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Manuel D Cerqueira - One of the best experts on this subject based on the ideXlab platform.
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the future of Cardiac Imaging report of a think tank convened by the american college of cardiology
Jacc-cardiovascular Imaging, 2016Co-Authors: Pamela S. Douglas, Partho P Sengupta, Manuel D Cerqueira, Daniel S Berman, Kavitha Chinnaiyan, Meryl S Cohen, Justin B Lundbye, Rajan A G Patel, Prem Soman, Neil J WeissmanAbstract:The American College of Cardiology's Executive Committee and Cardiovascular Imaging Section Leadership Council convened a discussion regarding the future of Cardiac Imaging among thought leaders in the field during a 2 day Think Tank. Participants were charged with thinking broadly about the future of Imaging and developing a roadmap to address critical challenges. Key areas of discussion included: 1) how can Cardiac Imaging services thrive in our new world of value-based health care? 2) Who is the Cardiac imager of the future and what is the role of the multimodality imager? 3) How can we nurture innovation and research in Imaging? And 4) how can we maximize Imaging information and optimize outcomes? This document describes the proceedings of this Think Tank.
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patient centered Imaging shared decision making for Cardiac Imaging procedures with exposure to ionizing radiation
Journal of the American College of Cardiology, 2014Co-Authors: Andrew J Einstein, Manuel D Cerqueira, Jeffrey J Carr, Thomas C Gerber, Daniel S Berman, James K Min, Robert C Hendel, James S Cullom, Robert A Dekemp, Neal W DickertAbstract:The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered Imaging and shared decision-making in Cardiac Imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an Imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An Imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of Cardiac Imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the Imaging community to create an accountability framework to safely drive appropriate Imaging utilization.
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patient centered Imaging shared decision making for Cardiac Imaging procedures with exposure to ionizing radiation
Journal of the American College of Cardiology, 2014Co-Authors: Andrew J Einstein, Manuel D Cerqueira, Jeffrey J Carr, Thomas C Gerber, Daniel S Berman, Robert C Hendel, James S Cullom, Robert A Dekemp, Neal W Dickert, Sharmila DorbalaAbstract:The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered Imaging and shared decision-making in Cardiac Imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an Imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An Imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of Cardiac Imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the Imaging community to create an accountability framework to safely drive appropriate Imaging utilization.
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selective improvement in seattle heart failure model risk stratification using iodine 123 meta iodobenzylguanidine Imaging
Journal of Nuclear Cardiology, 2012Co-Authors: Eric S Ketchum, Jagat Narula, Arnold F Jacobson, James H Caldwell, Manuel D Cerqueira, Gregory S Thomas, Denis Agostini, Wayne C LevyAbstract:Background The Seattle Heart Failure Model (SHFM) is a multivariable model that uses demographic and clinical markers to predict survival in patients with heart failure. Inappropriate activation of the sympathetic nervous system, which contributes to the progression of heart failure and increased mortality, can be assessed using iodine-123 meta-iodobenzylguanidine (MIBG) Cardiac Imaging. This study investigated the incremental value of MIBG Cardiac Imaging when added to the SHFM for prediction of all-cause mortality.
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standardized myocardial segmentation and nomenclature for tomographic Imaging of the heart a statement for healthcare professionals from the Cardiac Imaging committee of the council on clinical cardiology of the american heart association
Circulation, 2002Co-Authors: Manuel D Cerqueira, Dudley J Pennell, Neil J Weissman, Vasken Dilsizian, Alice K Jacobs, Sanjiv Kaul, Warren K Laskey, John A Rumberger, Thomas J Ryan, Mario S VeraniAbstract:Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), Cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are Imaging modalities that have been used to measure myocardial perfusion, left ventricular function, and coronary anatomy for clinical management and research. Although there are technical differences between these modalities, all of them image the myocardium and the adjacent cavity. However, the orientation of the heart, angle selection for Cardiac planes, number of segments, slice display and thickness, nomenclature for segments, and assignment of segments to coronary arterial territories have evolved independently within each field. This evolution has been based on the inherent strengths and weaknesses of the technique and the practical clinical application of these modalities as they are used for patient management. This independent evolution has resulted in a lack of standardization and has made accurate intra- and cross-modality comparisons for clinical patient management and research very difficult, if not, at times, impossible. Attempts to standardize these options for all Cardiac Imaging modalities should be based on the sound principles that have evolved from Cardiac anatomy and clinical needs.1–3⇓⇓ Selection of standardized methods must be based on the following criteria: An earlier special report from the American Heart Association, American College of Cardiology, and Society of Nuclear Medicine4 defined standards for plane selection and display orientation for serial …
Terrance S J Chua - One of the best experts on this subject based on the ideXlab platform.
