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Heart Teams for Cardiac Imaging: The Right Test at the Right Time for the Right Patient

  • Daniel Juneau
  • Benjamin J. W. Chow
  • Rob Beanlands
  • Andrew Michael CreanEmail author
Chapter

Abstract

Modern cardiology is both a complex business and a team sport. Treatment options have expanded and now extend to patients whose age and degree of sickness might have excluded them in the past. Correct diagnosis and treatment can be challenging, and imaging is central to understanding cardiac pathology and to guiding optimal treatment choices. It is almost impossible for a single physician to have full mastery of all the imaging tools available for diagnosis. Instead, it is incumbent upon hospitals to establish imaging teams which have both overlapping and unique expertise. These may be drawn from the ranks of cardiology, radiology, or nuclear medicine—skill set is of more importance than background specialty. Heart imaging teams, working together in unison, represent an ideal model to facilitate the right test at the right time for the right patient.

Keywords

Medical imaging Cardiac imaging Multidisciplinary Appropriate use criteria Cardiac CT Cardiac PET Nuclear cardiology Cardiac MRI Echocardiography 

References

  1. 1.
    Leslie A, Jones AJ, Goddard PR. The influence of clinical information on the reporting of CT by radiologists. Br J Radiol. 2000;73(874):1052–5.CrossRefGoogle Scholar
  2. 2.
    Mullins ME, Lev MH, Schellingerhout D, Koroshetz WJ, Gonzalez RG. Influence of availability of clinical history on detection of early stroke using unenhanced CT and diffusion-weighted MR imaging. Am J Roentgenol. 2002;179(1):223–8.CrossRefGoogle Scholar
  3. 3.
    Wassermann TB, Straus CM. A failure to communicate? Acad Radiol. 2018;25:943.CrossRefGoogle Scholar
  4. 4.
    Cohen MD, Curtin S, Lee R. Evaluation of the quality of radiology requisitions for intensive care unit patients. Acad Radiol. 2006;13(2):236–40.CrossRefGoogle Scholar
  5. 5.
    Saito JM, Yan Y, Evashwick TW, Warner BW, Tarr PI. Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics. 2013;131(1):e37–44.CrossRefGoogle Scholar
  6. 6.
    Alkasab TK, Alkasab JR, Abujudeh HH. Effects of a computerized provider order entry system on clinical histories provided in emergency department radiology requisitions. J Am Coll Radiol. 2009;6(3):194–200.CrossRefGoogle Scholar
  7. 7.
    Pevnick JM, Herzik AJ, Li X, Chen I, Chithriki M, Jim L, et al. Effect of computerized physician order entry on imaging study indication. J Am Coll Radiol. 2015;12(1):70–4.CrossRefGoogle Scholar
  8. 8.
    Ip IK, Schneider LI, Hanson R, Marchello D, Hultman P, Viera M, et al. Adoption and meaningful use of computerized physician order entry with an integrated clinical decision support system for radiology: ten-year analysis in an urban teaching hospital. J Am Coll Radiol. 2012;9(2):129–36.CrossRefGoogle Scholar
  9. 9.
    Vartanians VM, Sistrom CL, Weilburg JB, Rosenthal DI, Thrall JH. Increasing the appropriateness of outpatient imaging: effects of a barrier to ordering low-yield examinations. Radiology. 2010;255(3):842–9.CrossRefGoogle Scholar
  10. 10.
    Min JK, Gilmore A, Budoff MJ, Berman DS, O’Day K. Cost-effectiveness of coronary CT angiography versus myocardial perfusion SPECT for evaluation of patients with chest pain and no known coronary artery disease. Radiology. 2010;254(3):801–8.CrossRefGoogle Scholar
  11. 11.
    Sharples L, Hughes V, Crean A, Dyer M, Buxton M, Goldsmith K, et al. Cost-effectiveness of functional cardiac testing in the diagnosis and management of coronary artery disease: a randomised controlled trial. The CECaT trial. Health Technol Assess. 2007;11(49):iii–v, ix–115.CrossRefGoogle Scholar
  12. 12.
    Thom H, West NE, Hughes V, Dyer M, Buxton M, Sharples LD, et al. Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial. BMJ Open. 2014;4(2):e003419.CrossRefGoogle Scholar
  13. 13.
