The Blue Cross Blue Shield Association Technology Evaluation Center: how we evaluate radiology technologies

Fetal aneuploidy detection by maternal plasma DNA sequencing: a technology assessment

The American College of Obstetricians and Gynecologists currently recommends that all pregnant women be offered screening for chromosomal abnormalities, regardless of maternal age. Traditional screening tests have detection rates ranging from 85% to 90% and false-positive rates of 3% to 5%. A woman with an abnormal noninvasive test is offered a diagnostic test, but diagnostic tests are associated with a risk of pregnancy loss. Recently, analysis of cell-free fetal DNA (cffDNA) in maternal blood has been shown to have potential for the accurate detection of some of the common fetal autosomal aneuploidies. As part of a technology assessment for the California Technology Assessment Forum, we critically reviewed the evidence for the use of cffDNA as a prenatal screening test. We evaluated the evidence for its use as either a 'primary' or an 'advanced' screening test and for its use in screening for three different trisomies: 21, 18, and 13. We evaluated whether the use of cffDNA met established technology assessment criteria and established conclusions about evidence-based use of this new technology.

Computer-aided detection as evidence in the courtroom: potential implications of an appellate court's ruling

OBJECTIVE

The use of computer-aided detection (CAD) in radiology has been studied for different organ systems. As with any new technology, its impact on determinations of standards of clinical practice is an evolving one that is often defined by its acceptability not only in medical forums but also as defined by courts of law.

CONCLUSION

We discuss the first known appellate legal decision regarding the acceptability of CAD as it relates to the clinical practice of mammography.

The Diffusion of New Imaging Technologies: A Molecular Imaging Prospective

Molecular imaging is a complex of technologies that will diffuse into clinical practice over the next 10 to 20 years. Because of characteristics of both the technology and the environment, molecular imaging has the potential to be disruptive to conventional radiology practice. Environmental influences, including scientific and clinical characteristics of the technology, the interests of commercial firms, competition among radiologists and with other specialists, and regulation and reimbursement decision making will influence both the pace of diffusion and the eventual success of various molecular imaging technologies. Molecular imaging poses both threats and exciting opportunities for radiologists. Radiologists must decide how they wish to cope with the advent of molecular imaging, choosing for the present among ignoring its potential, attempting to fit molecular imaging into current practice models, or morphing how they practice to accommodate molecular imaging as a part of radiologic practice.