Radiologists have unique opportunity in cardiology

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Radiologists need to take cardiac imaging back from cardiologists, said Kerry Link, MD, director of the Center for Biomolecular Imaging at Wake Forest University Health Sciences, during the Annual Oration on Diagnostic Radiology: “Cardiac Imaging—A Second Chance” on Tuesday at RSNA 2006.
Radiologists’ recent resurgence of interest in cardiac imaging reflects proficiency with coronary CT angiography and a healthy concern over losing the turf. Radiologists need to be ready to fundamentally change the way they diagnose disease. “Will we take on the responsibility of monitoring patients while they are being imaged, which was a major causes for losing turf in the past?” asked Link of the attendees.
Ongoing advances will have “profound and long-lasting effects on medicine and especially the field of radiology. This is a defining moment,” he said.
Conventional wisdom has held the beliefs that cardiac imaging belongs to cardiologists, it’s not economically viable for it to fall under the purview of radiologists, it’s complicated, radiologists have a lack of training, and they don’t know how to access this new technology.
One of every 2.7 deaths in the United States is due to cardiovascular disease, Link said. It’s the single largest expense of the healthcare system. After the age of 40, 50 percent of men and 33 percent of women risk developing coronary heart disease. That is significant incentive for researchers and the development of new technologies for better detection and treatment. Link said that research should be a part of all residents’ training. “Researchers are drivers of the field and are who the decision-makers go to.” Without training in research, “we are shortchanging [residents] and jeopardizing their future,” Link said.
Information integration is the key to success in cardiac imaging, Link said. “Failure to integrate all available information reinforces the notice that cardiologists are best suited” for cardiac imaging. And, clinicians should be using all modalities, he said. “We shouldn’t put all our eggs in the basket of coronary CT or angiography.”
Separate workstations are one thing preventing good information integration. At many facilities, Link said that radiologists and cardiologists have separate PACS, which is redundant and isolates cardiologists. “Pathoanatomy is only one piece of the puzzle of coronary heart disease,” he said. The underlying theme of cardiac disease is pathophysiology.
Link cited the fact that one cardiac catheterization costs about $25,000. For the same price, clinicians can perform 34 coronary CT angiographies. “Coronary CTA is an opportunity for radiologists to become more involved in cardiac imaging,” he said. In 1998, 19 million studies were performed for imaging for cardiovascular disease, representing 18 percent of all Medicare-reimbursed imaging studies. However, they represent 34 percent of total expenses. In 2003, radiologists received 45 percent of imaging reimbursement and cardiologists received 25 percent. In 2006, healthcare expenditures are projected at $2.3 billion and $220 million of that for heart disease imaging. Medical imaging is third largest expenditure in the healthcare system at $110 billion.
All these numbers point to Link’s message that “we need to be performing these studies to have a voice in their use and reimbursement. Whoever is driving the field has a greater voice in negotiations.”
“The good news is that evaluating coronary arteries is not hard and the emphasis on CTA buys us time for training in other modalities,” he said. “Breakthroughs in cardiac imaging play to radiologists’ strengths.”
The current advances in cardiac imaging mark “a major turning point in radiology” and radiologists can take back cardiac imaging revamping training programs, focusing on research and putting a greater emphasis on pathophysiology rather than pathoanatomy.