DOI:10.2214/AJR.07.3274
AJR 2007; 189:1271
© American Roentgen Ray Society
Cardiac Imaging: Radiologists Prepare, Participate, and Publish
Patrick M. Colletti, Associate Editor
colletti{at}usc.edu
Introduction
With the development, maturity, and expanded availability of cardiac MRI
and cardiac CT, remarkable changes have occurred in cardiac imaging.
Radiologists and radiology organizations recognize this and are responding
accordingly.
Preparation
"Standing room only" (apologies to the fire marshals) coronary
CTA lectures at RSNA and ARRS meetings show radiologists' interest in cardiac
imaging. A number of academic centers offer training programs and fellowships
in cardiac CT. Of course, major CT vendors sponsor a variety of "level
1" and "level 2" physician training and technologist
training programs linked to equipment purchases. The ACR, ARRS, and RSNA have
responded to the demand for training and certification in coronary CTA. ACR
leadership, in creating reasonable requirements for radiologists to achieve
"level 1" certification
[1,
2], has encouraged the
formation of SAM programs to include 50 monitored cases. The ARRS has offered
two very successful coronary CTA courses (at a cost of $75 for ARRS members),
with 331 attending in San Diego in February, and with 159 at the recent
Minneapolis meeting. RSNA 2007, in conjunction with the North American Society
for Cardiac Imaging, will offer a similar course (at no additional cost for
RSNA members), with a large number of participants expected. In 2008, the ACR
will offer a series of 3-day courses ($4,000 for ACR members) with individual
workstation experience at the new ACR Education Center in Reston,
Virginia.
Participation
Cardiac MRI and CTA–capable equipment is expensive to acquire, house,
operate, and maintain. Expanding an outpatient CTA practice is difficult. It
is problematic to create a viable business plan for the exclusive cardiac
imaging use of such equipment
[3]. The great coming
application for cardiac imaging is in chest pain triage
[4–6].
This will be driven by emergency medicine physicians. It is likely that
radiologists currently offering CTPA will expand their services to include
coronary CTA and the "triple-rule-out" examinations. General
radiologists, emergency radiologists, and teleradiologists will be required to
supply timely CTA interpretations of coronary artery imaging and the routine
pulmonary artery and aorta evaluations. Indeed, it is possible, with a
relatively small increase in time and radiation exposure, to add delayed
contrast-enhanced CT to detect acutely infarcted and nonviable myocardium
[7]. Radiologists are the
specialists poised for this "quadruple-rule-out" task.
Publication
It is gratifying to note the high level of cardiac imaging manuscripts
received and published in Radiology and the AJR. An analysis
of 807 cardiac MR and CT publications between 1999 and 2004 showed that 399
(49.5%) of 807 had radiologists as the primary author
[8]. Indeed, cardiac MRI and CT
manuscript submissions and publications are as common in Radiology
and AJR as in Circulation and JACC.
Much has changed in cardiac imaging in the past 10 years. In 1998,
radiologists performed 16.7% of noninvasive cardiac examinations
[9]. Nearly all echocardiology
and more than half of cardiac nuclear imaging is performed by cardiologists.
That reality is unlikely to change. What will change are the relative use of
cardiac MRI and CT and the role of radiologists. The message is clear;
radiologists are preparing for, participating in, and publishing on cardiac
imaging.
References
- Budoff MJ, Cohen MC, Garcia MJJ, et al. ACCF/AHA clinical
competence statement on cardiac imaging with computed tomography and magnetic
resonance: a report of the American College of Cardiology Foundation/American
Heart Association/American College of Physicians Task Force on Clinical
Competence and Training. Am Coll Cardiol2005; 46:383
–402[Free Full Text]
- Weinreb JC, Larson PA, Woodard PK, et al. American College of
Radiology Clinical Practice Statement on noninvasive imaging.
Radiology 2005;235
: 723–727[Free Full Text]
- Rybicki FJ, Di Carli M. Development and management of a noninvasive
cardiovascular imaging service. AJR 2006;187
:1401
–1402[Free Full Text]
- White C, Kuo D, Kelemen M, et al. Chest pain evaluation in the
emergency department: can MDCT provide a comprehensive evaluation?
AJR 2005; 185:533
–540[Abstract/Free Full Text]
- Raptopoulos VD, Boiselle PB, Michailidis N, et al. MDCT angiography
of acute chest pain: evaluation of ECG-gated and nongated techniques.
AJR 2006; 186
[suppl]: S346–S356[Abstract/Free Full Text]
- Johnson TRC, Nikolaou K, Wintersperger BJ, et al. ECG-gated 64-MDCT
angiography in the differential diagnosis of acute chest pain.
AJR 2007; 188:76
–82[Abstract/Free Full Text]
- Habis M, Capderou A, Ghostine S, et al. Acute myocardial infarction
early viability assessment by 64-slice computed tomography immediately after
coronary angiography: comparison with low-dose dobutamine echocardiography.
J Am Coll Cardiol 2007;49
:1178
–1185[Abstract/Free Full Text]
- Miguel-Dasit A, Martí-Bonmatí L, Sanfeliu P,
Aleixandre R. Cardiac MR imaging: balanced publication by radiologists and
cardiologists. Radiology 2007;242
: 410–416[Abstract/Free Full Text]
- Levin DC, Parker L, Sunshine JH, Pentecost MJ. Cardiovascular
imaging: who does it and how important is it to the practice of radiology?
AJR 2002; 178:303
–306[Abstract/Free Full Text]
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Introduction
Preparation
