One of the most challenging aspects of medical practice is bridging the gap between scientific discovery and clinical care. As gatekeepers of healthcare technology, physicians also are tasked with preserving the delicate balance between revolutionary treatment plans and wise use of resources. Keeping patients’ needs paramount, we must strive to provide the highest level of care in a timely, cost-efficient way.

This belief holds especially true for the rapidly expanding field of medical imaging. Much attention has been focused on the raw growth in volume of medical scans. Insurers, legislators, and the medical community alike are gauging this growth and starting to develop plans for managing this exceptional technology. Critics of the growth in imaging allege “inappropriate” or “unnecessary” tests performed by nonradiologists. Others recognize that advanced imaging equipment has forever modified the way that cardiologists, oncologists, OB/Gyns, urologists, family practitioners, orthopedists, and many other physicians deliver patient care.

Undeniably, the volume of noninvasive diagnostic imaging procedures has increased steadily. However, pinpointing the cause of this growth is not so simple. As the patient population swells, so does the volume of healthcare services, including imaging procedures. In addition, these patients are living with chronic disease for longer periods of time. For example, the rise in cardiac imaging has tangibly reduced the rate of death from heart disease, and it has measurably improved the quality of life for those living longer with heart disease.

One recent article1 compared cardiac MR to a “high-tech crystal ball” because of its ability to predict cardiac events for at-risk patients. Using new imaging modalities, cardiologists are catching cardiovascular disease earlier, treating heart conditions faster, and offering patients less expensive noninvasive treatment options. In the long term, this should lower overall healthcare expenditures.

Yet, the short-term hike in healthcare spending forces physicians to defend their clinical decisions time and again. Trying to address the issue by limiting access to providers and services is an inappropriate way to manage increased patient need for imaging tests.

A lack of credible data complicates the debate. Most current research gives a distorted picture of imaging use by nonradiologists. Estimates generally overstate imaging growth because they fail to take into account shifts in site of service. Refinements in imaging technology have encouraged the move from invasive tests performed in hospitals to less invasive – and more accurate – diagnostic tools and image-guided therapy performed by professionals in an office setting.

Detractors of cardiologists’ role in providing diagnostic scans also have called into question the quality of tests performed. Often, this assertion is based on studies that lump practitioners into two groups: radiologists and nonradiologists. Cardiologists performing CT and MR scans are evaluated the same as podiatrists performing X-rays. Until more thorough, modality-specific research is available, it is premature to look for ways to narrowly define who is an appropriate imaging provider and where these tests may be administered.

The truth is, more patients will need diagnostic services if the US healthcare system is going to shift to a proactive model of disease management rather than a reactive system focused on end-stage treatment of illnesses. Limiting diagnostic scans only to radiologists will inappropriately exclude highly qualified physicians from performing life-saving tests in the most patient-friendly settings.

All physicians agree on one point: Unnecessary treatment – including the use of imaging services – is unsupportable from any vantage point. Excessive use of any technology is bad practice and a burden on our healthcare system. It is incumbent on us as physicians to always put patients before profits as well as clinical care before cost cutting. We must be responsible stewards of healthcare technology, advocating for our patients and considering the long-term impact of our decisions.

To help cardiologists navigate the fine line between patient access and provider excess in the field of cardiac imaging, the American College of Cardiology (ACC of Bethesda, Md) is in the process of developing appropriateness criteria for imaging utilization. The ACC is dedicated to bringing state-of-the-art technology, like cardiac imaging, to the patient’s bedside without putting an undue burden on our nation’s healthcare system.

As we continually strive to help patients live longer and healthier lives, we must keep in mind that there is a price to pay for medical progress. However, as every astute consumer knows, price is not equivalent to value. When evaluating the role of imaging services in our patients’ care, we must keep in mind the broader view. Investing in imaging now saves patients’ lives in the future. That’s an investment I’m willing to make.

Michael J. Wolk, MD, FACC, is president of the ACC.

References

  1. Thompson TL. Studies highlight cardiac MR’s prognostic potential. AuntMinnie.com. January 21, 2005. Available at: http://www.auntminnie.com/index.asp?Sec=sup&Sub=mri&Pag=dis&ItemId=65086. Accessed February 4, 2005.