Measuring Value, Outcomes, and Cost-Effectiveness in MSK Radiology: A Primer

It is with great pleasure that we present this special issue of Seminars in Musculoskeletal Radiology. We move beyond the traditional focus in radiology of defining the sensitivity, specificity, and accuracy of an imaging test to explore the larger questions of the impact of an imaging test on patient care, when to perform an imaging test, and how to choose between different imaging tests.

We believe the collection of articles in this issue will serve two purposes. First, it presents some of the most important challenges that radiologists are facing in today's complex health care environment, such as defining the value of imaging in patient care and selecting the most appropriate imaging tests for the varied clinical scenarios that we encounter. Second, it introduces scientific tools that radiologists can use to address some of these challenges: outcomes-based and comparative effectiveness research. As mentioned in the title, this is a primer. This issue is not intended to be a comprehensive review of these topics. Instead, our goal is for this collection of articles to serve as a starting point to gain a better understanding of radiology's future and an exciting new field of radiology research that will help shape it.

We begin with an article by Paul Harkey and Richard Duszak on defining value in radiology in today's changing health care environment. This article reviews how MSK radiologists can demonstrate their value and contributions to patient care through tools like information technology and meaningful metrics that can improve patient outcomes while reducing costs.

The next article is on the use of appropriateness criteria in MSK imaging by Jennifer Demertzis and David Rubin. It explains the reasons for establishing these types of criteria, their limitations, and potential challenges to their utilization.

The third article, by Shadpour Demehri, Michael Recht, and Christoph Lee, provides an overview of comparative effectiveness research (CER). It presents different facets of CER, including its expanding role in U.S. health care, potential research areas in MSK radiology, and potential funding opportunities for the MSK radiologist interested in this type of work.

Our next article, by Nancy Obuchowski and colleagues, discusses important statistical concepts for modern imaging research including statistical hypothesis testing, MSK imaging outcomes, and the relevance of confidence intervals. This is followed by an article discussing the potential uses of big data analyses in imaging research by Yindalon Aphinyanaphongs including a review on methods, data types, and large databases.

Our final article, by Jacob Visser and colleagues, covers the topic of cost-effectiveness analysis in MSK imaging. It presents an overview of the different components of this tool including information on types of health care costs, the importance of measuring effectiveness, and decision modeling.

It is an honor for us to guest edit this Seminars issue on measuring value, outcomes, and cost-effectiveness, topics that we believe are exciting and important new avenues for MSK radiology research. We hope you find this issue as enjoyable as we have.