Radiologist reponds to call for increased CTA collaboration

I read with interest Dr. DeFrance's article in the October 2006 issue, "Turf talk obscures CTA's potential as team builder," page S-14. I am not surprised he feels a collaborative approach to coronary artery CT angiography is the best solution. He is, after all, a cardiologist. How about a response from a radiologist?

I have been performing coronary artery CTA for over three years. My partner and I built the program despite an active campaign by our cardiologist to discredit the exam. After about nine months, the cardiologists abruptly changed their tune and said to administration that if they were not allowed to read CCTA, they would quit. In an absolutely unprecedented move, the medical executive committee agreed to let a group of physicians with no documented skills or training in the exam interpret CTA.

My issue is not that I can't work with cardiologists. But what do the cardiologists bring to the table that makes collaboration beneficial? If I hear one more comment about their knowledge of coronary anatomy, I think I will have a stroke. The exam is not an angiogram, it is a CT. I have yet to see a cardiologist who can identify on CT any other vessel than the arteries they discuss on their angiographic reports. They are not experts in coronary anatomy on CT. They bring no practical skills in terms of protocol design, scanning the patient, postprocessing, and troubleshooting. They have mediocre workstation skills and don't care to keep up on software upgrades.

We are always required to overread the case for ancillary findings when cardiologists primarily interpret the CTA. This is a situation I liken to cardiologists having a gourmet meal and requiring the radiologists to prepare the meal and clean up the dishes. There would be no program if it weren't for the radiologists. The same cannot be said for the cardiologists. The only thing cardiologists bring to the table is the patient.

In the final analysis, can cardiologists do a good job of interpreting CTA? Clearly, with proper training, yes. Can I work with the cardiologists? Yes. Should they interpret CTA? Only if they bring something to the table. In my experience, radiology does all the work, and the cardiologists get all the glory.

-David B. Winter, M.D.
Eau Claire, WI