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evaluation of the american college of cardiology foundation american society of nuclear cardiology appropriateness criteria for spect myocardial perfusion Imaging in an asian tertiary Cardiac center
Journal of Nuclear Cardiology, 2011Co-Authors: Angela S Koh, Jennifer L S Flores, Felix Keng, Ru San Tan, Terrance S J ChuaAbstract:Background Appropriate use criteria (AUC) for SPECT MPI have been published to address concern about the growth of Cardiac Imaging studies and the effective use of Imaging, but there is no published data on its role outside the United States.
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evaluation of the american college of cardiology foundation american society of nuclear cardiology appropriateness criteria for spect myocardial perfusion Imaging in an asian tertiary Cardiac center
Journal of Nuclear Cardiology, 2011Co-Authors: Jennifer L S Flores, Felix Keng, Terrance S J ChuaAbstract:Background Appropriate use criteria (AUC) for SPECT MPI have been published to address concern about the growth of Cardiac Imaging studies and the effective use of Imaging, but there is no published data on its role outside the United States.
Mario S Verani - One of the best experts on this subject based on the ideXlab platform.
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standardized myocardial segmentation and nomenclature for tomographic Imaging of the heart a statement for healthcare professionals from the Cardiac Imaging committee of the council on clinical cardiology of the american heart association
Circulation, 2002Co-Authors: Manuel D Cerqueira, Dudley J Pennell, Neil J Weissman, Vasken Dilsizian, Alice K Jacobs, Sanjiv Kaul, Warren K Laskey, John A Rumberger, Thomas J Ryan, Mario S VeraniAbstract:Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), Cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are Imaging modalities that have been used to measure myocardial perfusion, left ventricular function, and coronary anatomy for clinical management and research. Although there are technical differences between these modalities, all of them image the myocardium and the adjacent cavity. However, the orientation of the heart, angle selection for Cardiac planes, number of segments, slice display and thickness, nomenclature for segments, and assignment of segments to coronary arterial territories have evolved independently within each field. This evolution has been based on the inherent strengths and weaknesses of the technique and the practical clinical application of these modalities as they are used for patient management. This independent evolution has resulted in a lack of standardization and has made accurate intra- and cross-modality comparisons for clinical patient management and research very difficult, if not, at times, impossible. Attempts to standardize these options for all Cardiac Imaging modalities should be based on the sound principles that have evolved from Cardiac anatomy and clinical needs.1–3⇓⇓ Selection of standardized methods must be based on the following criteria: An earlier special report from the American Heart Association, American College of Cardiology, and Society of Nuclear Medicine4 defined standards for plane selection and display orientation for serial …
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standardized myocardial segmentation and nomenclature for tomographic Imaging of the heart a statement for healthcare professionals from the Cardiac Imaging committee of the council on clinical cardiology of the american heart association
Circulation, 2002Co-Authors: Manuel D Cerqueira, Dudley J Pennell, Neil J Weissman, Vasken Dilsizian, Alice K Jacobs, Sanjiv Kaul, Warren K Laskey, John A Rumberger, Thomas J Ryan, Mario S VeraniAbstract:Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), Cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are Imaging modalities that have been used to measure myocardial perfusion, left ventricular function, and coronary anatomy for clinical management and research. Although there are technical differences between these modalities, all of them image the myocardium and the adjacent cavity. However, the orientation of the heart, angle selection for Cardiac planes, number of segments, slice display and thickness, nomenclature for segments, and assignment of segments to coronary arterial territories have evolved independently within each field. This evolution has been based on the inherent strengths and weaknesses of the technique and the practical clinical application of these modalities as they are used for patient management. This independent evolution has resulted in a lack of standardization and has made accurate intra- and cross-modality comparisons for clinical patient management and research very difficult, if not, at times, impossible. Attempts to standardize these options for all Cardiac Imaging modalities should be based on the sound principles that have evolved from Cardiac anatomy and clinical needs.1–3⇓⇓ Selection of standardized methods must be based on the following criteria: An earlier special report from the American Heart Association, American College of Cardiology, and Society of Nuclear Medicine4 defined standards for plane selection and display orientation for serial …
Trip J. Meine - One of the best experts on this subject based on the ideXlab platform.
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Cardiac Imaging impaired by a silicone breast implant
Clinical Nuclear Medicine, 2005Co-Authors: Trip J. Meine, Manesh R. Patel, John F. Heitner, Terry Fortin, Robert Pagnanelli, Thomas R. Gehrig, Salvador BorgesnetoAbstract:Abstract:The authors report a case of a left-sided silicone breast implant interfering with nuclear Imaging of the myocardium. Cardiac SPECT Imaging of a woman documented widespread infarct in the anterolateral, inferior, and posterolateral walls, as well as mixed ischemia/infarct in the anterior wa
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Cardiac Imaging impaired by a silicone breast implant.
