Improving Imaging
Our Professional Imperative
Pamela S. Douglas, MD, MACCa,*
Cardiovascular Medicine Division, Department of Medicine, Duke University, Durham, North Carolina
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Figure 1 (A) Current American College of Cardiology/American Heart Association (ACC/AHA) Guidelines contain a total of 745 recommendations on the use of imaging, with just over one-half being class I, indicating that the procedure is beneficial, useful, and effective, and only 18% class II, indicating that the procedure is not useful or effective and may be harmful. (B) The level of evidence to support the use of imaging used in the ACC/AHA Guidelines is in contrast to the class of the recommendations. The majority are level 3, indicating that the recommendation is supported only by the consensus opinion of experts, case studies, or standard-of-care, rather than representing level 1 evidence derived from multiple randomized clinical trials.
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Figure 2 (A) The current process of imaging development requires only demonstration of technical capability or test performance for reimbursement and subsequent clinical adoption, without a need for demonstration of clinical utility. Further, there are few intermediate steps designed to assess the impact of such use and few guidelines directed at ensuring appropriate care. Finally, it is linear, with little feedback from clinical experience onto subsequent technology development. (B) An ideal cycle of imaging development would incorporate all of these steps into a continuous creation of evidence and incorporation into clinical care as well as the development of new imaging technology.
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