The Evolution of Cardiac Imaging

DR. SWANTimothy L. Swan, MD, FACR, FSIR, American College of Radiology Board of Chancellors member-at-large, contributed this post.

February is American Heart Month, a federally designated event that began in 1964 with a proclamation by President Lyndon Johnson. We are encouraged to actively begin or renew efforts to improve our own heart health, including increasing physical activity, maintaining a healthy weight, eating a nutritious diet, quitting tobacco, reducing stress and getting better sleep. Another key to heart health is seeking and maintaining close and positive relationships with family and friends.

Heart Month also affords an opportunity to marvel at the evolution of cardiac imaging and intervention, and the radiologists who pioneered this evolving field. Drs. Leo Rigler and Fred Hodges recognized early the importance of evaluating the heart in plain film radiography. Cardiac and coronary angiography were introduced into practice in the 1940s to 1960s by radiologists and cardiologists working competitively and collaboratively.

Therapeutic cardiac interventions, particularly coronary artery interventions, became possible because of the pioneering work of Charles Dotter (angioplasty) and Melvin Judkins (angiography), with Andreas Gruentzig subsequently performing the first coronary balloon angioplasty in the late 1970s. Kurt Amplatz developed power injectors and later developed devices for percutaneous repair of congenital cardiac defects.

Two-dimensional cardiac echocardiography, as practiced today, is based on early work by Raymond Gramiak in the late 1960s and early 1970s.

Gated coronary CT was introduced in the 1980s and demonstrated a wide range of pathology, including intracardiac thrombus, ventricular aneurysms and cardiac scars. Coronary artery calcification evaluation by gated CT was also introduced in the late 1980s. Cardiac CT angiography slowly entered clinical practice in the early 2000s when multi-detector row CTs were developed. Cardiac magnetic resonance (MR), both morphologic and functional, and cardiac MR angiography continue to evolve in clinical practice.

Imaging and percutaneous cardiac/coronary interventions continue to play significant roles in contemporary cardiac care management. Throughout the remainder of this Heart Month, let’s celebrate the grand history of cardiac imaging while also focusing on our own heart health.

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ACR Chair Discusses Partnership for America’s Health Care Future

Geraldine McGinty, MD, MBA, FACR, chair of the ACR Board of Chancellors, contributed this post.

Geraldine McGinty_MGF1866The ACR’s core purpose is “To serve patients and society by empowering our members to advance the practice, science and professions of radiological care.” As I said in my November 2019 JACR® column, “empowered imaging professionals’ practice of medicine is structured to support them in delivering the highest standard of care to the patients in whose diagnosis or treatment they are privileged to participate.”

What is critical to empowering our members is the ability to have a voice in the regulatory process that governs our practice and the reimbursement that sustains it. The decision that your American College of Radiology® (ACR®) leadership made to participate in the Partnership for America’s Health Care Future was predicated on the imperative to preserve that voice.

Our US health care system can, for some, be the best in the world, and yet we know that for others it is far from that. The debate on how to reform how we deliver and pay for health care is not new, but has taken on new momentum with the discussion of a more comprehensive role for the government variously called “single payer” or “Medicare for All.” As we trend towards spending 20% of our national output on a system that does not always deliver the outcomes we might hope for, we need to do better. Opinions, not surprisingly, vary on how to do that. What is critical is that we as radiologists continue to be part of the decision-making process.

As such, after much thought and a unanimous vote of the ACR’s Board of Chancellors, the decision was made to support and participate in the Partnership in May 2018. That decision has been reviewed since and will likely be reviewed again as we get closer to the election, and pending any discussion on the Council floor at the Annual meeting. ACR participation followed extensive discussion and deliberation, and has been discussed in the press, on social media and on the ACR website. 

The Partnership, comprised of stakeholders throughout the American health care system, is a coalition pledged to support federal policies that build on the strength of employer-provided health coverage, a delivery system based on our current multi-private payers, while preserving federal programs such as Medicare, Medicaid and other proven solutions that hundreds of millions of Americans depend on. All in the Partnership are committed to legislative solutions to fill in the gaps where they exist — to expand access to affordable, high-quality coverage for all Americans.

