Wishful thinking

October 24, 2005

Doves like truces. A truce gives the two sides a chance to enjoy peace, if only for a short time. Maybe they’ll like it enough to stop fighting altogether, or so the thinking goes.

Doves like truces. A truce gives the two sides a chance to enjoy peace, if only for a short time. Maybe they'll like it enough to stop fighting altogether, or so the thinking goes.

Hawks, on the other hand, don't much like truces. Anyone wanting a truce must be getting tired and, if that's the case, it's better to pour it on than turn it off, or at least that's what I've been told.

There are exceptions, where everyone involved - doves and hawks alike - might find common ground. These instances admittedly don't come along too often, but one might be at hand right now. It involves two of the most rivalrous factions in medicine: radiologists and cardiologists.

These two have been unhappy with each other for as along as I can remember. They've fought over ultrasound, over gamma cameras, over angiography suites. The introduction of 64-slice CT, with its obvious implications for cardiology, seemed the next likely battleground.

Cardiologists saw radiologists invading the turf they have held for decades with cardiac cath equipment. When word spread that cardiologists would get CTs of their own, radiologists were aghast. CT was theirs and had been for three decades.

And then, just as the two groups seemed ready to duke it out, a funny thing happened. Radiologists and cardiologists started working together. Much of the impetus involved practical considerations.

Most of the work done on a CT, after all, is radiology-based. Siting these new systems in radiology departments where cardiologists can refer patients made sense, at least initially, especially since the CPT codes and reimbursement for cardiac CT were still a ways off.

Given these considerations, some might see this as a fleeting collaboration, one based on expedience. But in the interim, something else happened.

Cardiologists and radiologists began taking an interest in sharing ultrasound equipment. Now, shared service equipment has been around for decades. But vendors typically have equipped these machines with only enough power to satisfy the simplest needs, the kind met at community and rural hospitals. Just recently, however, at least one vendor - Philips Medical - decided to make a shared services system that could handle some of the toughest cases on either side of the fence.

Maybe it's the ability to pack ever more power into less expensive packages. Maybe it's the need for large hospitals to get more bang for their buck. Either way, cardiologists and radiologists are showing an increased interest, according to Philips, in truly sharing ultrasound.

These developments in ultrasound and CT raise the possibility that the current collaborations might develop into something long term. They might even spread into other modalities, such as PET/CT, which - with the availability of a good perfusion agent - could evolve from an almost entirely oncological application to a mix involving cardiology.

Plenty could still go wrong. Vendors are making software packages that deliver just cardiac data and they're putting them on megaslice CTs optimized for cardiac protocols. Cardiologists might ultimately opt to buy these rather than collaborate with radiologists. High-performance shared service ultrasound systems might become novelties rather than the catalysts for cooperation between the specialties. But I can't help thinking . . .

Wouldn't it be something if derivations of the technology that once pitted radiologists and cardiologists against each other brought them together? Time will tell whether that's just wishful thinking.