Computed tomography angiography is booming. In 10 painless minutes, this noninvasive test provides a detailed, colorful three-dimensional view of a patient's heart. Many specialists say the CT procedure is more accurate and precise than other heart tests.
Exact figures aren't available, but some experts think Americans undergo several hundred thousand CT angiographies a year, perhaps more than a million.
"It's a very easy test to do," says Dr. Michael Lauer, a heart researcher at the National Heart, Lung and Blood Institute. The test is "proliferating," he says.
That, critics say, is a problem. They call the procedure untested, overused, risky and a prime example of health care ruled by profit and fad rather than hard science.
The debate has intensified since January, when the federal agency that oversees Medicare proposed tight restrictions on insurance reimbursement for CT angiography, a technique that relies on multiple X-rays to create a three-dimensional image of internal organs.
The test typically costs $1,000 to $1,200, more than many patients can pay on their own. So the agency's move would significantly reduce its use. Because many insurance companies follow Medicare's lead, the agency's final decision, due next month, could affect the entireindustry.
"It would have a major effect" on the number of patients who get the test, says Dr. Sean Tunis, director of the Center for Medical Technology Policy.
His San Francisco-based group is an independent nonprofit that studies the ways new medical procedures are tested. Until 2005, Tunis, who lives in Baltimore, was chief medical officer of the Centers for Medicare and Medicaid Services, the agency that oversees Medicare.
Since the CMS proposed the change, cardiologists, radiologists and other doctors who use CT angiography have flooded the agency with appeals.
"This test has huge promise," says Dr. Armin Zadeh, a cardiologist at Johns Hopkins University School of Medicine. "For the first time, we are able to non-invasively see coronary artery disease."
CT angiography arrived a decade ago, and its use has grown steadily. It is one of a growing number of tests that use computed tomography. The Food and Drug Administration oversees CT scanners but does not regulate their day-to-day use.
"CT angiography has revolutionized the way doctors treat heart disease," says Andrew Whitman,vice president of the Medical Imaging & Technology Alliance, a medical-imaging trade group. "The evidence is well established."
