How to take your CCTA program to the next level
Hospitals and cardiology practices are increasingly turning to coronary CT angiography (CCTA) as guidelines and payer policies evolve, but successful program growth requires careful planning, according to Jaime Warren, EdD, MBA, BHS, CNMT, NCT, FACC, vice president of care transformation at MedAxiom, an ACC company.
“Questions about CCTA expansion come to us multiple times per week,” Warren said. “They’re often centered on two main issues—how cardiology can better partner with radiology, and how practices can consider owning and managing their own CT equipment and outpatient imaging centers.”
Once the domain of large academic centers, CCTA programs are now increasingly being adopted in smaller cardiology practices. Warren said this shift is partly driven by the 2020 chest pain guidelines, which recommend CCTA as a first-line test in many patients. That has prompted practices to reevaluate their nuclear medicine SPECT volumes and consider whether investing in a CT scanner could be a better long-term strategy.
But starting or expanding a program is not as simple as buying a scanner. “When we think about cardiology running outpatient centers, we don’t always think about questions like, where do you get contrast from? Where do you find a CT technologist? How do you structure the workflow?” Warren explained. “Those are the kinds of questions that come our way.”
Insurance coverage has also pushed adoption forward, reinforcing the need to apply appropriate-use criteria to select the right patients for the right test at the right time.
Warren emphasized that change management is a critical piece of program expansion. Too often, she said, institutions invest millions in new scanners without involving technologists or frontline staff in the planning process. That can create friction that could have been avoided through early collaboration. She said while expanding CCTA seems like a great idea, the front line technologists may share issues with not being able to keep up with current scanning volumes and the need for more staff, or the need for cardiac CT specific training.
“The workflow really begins when the patient arrives in the parking lot,” Warren said. “From preparation, to scanning, to turning over the room, there are many moving parts. If your technologists and imaging staff have a seat at the table from the beginning, you will have a stronger program and a more positive patient experience.”
She pointed to parallels with structural heart programs, where imaging is a critical piece of care coordination. For example, transcatheter aortic valve replacement planning committees sometimes neglect to include imaging leaders, leading to resource strain after volumes increase.
“It’s about having the full patient journey in mind and giving imaging a true voice,” Warren said. “If your staff feels like they’re part of the team, you’ll not only run a better program, but you’ll become the employer of choice.”
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]