The Changing Role Of Cardiac CT As Radiation Doses Decline

The increasing utilization of medical imaging for both screening and diagnosis has focused more attention on the potentially harmful effects of initial and potentially cumulative radiation exposure. CT vendors and researchers have responded with a variety of strategies for reducing the radiation dose required for a Cardiac CT Angiography. While the dose has remained essentially unchanged for other cardiac imaging modalities (such as a nuclear stress test) these new techniques for Cardiac CTA mean that many patients can be evaluated at extremely low doses. As the radiation dose of a Cardiac CTA approaches that of common screening studies such as Mammography, it is raises the question of whether CTA will eventually replace other modalities as the primary diagnostic or screening cardiovascular study?

The Time Are A'Changing for Reimbursement 

And nowhere are they changing faster than in Cardiac CT. The latest agent of that change is a sudden shift in the insurance reimbursement landscape.

The introduction of 64-Slice Coronary CT Angiography promised to revolutionize, and possibly threaten, the practice of cardiology. But the difficult reimbursement environment quelled the initial burst of enthusiasm and limited widespread use. Early adopters found they encountered unexpected expenses and patients who preferred an invasive procedure covered by their insurance to paying out of pocket for a simpler and safer test.

The need for cardiologists to be prepared for wider use of cardiac imaging has been a settled issue for several years. When the ACCF/AHA Cardiac CT Credentialing Guidelines were published many cardiologists quickly signed up for CT training to ensure they qualified for Level II Training prior to the grandfathering deadline of mid-2008. When the deadline was extended to 2010 it seemed to remove the sense of urgency and many put off their training.