Radiologists must use cardiac CT or lose it

The rise of cardiac CT and MRI is creating opportunities for radiologists to again become a serious force in cardiac imaging. Radiologists were encouraged at the 2005 RSNA meeting to learn and apply applications associated with these two growing modalities to avoid losing them to cardiologists.

"This is a wake-up call," said Dr. George Hartnell, director of cardiovascular and interventional radiology at Bay State Medical Center in Springfield, MA.

Since 1980, he has seen radiologists lose turf battles for coronary angiography, echocardiography, and nuclear cardiology. Hartnell is now seeing the demand explode for cardiac CT. He estimates that his hospital may soon perform 10,000 coronary CT angiography exams per year as a screening test to rule out myocardial infarction. Across the country, the two modalities could ultimately replace many of the 1.5 million cardiac catheterizations performed each year.

Billions of dollars and the safety of millions of patients are at stake, Hartnell said. As shown in a study by Dr. Joshua Macatol at the meeting, incidental disease often appears in wide field-of-view cardiac CT images. His research at William Beaumont Medical Center in Royal Oak, MI, found at least one noncoronary finding in 37% of the scans. Major findings from 243 patients included pulmonary nodules, pulmonary emboli, a large hiatal hernia, and bulky lymphadenopathy.

"It is important for radiologists to be involved because they will detect things that nonradiologists will miss," Hartnell said.

He urged radiologists to learn cardiac anatomy and pathology and to collaborate when possible with cardiologists to perform the procedures.

"Remember the history of cardiac cath," he said. "We did not respond quickly enough, and we did not perform it well enough, and we lost it."