SNMMI: Cool pics dont cut it-why imaging needs comparative effectiveness studies

Cardiac CT with Somatom DefinitionSource: Siemens Healthcare

MIAMI—It’s not enough to generate cool pictures for referring physicians, Rory Hachamovitch, MD, of Cleveland Clinic, said during a comparative effectiveness research symposium in cardiovascular molecular imaging at the annual meeting of Society of Nuclear Medicine and Molecular Imaging (SNMMI). Instead of anatomical endpoints, referring physicians need information about whether or not the imaging exam benefitted the patient. These data form the crux of comparative effectiveness research.

The pitfall for imagers in comparative effectiveness is that the value of imaging cannot be directly assessed. “This may be a fatal flaw,” said Hachamovitch. “Imaging doesn’t alter patient outcomes. It alters physician management, which alters treatment, which, [in turn] impacts outcomes.”

Despite the inherent challenges of comparative effectiveness research, there may be some golden opportunities for cardiovascular imagers, said Hachamovitch. These include:

• Clinical situations where there is a frequent or impactful disease state;
• Clinical situations characterized by uncertainty regarding decision-making; and
• Clinical situations in which a treatment is available but expensive.

Examples of situations that meet the bar include use of an imaging exam to determine patients who would benefit from a coronary artery bypass graft, percutaneous intervention or desynchronization therapy. A trial that demonstrated which patients are most likely to have an ICD fire would be a boon to the field of electrophysiology, continued Hachamovitch.

Prospective researchers should ponder a pair of pointers to set the stage for a meaningful trial. The results of the imaging study should be the basis of a change in therapy and intervention on the basis of results should improve patient outcomes.

Hachamovitch concluded by emphasizing the challenge and opportunity for imagers. “Until imaging can be shown to enhance outcomes or patient benefits, its future will remain uncertain. Comparative effectiveness research is a huge opportunity for us to show what our field can offer.”