By Amit R. Patel, MD, FACC, FSCMR, FSCCT
While nuclear cardiac imaging and echocardiography have been the mainstays of cardiovascular imaging modalities, MRI and CT offer cardiologists additional diagnostic tools that could improve outcomes in patients with heart disease. For example, advances in coronary CT technology allow for novel analyses such as removal of artifacts related to coronary calcification, detailed coronary plaque characterization, and even dynamic myocardial perfusion analysis. Similarly, advances in other imaging modalities allow for new insights into cardiac structure and function.
With these advances, cardiologists can gain flexibility and offer patients a fully integrated suite of noninvasive, multimodality diagnostic options. Yet MRI and CT still lag behind other imaging modalities in terms of cardiologist adoption. A 2021 study by the Radiological Society of North America found that less than 1% of cardiologists provided cardiovascular MRI and CT services, although their usage is rising (Goldfarb & Weber, 2021).
The reasons for the lag in adoption are many. Often, the imaging modalities are less accessible to cardiologists. Nuclear and echocardiography imaging are present in virtually every cardiology practice nationwide and deeply entrenched in the culture of the field. MRI and CT equipment is not as available, nor are qualified people who are credentialed by healthcare institutions to conduct the imaging.
The expense, complexity, and long post-processing times of MRI and CT information has also put the technologies out of reach for some in-office cardiology practices. And the cost barriers were only exacerbated by the imaging reimbursement cuts in the Deficit Reduction Act of 2005, which was designed to reduce the number of self-referred tests and imaging exams done outside the hospital.
Internal struggles over who should be performing and reading the tests, and who should be paid for the services, have also hindered adoption. Hospitals, not individual practices, typically own MRI and CT equipment, and radiology departments historically have tended to control this equipment. The intra-hospital friction will intensify as more physicians adopt cardiology-based MRI and CT imaging.
Closing the certification gap
But perhaps the greatest barrier to wider adoption of these modalities is the dearth of trained and certified cardiologists in the areas of MRI and CT imaging. Increased access to safe and economically viable MRI and CT imaging can greatly improve cardiac care across the world, expanding cardiologists’ diagnostic toolbox. The skills that certified professionals acquire can earn the trust of a practice’s patients and management. Patients are becoming more aware of the importance of certifications and understand how they are needed to enhance care and safety.
Certification programs can also help the industry grow and elevate the standards in cardiac care. Standards are necessary to ensure that training education is universal across all cardiology practices and hospitals. Patients will feel more confident that excellent diagnostic imaging care is available wherever they go, and standard certification protocols are essential for achieving this.
For example, the Alliance for Physician Certification & Advancement (APCA) is a nonprofit, third-party certification organization whose credentials are accepted as proof of proficiency. It provides physician-only access to the Certification Board of Cardiovascular Computed Tomography (CBCCT), the Certification Board of Cardiovascular Magnetic Resonance (CBCMR), and the American Board of Vascular Medicine (ABVM).
Gaining MRI and CT certification shows that a cardiologist has diversified their practice to include more multimodality imaging capabilities. Certification may allow cardiologists to access more resources while also demonstrating their commitment to increasing their knowledge, skills, and abilities beyond the scope of a general cardiology practice. They can improve patient care by being able to select the right test at the right time.
These new skills, in turn, make the physician more valuable and marketable to the practice or hospital. Multimodality cardiac imaging expertise can put vital diagnostic tests in more patients’ reach as well as open up employment opportunities for physicians.
Increased access to safe and economically viable diagnostic imaging is a major step in improving cardiac patient care across the world. As cardiac MRI and CT imaging continues to escalate in importance, cardiologist training must keep up with market demand. To improve access to training and transform global healthcare, certification standards and validation will be critical.
Goldfarb, J. W., & Weber, J. (2021). Trends in cardiovascular MRI and CT in the U.S. Medicare population from 2012 to 2017. Radiology: Cardiothoracic Imaging, 3(1), e20012. https://doi.org/10.1148/ryct.2021200112
Amit R. Patel, MD, FACC, FSCMR, FSCCT, is a cardiologist who specializes in cardiac imaging. He is a professor of medicine and director of noninvasive cardiac imaging at University of Virginia. Dr. Patel has expertise in using advanced imaging techniques to develop targeted treatment plans for patients with heart disease. In addition to his clinical work, Dr. Patel is an avid researcher and focuses on evaluating new noninvasive cardiac imaging tools designed to improve care for heart patients.