This article is more than 5 years old. Information may no longer be current.
Considerations should be made for subspecialty integration of cardiovascular MRI, CT
Click Here to Manage Email Alerts
Recent hardware and software developments have enabled physicians to utilize cardiovascular magnetic resonance and cardiovascular computed tomography to identify abnormal pathophysiology in patients with cardiovascular disease.
These technologies allow one to assess multiple facets of the cardiovascular system, including the function, arterial supply, structure, perfusion, tissue characterization, and in certain circumstances, metabolism, during a single examination. Moreover, with these technologies imaging is not confined specifically to the heart. With both CV MRI and CT one can assess the heart, great vessels, medium-sized arteries (femoral and renal arteries) or microcirculation during a single examination. This capability to thoroughly evaluate the CV system can expedite the evaluation of patients with CVD. For example, in those individuals with lower extremity claudication, one can identify peripheral arterial disease and atherosclerosis, and in the same setting perform functional and structural assessments of the heart.
It is important to realize that many departments or divisions within health care delivery systems currently perform CV imaging. At present, neurology, cardiology, vascular surgery, obstetrics, nephrology, radiology and pediatrics all routinely image the CV system. The new imaging modalities, CV MRI and CT, provide an opportunity for these physician groups to interact in order to image patients and provide expert individualized care. Not only is there an opportunity for physician interaction, but also an opportunity exists for input to be gathered from the technical staff that implement the procedures, interact with the patients, and operate the equipment and manage patient flow across and throughout health care delivery systems.
Several considerations within the current health care environment must be addressed for the purpose of effectively implementing CT and CV MRI. These include operations and administration, physician expertise, quality control, imaging management and reporting, and patient education. Integration of subspecialty care can be used to address these five considerations.
Operations and administration
|
|
Timely performance of procedures is necessary to facilitate patient management. CV applications often must be ordered and performed within several hours of the referring physicians’ request because additional invasive procedures often are scheduled as a result of testing. Methods to order, perform and report data are necessary. Since the cost of implementing these technologies is relatively high, many CV procedures must be coordinated around schedules that encompass other imaging procedures (ie, CNS system). Groups of physicians from different specialties can most effectively coordinate these scheduling efforts.
Physician expertise
Utilizing the talent and expertise from various physician groups enhances the opportunity for providing optimal patient care. It is well recognized that physicians from one subspecialty possess expertise unique to their subspecialty training. Integrating these talents offers potential for improving patient management and heightening procedural diagnostic capability. Joint reading room space is attractive because it allows individuals from various subspecialties to interact and consult with one another in order to manage patients, interpret images and address unexpected findings. Also, involving physicians from different subspecialties allows more opportunities for physicians to fulfill their coverage responsibilities.
Quality in imaging
Quality-control programs are necessary to optimize patient selection, perform diagnostic procedures and generate results for dissemination across various platforms within health care delivery systems. In this regard, accreditation needs to be accomplished for sites delivering these procedures. Facilities must monitor study performance, including the identification of the sensitivity, specificity, reproducibility, and inter-observer variability for their performed procedures. All of these tasks are often best addressed by the various physician subspecialties that order, perform, interpret and direct therapy as a result of the imaging procedures. This arrangement allows facilities to react and implement change when procedural performance falls below accepted standards.
Image management and reporting
|
Source: WFUBMC |
Information technology is necessary to standardize image acquisition and storage, generate structured reports, archive the reports and image data, and allow transfer of the structured reports (along with images) to the appropriate referring physicians within and outside of health care delivery systems.
Given the array of users of this digital information, combined efforts directed by multiple subspecialties offer the greatest possibility for optimizing patient care across health care delivery systems.
Finally, patient education is essential for the delivery of these new technologies. Heightening familiarity with patients and their study results can enhance cooperation of patients with their therapeutic regimens. Electronic, written or personally presented materials that are assembled with input from all specialties involved in CV imaging offer great potential for educating patients regarding the information presented with CT and CV magnetic resonance.
In summary, the evolution of imaging in the last decade has produced two relatively new technologies that allow for the acquisition of important information that can be gathered regarding the CV system. Integrating the capabilities of the various physician services that assess the CV system offers a unique opportunity to maximally deliver quality care with CV MRI and CT.
W. Gregory Hundley, MD, is Professor in Internal Medicine and Radiology, and Medical Director of Cardiovascular MRI at Wake Forest University Baptist Medical Center. He is editor of Cardiology Today’s Imaging Section.
For more information:
- Dr. Hundley is supported in part by National Institutes of Health Grants R01HL076438, R01HL18915, R41AG030248, R21CA1219601, R33CA1219601, and P30AG21332.