Diagnostic Imaging
January 2004

News from the 2003 meeting of the RSNA - In Review

Imaging technique refinements bring radiologists back to heart

Overflowing sessions at RSNA meeting portend resurgence in radiologists' interest in cardiac imaging

There is good news and bad news for radiology. First the bad news: Cardiologists are gobbling up noninvasive imaging dollars faster than radiologists. The good news is that modern techniques of cardiac imaging, including CT angiography and MR perfusion, are proving to be radiologists' entree back into the heart.

For years, Philadelphia researchers have documented the lopsided utilization of noninvasive diagnostic imaging by cardiologists compared with radiologists and other nonradiologist physicians. Last year proved no exception. Although radiologists are often singled out as the cause of increasing costs in medicine, research by the team at Thomas Jefferson University Hospital reported that radiologists themselves showed otherwise.

While overall payments for noninvasive diagnostic imaging rose 71% from 1993 to 2001, cardiologists' share of those Medicare dollars increased almost twice as rapidly as that of radiologists. More important, according to Dr. Vijay Rao, radiology chair at Thomas Jefferson, payments to cardiologists in offices and private imaging centers grew at a rate of 240%.

"This trend calls for closer scrutiny of practices in private imaging centers and offices, especially when given the potential for self-referred studies by cardiologists," Rao said.

At a refresher course on error reduction, Dr. Tejal K. Gandhi, a primary-care physician and director of the patient safety program at Brigham and Women's Hospital, detailed the challenges and progress of the three-year-old safety stratagem. At her conclusion, Dr. David C. Levin, a coauthor of the Jefferson study, made this comment, during which the audience twice erupted in applause:

"The effort to reduce medical errors is laudable, but there's a certain amount of hypocrisy built into the process, at least as it applies to radiology. Many hospitals, while paying lip service to reducing medical errors, will very casually allow cardiologists to do procedures, such as peripheral vascular interventions, for which they are not well trained. The same thing happens with emergency department ultrasound, neuroimaging, and other areas where untrained physicians are given privileges by hospitals to do procedures or interpret images that they are not nearly as well trained to do as radiologists."

Gandhi called on radiology leaders to persist in presenting their concerns to senior leadership. She encouraged radiologists to help set up patient safety programs so that these issues can be addressed in a timely manner.

Nonetheless, the future of cardiac imaging looks bright for radiologists, particularly because of the latest generation of CT and MR scanners, said Levin, who is now national medical director of HealthHelp, a utilization consulting group in Houston. He compared the dismal attendance at cardiovascular imaging courses at RSNA meetings in the early 1990s with the overflowing sessions in 2003.

"There is a reawakening of interest in cardiac imaging," he said.

Levin is now back at Jefferson part-time in order to organize a cardiac imaging program, beginning with coronary artery CTA. In time, he said, CTA could supplant stress echocardiology and stress nuclear cardiology.

"Cardiologists understand the implications of this, and radiologists should stand firm. If cardiologists take away cardiac CT-and by extension cardiac MR-then all imaging will fall away from radiology like dominoes," he said.