Now by two-headed Janus

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In the Merchant of the Venice, Shakespeare harkens back to the Ancient Roman god of gates and doorways, often depicted with a double-faced head, each looking in opposite directions to represent a paradoxical nature trapped in a single entity. While Janus and its image have evolved to more duplicitous interpretation, its origins emulate the polarized nature of cardiovascular imaging. Although many tout the benefits of medical imaging for early identification of plaques and other indicators of heart disease, the adjunctive drawbacks of radiation exposure and the specter of unnecessary tests ordered to pad profits has caused these technologies to be viewed in a Janus-faced manner.

After a long legislative battle, Texas is focusing on the beneficial aspects of imaging by requiring insurance companies to pay for heart attack preventive screening tests as of Sept. 1. In fact, all state payors will be required to provide up to $200 per patient—including diabetics and men and women of certain age groups—for a CT calcium scan or carotid ultrasound test every five years.

The Texas Heart Attack Prevention Bill met much resistance before becoming law, due to its widespread screening approach. In fact, the American Heart Association and the American College of Radiology have refused to take a stance on its passage.

Meanwhile, concerns about radiation exposure associated with imaging tests continue to abound. The National Institutes of Health ( NIH) is working toward having all radiation dose exposure from CT and PET/CT studies at its Clinical Center be automatically recorded in a patient's EMR. The NIH wants equipment vendors to develop the software that will extract such data, along with other information, and include it on the patient's CD-ROM and in their EMR. The goal is to track the radiation dose from medical imaging to determine what effect it may have on long-term health.

Also concerning molecular imaging, a new market research report found that PET procedures slowed to a growth of 7 percent in 2008 to about 1.8 million exams, including rubidium studies. Although growth slowed due to lower reimbursement the past two years, some recovery is expected over the next two years, reaching 5.4 million annual procedures by 2016. As a reflection of the current economic times, refurbished PET scanners accounted for 17 percent of all U.S. units ordered in 2008.

In fact, a recent guest commentary, written by John Rebok, director of operations ot Austin Heart in Texas, also discussed how refurbished PET scanners can present an economically viable alternative when facilities or departments are faced with diminished budgets.

While cardiovascular imaging may never surmount its dichotomous perception, the original Janus also held the role of gatekeeper, standing on the threshold of acceptance and rejection.

On these topics, or any others, feel free to contact me.

Justine Cadet