It's time to clean up cardiac imaging diagnostics. Cardiologists call for systemic changes

Computed tomography and cardiac MRI have fundamentally changed clinical practice in cardiology in recent years. These are examinations that not only confirm the diagnosis, but increasingly determine the patient's further treatment, qualification for drug therapy, surgery or observation. Their interpretation requires a combination of images with symptoms, history, previous treatment and a plan for further management.

Modern cardiology relies on diagnostics, which should lead to clear and timely therapeutic decisions. In this context, cardiac computed tomography, especially angio-CT of the coronary arteries, is of particular importance, and is increasingly becoming the test of first choice in patients with suspected coronary artery disease.

At the same time, the role of cardiac MRI is growing, which is conclusive in many clinical situations. This examination allows precise evaluation of cardiac function and morphology, tissue characterization, diagnosis of myocarditis, cardiomyopathy or post-infarction lesions. It is also an important tool in risk stratification and therapy planning. In these areas, the quality of the description and its embedding in the clinical context have a direct bearing on patient safety.

As experts point out, it is increasingly clear in system practice that the bottleneck of diagnostics is not the test itself, but access to timely, unambiguous and clinically useful descriptions. Descriptions devoid of reference to the full clinical picture lead to uncertainty in decision-making, lengthening the diagnostic pathway and increasing the number of additional tests and procedures, including invasive ones. Such a model burdens both the patient and the health care system.

"The overriding goal is the welfare of the patient. Timely, unambiguous and clinically useful examination description translates into better therapeutic decisions and patient safety. Competency-based certification is a rational direction for the development of the system." - emphasizes Prof. Marek Gierlotka, president of the Polish Society of Cardiology.

The Polish Society of Cardiology notes that the current limitations on describing cardiac CT and MR imaging do not meet the realities of modern clinical practice or the needs of patients. Interpretation of cardiac imaging studies requires combining the image with the patient's symptoms, history and responsibility for further treatment.

"Imaging diagnostics make sense when they lead to a specific clinical decision. Cardiologists have always performed and interpreted coronary angiography. Non-invasive coronary angiography is now an essential diagnostic tool. A cardiologist who knows the patient can assess the cardiovascular risk and suggest optimal management without unnecessary procedures," - points out Prof. Janina Stępińska, director of the National Cardiology Institute of Stefan Cardinal Wyszynski State Research Institute, chairwoman of the National Council for Cardiology (president of the PTK in 2011-2013).

In a position paper published by the Polish Society of Cardiology, the cardiology community is calling for the introduction of a certification system that will also allow appropriately trained cardiologists to describe cardiac CT and MR examinations. The proposed model assumes clearly defined competencies, standardized training, working under supervision, quality criteria and periodic recertification, while maintaining close cooperation with radiologists.

"The role of CT and MRI in cardiology is steadily growing. The health care system must keep up with this change. The solution is not to limit competencies, but to clearly define them and certify them based on real experience," stresses Professor Waldemar Banasiak, national consultant in cardiology (president of the PTK from 2009 to 2011).

Source: PTK