Study explores trends in cardiac imaging from 2010 to 2019

A new study published in Radiology: Cardiothoracic imaging on trends in cardiac imaging over a decade reports that the rate of coronary angiography computed tomography (CTA) examinations by radiologists in hospital outpatient departments increased significantly from 2010 to 2019, suggesting a promising future for technology. The study also found that reimbursement cuts and technological advancements have helped shift much of the imaging done by cardiologists from the office to the hospital’s outpatient department.

Imaging has long played an essential role in the diagnosis of cardiovascular disease, the leading cause of death worldwide. Radiologists and cardiologists both perform non-invasive cardiac imaging, but over time two of the most common cardiac imaging methods, echocardiography and myocardial perfusion imaging, have become almost exclusively the domain of cardiologists. .

The dominance was in part due to a cardiologist’s unique position as a supplier who both orders and performs diagnostic cardiac imaging. However, reimbursement cuts in the Deficit Reduction Act (DRA) of 2005 had a major impact on in-office cardiac imaging.

“In the early 2000s, the use of cardiology office imaging was skyrocketing,” said lead author Russell A. Reeves, MD, of the Center for Research on Utilization of Imaging Service. (CRUISE) and resident in Diagnostic Radiology in Thomas Jefferson’s Department of Radiology. University of Philadelphia. “The changes made by DRA have reversed this trend to a point where it was no longer lucrative or even feasible for many cardiologists to do imaging in their offices.”

During the same period, advancements in technology have made competitive imaging exams traditionally performed by radiologists, such as cCTA, attractive options.

Dr Reeves and his colleagues studied data from the 2010-2019 physician vendor procedure summary files to assess the impact of these developments on the use of different types of cardiac imaging.

They found that cardiologists’ office myocardial perfusion imaging rates per 100,000 Medicare beneficiaries fell 52%, from 4,426 to 2,119, over the 10-year period. As a result, imaging rates per 100,000 beneficiaries in hospital outpatient departments increased by 71%, from 935 to 1,598.

Cardiologists don’t do as many myocardial perfusion scans as they used to, and most are now done in hospital outpatient imaging departments. “

Russell A. Reeves, MD, Resident in Diagnostic Radiology, Department of Radiology, Thomas Jefferson University

Over the same period, rates of cCTA by radiologists in hospital outpatient departments increased by 355%. Overall rates, however, remained low compared to myocardial perfusion imaging, despite some studies showing cCTA to be more accurate. Adoption of the technology may be limited, Dr Reeves said, by its complexity and the cost of the equipment, in addition to the fact that it requires a dedicated technologist.

Yet, he said, the increasing rate of cCTA performed by radiologists represents a growing opportunity for collaboration in cardiac imaging. Recently, at Thomas Jefferson’s, cardiologists have expressed an interest in reading cCTA exams alongside radiologists to improve patient care.

“Coronary CTA is a useful screening tool for coronary artery disease that avoids the need for invasive coronary angiography,” said Dr. Reeves. “I think the future looks bright.”

Cardiac PET (cPET) levels in cardiology offices increased by 193% over the 10-year period, but cardiac PET performed by radiologists in hospital outpatient offices and departments was little changed. The increase in in-office cPET is likely due to a combination of technological advancements, familiarity with interpretation, and financial incentives, according to Dr. Reeves.

Dr. Reeves plans to continue tracking trends to study the impact of regulatory, economic and other factors on the use of imaging.

“Ultimately, as radiologists we have to be self-regulators and also do research to support change, help the specialty and help medical practices in general in the future,” he said.

The research is also a way to honor the legacy of Dr. Reeves’ mentor, David Levin, MD, professor and president emeritus at Thomas Jefferson University. Dr Levin, a former fighter pilot who became a leading researcher in imaging usage trends and founded CRUISE, died in 2020.

“Cardiac Imaging Trends 2010-2019 in the Medicare Population.” Collaborating with Dr. Reeves were Ethan J. Halpern, MD, and Vijay M. Rao, MD, FACR.