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Value-Based Radiology in Cardiovascular Imaging

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Value-based Radiology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

In this chapter six case scenarios are presented encompassing many common questions and issues that we may frequently face in the field of cardiovascular imaging and where the radiologists will bring added value through their expertise input. Scenarios like those where one can clearly improve patient outcomes are detailed, like the management of inferior vena cava (IVC) filter through a software that helps to track patients or through the implementation of specific macros for CT reading highlighting key points in IVC filter description. The added value for patient outcomes regarding coronary CTA is also highlighted, namely the help in early discharge from emergency department (ED) in the setting of chest pain of doubtful coronary origin. Also, scenarios where the radiologist can also add value, but mainly through helping to reduce redundancy or unnecessary imaging, that is in the end reducing the final healthcare costs are detailed, like the case for stress imaging in preoperative setting or venous thromboembolism, namely in the optimization of the diagnostic workup involving imaging tests.

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References

  • American College of Radiology Appropriateness Criteria® (2018). https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria. Accessed 30 Aug 2018

  • Angel LF, Tapson V, Galgon RE et al (2011) Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol 22(11):1522–1530.e3

    Article  Google Scholar 

  • Carrier M, Righini M, Wells PS et al (2010) Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost 8:1716–1722

    Article  CAS  Google Scholar 

  • Chong J, Lee TC, Attarian A et al (2018) Association of lower diagnostic yield with high users of CT pulmonary angiogram. JAMA Intern Med 178(3):412–413

    Article  Google Scholar 

  • Choosing Wisely® (2018). The American Board of Internal Medicine Foundation. http://www.choosingwisely.org/wp-content/uploads/2015/01/Choosing-Wisely-Recommendations.pdf. Accessed 30 Aug 2018

  • Chung JH, Landeras L, Haas K et al (2018) The value of a disease-specific template and an IT-based quality tracking system in pulmonary embolism CT angiography. J Am Coll Radiol 15(7):988–992

    Article  Google Scholar 

  • Di Nisio M, van Es N, Büller HR (2016) Deep vein thrombosis and pulmonary embolism. Lancet 388(10063):3060–3073

    Article  Google Scholar 

  • Freund Y, Cachanado M, Aubry A et al (2018) Effect of the pulmonary embolism rule-out criteria on subsequent thromboembolic events among low-risk emergency department patients: the PROPER randomized clinical trial. JAMA 319(6):559–566

    Article  Google Scholar 

  • Gibson NS, Sohne M, Kruip MJ et al (2008) Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 99:229–234

    Article  CAS  Google Scholar 

  • Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. Lancet 379(9828):1835–1846

    Article  Google Scholar 

  • Goldstein JA, Chinnaiyan KM, Abidov A et al (2011) The CT-STAT (coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol 58:1414–1422

    Article  Google Scholar 

  • Hirmerova J, Seidlerova J, Chudacek Z (2018) The prevalence of concomitant deep vein thrombosis, symptomatic or asymptomatic, proximal or distal, in patients with symptomatic pulmonary embolism. Clin Appl Thromb Hemost 24(8):1352–1357

    Article  Google Scholar 

  • Hoffmann U, Truong QA, Schoenfeld DA et al (2012) Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 367:299–308

    Article  CAS  Google Scholar 

  • Hutchinson BD, Navin P, Marom EM et al (2015) Overdiagnosis of pulmonary embolism by pulmonary CT angiography. AJR Am J Roentgenol 205(2):271–277

    Article  Google Scholar 

  • Juluru K, Elnajjar P, Shih HH et al (2018) An informatics approach to facilitate clinical management of patients with retrievable inferior vena cava filters. AJR Am J Roentgenol 5:W1–W7

    Google Scholar 

  • Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352

    Article  Google Scholar 

  • Kline JA, Mitchell AM, Kabrhel C et al (2004) Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2(8):1247–1255

    Article  CAS  Google Scholar 

  • Konstantinides SV, Torbicki A, Agnelli G et al (2014) ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35(43):3033–3069, 3069a-3069k

    Article  CAS  Google Scholar 

  • Leung AN, Bull TM, Jaeschke R et al (2011) An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med 184(10):1200–1208

    Article  Google Scholar 

  • Levin DC, Parker L, Halpern EJ et al (2018) Coronary CT angiography: use in patients with chest pain presenting to emergency departments. AJR Am J Roentgenol 210(4):816–820

    Article  Google Scholar 

  • Litt HI, Gatsonis C, Snyder B et al (2012) CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 366:1393–1403

    Article  CAS  Google Scholar 

  • Liu MY, Ballard DW, Huang J et al (2018) Acute pulmonary embolism in emergency department patients despite therapeutic anticoagulation. West J Emerg Med 19(3):510–516

    Article  Google Scholar 

  • Makary MS, Kapke J, Yildiz V et al (2018) Outcomes and direct costs of inferior vena cava filter placement and retrieval within the IR and surgical settings. J Vasc Interv Radiol 29(2):170–175

