ASNC2012: Keeping Nuclear Cardiology Relevant in an Era of Cost Containment and Radiation Concerns

Patient safety and reducing skyrocketing health care spending are two of the most common topics of debate among health care stakeholders, Congress and payers these days. Some experts say that as much as 30 percent of health care delivered in the U.S. may not improve patients' health. Providers and economists agree that this is not only unsustainable from a financial perspective, it also threatens America's ability to provide the highest quality of care possible to all patients. How to keep nuclear cardiology relevant in this era of cost containment and patient safety concerns was discussed in detail during a session Sept. 10 at the American Society of Nuclear Cardiology's (ASNC) annual conference in Baltimore.


Raymond Gibbons, MD, FACC, professor of medicine at the Mayo Clinic, kicked off the session by highlighting initiatives, such as Choosing Wisely, that focus on ensuring appropriate use of testing and procedures and eliminating those that are unnecessary. Earlier this year the ACC, ASNC, and six other medical specialty societies joined ABIM Foundation's Choosing Wisely Campaign to address the concerns of waste in the health care system, and have each released a list of "Five Things Physicians and Patients Should Question." Gibbons described ASNC’s list which includes:

  • Don't perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present;
  • Don't perform cardiac imaging for patients who are at low risk;
  • Don't perform radionuclide imaging as part of routine follow-up in asymptomatic patients;
  • Don't perform cardiac imaging as a pre-operative assessment in patients scheduled to undergo low- or intermediate-risk non-cardiac surgery; and
  • Use methods to reduce radiation exposure in cardiac imaging, wherever possible, including not performing such tests when limited benefits are likely.
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Gibbons notes, "we must regulate ourselves by increasing the value of cardiac imaging, and we can begin to do this by not doing the tests in the ASNC Choosing Wisely list."

On the patient safety front, Ernest Garcia, PhD, professor of radiology at the Emory University School of Medicine, highlighted different approaches for reducing radiation dose and detailed ASNC's  recommendations for reducing exposure in myocardial perfusion imaging. He presented an algorithm for maximal reduction in patient radiation exposure that starts with the questions: 1) is this study appropriate? and 2) is a comparable diagnostic test without radiation available?" Ultimately, the small risks incurred from a diagnostic study should be contrasted to the benefit of the diagnosis to the cardiac patient, he noted. However, he also cautioned that "perception is reality" and reinforced the need for continued patient education.

Moving into the future, Manuel Cerqueira, MD, FACC, chair of the ACC's Imaging Council, urged cardiovascular professionals to be pragmatic in implementing the many new technologies available, including quantitative myocardial blood flow, neuorocardiac imaging, and new instruments and software like CZT systems, attenuation correction, interactive reconstruction and new collimation. "We should take these technologies out of the 'centers for excellence' and make more mainstream, as well as transition to PET to take advantage of improved imaging quality and potential for new tracers," he said. "Using these techniques the hope is to use the right test(s) for the right patient at the right time," added Cerqueira.

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