Anam Waheed, MD, FACC, spoke with Ron Blankstein, MD, FACC, about leadership, education and advocacy in the cardiovascular imaging field. Blankstein is a professor of Medicine and Radiology at Harvard Medical School, and the director of the Cardiac Computed Tomography, associate director of the Cardiovascular Imaging Program, and co-director of the Cardiovascular Imaging Fellowship at Brigham and Women's Hospital. He is a past-president of the Society of Cardiovascular Computed Tomography, and currently serves as chair of ACC's Cardiovascular Imaging Section and associate editor for JACC: Cardiovascular Imaging.

What advice do you have for those building cardiovascular imaging service lines at their institutions?

The first step is to offer a high-quality product. Spend time to get the best possible images and provide a high-quality experience for the patient and ordering physician. High-quality imaging requires having good equipment and investing in your technologists. Additionally, what may seem like a routine scan can be frightening for patients, and we should make sure it is a good experience.

Test results alone do not improve patient outcomes; it is how we act on them. Complex findings should be communicated in clear, actionable steps. I am a big supporter of picking up the phone and sharing findings and recommendations with referring physicians, especially for complex cases. Familiarize clinicians with tests available and when to use them, while fostering a relationship they can rely on for questions. Knowing when to recommend a more suitable test, even if it's not the one requested, is crucial. This builds credibility for you, your service and your imaging program.

What advice do you have for program directors on cultivating the next generation of imaging specialists?

All of us try to emulate individuals we respect and who we think bring something to the field. I have always valued my teachers and individuals who can take a complex topic and distill it down. Cardiovascular imaging can be complex, but the importance of education is to take things that seem complex and break them down to principles that everyone can understand. I enjoy teaching, and it is also another way to make an impact. I feel that if I teach individuals and then they go on to different places and teach other individuals and establish new programs, that has a huge impact over time, which is very rewarding.

What advice do you have for cardiovascular imagers/institutions who are trying to set up cardiovascular imaging training programs?

For institutions trying to set up training programs, it's important to have strong imaging programs, ideally across all four main imaging modalities. However, some programs may offer dedicated training in only one or two modalities. Then, for any modality where training is offered there needs to be a high volume and diversity of cases, a focus on high-quality imaging, and faculty members who are experts in their field and who are committed to education and training. For training in multimodality imaging, it is important for programs to break down any barriers so that imaging is not performed in silos.

Could you share your insights on the importance of Advocacy and how can others get involved?

Cardiac imaging specialists should understand the basics of Medicare reimbursement, a priority Advocacy issue for the College, including the distinction between professional and technical fees, typical reimbursement rates for tests and the reasons behind payment disparities. This knowledge empowers you to advocate locally with payers and insurers, and nationally with the Centers for Medicare and Medicaid to establish sustainable Medicare payment practices and ensure cardiovascular clinicians can continue to care for patients who rely on Medicare for their health care needs.

While we are fortunate that ACC and all the imaging societies are engaged in advocacy, it is crucial for all ACC members to be involved. If you are a cardiac imager, pay attention to what is happening in Advocacy. Look for grassroots alerts from ACC and your chapter to urge lawmakers to take specific action on an issue because your voice can make a difference.

Learn more about getting involved in Advocacy at the ACC here.

As a leader in the field of cardiovascular imaging, where do you see the field evolving in the next decade?

Nobody can predict the future. The past decade has shown substantial growth in all imaging modalities, and I think we are going to see continued advances in technology and numbers in the future. I don't think we'll ever have a "one stop shop," or one test that will do it all.

There is always going be a very important need for multimodality imagers and cardiologists, who are trained in all modalities and who can help select between the tests. We will also see increased applications of artificial intelligence. However, ultimately cardiovascular imaging specialists will decide how to put the results together, ensure they are not influenced by artifacts and decide how they should be integrated in patient care.

The more we can integrate imaging as part of clinical decision-making, the more meaningful imaging will be with respect to changing patient outcomes. We're doing this now, but I hope we'll do it even better ten years from now!

This article was authored by Anam Waheed, MD, FACC, an early career Imaging Cardiologist at Medstar Washington Hospital Center/ Georgetown University in Washington, DC.