to make.”

Setting Standards
“Safety standards are a big part of what we do as well,” says Dr. Rodriguez. “We work very closely with the Food and Drug Administration making sure that these products are regulated appropriately and that the equipment is as safe as it can possibly be.” At the moment, the organization is making great strides with its MITA Smart Dose initiative. “MITA Smart Dose CT is a national standard that identifies key features on a CT scanner that every CT scanner should have in order to be able to manage dose, report dose, and record dose. It is the first of its kind.”

CT scanners use “relatively high” levels of ionizing radiation when compared to a traditional X-ray, so ensuring that this radiation dose is kept as low as possible is crucial. “We have been working with the FDA in recent years to try to get that dose down as far as we possibly can without sacrificing the ability to diagnose something,” Dr. Rodriguez reports. The process requires a careful balancing act; “if you cut the dose down too much, the physician won’t be able to read the scan,” she explains. “The [manufacturers and developers] have been working for years to try and reduce that dose as much as possible, particularly for children. These individuals spend an awful lot of time and money trying to get at how to do that and how to do it the most effectively.”

The industry-wide effort enabled MITA to publish its new Smart Dose guidelines in 2013. All of the major industry insiders – from the FDA, to the American College of Radiology, to the American Academy of Physicists in Medicine – are on board. “The entire community has worked together quite extraordinarily in recent years.”

The majority of scanners in use today do comply with the standard, or could be upgraded to comply. But, a third of the scanners currently in use around the country are not, and cannot be made compliant. “They are that old,” Dr. Rodriguez explains. The hope is that the MITA Smart Dose standard will encourage healthcare institutions to upgrade or replace these older scanners in order to lower patient exposure to radiation as much as possible. Already, the plan appears to be making headway, with Medicare agreeing to pay less for scans performed on noncompliant equipment. These pay cuts are not huge, “but hopefully enough to make providers realize that it is time to get rid of that high dose machine.”

Fighting the Device Excise Tax
MITA has also been busy battling the Affordable Care Act’s medical device excise tax. “We think the fewer the taxes on manufacturers and developers and innovators the better,” says Dr. Rodriguez. “But this one is particularly egregious because it is a tax on revenue, not profit.”

The tax is already hitting smaller companies particularly hard, and is hindering research and development. “We have a lot of small companies in this market who aren’t profitable yet, so what this tends to do is diminish the ability to invest in R&D. And of course, what comes after R&D is jobs, so the downstream [effect] is negative as well.”

The tax’s implementation has also been burdensome and confusing, Dr. Rodriguez adds. “It’s been awkward all around,” she explains. “These folks have to pay a lot [of money], and they have to pay it frequently. It’s not like they can file quarterly.” Resources that once went to things like R&D are now being spent deciphering the new tax codes. “The infrastructure needed, particularly at the small companies, is costly; they have to get a lot of tax advice on this. And the IRS has had its own little bumps and glitches trying to get this set up.”

With diagnostic imaging devices playing a significant role in the economy, MITA is very concerned about the long term effects of the new tax. “This is a really important domestic industry. We should be protecting it, not hindering it.”

The organization’s goal is to see the tax repealed completely. “We would love to see it go away,” Dr. Rodriguez says. “There is pretty strong bipartisan support for that.” But that goal is unlikely to be met this year, she predicts. So, until it is, “we will continue to demonstrate the number of jobs, the economic impact, the importance of this industry to the U.S. economy. We are going to continue to beat that drum. We don’t want [the tax] to hurt an industry that is doing all the right things.”

Moving forward, Dr. Rodriguez predicts that “neuroimaging is the next big unmet medical need where we can really benefit the patient.” Even with so much already accomplished in the industry, there is still plenty of ground left to cover – and MITA is there to see it through. “In less than a lifespan we are seeing things that I never thought I would see, and I have been in imaging for 21 years,” Dr. Rodriguez remarks. “It is just amazing.” More importantly, it is only the beginning.

July 19, 2018, 9:37 AM EDT

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