Commentary: Radiologists, say goodbye to cardiac CT

When radiologists look back on how ultrasound and nuclear medicine evolved, some lament battles lost. Once firmly in the grip of radiologists, these modalities slipped from their grasp into the hands of other specialists, notably those of cardiologists. It's about to happen again--this time in CT.

At the Transcatheter Cardiovascular Therapeutics conference in Washington, DC, Philips Medical Systems will unveil a 16-slice CT scanner designed specifically for diagnostic cardiologists working in private practice. The aptly named Brilliance CT Private Practice CV could single-handedly dash the hope that radiologists might extend their reach into cardiology. Even more ominous, this device, which has been optimized not only for cardiac but also for vascular studies, will provide cardiologists with the tools for CT angiography.

Philips plans to begin shipping its new CT before the end of this year. Other such systems are sure to follow. Until now, CT manufacturers have been loading cardiac software on premium systems and pricing them well beyond the reach of cardiologists. Not so for Philips' new CT product, which is priced under $700,000 with the express intent of drawing cardiologists to buy it.

In retrospect, it seems inevitable that some company would do what Philips is doing. Echocardiography systems are optimized for cardiology and have been for a long time. The same is true for gamma cameras operating in nuclear cardiology. These products became popular when they were priced within the budgets of their intended customers: cardiologists.

Until this year, 16-slice scanners were at the top of the food chain. The impending debut of 32-, 40-, and 64-slice products changed that, dropping 16-slice systems well below a million dollars. As the march of technology continues, these systems will cost less and less, and they will be less and less appealing to radiologists. Philips is the first to jump on the commercial possibilities that this change is bringing about. They will not be the last.

In the years ahead, 32- and 64-slice scanners, whose capabilities will be even more suited to cardiology, will drop in price to the range now filled by 16-slice scanners. With that, the fate of radiologists' future in cardiac CT will be sealed.

Market forces will dictate which specialty controls cardiac CT--possibly even CTA. In the past, these forces have not been kind to radiology. They are about to get worse.