ACC: Cards must drive better imaging quality

A top official for the American College of Cardiology says cardiologists should drive quality improvements in cardiac imaging, and that a major effort should be made to increase how imaging is used in cardiology research and practice.

"New diagnostic tools and creative treatments have sparked an exciting evolution in medicine. While this would seem to be a positive change, sometimes we adopt these new tools without enough thought to ensuring quality," said Dr. Pamela S. Douglas, outgoing president of the ACC, during opening remarks at the organization's 2006 meeting.

Douglas called imaging vital to the development of cardiology.

Dr. James P. Borgstede, immediate past board chair of the American College of Radiology, said he commends the ACC for its "new" interest in imaging quality.

"We welcome them on board," he said. "This is a ship the ACR has been sailing alone for so many years."

In her speech, Douglas cited the rapid growth, inconsistent use, few regulatory controls, little evidence for outcomes, and a lack of consensus on the definition of quality as reasons why the cardiovascular community needs to take the lead on quality imaging. (Douglas declined to be interviewed; her remarks were published on www.acc.org as part of the group's annual meeting coverage.)

Dr. David Levin, an expert on self-referral and overutilization issues, is not convinced cardiologists should be taking the lead in this effort.

"There is nobody better to focus on image quality than radiologists, who are fully trained in CT and MR," Levin said. "The best way to produce quality imaging is to make sure that those doing it are appropriately trained. For the most part, that is not cardiologists."

In her address, Douglas pointed to recent efforts by the ACC to improve quality in imaging, including increased advocacy on Capitol Hill and the formation of the Coalition for Patient-Centered Imaging, a group of about 24 medical specialty organizations whose aim is to keep imaging available to all specialists.

"It is refreshing to see the recent interest other organizations have shown in quality imaging, particularly at a time when inappropriate utilization of diagnostic imaging is such a target of the government and payers," Borgstede said.

The ACR has a long history of improving quality imaging, he said, beginning in 1963 with the first accreditation program. It continued in 1993 when it established the first appropriateness criteria, punctuated by nearly $300 million in imaging research funding from the National Institutes of Health.

Cardiac CT and MRI presents the opportunity for true collaboration between cardiology and radiology, said Dr. Daniel Berman, director of cardiac imaging at Cedars-Sinai Medical Center in Los Angeles and a cardiologist within an imaging department.

"These high resolution anatomic and functional methods provide diagnostic information never before available," Berman said. "Optimizing

quality in imaging with these new modalities involves the entire spectrum, from indications for procedures to effectively guiding patient management, to achieve what is best for the patient. These considerations cross specialties and are not within the purview of any single professional group."