Coronary angiography: the need for improvement and the barriers to adoption of new technology.

Traditional coronary angiography presents a variety of limitations related to image acquisition, content, interpretation, and patient safety. These limitations were first apparent with coronary angiography used as a diagnostic tool and have been further magnified in today's world of percutaneous coronary intervention (PCI), with the frequent use of implantable coronary stents. Improvements are needed to overcome the limitations in using current two-dimensional radiographic imaging for optimizing patient selection, quantifying vessel features, guiding PCI, and assessing PCI results. Barriers to such improvements include the paucity of clinical outcomes studies related to new imaging technology, the resistance to changing long-standing practices, the need for physician and staff member training, and the costs associated with acquiring and effectively using these advances in coronary angiography.