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He said, he said: Physicians discuss imaging ownership

Radiology Administrator's Compliance and Reimbursement Insider, June 1, 2007

Some say radiologists understand the science and art of body imaging better than anyone. Although cardiologists may agree with that premise, they say that they know the structure and beat of the heart better than the backs of their hands-and certainly better than radiologists do.

So who should perform cutting edge scans of the heart and vasculature-radiologists or cardiologists? Two experts weighed in on the matter during the December 2006, HCPro, Inc., audioconference "The 64-Slice CT Scanner: The latest battleground in specialty turf disputes."

Radiologists say

The primary reason to maintain cardiac imaging procedures under radiologists' supervision-if not outright ownership-is because of their expertise with the equipment, argued Michael Nicholas Brant-Zawadzki, MD, FACR, medical director of the radiology department at Hoag Mem-orial Hospital Presbyterian in Newport Beach, CA.

"Arguing that cardiologists should read a heart scan is to argue that a neurologist should read a brain CT scan or a gastroenterologist should read an abdominal CT scan," he said.

This concern earned decades-long debate, Brant-Zawadzki said. "The role of the radiologist represents the specialization in imaging technology across the entire body. Part of a radiologist's core competence is whole-body imaging-understanding the principals with which those images are obtained," he said.

Radiologists work on a daily basis with a variety of cutting-edge technologies for many studies. Further, Brant-Zawadzki argued, radiologists better understand radiation risks, physics, and the engineering behind equipment selection and scanner operations.

Also, radiologists know how to select the proper ra-diation settings, assign technologist protocols, establish policies for contrast-agent administration, and understand the myriad details that take place prior to the actual data acquisition and analysis of the image. After obtaining the images, data-processing work for two- and sometimes three-dimensional images still remains. Such scans often require additional time dedication and a separate skill set, he said.

"All of these particulars are second nature to a radiologist," said Brant-Zawadzki. "Some of our cardiology colleagues simply think it's a matter of looking at the images. We're seeing many cardiologists who want to get involved, but who do not understand what comes first."

Once cardiologists understand the complete nature of new cardiac-imaging technologies-the postprocessing, slicing and dicing of arterial images and the examining of various projections-their interest in performing these complex procedures may become clearer, he said.

"These problems still need to be worked out." Brant-Zawadzki said.

Cardiologists say

Cardiologists know the heart-that's their primary argument for including their professional analysis into new cardiac imaging technology procedures.

Heart specialists say their interest in cardiac imaging revolves around whatthey're imaging, not the technology itself.

With so much information included in a cardiac CT, applying that information to a particular patient for prognosis and treatment often proves onerous. "That's my bias for cardiologists to understand this [new] technology," said Timothy Albert, MD, a cardiologist at Central Coast Cardiology, in Salinas, CA.

"When we start seeing all this information, we have to go back and see the patient and ask 'Does this information apply to him or her?' 'Is this a finding which requires physician follow through?' " Cardiologists offer the best answers to those questions, he said.

Cardiologists bring a great deal to the table, agreed Brant-Zawadzki. "Their knowledge of coronary artery disease [CAD] is much more in-depth than radiologists'." But, he argued, many radiology programs cover CAD basics today, and radiologists who chose to specialize in heart imaging take advance training in both technology and anatomy through cardiovascular fellowships.

Patients in need of cardiac imaging require cardiologist's care, suggested Albert. "These are patients that cardiologists are very comfortable with. It fits our professional experience very well."

Albert pointed to previous cardiology involvement with ultrasound for the heart. "We all adopted it," he said, not because it represented new technology or new payment avenues, "but because we saw opportunity for improved care.

That's why there's so much excitement" around cardiac imaging even now.

Editor's note: To purchase a prerecorded copy of the audioconference, visit www.hcmarketplace.com/prod-4874.html.

Insider sources:

Michael Brant-Zawadzki, MD, FACR, radiology department medical director, Hoag Memorial Hospital Presbyterian, One Hoag Drive, P.O. Box 6100, Newport Beach, CA 92658-6100, 949/764-5942; mbrant@hoaghospital.org.

Timothy Albert, MD, cardiolgist, Central Coast Cardiology, 230 San Jose Street, Salinas, CA 93901, 831/758-2100; timothy.albert@gmail.com.

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