The business of cardiac CT

Cardiac CT is not just about the science; there also is a business aspect that is important for hospitals, imaging departments, cardiologists and radiologists to all understand. This is especially true as more hospitals expand or initiate cardiac CT programs. Sessions at SCCT 2023 included several discussions on the business side of CT operations. This included topics like CPT codes, reimbursement structures, recruiting, retaining staffing amid the current shortage and dealing with insurance companies. These discussions are vital to ensure that cardiac CT remains accessible and sustainable for patients and healthcare providers alike, Ghoshhajra said.

"With the 'Business of CT' session, they talked a lot about CPT codes and how to work with CMS and the insurance companies. Physicians are trained to go treat patients and look at things clinically. They're not trained in the ones and zeros to do the accounting for the department," Ghoshhajra explained. "In the U.S., we have Medicare as the elephant in the room ... we always want to make sure we have reimbursements maximized and fairly accounted for. Also, the CPT codes and the way that things are categorized should be consistent."

Click here for an interview with Mark Rabbat, MD, chairman of the SCCT Advocacy Committee and one of the speakers from the Business of Cardiac CT session.

The proliferation of AI in cardiac CT

Artificial intelligence (AI) has been a buzzword in medical imaging, and cardiac CT is no exception. Ghoshhajra emphasized that the era of "big recon" AI is upon us, with numerous companies looking to enhance interpretive and reconstruction capabilities using the technology. This includes very detailed and precise assessments of coronary plaque that would be too time consuming for a human imager to calculate manually. AI is also automating CT fractional flow reserve (CT-FFR) assessments to noninvasively evaluate hemodynamic flow and it enabling automated quantification of various diseases, structural heart measurements, CAD-RADS scores, calcium scoring and other tasks to save the human imagers time and make workflow more efficient.

However, he said the implementation of AI also comes with ethical, financial and practical challenges that require oversight and validation to ensure real-world efficacy and safety.

"There are a ton of companies that want to get involved in AI, especially on the interpretive in the reconstruction side. It's rubber meets road and there's a long road to implement any of these AI algorithms," Ghoshhajra  explained. "Plaque analysis is something that gets too detailed and too heavy of a lift for individual readers to do and do consistently."

He said discussions have moved away from hype to how FDA-cleared AI algorithms can help an institution solve workflow issues. With several vendors now getting commercial approval for their algorithms, physicians are going to have to pick which ones to use.

"It is nice to have all the different options, but you really should select one and make sure it's implemented correctly. And those are the kind of issues that practitioners of cardiac CT are going to have to deal with. Which algorithm do you select? Are you using it properly and are you validating the results that you think you're going to get, that you're getting?" Ghoshhajra said. 

So in addition to the image reconstruction space, he said structural heart applications are now being seen for all of the valve positions. He said nearly all structural heart interventions have CT component for analysis and procedure preplanning. 

Growing role of structural heart cardiac CT

Cardiac CT has become a standard tool for the analysis of various interventions involving heart valves. From transcatheter aortic valve replacement (TAVR) to other implantable valves, cardiac CT plays a crucial role in preoperative planning and postoperative assessment. This trend highlights the expanding applications of cardiac CT beyond diagnostics.

Structural heart imaging has been a growing field, and SCCT 2023 continued to showcase its importance in sessions, including hands-on sessions for using various types of assessment software tools.  

Impact of chest pain guidelines on CT is helping expand its use

The release of 2021 ACC/AHA chest pain guidelines elevated coronary CT angiography (CCTA) to a class 1A recommendation. This has had a significant impact on the field in the past two years. Cardiac CT volumes have increased as more referring physicians recognize its clinical utility, aligning with the science behind it.

Ghoshhajra said SCCT 2023 also witnessed record-breaking meeting attendance, with more than 900 attendees and a membership close to 4,000, the highest it has been since the society began in 2005. This growth underscores the increasing interest and importance of cardiac CT in the medical community. He added that the expansion of the technologist membership is particularly noteworthy, as it highlights the collaborative effort required to leverage the potential of cardiac CT. While the latest science and techniques are discussed in sessions at SCCT, Ghoshhajra said these cannot be put into daily practice without the work of the technologists who actually scan the patients. 

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