The Back Page: ASNC Commits to Patient-Centered Care
The 16th annual scientific session of the American Society of Nuclear Cardiology (ASNC), Sept. 8-11, brings together scientists, clinicians and industry to establish and discuss optimal standards of imaging care. Thus, this year's meeting focuses on patient-centered imaging. Putting the patient first for safe and effective clinical decision-making cannot be emphasized enough in the present environment of pre-certification, prior authorization and reimbursement decisions that are based on saving money instead of patient needs.

While nuclear cardiology is the meeting's foundation, the society also evaluated the complementary role of other modalities such as cardiac CT, MRI and echocardiography to achieve the goal of providing optimal care to patients.

Three elements of patient-centered imaging, which were reinforced during this year's conference, are:
  1. Appropriate use criteria (AUC),
  2. Comparative effectiveness research, and
  3. Radiation safety.
As one of the partners of the published AUC for nuclear imaging, along with the American College of Cardiology, ASNC supports the adoption of the criteria by nuclear cardiology laboratories and promotes the use of AUC by government and private payors to track and manage utilization practices. As a process improvement tool, AUC can target who will benefit from imaging, as well as inappropriate candidates for imaging. Inherent in AUC is the concept of safety because an appropriate indication is by definition one in which the clinical benefit exceeds the projected risk in terms of radiation exposure.

During this year's meeting, various sessions examined how AUC can help predict inappropriateness criteria and how to ensure referrals for SPECT, or other imaging exams, are appropriate.

Comparative effectiveness research is essential to guide clinical decision-making in a multimodality imaging world and expand novel indications for testing. Developing practice-based registries also will be important for this process. This focus was exemplified in ASNC2011 presentations, like "Comparative Effectiveness of Software and Hardware Approaches to Limit Radiation Exposure in Myocardial Perfusion SPECT."

Finally, helping clinicians, policymakers and patients weigh the clinical benefits compared with radiation exposure is vital to patient-centered care. This demands that we guarantee that nuclear imaging is AOK: Appropriately utilized, Optimally dose-reduced for large segments of the population (whenever possible) and conducted by Knowledgeable practitioners and laboratory staff.

Numerous experts discussed the complicated issue of radiation dose and evaluation of radiation risk throughout the meeting in sessions, such as "Radiation Safety: The Technologist's Role in Reducing Exposure" and "Clinical Value of Contemporary Nuclear Cardiology in an Era of Radiation Scrutiny."

Through didactic lectures, panel discussions and more than 90 abstract presentations, ASNC2011 provided attendees with new data and best practices to ensure that their patients receive the right test at the right time.  

In the near future, physicians will need to be positioned to demonstrate value and advocate for payment and reimbursements that are based on quality, which will permeate all facets of physician practice, including imaging. Success in the new healthcare paradigm will require a patient-centered approach to the delivery of care, which is why ASNC launched the Excellence in Imaging campaign that seeks to drive education and research in nuclear cardiology. 

By taking a proactive stance on defining quality in nuclear cardiology and demonstrating our members' commitment to these defined quality measures, ASNC hopes to lead the discussion about appropriate use and set the standards by which our patients receive optimal care.

Dr. Shaw is the ASNC president, and an outcomes research scientist with a background in the diagnosis of coronary disease and the evaluation of cardiovascular imaging modalities at Emory University.