The ACR and its members work to provide for the best radiologic care possible, and we support policies that expand access to these services. Like any nonpartisan health care association, the ACR advances policies to benefit patients and members without allegiance to a single political party or a party’s specific policy platform. The ACR wants to work together with other stakeholders to lower costs, protect patient choice, expand access, improve quality and foster innovation. For these reasons, we have worked for decades to ensure the appropriate utilization of diagnostic imaging services.

Polling shows that a single payer system is actually not attractive to the public once they learn the specifics of its cost ($32 trillion) and the potential for increased patient wait times and provider reimbursement cuts — estimated by CMS (figure 1) and others at 40 percent vs private plans. Studies and news reports have discussed the widely accepted view that the services and hospitals likely most affected would be in rural and underserved areas.

We are on the brink of an exciting era, when artificial intelligence (AI) and machine learning will empower advancements that all Americans must be able to access. However, advanced technologies may be rationed in a single payer system — stifling the ability to improve patient care with innovative tools and treatments.

As our specialty demands unique expertise and touches virtually every part of patient care, radiology must take a leadership role. This involves engaging with other stakeholders in many venues — including The Partnership.

ACR leadership, chosen by College membership and tasked with executing the policies voted on by Council, welcomes and relies on member involvement and good faith input to represent the best interests of our members and those they serve.

We are all in this together — as we consider our ongoing involvement in The Partnership — and the myriad challenges we will face in the months and years to come.

Investing in the Future of Radiology Research and Innovation

Woodard_headshot_102219Pamela K. Woodard, MD, FACR, member of the ACR Board of Chancellors and chair of the ACR Commission on Research, contributed this post.

The American College of Radiology® (ACR®) Center for Research and Innovation™ (CRI™) supports, designs and manages research studies that aim to translate new evidence into clinical practice. To help continue to uphold this mission, we upgraded our facility and recently moved to Two Liberty Place in Philadelphia, several blocks from our prior location.

We are proud to have cut the ribbon on a new first-class working environment on Monday, Feb. 3, welcoming our researchers and staff, who serve as leading experts in academia and industry on clinical trial design and management, and on precision diagnostics and treatment. This new location in Philadelphia provides the CRI team and their collaborators with a state-of-the-art Facility.

Ribbon Cutting

ACR Chief Executive Officer William T. Thorwarth Jr., MD, FACR, ACR Board of Chancellors Chair Geraldine B. McGinty, MD, MBA, FACR and ACR Center for Research and Innovation Executive Vice President Charles Apgar cut the ribbon at the new facility. (Photo/Becky DiGati)

 

This new location is now home to our ongoing studies, including the Tomosynthesis Mammographic Imaging Screening Trial (TMIST), the Imaging Dementia–Evidence for Amyloid Scanning (IDEAS) study, the Detection of Early Lung Cancer Among Military Personnel (DECAMP) study, and the extensive portfolio of radiation therapy research trials, such as RTOG and NRG. To facilitate these studies, we rely on over 100 ACR staff researchers at the Philadelphia and Reston, VA ACR offices, as well as thousands of imaging scientists and accredited facilities throughout the United States.

This upgraded, modern facility with new technology — including enhanced videoconferencing capabilities — will encourage collaboration with both on-site and remote participants. The new space includes a conference center and provides the ACR with the ability to host scientific summit meetings and conferences with up to 200 attendees. Our new space is located in the heart of the city of Philadelphia, easily accessible from nearby train stations, airports and highways, and near numerous first-class restaurants.

The CRI has fully embraced the use of cloud-based solutions for information technology architecture and leverages our collaborative relationship with the ACR Data Science Institute®. These strategies will enhance researchers’ access to curated data and create opportunities to develop new analytic tools and resources. In particular, these advancements position the CRI to support emerging science related to precision medicine, the role of machine learning in research and integrated diagnostics.

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