Why radiologists should have a primary role in cardiac imaging

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A strong case can be made for radiologists taking a leadership role in cardiac imaging, after years of being cast out of the specialty area, said David Levin, MD, in a presentation at this week’s Radiology Business Management Association 2007 annual meeting in St. Louis, Mo. Levin chaired the department of radiology at Thomas Jefferson University for 16 years until semi-retiring in 2002.

Levin believes that the advent of coronary computed tomography angiography (CTA) is a "holy grail," a "dramatic, important new place for radiology" that he feels could be the most exciting event in radiology over the past 10 years.

One major change in cardiac imaging for radiologists is that they are "far more interested in cardiac CT and MR now than they were in coronary angiography in the 1970s and 1980s" and radiologists are doing more cardiac CT and MR research. Levin also believes that radiologists have a superior understanding of the technology as opposed to cardiologists.

And, in a reversal of most sentiments uttered at conferences such as these, in this instance the Deficit Reduction Act of 2005 (DRA) may actually add up to a positive for radiologists because cardiac CT and MR are largely outpatient procedures. The DRA will therefore likely reduce the "incentive for cardiologists to put machines in their offices" because of the types of reimbursements it calls for, Levin said.

There are a few reasons why cardiologists should remain the primary provider of the types of studies, Levin said, such as a better understanding of anatomy, more knowledge of a patient’s clinical condition, and because "results are more rapidly available to patients and the cardiologist as the treating physician." However, he believes these are some of the only valid reasons.

"There are a number of reasons why radiologists should preferably perform these procedures," he said.

These reasons include: radiologists have more knowledge regarding the physics and technology of CT and MRI; they are better trained to pick up other chest lesions that could possibly mimic cardiac problems; and radiologists are not in a position to "self-refer and over-utilize."