Attaining high-quality cardiovascular imaging

Cardiologists reviewed the proceedings of a Duke University and American College of Cardiology think tank on establishing high-quality cardiovascular imaging in the Nov. 21 issue of the Journal of the American College of Cardiology. The article won the endorsement of 12 professional societies.

The reviewers listed routes to accreditation of imaging modalities. However, they noted that accreditation establishes a minimally acceptable standard of quality and rates practices at a single point in time rather than on an ongoing basis. Furthermore, some accrediting bodies have allowed laboratories to choose what may be reviewed — a subjective decision.

Besides evaluating accreditation, the reviewers proposed additional quality measures for imaging modalities. Those measures pertained to patient selection, image acquisition, image interpretation, reporting and health-related outcomes. To address variation among image interpretations, the authors suggested measuring interpretive variability annually by reviewing the lesser of 5 percent or 50 studies, examining Web-based case studies or comparing results among multiple institutions. They also encouraged external and internal review. They remarked that patient outcomes can be analyzed in part by determining the number of false-positive diagnoses and by comparing newly acquired images to standard images. The authors stated that new research should place more emphasis on testing existing imaging modalities and on establishing more national standards.

The authors hope that institutions will believe that improvements in imaging quality are a “professional mandate,” but they understand that adopting better practices will be difficult. They suggest numerous ways to facilitate implementation of the recommended quality measures. (Journal of the American College of Cardiology, November 2006, pp. 2141-2151.)