Colleges converge on cardiovascular imaging quality

Officials from the American College of Radiology and the American College of Cardiology, along with other interested stakeholders, have published a consensus report defining quality for all cardiovascular imaging modalities. They say that the focus on quality in cardiovascular imaging has been less intense than in other areas of cardiovascular medicine.

The panel, which also included representatives of private payers, government agencies, and industry, said the document is intended to be the start of a process culminating in the development, dissemination, and adoption of cardiovascular imaging quality measures. It was published in the Nov. 14 issue of the Journal of the American College of Cardiology.

"We are in the midst of a national debate on the rising use and costs of these technologies," said Dr. Pamela Douglas, chief of cardiovascular medicine at Duke University, immediate past president of the ACC, and first author of the report. "We believe there is good reason to change the debate from how to cut costs to how to provide the best value to patients."

While drugs or medical devices must be tested rigorously for safety and effectiveness in clinical trials before receiving government approval for use, imaging technologies tend to be subject to less scrutiny, since most pose few immediate risks to patients, Douglas said.

Officially called the American College of Cardiology-Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging, the panel met in Washington, DC, in January 2006. The meeting was supported by unrestricted grants from a number of healthcare and medical imaging companies, including GE Health Care, Siemens Medical Solutions, Toshiba America Medical Systems, Blue Cross Blue Shield, and AstraZeneca Pharmaceuticals.

In its analysis, the panel looked at four broad aspects of how imaging technologies are used in evaluating heart patients: matching patients with the best imaging technique, acquiring the best images, correctly interpreting the images, and communicating the results of the tests to the patients' physicians.

The group proposed potential actions for each:

• For patient selection, develop appropriateness criteria for all imaging modalities.

• For image acquisition, define key acquisition elements of imaging protocols and sequences.

• For image interpretation, develop standard methods for determining inter- and intrareader variability.

• For results communication, develop timeliness criteria and standards for completeness and definitiveness, define key structured reporting data elements, and create structured reports for all modalities.

The group also focused on laboratory structure and outcomes. It suggests mandatory laboratory accreditation and physician training and certification requirements. To ensure improved patient care, actions to be taken include developing standard methods for determining cross-modality correlation and for measuring patient outcomes and impact on medical decision making.

"Strong leadership is needed to accomplish these perhaps costly, perhaps difficult, but necessary undertakings. To be successful, this effort will require commitments from a broad range of practitioners, payers, and policymakers," the authors said.

Other professional societies involved in this effort were the American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Coalition of Cardiovascular Organizations, Heart Failure Society of America, Heart Rhythm Society, Intersocietal Accreditation Commission, Society of Atherosclerosis Imaging, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society for Vascular Medicine and Biology Quality.

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