    Pontone G, Andreini D, Guaricci AI, Rota C, Guglielmo M, Mushtaq S, et al. The STRATEGY study (stress cardiac magnetic resonance versus computed tomography coronary angiography for the management of symptomatic revascularized patients): resources and outcomes impact. Circ Cardiovasc Imaging. 2016;9(10):pii:e005171.Google Scholar
  14. 14.
    Sikkens JJ, Beekman DG, Thijs A, Bossuyt PM, Smulders YM. How much overtesting is needed to safely exclude a diagnosis? A different perspective on triage testing using Bayes’ theorem. PLoS One. 2016;11(3):e0150891.CrossRefGoogle Scholar
  15. 15.
    Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for multimodality imaging in valvular heart disease: a report of the American College of Cardiology appropriate use criteria task force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;70(13):1647–72.CrossRefGoogle Scholar
  16. 16.
    Rybicki FJ, Udelson JE, Peacock WF, Goldhaber SZ, Isselbacher EM, Kazerooni E, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS appropriate utilization of cardiovascular imaging in emergency department patients with chest pain: a joint document of the American College of Radiology appropriateness criteria committee and the American College of Cardiology appropriate use criteria task force. J Am Coll Cardiol. 2016;67(7):853–79.CrossRefGoogle Scholar
  17. 17.
    Patel MR, White RD, Abbara S, Bluemke DA, Herfkens RJ, Picard M, et al. 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: a joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2013;61(21):2207–31.CrossRefGoogle Scholar
  18. 18.
    Hendel RC, Lindsay BD, Allen JM, Brindis RG, Patel MR, White L, et al. ACC appropriate use criteria methodology: 2018 update: a report of the American College of Cardiology appropriate use criteria task force. J Am Coll Cardiol. 2018;71(8):935–48.CrossRefGoogle Scholar
  19. 19.
    Cardiac imaging: radiologists move to protect MR and CT turf | diagnostic imaging [Internet]. Available at: http://www.diagnosticimaging.com/nuclear-imaging/cardiac-imaging-radiologists-move-protect-mr-and-ct-turf. Cited 10 Jun 2018.
  20. 20.
    Levin DC, Rao VM. Turf wars in radiology: should it be radiologists or cardiologists who do cardiac imaging? J Am Coll Radiol. 2005;2(9):749–52.CrossRefGoogle Scholar
  21. 21.
    Rao VM, Levin DC. Turf wars in radiology: training in diagnostic imaging: how much is enough? J Am Coll Radiol. 2005;2(12):1016–8.CrossRefGoogle Scholar
  22. 22.
    Munk PL, Liu DM. Training standards and imaging: will these have any impact on turf wars affecting radiologists? Can Assoc Radiol J. 2010;61(2):66.CrossRefGoogle Scholar
  23. 23.
    Levin DC, Rao VM. Turf wars in radiology: updated evidence on the relationship between self-referral and the overutilization of imaging. J Am Coll Radiol. 2008;5(7):806–10.CrossRefGoogle Scholar
  24. 24.
    Agarwal R, Levin DC, Parker L, Rao VM. Trends in PET scanner ownership and leasing by nonradiologist physicians. J Am Coll Radiol. 2010;7(3):187–91.CrossRefGoogle Scholar
  25. 25.
    Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH. Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral. J Am Coll Radiol. 2008;5(12):1206–9.CrossRefGoogle Scholar
  26. 26.
    Okawa G, Ching K, Qian H, Feng Y. Automatic release of radiology reports via an online patient portal. J Am Coll Radiol. 2017;14(9):1219–21.CrossRefGoogle Scholar
  27. 27.
    Wiefels C, Erthal F, deKemp RA, et al. Radionuclide imaging in decision-making for coronary revascularization in stable ischemic heart disease. Curr Cardiovasc Imaging Rep. 2018;11:20.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Daniel Juneau
    • 1
    • 2
  • Benjamin J. W. Chow
    • 2
  • Rob Beanlands
    • 2
  • Andrew Michael Crean
    • 2
    Email author
  1. 1.Centre Hospitalier de l’Université de Montréal (CHUM), Department of Nuclear MedicineMontrealCanada
  2. 2.Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada

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