CA's, MRA's

[fedor]

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What percentage of coronary angiographs are done by radiologists versus cardiologists?

I'm aware that angioplasty is a form of CA that is now usually done by cardiologists but was originally developed by radiologists.

MRA's are being developed by radiologists, but are these being used clinically these days or so far just in research studies?

Would you say that eventually (1) MRA will replace CA and that (2) MRA will remain firmly in the domain of radiologists?

 

[hans19]

What percentage of coronary angiographs are done by radiologists versus cardiologists?

I'm aware that angioplasty is a form of CA that is now usually done by cardiologists but was originally developed by radiologists.

MRA's are being developed by radiologists, but are these being used clinically these days or so far just in research studies?

Would you say that eventually (1) MRA will replace CA and that (2) MRA will remain firmly in the domain of radiologists?

0% of conventional coronary angiograms are done by radiologists today. You are correct, coronary angiography was mostly developed by radiologists. In fact some programs in the Northeast still retain the vestiges in their titles IE 'Cardiovascular and Interventional Radiology' fellowships at MGH.

MRA is used to evaluate the great vessels and peripheral arteries. If anything , vascular surgeons rather than cardiologists will want to get in on this, but MR is much harder to pick up than fluoroscopy. It is not really used for coronary angiography. MR is used in cardiac studies to study ventricular function and perfusion. CTA is used to study the coronaries.

Currently, most of CTA (CT angiography) is performed by radiologists in academia and cardiologists in private practice. In the future it will be closer to 50-50: cardiologists will interpret the CTAs of their own patients and Radiologists will read the CTAs of the patients coming through the ER. Furthermore, the acquired data from a CTA includes information about the mediastinum and the lungs, which the radiologist is better suited to read.

 

[awdc]

That's interesting... Did cardiology teach themselves how to perform coronary angios or was it radiology that taught them. Could the same thing happen with neurointerventional procedures and neurologists or neurosurgeons? Do radiologists care or are they just happy to let someone else do this type of work?

 

[hans19]

That's interesting... Did cardiology teach themselves how to perform coronary angios or was it radiology that taught them. Could the same thing happen with neurointerventional procedures and neurologists or neurosurgeons? Do radiologists care or are they just happy to let someone else do this type of work?

Radiologists taught cardiologists, then the cardiologists taught each other.

The same could conceivably happen with neurointerventional procedures. Most general private practice neurosurgeons primarily work outside the cranium (ie spinal surgery)- its lucrative and offers a reasonable lifestyle. Less neurosurgeons are interested in cerebrovascular disease (not so great lifestyle with no extra compensation). However, those that are interested in cerebrovascular disease will try to learn endovascular procedures for self-preservation. Look what coronary angioplasty/stenting did to the CT surgeons--The treatment of coronary disease was once the bread and butter of the CT surgeon. Something that should be made clear-- Neurointerventional procedures are not a replacement for bread and butter neurosurgery, it is complementary to a subset of neurosurgical procedures-- those that deal with neurovascular disease.

As far as non radiologists taking over neurointerventional procedures, the problem is that many radiology residents (and most graduating med students) are more life-style conscious. Few are willing to pursue 3 - 4 extra years of fellowship training (thats 3-4 years of opportunity cost) for a potentially horrible lifestyle for a modest increase in compensation.

There is a need for neurointerventionalists, and if no radiologist residents are willing to step up to the plate, the academic neurointerventionalists will take on an aggressive neurologist or neurosurgeon, if for no other reason, to help with the huge workload.

 

[fedor]

Great explanation! Thanks