Building Collaboration in Cardiac Imaging

Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery disease (CAD) detection has captured the imagination of the public appears exceptional. This interest has been fuelled by reports in the popular press. In 2005, a popular US-based news magazine ran a cover story describing the ability of CT angiography to detect coronary artery disease. It has been suggested by some news articles that early detection of heart disease by this technology can help us prevent heart attacks before they occur, thus potentially saving lives. Many cardiologists have now come to expect that their patients will ask routinely whether they need the latest heart scan. Indeed, the high spatial, and adequate temporal, resolution of modern CT scanners has made non-invasive imaging of the coronary arteries feasible in routine clinical practice, a much sought-after “holy grail” of cardiac imaging. Nevertheless, although MSCT has made a promising start as a diagnostic tool for detecting coronary artery disease, popular claims about the ability of this technology to prevent heart attacks by providing for earlier diagnosis require further study and are not yet proven. As with other methods for CAD detection, assessing the true value and clinical role of this exciting new technique requires more information about the long-term outcomes and its prognostic utility. In short, while we should not deny patients the benefits of this new approach where deemed appropriate, more research is needed. The key is to balance safety, diagnostic accuracy, and appropriateness on the one hand, with a willingness to explore new imaging options on the other. The advent of MSCT has also ignited a debate about the value of screening for heart disease, as well as who should provide that imaging. This has been reported by the US popular press as a “turf war” between radiologists and cardiologists over cardiac CT. Radiologists have focused their career on medical imaging, whether using X-rays, ultrasound or magnetic resonance. Their training emphasises expertise in the technical aspects of imaging, such as physics and radiation safety, as well as the interpretation of Building Collaboration in Cardiac Imaging Terrance SJ Chua,1MBBS, FRCP, MMed (Int Med), Bien-Soo Tan,2MBBS, FRCR, FAMS