Noor Conference | Global Knowledge Forum | http://www.noor.org.sa | Day 2 - Panel 3 - Appropriate Use Of Modern Technology By Arfa Khan, Noor

1. Arfa Khan MD, FACR Professor of Radiology Albert Einstein College of Medicine Chief of Thoracic Radiology LIJ Medical Center, New Hyde Park, NY 11040 Chair ACR-Appropriateness Criteria Expert Chest Panel Appropriate Use of Modern Technology

2. Advances in Medical Technologies

3. Growth rate for Imaging Services (1997-2003) High-tech 12.9% Low-tech 4.5% Distribution of Imaging Services (2003) Low-tech 80% High-tech 20% 15.8% 20% MRI CAGR (%) 15% 10% 5% 0% 13.9% 11.4% 9.2% 8.3% 7.2% 2.5% NUC MED CT INT MAM US X-RAY Growth in high-tech services have made diagnostic imaging the fastest growing physician service in the United States

4. Projected Growth in Imaging Procedures (2000-2008) Source: Sg2 Volume of Imaging Procedures (M) Imaging service volume will continue to increase as use of high-tech procedures drive growth 281 299 323 349 374 401 430 450 471 600 2000 500 400 300 200 100 0 2001 2002 2003 2004 2005 2006 2007 2008 (9%) 122% X-RAY CT Scan 57% 133% Ultrasound MRI Projected Growth 2002-2008

5. SAMPLE TOPIC Clinical Condition: Low Back Pain Variant 1: Uncomplicated. No red flags. (Red flags defined in text.) Variant 2: Low velocity trauma, osteoporosis, and/or age >70 Variant 3: Suspicion of cancer, infection, or immunosuppression Variant 4: Radiculopathy Variant 5: Prior lumbar surgery Variant 6: Cauda equina syndrome

6. SAMPLE VARIANT TABLE Clinical Condition: Low Back Pain Variant 2: Low velocity trauma, osteoporosis, and/or age >70. Appropriateness Criteria Scale 1 2 3 4 5 6 7 8 9 1=Least appropriate 9=Most appropriate 3 MRI, lumbar spine, without and with contrast 4 NM, bone scan MRI preferred. CT useful if MRI contraindicated or unavailable. 6 CT, lumbar spine, without contrast 6 X-ray, lumbar spine 8 MRI, lumbar spine, without contrast Comments Appropriateness Rating Radiologic Procedure