By Dr. Alberto Morales

Recognizing that fewer than 5% of U.S. patients who need cardiac CT scans receive them when needed, I decided to take a different approach. Aware of the shifts in cardiology and realizing the potential of advanced imaging technologies, I recognized a clear need for a more straightforward and patient-focused diagnostic process.

The traditional approach, which makes use of external referrals and involves multiple healthcare facilities, hinders both efficiency and the overall patient experience. For providers, the decision to refer patients out for imaging often comes with a cost — not just in terms of added burden for patients, but also missed revenue opportunities.

Recognizing the necessity for a more integrated and accessible solution to cardiovascular healthcare, I envisioned a model of in-house cardiac imaging that would redefine patient care and set a standard for cardiology's future. The implementation of in-house cardiac imaging streamlined patient care, improved efficiency and personalized services, as well as increased patient motivation and compliance.

Charting the advancement of cardiac imaging
Nearly a decade ago, I completed an advanced cardiac imaging fellowship at the University of South Florida. During that period, I developed a sense of how advanced imaging will shape the future of cardiology. Recognizing the community's needs, I gave lectures and worked on building a program and referral network with other hospitals and cardiology groups.

Since the introduction of 64-slice scanners in the early 2000s, CT imaging of the heart has evolved significantly, with later scanners offering higher speeds, increased volume coverage, and enhanced capabilities. The non-invasive procedure does not require hospitalization and is well tolerated by most patients.

Modern scanners and techniques have reduced radiation and contrast agent doses to modest levels. High-resolution anatomical images of the heart and coronary arteries are useful in identifying various heart diseases and conditions, while a considerable number of invasive catheterizations often fail to identify significant obstructions. The need for such interventions can be mitigated through prior CT imaging of the coronaries.

Committed to elevating patient care, I established my own private practice utilizing advanced imaging technologies. As the first private cardiologist in the region to embrace cardiac CT and MRI, I aimed to enhance diagnostic practices and empower patients with a deeper understanding of their cardiac health.

A new approach to preventative cardiology and streamlined patient care
Incorporating advanced imaging into my private practice was a significant professional milestone. By presenting patients with their cardiac CT and MRI images, detailing the current state of their arteries, and comparing them to others, we provide a deeper understanding of each patient's condition and look to uncover potential issues that may go unnoticed in conventional stress tests.

In a recent case, a 42-year-old man with a family history of heart issues had undergone years of normal stress tests, reassured by various cardiologists about his low risk. Despite being told he had the "heart of a lion" and normal arteries, an in-office coronary CT angiogram revealed that he had significant blockages in all three major blood vessels.

The unexpected finding elevated his risk to stage three, indicating a more than 15% chance of heart attack or death over the next 15 years. The disparity between previous stress test results and the CT angiogram emphasizes the value of direct testing in assessing true cardiovascular risk.

The in-house model has also streamlined the patient experience by eliminating the need for external referrals and reducing barriers associated with visiting separate imaging facilities. Our in-house setup enables quicker assessments, timely interventions, and an overall smoother healthcare journey for our patients.

Consolidating the diagnostic process within our practice ensures that patients no longer face challenges navigating through multiple facilities. Patients benefit from interacting with a familiar team, receiving detailed explanations about their imaging procedures, and having a consistent point of contact throughout their cardiac imaging experience.

Advancing patient safety and diagnostic precision
Advanced scanners also offer significant improvements in patient safety. By reducing radiation exposure and contrast load, the advanced imaging tool aligns with evolving care standards. The focus on minimizing potential risks while maintaining diagnostic accuracy paves the way for a safer, more patient-centric future in cardiac imaging.

A scanner's ability to provide detailed insights into plaque progression and stabilization is an important advancement in cardiovascular care. Moving beyond traditional risk assessments, modern scanners allow for a meticulous arterial health examination. The shift from indirect surrogate markers to direct visualization of arteries enhances diagnosis precision.

In another recent case, a patient came to me after seeing other doctors related to chest tightness, shortness of breath, and swelling of her left leg. Despite normal results from tests conducted by two different cardiologists and a lung specialist, her symptoms persisted. Reviewing her non-contrast CT chest scan, I detected no signs of lung inflammation or bronchial changes. Concerned about her pulmonary health, I conducted an ultrasound of her heart, revealing slightly elevated pulmonary pressure.

A subsequent chest CT scan revealed extensive clots throughout her lungs. We promptly referred her to the hospital, initiating blood thinner therapy and ensuring appropriate management. In this case, in-house cardiac imaging helped uncover critical diagnoses that might otherwise have gone unnoticed.

Enhancing practice growth for providers
The choice to bring in-house cardiac imaging into my practice has not only been beneficial for patient care but has also had a positive impact financially. An in-house CT scanner has proven to be a pivotal asset in propelling our practice’s growth. Comparing this year's figures with the previous one, we've seen a remarkable increase in revenue.

Our convenience and expertise have made us a national hub for cardiac care. We have elevated both our practice quality and the referral pattern. The scanner's comprehensive and efficient imaging capabilities have made us the preferred choice for referrals from other healthcare professionals. As a result, we have simplified our referral process and strengthened our collaborative network.

The future of cardiology
For providers contemplating advanced imaging, it's important to consider having a dedicated in-house reader. An expert who can interpret and analyze imaging results internally streamlines the diagnostic process. Facilitating a seamless communication loop within the practice improves efficiency and patient care.

In-house imaging success is intricately linked to robust referral networks and patient volume generation. Providers should engage in building relationships with referring physicians and cardiology groups. Educating the community about the benefits of in-house imaging can contribute to a steady influx of patients, laying the foundation for a successful practice.

Beyond technological aspects, providers should recognize the importance of a supportive team. The success of incorporating advanced imaging is more than the machine — it relies on a team that understands the nuances of cardiac care and is dedicated to ensuring a smooth and effective integration of in-house imaging into the practice.

In-house cardiac imaging is certainly convenient, but it’s also the future of cardiology. Our approach, combining thorough artery assessments, risk evaluation, and proactive medical management, reflects the direction cardiology is heading. Through our commitment and use of advanced technology, we are practicing what many envision as the future standard of cardiology.

About the author: Dr. Alberto Morales, South Tampa Cardiology and Advanced Imaging Center.