A Conversation with ASNC President Dr. James A. Arrighi

June 16, 2013

What are the specific effects of the cost and value conversation on the practice of nuclear cardiology?
Conversations about cost and value of nuclear cardiac imaging are important but should not replace those about quality imaging. As cardiac imagers, our two major responsibilities are first to ensure that a test is properly indicated, and second, to select protocols that will result in high-quality studies with the least risk to the patient. A low-quality study represents wasted cost and has no value! We must ensure that our referring physicians are obtaining clinically useful information from our studies.

Patient safety is another major theme that comes up in policy and clinical conversations, particularly involving exposure to radiation. What do patients and policymakers need to know about the risks and benefits of nuclear cardiology?
First, we must convince both patients and policymakers that whenever we order or perform a particular diagnostic test, including nuclear cardiology procedures, we are doing so because that test has potential benefits for them. For nuclear cardiology procedures in particular, this means that the results of the test may influence management and/or assist in prognostication. If the test has no potential benefit, then discussions of risk are moot. The profession as a whole must earn the public trust, and we must demonstrate that we are committed to police and educate ourselves, to ensure that we are always acting with the best interests of the patients in mind. Second, we must demonstrate to patients and policymakers that decisions on which test and which test protocol is used for a particular case are best made by the cardiologist. We have the expertise to choose among a rapidly increasing set of options.

How can clinicians both in advocacy and practice make the case for the value of the work they do?
In a broad sense, scientific studies that address the clinical value of cardiac imaging will provide an important piece to this puzzle. But in everyday practice, I think clinicians can demonstrate value by adhering to old-fashioned principles of providing a good quality service, communicating effectively with patients and referring providers and by being honest about the strengths and limitations of what we do.