The importance of multidisciplinary heart teams has soared in the past decade, starting with structural heart and then moving to heart failure, cardio-oncology, and acute care teams for pulmonary embolism, aortic aneurysm and stroke. At the forefront of all of these teams are multimodality imagers, who play a pivotal role in enhancing connecting all the team members and impacting patient outcomes. These types of heart and care teams are reshaping the landscape of cardiovascular medicine.
One of the evangelists for promoting the role of heart team imagers is João Cavalcante, MD, section head for cardiac imaging for the Allina Health Minneapolis Heart Institute. He spoke in sessions at the Radiological Society of North America (RSNA) 2023 meeting on various cardiac imaging topics and worked to get more radiologists interested in cardiac imaging to fill the imager role on cardiac care teams. The imager's role is also growing since cardiac CT its seeing expanded use and these images are being used increasingly to also help surgeons and interventional cardiologists with preplanning and peri-procedural guidance. He spoke with Cardiovascular Business during RSNA.
"The imagers, be that a cardiologist or radiologist, is going to be very important to bring the team together. The value for this heart team, this is something that there are many training pathways. We need more of us, we need more folks. Especially at a meeting like RSNA we really want to highlight the number one killer in the world is heart disease. Yet cardiac imaging is not as visible as other domains at RSNA, like brain, knees and breast, because it's still relegated to a smaller cohort of a group of individuals that have that vested interest," explained Cavalcante.
He underscores the transformation in patient care ushered in by these multidisciplinary teams. Each team member contributes a unique skill set and perspective, with imagers standing as the bedrock of best practices. Their proficiency in acquiring and interpreting high-quality images becomes integral not just in solitary readings but in active participation during multidisciplinary meetings. These sessions foster collaborative discussions, guiding treatment decisions for individual patients.
Historically there were silos within cardiology and radiology, and competition between surgeons and interventional cardiologists greatly limited collaboration. But today, Cavalcante said imagers help bridge these gaps, conversing fluently with various specialists and bringing additional clinical insights and skill sets into the conversations.
The evolution of these teams is not limited to structural heart concerns anymore and now extends to a wide spectrum of cardiac issues, from aortopathy to congenital heart disease and cardio-oncology. The complexities faced in treating older patients with diverse comorbidities also highlight the necessity for collaborative approaches between specialists and a blend of diverse voices within these teams to offer other prospectives on how to best care for the patient.
"It's not uncommon that we get asked, 'Can you take a look at this study? Can you help me out? What should I do next?' So it's not just an interpretation in the vacuum. You have to really integrate into looking at the chart, looking at other special specific cardiac studies to really convey the direction, the guidance that the physicians need. And that is obviously at the reading center, but also during this multidisciplinary teams that we have once a week in which we discuss patient by patient how to also interpret these images to provide the best results for the treatment. And that's why I think this field continues to evolve, because these therapies are not a static. And the risk as well in these procedures and who can be treated also continues to change," Cavalcante explained.
There is a growing need for more heart team, multimodality imagers
Just as there is a growing shortage of radiologists, which was very pronounced at RSNA this year, there is also a shortage of these multidisciplinary imagers for heart teams.
"We're going to need more people interested. We see already that interest coming from the cardiology side and I'm talking with a few colleagues also there is interested from the radiology side as well. And there are programs that would train both and that is the best. And when they really can cross-pollinate and they can share their knowledge together," Cavalcante said.
However, integrating imagers into these teams also necessitates time and resources, since the work they do is not completely covered by traditional RVU models. Different models exist, from specialized 3D labs to training programs involving fellows that can help with a lot of the work. He said each model demands due compensation and acknowledgment for the invested time and expertise.
Cavalcante said the message is simple: the world’s leading cause of death, heart disease, demands a more inclusive approach. Also, there is a need to expand the cadre of individuals passionate about cardiac imaging to enhance patient care.
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: dfornell@innovatehealthcare.com