Cardiac Imaging?

[MouseChair]

We hear a lot about the usual suspects - body, Msk, breast, IR- in radiology residency as well as on job boards. But dont hear much at all about cardiac imaging. I chatted with the imaging fellow at my institution and they believe CT coronary will replace cardiac cath. What is the scope for cardiac imaging fellowships for the Radiologist? Any PP attending that can give insight into the market demand for cardiac imagers? Is it completely cornered off by Cardiology?

We don’t read cardiac at my institution, so very limited exposure

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[maxxor]

We hear a lot about the usual suspects - body, Msk, breast, IR- in radiology residency as well as on job boards. But dont hear much at all about cardiac imaging. I chatted with the imaging fellow at my institution and they believe CT coronary will replace cardiac cath. What is the scope for cardiac imaging fellowships for the Radiologist? Any PP attending that can give insight into the market demand for cardiac imagers? Is it completely cornered off by Cardiology?

We don’t read cardiac at my institution, so very limited exposure

It depends on the relative aggressiveness of your cardiologists and if they are insistent on doing the professional component themselves or if they just want the technical for their own scanners.

In my large metro area (4-5 million people), I know of 1 private practice that does any cCTA and they are almost a mega group of 80+.

It’s pretty niche and will be stuck in academics or very large practices.

I have a CBCCT board cert. I’ve never had the opportunity to use it since graduating.

 

[guytakingboards]

My 100+ person PP group does 0 cCTA or cMRI. The cardiologists in town control it entirely. We're happy not to do it too; it's resource intensive. Takes a lot of time to post-process, gotta have good equipment and well trained tech's.

Cardiac is probably the single lowest demand sub-specialty in PP.

 

[Medstart108]

I think for cardiac CT to replace cath, it has a bit of an uphill battle. The problem is that coronary angiograms are controlled by cardiology and they don't have an incentive to replace those with CT. Angiograms also have the added benefit of being therapeutic on top of diagnostic.

You'd need to get the specificity up to about 98% which is where angiogram is while keeping sensitivity close to 100% in order to argue the point. Right now the number taught is 100% sensitivity 70% specificity and that really is the reason it remains the test of choice when you have a low-mod pretest probability of coronary disease.

 

[maxxor]

I think for cardiac CT to replace cath, it has a bit of an uphill battle. The problem is that coronary angiograms are controlled by cardiology and they don't have an incentive to replace those with CT. Angiograms also have the added benefit of being therapeutic on top of diagnostic.

You'd need to get the specificity up to about 98% which is where angiogram is while keeping sensitivity close to 100% in order to argue the point. Right now the number taught is 100% sensitivity 70% specificity and that really is the reason it remains the test of choice when you have a low-mod pretest probability of coronary disease.

When I hear the academic cardiologists talk, they do **** talk the people who diagnose and intervene in the same cath, especially outpatients. It’s different obviously for acute settings/STEMI etc.

But back to cCTA, it *can* argue to be a cost savings method in the ER setting as it’s faster to turn around than a conventional rule out +/- perfusion imaging.

I agree it’s a good test. It’s just mired in politics because cardiology has spent forever trying to take over diagnosis of everything and now don’t really want to give up anything that they already control.

The only way radiology ever wins against the referring services is speed, ie we turn around results faster and have someone working already. Once cardiology buys their own CT scanner and has someone available at all times, you’ll never see a ccta again.

 

[Medstart108]

When I hear the academic cardiologists talk, they do **** talk the people who diagnose and intervene in the same cath, especially outpatients. It’s different obviously for acute settings/STEMI etc.

But back to cCTA, it *can* argue to be a cost savings method in the ER setting as it’s faster to turn around than a conventional rule out +/- perfusion imaging.

I agree it’s a good test. It’s just mired in politics because cardiology has spent forever trying to take over diagnosis of everything and now don’t really want to give up anything that they already control.

The only way radiology ever wins against the referring services is speed, ie we turn around results faster and have someone working already. Once cardiology buys their own CT scanner and has someone available at all times, you’ll never see a ccta again.

Yeah i've heard the cardiologists buy their own scanners and then its over. There is definitely a role for coronary CTA, if you look at vascular, we order CTAs all the time before we jump to angio and surgeons are willing to operate on a CTA alone. Surgeons will need to get better at reading coronary CTAs though, we get almost no training on them.