Cardiac Imaging....Do we have a way back in this game?

[nv45]

There has been talk for a number of years now that Cardiac CT may replace a good amount of the imaging that cardiologists have taken from us (i.e. diagnostic coronary cath, echocardiography, nuclear stress), but with the development of the new CT technology, does anyone know if we got a shot back into this game?
Reasons that I think we have a shot at this:
1) Radiologists are all trained in the physics and technology of CT and are much more able to acquire optimal images than cardiologists who know none of this technology.
2) Radiologists are trained to detect all noncardiac lesions on cardiac CT. One study showed that major noncardiac lesions can be found on up to 16-20% of cardiac CT scans. If cardiologists try to intepret cardiac CT, they will miss up to 1 in 5 patients who have noncardiac lesions that mimic cardiac symptoms.
3) Radiologists are in no position to self-refer so they cannot unnecessarily drive up health care costs and are in no position of having a conflict of interest.
4) On the business side, Radiologists are much more likely to utilize CT to a fuller extent and make them more profitable since they can utilize them for all body parts and so can easily cover the costs required to purchase the equipment. Cardiac CT is much less profitable for cardiologists compared to their other tools since the read is much less money and the costs are much higher. It would be hard for them to make it worth it since they only are going to scan for cardiac problems.
5) Radiologists can cut off cardiologists by simply getting referrals from primary care physicians and surgeons. This is likely to be beneficial to internists/family doctors because this way the primary care provider does not "lose" the patient to the cardiologists since we can't "steal" them.

For decades, the one aspect of imaging where radiologists have been absent has been cardiac imaging. But now, I think we actually have a shot at taking a good amount back. I don't think we can totally keep cardiology out, but even if we take some of it, it will be a much better improvement since our status quo right now is pretty good already with the control of imaging for everything besides the heart.
What do you guys think?

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[Taurus]

The outlook for cardiac imaging for radiologists is positive. In a recent NEJM study, only 38% of coronary catherizations were positive. So that means that there's a huge number of false positive echoes and stress tests. With triple rule-out CTA, you don't just look at the heart but the entire chest, the domain of radiologists.

 

[colbgw02]

I've heard some rumblings that new healthcare legislation may close the Stark loophole that allows cardiologists to self-refer. Anybody hear anything about that?

 

[staup]

The outlook for cardiac imaging for radiologists is positive. In a recent NEJM study, only 38% of coronary catherizations were positive. So that means that there's a huge number of false positive echoes and stress tests. With triple rule-out CTA, you don't just look at the heart but the entire chest, the domain of radiologists.

This assumes that everyone who goes for cath had a stress test or echo first, and that is not entirely true, probably a quarter to half of them don't.

 

[Vince]

Senior radiology resident and I just finished a training course to read cardiac CTA.....was nice to learn but not sure if I'll be doing it in private practice. You sort of need to be present at the time of the scan, to give beta blockers, etc. to get a good study. The benefit to have radiologists doing this is that we have the scanners that can be used for anything, so we don't have to buy a 64 slice scanner(or better) to do the study...many radiology departments already have the equipment. I do agree that cardiologists could miss findings in the lung, spine, beneath the diaphragm, or other areas that are often included in the narrow field of view cardiac images. The course I took stressed the importance of having the non-cardiac structures "over-read" by a radiologist. Personally, I have problems reading studies for which I had no control over how they were performed. If the cardiologist wants to do the study, they can try to read the whole thing themself. It might be easier for Cardiac CTA to be entirely read by radiologists if physicians other than cardiologists are ordering the studies, i.e. internists, emergency physicians, etc.....but then you are opening up a door to the likelihood of reading a lot of studies that weren't indicated in the first place...and Cardiac CTA gives a significant radiation dose.

I do agree that there is too much self-referral with respect to imaging....and of course....a lot of medical imaging isn't indicated in the first place. We'll see how things play out...