Clinical nuclear medicine, 2005Co-Authors: Trip J. Meine, Manesh R. Patel, John F. Heitner, Terry Fortin, Robert Pagnanelli, Thomas R. Gehrig, Raymond J. Kim, Salvador Borges-netoAbstract:The authors report a case of a left-sided silicone breast implant interfering with nuclear Imaging of the myocardium. Cardiac SPECT Imaging of a woman documented widespread infarct in the anterolateral, inferior, and posterolateral walls, as well as mixed ischemia/infarct in the anterior wall. Subsequent Cardiac MRI revealed just anterolateral and inferolateral infarct. The anterior wall was completely viable. Also apparent on the MR images was a left breast implant overlying the anterior myocardial wall. This case of a left-sided silicone breast implant interfering with nuclear Imaging of the myocardium highlights the importance of understanding the potential interference from silicone breast implants.
Andrew J Einstein - One of the best experts on this subject based on the ideXlab platform.
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patient centered Imaging shared decision making for Cardiac Imaging procedures with exposure to ionizing radiation
Journal of the American College of Cardiology, 2014Co-Authors: Andrew J Einstein, Manuel D Cerqueira, Jeffrey J Carr, Thomas C Gerber, Daniel S Berman, James K Min, Robert C Hendel, James S Cullom, Robert A Dekemp, Neal W DickertAbstract:The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered Imaging and shared decision-making in Cardiac Imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an Imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An Imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of Cardiac Imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the Imaging community to create an accountability framework to safely drive appropriate Imaging utilization.
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patient centered Imaging shared decision making for Cardiac Imaging procedures with exposure to ionizing radiation
Journal of the American College of Cardiology, 2014Co-Authors: Andrew J Einstein, Manuel D Cerqueira, Jeffrey J Carr, Thomas C Gerber, Daniel S Berman, Robert C Hendel, James S Cullom, Robert A Dekemp, Neal W Dickert, Sharmila DorbalaAbstract:The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered Imaging and shared decision-making in Cardiac Imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an Imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An Imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of Cardiac Imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the Imaging community to create an accountability framework to safely drive appropriate Imaging utilization.
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effects of radiation exposure from Cardiac Imaging how good are the data
Journal of the American College of Cardiology, 2012Co-Authors: Andrew J EinsteinAbstract:Concerns about medical exposure to ionizing radiation have become heightened in recent years as a result of rapid growth in procedure volumes and the high radiation doses incurred from some procedures. This paper summarizes the evidence base undergirding concerns about radiation exposure in Cardiac Imaging. After classifying radiation effects, explaining terminology used to quantify the radiation received by patients, and describing typical doses from Cardiac Imaging procedures, this paper will address the major epidemiological studies having bearing on radiation effects at doses comparable to those received by patients undergoing Cardiac Imaging. These include studies of atomic bomb survivors, nuclear industry workers, and children exposed in utero to x-rays, all of which have evidenced increased cancer risks at low doses. Additional higher-dose epidemiological studies of cohorts exposed to radiation in the context of medical treatment are described and found to be generally compatible with these Cardiac dose–level studies, albeit with exceptions. Using risk projection models developed by the U.S. National Academies that incorporate these data and reflect several evidence-based assumptions, cancer risk from Cardiac Imaging can be estimated and compared with the benefits from Imaging. Several ongoing epidemiological studies will provide better understanding of radiation-associated cancer risks.
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cumulative exposure to ionizing radiation from diagnostic and therapeutic Cardiac Imaging procedures a population based analysis
Journal of the American College of Cardiology, 2010Co-Authors: Jersey Chen, Khurram Nasir, Andrew J Einstein, Reza Fazel, Harlan M Krumholz, Yongfei Wang, Joseph S Ross, Henry H Ting, Nilay D ShahAbstract:Objectives The purpose of this study was to describe radiation exposure from Cardiac Imaging procedures over time in a general population. Background Cardiac Imaging procedures frequently expose patients to ionizing radiation, but their contribution to effective doses of radiation in the general population is unknown. Methods We used administrative claims to identify Cardiac Imaging procedures performed from 2005 to 2007 in 952,420 nonelderly insured adults in 5 U.S. health care markets. We estimated 3-year cumulative effective doses of radiation in millisieverts from these procedures We then calculated population-based annual rates of radiation exposure to effective doses ≤3 mSv/year (background level of radiation from natural sources), >3 to 20 mSv/year, or >20 mSv/year (upper annual limit for occupational exposure averaged over 5 years). Results A total of 90,121 (9.5%) individuals underwent at least 1 Cardiac Imaging procedure using radiation. Among patients who underwent ≥1 Cardiac Imaging procedures, the mean cumulative effective dose over 3 years was 23.1 mSv (range 1.5 to 543.7 mSv). Myocardial perfusion Imaging accounted for 74% of the cumulative effective dose. Overall, 47.8% of Cardiac Imaging procedures were performed in physician offices; this proportion was higher for myocardial perfusion Imaging (74.8%) and Cardiac computed tomography studies (76.5%). The annual population-based rate of receiving an effective dose of >3 to 20 mSv/year was 89.0 per 1,000; and 3.3 per 1,000 for cumulative doses >20 mSv/year. Annual effective doses increased with age and were generally higher among men. Conclusions Cardiac Imaging procedures lead to substantial radiation exposure and effective doses for many patients in the U.S.