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Panel seeks improvements in cardiovascular imaging

Jan 2007
Michael A. Greenwood

Seeking to improve the quality of cardiovascular imaging in the US, a panel of specialists has introduced a series of recommendations that could lead to tougher standards and better patient health.

Noninvasive imaging techniques such as ultrasound, CT scans and MRI, along with more invasive procedures such as angiography, are powerful tools frequently used by health professionals to detect and diagnose heart disease. Still, a need remains for rigorous and consistent guidelines for health workers to follow. The lack of standards for when to use imaging, or what type of imaging technique to choose, has contributed to differences in the care that patients receive and, in some cases, has caused patients to undergo diagnostic testing that is not the most suitable for their condition.

Members of the panel comprised officials from professional societies of imaging specialists, from companies that develop imaging technology, from government regulatory agencies and from insurance companies. Dr. Pamela S. Douglas of the Duke University Medical Center in Durham, N.C., was the lead author of the report.

The group -- officially known as the American College of Cardiology-Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging -- presented the report as a first step toward addressing shortcomings in the use of cardiovascular imaging. Recommendations include:

• Mandating that all imaging laboratories receive accreditation and that physicians and technologists are certified. Currently, accreditation is voluntary.

• Developing appropriateness criteria for all imaging technologies. The panel said that such criteria would help health care workers match patients with the right test at the right time.

• Ensuring the accuracy of image interpretation. The panel suggested that this could be done by establishing independent groups to review physician interpretations and determine their accuracy. Comparative studies using com- puterized databases also could improve accuracy. At the minimum, professionals who read and interpret images must undergo certification.

• Developing criteria for communicating imaging results to patients in a clear and timely manner. High-risk findings should also prompt the rapid notification of the ordering physician.

• Developing methods for measuring patient outcomes and for reviewing the impact this has on medical decision-making.

Although the initial planning has been completed, much work remains, Douglas said. The panel’s general suggestions must be developed further before their possible implementation nationwide. It plans to spend the next 18 months writing specific criteria.

The authors acknowledge that the initiative will likely be expensive and perhaps difficult to implement, but they do not provide estimates of what the recommendation might cost. They maintain that changes are necessary if a good system of cardiovascular care is to be made better.

Journal of the American College of Cardiology, Nov. 14, 2006, pp. 2141-2151.

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