Can Radiology & Cardiology Discover Common Ground?


Angio Operation It’s like the movie, West Side Story, in the battle for the CT angiography turf. The radiologist and the cardiologist are the modern day “Sharks” and “Jets” in the fight to own the market. Who will emerge victorious? Will there be a Tony and Maria to bring the two sides together? The drama is palpable; and the two sides are not playing it so cool.

A War of Words

The battle lines are certainly not new.

“Radiologists are going to fight for control of CT angiography, there’s no question about it,” radiologist Dr. David Levin (Thomas Jefferson University, Philadelphia, PA) told heartwire in 2004. “And if there’s going to be a battle—if the cardiologists want to make a battle out of it—I think the radiologists are going to win.”

In the same article, and speaking for the cardiology side, Dr Matthew Budoff (University of California, Los Angeles) called the simmering dispute over CT angiography a “national war.”

“I think who controls the equipment, who owns the equipment, and who interprets the scan are all going to be under intense debate,” he acknowledged. “Some radiologists have a different perspective on this, but I think in reality cardiac CT is going to go the way of echo, catheterizations, and nuclear medicine. Cardiologists are going to manage, run, interpret, and order the tests and that’s just the way that cardiology practice operates in the US.”

Fast forward to 2005. At the Radiological Society of North America (RSNA) meeting in November 2005 Dr. Levin presented research at the meeting showing that radiologists’ share of the cardiovascular imaging market declined between 1993 and 2002. During the same period, cardiologists’ share of the market rose substantially.

The New Landscape

While the war may still burn, there is more recent evidence to suggest that this has been brought down to a simmer rather than a rage.

According to a 2011 article by Lisa Fratt of Health Imaging “A new collaborative model is beginning to emerge across the radiology/cardiology spectrum—cardiovascular imaging, vascular medicine and cardiac cath labs. Indeed, external factors, including healthcare reform, reimbursement cuts and increasing health imaging scrutiny, may accelerate the development of partnerships and blur traditional boundaries between specialties and departments.”

Further, a number of health care systems can be seen first-hand working to end this turf battle and focus on cooperation to the benefit of the patient.

Fratt’s article shares the story of Winthrop University Hospital in Mineola, N.Y., describing how it recently formalized a collaborative comprehensive cardiovascular imaging program. “Before this, patients were traveling to different institutions for cardiac CT and MRI. Studies weren’t directly accessible to our cardiologists,” recalls Orlando Ortiz, MD, MBA, chairman of radiology. Now, cardiologists and radiologists work together to obtain the highest quality study based on the patient’s history and presentation. The two departments are adjacent. Kevin Marzo, MD, chairman of cardiology at the hospital put it like this, “We’re talking to each other all of the time. It makes for a healthy relationship.”

Now is the time for radiologists and cardiologists to end the turf wars and play it cool, real cool.

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