    Article  Google Scholar 

  • Marx N (2017) Heart failure and diabetes - underestimated, underdiagnosed and poorly understood: a call for action. Diab Vasc Dis Res 14(2):67–68

    Article  Google Scholar 

  • Meyer G, Planquette B, Sanchez O (2008) Long-term outcome of pulmonary embolism. Curr Opin Hematol 15(5):499–503

    Article  Google Scholar 

  • Mongan J, Avrin D (2018) Impact of PACS-EMR integration on radiologist usage of the EMR. J Digit Imaging 31(5):611–614. https://doi.org/10.1007/s10278-018-0077-8

    Article  PubMed  PubMed Central  Google Scholar 

  • National Institute for Health and Care Excellence (2018). Chest pain of recent onset: assessment and diagnosis. https://www.nice.org.uk/guidance/cg95. Accessed 30 Aug 2018

  • Oktay AA, Shah SJ (2015) Diagnosis and management of heart failure with preserved ejection fraction: 10 key lessons. Curr Cardiol Rev 11(1):42–52

    Article  Google Scholar 

  • Pena E, Kimpton M, Dennie C et al (2012) Difference in interpretation of computed tomography pulmonary angiography diagnosis of subsegmental thrombosis in patients with suspected pulmonary embolism. J Thromb Haemost 10(3):496–498

    Article  CAS  Google Scholar 

  • Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 18(8):891–975

    Article  Google Scholar 

  • Raja AS, Greenberg JO, Qaseem A et al (2015) Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the clinical guidelines Committee of the American College of physicians. Ann Intern Med 163(9):701–711

    Article  Google Scholar 

  • Rybicki FJ, Udelson JE, Peacock WF et al (2016) Appropriate utilization of cardiovascular imaging in emergency department patients with chest pain. J Am Coll Radiol 13(2):e1–e29

    Article  Google Scholar 

  • Shah AD, Langenberg C, Rapsomaniki E et al (2015) Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 3(2):105–113

    Article  Google Scholar 

  • Sheffield KM, McAdams PS, Benarroch-Gampel J et al (2013) Overuse of preoperative cardiac stress testing in Medicare patients undergoing elective noncardiac surgery. Ann Surg 257(1):73–80

    Article  Google Scholar 

  • Shin BJ, Habibollahi P, Zafar H et al (2018) Reporting of inferior vena cava filter complications on CT: impact of standardized macros. AJR Am J Roentgenol 211(2):439–444

    Article  Google Scholar 

  • Stein PD, Fowler SE, Goodman LR et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327

    Article  CAS  Google Scholar 

  • US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK et al (2018) Risk assessment for cardiovascular disease with nontraditional risk factors: US preventive services task force recommendation statement. JAMA 320(3):272–280

    Article  Google Scholar 

  • van Riet EES, Hoes AW, Limburg A et al (2014) Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 16(7):772–777

    Article  Google Scholar 

  • Velasco A, Reyes E, Hage FG (2017) Guidelines in review: comparison of the 2014 ACC/AHA guidelines on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery and the 2014 ESC/ESA guidelines on noncardiac surgery: cardiovascular assessment and management. J Nucl Cardiol 24(1):165–170

    Article  Google Scholar 

  • Venkatesh AK, Agha L, Abaluck J et al (2018) Trends and variation in the utilization and diagnostic yield of chest imaging for medicare patients with suspected pulmonary embolism in the emergency department. AJR Am J Roentgenol 210(3):572–577

    Article  Google Scholar 

  • Vorobyeva NM, Dobrovolsky AB, Titaeva EV, Kirienko AI, Panchenko EP (2013) D-dimer testing during anticoagulant therapy should be used to indicate patients who need extended anticoagulant therapy. Eur Heart J 34(suppl_1):1080. https://doi.org/10.1093/eurheartj/eht308.1080

    Article  Google Scholar 

  • Wells PS, Anderson DR, Rodger M et al (2000) Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 83:416–420

    Article  CAS  Google Scholar 

  • Wells PS, Anderson DR, Rodger M et al (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 349:1227–1235

    Article  CAS  Google Scholar 

  • Wiener RS, Schwartz LM, Woloshin S (2013) When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 347:f3368

    Article  Google Scholar 

  • Wilbur J, Shian B (2017) Deep venous thrombosis and pulmonary embolism: current therapy. Am Fam Physician 95(5):295–302

    PubMed  Google Scholar 

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Correspondence to Carlos Francisco Silva .

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Silva, C.F. (2019). Value-Based Radiology in Cardiovascular Imaging. In: Silva, C., von Stackelberg, O., Kauczor, HU. (eds) Value-based Radiology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2018_205

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  • DOI: https://doi.org/10.1007/174_2018_205

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31554-2

  • Online ISBN: 978-3-030-31555-9

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