Miriam Researchers Examine the Evolving Practice of Nuclear Cardiology

Posted Wednesday, October 10, 2012

A new survey of nuclear cardiology practices reveals changing practice patterns that reflect an increased focus on cost containment and patient safety, according to researchers from The Miriam Hospital.

The findings, published online in the Journal of Nuclear Cardiology, provide valuable baseline data that allows organizations such as the American Society of Nuclear Cardiology (ASNC) to monitor the effects of future regulatory, insurer, payor and other external influences on these noninvasive cardiac imaging tests.

“Many factors are currently affecting the practice of nuclear cardiology in this country, including dramatic reductions in reimbursement, increased regulations and an explosive growth of at-risk patients, such as obese individuals and those with diabetes,” said lead author Peter Tilkemeier, MD, interim director of cardiology at Rhode Island and The Miriam hospitals. “This data can prove invaluable to target educational needs of nuclear cardiologists and radiologists and also inform health care policy of contemporary nuclear cardiology practice.”

Nuclear cardiology studies are procedures in which a small amount of radioactive material is used to assess blood flow in the heart, evaluate the pumping function of the heart and visualize the size and location of a heart attack. A very sensitive gamma camera then takes still pictures and movies of the heart with rest, exercise, or medication-induced stress testing.

These highly accurate measurements of heart size and function and amount of heart muscle at risk of damage enable cardiologists to better prescribe medications and select further testing like a coronary angiogram, the need for angioplasty and bypass surgery, or devices to optimize treatment outcomes.

Tilkemeier and colleagues randomly surveyed nuclear cardiology practices nationwide, focusing on 73 imaging laboratories representing 202 physicians (mostly cardiologists) and 177 technologists. When compared to a similar survey conducted ten years ago, the authors noted nuclear cardiology laboratories are increasingly found in hospitals, rather than standalone cardiology practices. They also found that, compared with 2001, the use of higher dose dual isotope imaging protocols dropped from 72 percent to 15.6 percent, a likely result of increased attention on reducing radiation exposure.

“Despite this positive step toward achieving ASNC’s radiation safety goals, there is still substantial room for improvement,” said Tilkemeier. “Specifically, practices should develop programs to promote increased use of lower dose stress-only and stress-first protocols and also limit use of dual isotope imaging involving thallium.”

The research team also surveyed members on five markers of quality, ranging from post-test therapeutic management to radiation dose tracking. According to their findings, 61 percent of practices use the American College of Cardiology’s Appropriate Use Criteria for radionuclide imaging for their image interpretation and final report. Meanwhile, only 32 percent of laboratories say they provide guidance on post-test therapeutic management in their final report. The vast majority of laboratories (89 percent) reported performing correlations between nuclear cardiology results and invasive coronary angiography. And only 33 percent of practices reported implementing some form of radiation dose tracking.

Study co-authors included Leslee J. Shaw, MD, Jacqueline Green, MD, MPH, and Reza Fazel, MD, MSc from Emory University School of Medicine; Andrew J. Einstein, MD, PhD, from Columbia University College of Physicians and Surgeons; Patricia Reames, RTR, CNMT, NCT, from Ohio State University.

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