OrrThe Society of Cardiovascular Magnetic Resonance recently attracted another record-breaking crowd to hear the latest research and developments in this rapidly expanding field.

More than 1,000 attendees packed the Sixth Annual Scientific Sessions meeting (Orlando, Fla., February 6-9th, 2003). While this meeting has traditionally been oriented towards the physics of cardiovascular MR (CMR), this year the group was more evenly balanced with the presence of real-world physicians that need a clean and sharp report in order to get paid.

The most interesting aspect of this year’s meeting was the expanded discussion on clinical use of these technologies. There was also an extensive Q&A session with tabulated responses from the audience, demonstrating that the technology has achieved broad clinical use today (even in radiology departments), with high expectations for further expansion of procedures in the next year.

Most of the MRI systems used to perform CMR procedures today are not dedicated solely to cardiac MRI, but are shared systems that support other general purpose radiology procedures. I would expect that most sites will soon opt to purchase a dedicated and even more advanced cardiac MRI scanner in the next two to three years (or even sooner). The logistics of scheduling patients and managing emergency imaging needs are ultimately destined to drive this demand, as same-day available scheduling time on most MRI scanners today is non-existent, which directly affects the ability to manage CMR candidate patients.

Cardiovascular MRI continues to hold a front-row seat among the hottest medical imaging market segments, worldwide, but the elbow space is shrinking as cardiac CT makes its entrance into this same market. The new generation of 16-slice CT scanners will offer quick studies of ventricular function, improved coronary artery imaging, and calcium scoring that will benefit the diagnosis of cardiovascular disease.

So, it seems that a new turf war may be ready to start, drawn along imaging modality lines vs. the traditional medical specialty battles between radiologists and cardiologists. Obviously, the specialists who have built their medical and business careers using echocardiogrpahy, nuclear medicine, cath lab imaging and PET will be certain to enter this battle for survival — not everyone will survive without some change and adaptations. So, if you are making or selling these cardiovascular imaging modalities, you might want to re-visit your long range plans, and soon. Whole markets might be re-arranged overnight if new referral patterns and diagnostic protocols are established. I would expect the American College of Cardiology will soon have some insights in this area as well.

Seriously, the challenges of performing clinical cardiovascular MRI studies are not to be underestimated, but the real world success stories are beginning to add up. There are now more than 50 cardiac MRI courses scheduled this year, and offered around the world (and that’s the current count to date). So the cookbooks have been written and tested, and the procedures are ready for primetime. Recommendations to visit the SCMR web site at www.scmr.org are certainly in order, as the society has provided a tremendous service to its members in all aspects of this technology and its clinical use.

Collaborative approaches between the radiologists and cardiologists were more the standard than the exception this year, as these specialties of imaging science and cardiovascular disease states have discovered that there is more than enough work to keep them both busy and an active member of the team.

Cardiac MRI imaging procedures continue to focus on assessing cardiac function, viability and perfusion — though there is presently no contrast agent specifically indicated for use in cardiac MRI perfusion procedures. The research involving late-enhancement of myocardial tissue, using contrast agents, was particularly noteworthy, as the research consistently showed these areas to be non-viable, in effect ruling out the need for reperfusion therapy at identified sites. The vascular applications also continue to provide outstanding information on blood-flow volume and velocity within arteries, veins and ventricles, throughout the body. Pediatric studies of congenital heart disease were widely discussed at the meeting as well, as use of non-radiation based procedures to obtain a definitive diagnosis were well received by both patients and M.D.s.

While these studies are performed in traditional 1.5T magnets today, the potential for improving these procedures with 3T magnets will likely be the focus of next year’s sessions.

Reimbursement improvements are desired, but the CPT codes in use today are sufficient for launching a program without breaking the bank.

In summary, the SCMR leaders should receive a well-earned round of applause for their outstanding progress this past year, as the CMR foundation is well-established today.

Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].