ESC recommends interdisciplinary collaboration in non-invasive imaging

The paper is a joint statement from the Presidents and Chairmen of several specialty groups within the European Society of Cardiology – the European Association of Echocardiography, the Working Group on Cardiovascular Magnetic Resonance, the Working Group on Computers in Cardiology, and the Working Group on Nuclear Cardiology – together with colleagues from the European Association of Nuclear Medicine and the Association for European Paediatric Cardiology. Uniquely, the statement is being published simultaneously by three specialist medical journals – the European Heart Journal, the European Journal of Echocardiography, and the European Journal of Nuclear Medicine and Molecular Imaging.

The major recommendations are:

• Cardiac units should develop joint clinical services with common diagnostic pathways for patients with suspected cardiovascular disease, which are organised in collaboration between cardiologists, radiologists, and specialists in nuclear medicine. This will require reorganisation of traditional hospital structures and a new way of working.
• Future diagnostic specialists in cardiology should be trained in several imaging modalities.
• Diagnostic tests should be evaluated by their impact on clinical outcomes, rather than their ability to provide better pictures or more diagnostic information. Different tests vary widely in their technical requirements, benefits, limitations, and costs. Surprisingly, relatively little is known about which diagnostic tests most favourably change the course of an illness, when clinical decisions are based on the findings of the test. At the same time, most diagnostic tests are imperfect – they cannot always give the correct answer.
• Diagnostic guidelines should compare all methods that can be applied to a particular clinical question. Clinical doctors need impartial expert advice that summarises and compares all the alternative tests.
• New criteria need to be developed for judging the quality of diagnostic research.
• Expertise in clinical diagnosis and imaging needs to be encouraged in universities, and funding should be available for research in diagnostic methods as an integral component of basic, epidemiological and clinical collaborative research networks.

Professor Michal Tendera, President of the European Society of Cardiology, described this document as “an important step forward in the discussion of the future of imaging.”

“Advances in imaging technology now provide a wonderful spectrum of diagnostic tools to investigate heart and vascular disease, but much less is known about which test performs best in which circumstances and which test might have the greatest impact on improving treatment” said Alan Fraser, President of the European Association of Echocardiography. “There is an urgent need for collaboration between experts in different techniques, with appropriate research funding, to establish how these expensive tools can best be used to provide the greatest benefits to patients and to reduce health care costs”.