Keeping on top of current medical literature and monitoring industry trends are essential ways we help ensure quality, affordable care for your members. By understanding how our industry evolves, we’re better able to tailor our solutions to meet the needs of your organization, your providers, and your members.

Created for health plan executives, our Trio series spotlights compelling trends in complex medical specialties for your organization. In this edition of Trio, Chris Buckle, MD, Associate Chief Medical Officer for AIM and clinical lead for the Radiology Solution, presents three important trends in advanced imaging.

Trend 1 – Global supply chain issues impacting contrast availability

Supply chain issues related to COVID-19 directly impacted radiology when, in April 2022, GE Healthcare’s Shanghai factory (a primary supplier of iodinated contrast media for CT exams) shut down due to a regional outbreak. The ensuing contrast shortage affected facilities across the U.S., which had to delay elective contrast-enhanced CT exams, reduce or eliminate contrast media doses, and substitute other types of exams (such as MRI, ultrasound, or noncontrast PET/CT), when possible.

AIM was able to accommodate these evolving practice changes without workflow disruptions. Should concern for future contrast supply lead again to use of alternative modalities as one group has proposed1, we remain well-positioned to adapt quickly.

Trend 2 – Questioning the role of MRI in stroke imaging

Patients with acute ischemic stroke are typically imaged with CT and subsequently by MRI. Though the use of MRI in stroke increased from 28 to 66 percent between 1999 and 2008, the incremental value of MRI to stroke evaluation isn’t clear, suggests a study published recently in JAMA Network Open.2

The study found that the rates of adverse outcomes were higher for patients who received MRI in addition to CT, versus those who received CT alone. While the difference was not statistically significant, the findings support that CT alone was noninferior to CT with added MRI. Acknowledging such outcomes may have substantial implications on long-standing stroke imaging practices and utilization, with the authors concluding that the “value of MRI added to CT in patients such as these should not be presumed.”

While current data does not suggest CT alone is a definitive best practice for stroke imaging, AIM will continue monitoring relevant literature and evidence to determine whether future updates to our clinical guidelines are needed.

Trend 3 – CMS delaying appropriate use criteria and clinical decision support mandate

The Centers for Medicare and Medicaid Services (CMS) has postponed the start of the penalty phase for its appropriate use criteria (AUC) mandate. The mandate requires a provider to consult CMS-approved AUC through a qualified clinical decision support (CDS) mechanism, such as our CDS tool, before ordering advanced imaging for an outpatient with traditional (fee-for-service) Medicare coverage.3 As a result of the postponement, the ongoing educational and operations testing period will continue through at least January 2023.

This delay adds to the uncertainty regarding the implementation of the AUC mandate in its current state. Challenges integrating CDS tools across existing order entry platforms persist, as do concerns about referring providers’ preparedness to submit requisite documentation.

Collectively, these challenges highlight the value of working with AIM. We configured our CDS tool to parallel the workflow of our radiology prior authorization program, and we’re making the bundle available through provider electronic medical record (EMR) systems. With AIM, your members already receive care aligned with AUC tenants and your providers are well-prepared to transition when the CMS mandate advances.


  1. Fiori T, Lisewski D, Flukes S, Wood C, Gibson D. Lessons learnt from the global iodinated contrast media shortage in head and neck imaging [published online ahead of print, 2022 Sep 20]. J Med Imaging Radiat Oncol. 2022;10.1111/1754-9485.13472.
  2. Cabral Frade H, Wilson SE, Beckwith A, Powers WJ. Comparison of Outcomes of Ischemic Stroke Initially Imaged With Cranial Computed Tomography Alone vs Computed Tomography Plus Magnetic Resonance Imaging. JAMA Netw Open. 2022;5(7):e2219416. Published 2022 Jul 1.
  3. Clinical Decision Support Mechanisms (, accessed Oct. 27, 2022.

Chris Buckle, MD, MBA, FRCPC

Associate Chief Medical Officer and National Medical Director, Radiology and Guideline Development

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