Cardiologists long ago became the dominant practitioners of cardiac ultrasound and nuclear cardiology. Similarly, interventional radiologists can no longer claim peripheral angiography and intervention as their exclusive territory.
It's natural, then, to wonder how cardiovascular MR and CT will develop, and who will master the capabilities of these noninvasive forms of cardiovascular imaging. Following are the thoughts of a sampling of imaging insiders:
Dr. J. Jeffrey Carr, assistant professor of radiology and public health sciences at Wake Forest University: "The complexity of life is such that it requires interdisciplinary teams of individuals to put together a technology development program for a new modality or a new application. You need someone who understands the clinical problems and cardiac physiology. You need other people who understand imaging technology, including its strengths and limitations. You need engineers. You need computer programmers. You need research people. Each site needs this kind of team."
John Sandstrom, Ph.D., manager of CT at Siemens Medical Systems: "We've operated in radiology for some time, but now we're doing research with cardiologists, too. I think it's key. CT won't have success in cardiovascular imaging unless we do. It has been an eye-opener, as the two specialties are like night and day. There's a different sort of scientific expectation in cardiology, compared to radiology. Patient populations become bigger. There's a bit more tightness in looking at statistics on outcomes and so on. In that sense we are adapting to these new requirements, too."
Michael Webb, CEO of Epix Medical: "My view is that the war is already over, and that cardiac MR is going to be done by cardiologists. Peripheral MR is going to be done largely by radiologists, but more and more peripheral MR will be done by integrated vascular groups, made up of cardiologists and cardiac surgeons and radiologists and vascular surgeons, all treating the vascular system as a whole. The major manufacturers of MRI equipment all have on the market-and are designing even more advanced forms of-cardiac-specific imaging equipment that will be marketed directly to cardiologists. If radiologists ever thought they were going to control cardiac MR imaging, they probably don't anymore."
H. David He, Ph.D., manager of CT cardiology business at GE Medical Systems: "CT has traditionally been the modality of choice in radiology, and I would bet that a majority of the CT scanners are still associated directly with radiology. That has been our customer base. The extension of their interest into cardiac application is certainly very natural. On the other hand, we see emerging interest in cardiology for using this clinical utility as well. That represents an emerging opportunity, from both a clinical and a business point of view. We would like to work with physicians both in radiology and cardiology to provide the right tools for their clinical applications."
Michael S. Sims, director of CT at Marconi Medical Systems: "The best scenario I can imagine is a joint effort, not only in cardiovascular imaging, but also in minimally invasive surgery and intervention. But there's nothing to prevent aggressive entrepreneurial cardiologists who believe in the technology to ramp it up fast, because they control the patient. Vascular surgeons control the patient. Radiologists rely on referrals."
So what's going to happen in cardiac CT? It depends on who takes a leadership role. It's a difficult line for industry to walk right now, because of our commitment to the radiology community.
