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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPamela S. Douglas, MD, President of the American College of Cardiology, and Chief, Cardiovascular Medicine, Duke University, launched the 55th Annual Scientific Session of the American College of Cardiology with a Presidential Address titled \u201cImproving Imaging: Our Professional Imperative.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac imaging (radiology)\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPamela S. Douglas, MD, President of the American College of Cardiology, and Chief, Cardiovascular Medicine, Duke University, launched the 55th Annual Scientific Session of the American College of Cardiology with a Presidential Address titled \u201cImproving Imaging: Our Professional Imperative.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1225908424\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16100\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\u201cNew diagnostic tools and creative treatments have sparked an exciting evolution in medicine,\u201d said Dr. Douglas. \u201cAnd while this would seem to be a positive change, sometimes we adopt these new tools with not enough thought to ensuring quality.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ECardiovascular imaging, she said, is a case in point. \u201cIf imaging were a drug, regulatory approval would be denied,\u201d she said, calling for more and better research, standards, and guidelines in CV imaging.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EMedical imaging joined such fundamental innovations as anesthesia and antibiotics when the \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E cited the top 11 medical developments of the past millennium. Two years after that announcement the landmark study \u201cPhysician\u0027s Views of the Relative Importance of 30 Medical Innovations\u201d (Fuchs VR et al, \u003Cem\u003EHealth Affairs\u003C\/em\u003E Vol. 20, #5, Sept\/Oct 2001) reported on a survey of U.S. internists that identified MR\/CT as the single most important innovation of the last quarter-century.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAs imaging has moved to the forefront of innovation, cardiology has served as a fertile creative platform and testing ground for many of imaging\u0027s advances, and continues to do so. These advances have certainly enhanced detection and diagnosis and enabled interventions of unparalleled success. A few of the more intriguing areas of research and treatment include:\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\n            \u003Cstrong\u003ECardiac magnetic resonance imaging (CMI)\u003C\/strong\u003E has several advantages over echocardiography, including fewer artifacts and unlimited acquisition windows. CMI is noninvasive, carries no radiation risks, uses benign contrast agents, and offers comprehensive information from a single examination. To obtain similar information currently requires a complicated and time-consuming combination of diagnostic tests. Software development has made, real-time imaging possible and has decreased data acquisition time.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003E\n            \u003Cstrong\u003EContrast-enhanced magnetic resonance angiography (MRA)\u003C\/strong\u003E with \u201cbolus chase\u201d is a technique achieved by administrating a contrast bolus into a peripheral vein and then \u201cchasing\u201d the bolus on its voyage through the vasculature of the abdomen, pelvis, and lower extremities. Bolus-chase MRA has allowed for quick and reproducible angiography of the abdominal aorta, pelvis, and lower extremities in evaluating peripheral arterial disease. MRA has also demonstrated promise in other vascular imaging, notably in post-procedure evaluation of aortic endovascular stent grafts.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003E\n            \u003Cstrong\u003EMultidetector computed tomographic (MDCT) scanning\u003C\/strong\u003E has emerged as a complementary technique to echo, particularly in evaluating congenital heart disease. MDCT very accurately images the aorta, right ventricle, and pulmonary artery. The newer MDCT scanners have augmented the ability of CT angiography to identify pulmonary embolism. MDCT is an example of an imaging innovation that mitigates (or removes) traditional sources of confusion in earlier forms of imaging, particularly in the lungs (e.g., pulmonary veins, non-specific densities, lymphatics, etc.)\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003E\n            \u003Cstrong\u003EComputed tomographic angiography (CTA)\u003C\/strong\u003E has shown potential in planning interventional vascular therapy. With a very large portfolio of images and techniques of \u201cautomated vessel extraction\u201d both quantitative and visual assessments can be achieved.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003E\n            \u003Cstrong\u003ECardiovascular molecular imaging (CMI)\u003C\/strong\u003E is implemented by contrast-tagged molecular agents (either organic compounds or synthetic nanoparticles) which are injected and subsequently bind to target molecules in the heart and vasculature. (This technique has been experimentally demonstrated in laboratory animals by \u201clighting up \u201c fibrin as a marker for plaque rupture, as well as detecting angiogenesis of vessels supporting plaques.) Contrast-tagged molecular agents can serve to visualize pathological states or activities, as drug-delivery vehicles, or both.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1225908424\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/31\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16101\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EPopular magazines, including \u003Cem\u003ETime\u003C\/em\u003E and \u003Cem\u003EU.S. News and World Report,\u003C\/em\u003E have reported \u201cglimpes into the future\u201d in recent issues that characterize cardiac imaging using varieties and combinations of the above technologies. A \u201cheart test\u201d in the near future might utilize a \u201cfusion application\u201d that will generate a personalized profile revealing ventricular volumes and function, valvular structure, function, and dynamics, and coronary artery anatomy with luminal images of startling resolution. From the information obtained, a patient can be risk-stratified\u2014educated appropriately, placed on an evidence-based plan, and treated if therapy is indicated. And, indeed, the technology to achieve all of this is, for the most part, in place or moving quickly toward reality.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EBut as exciting as these imaging alternatives are, clinicians are often divided on appropriate applications, benefits, and safety. This point was indirectly emphasized by the many imaging-related presentations at ACC 2006, many of which discussed a spectrum of applications for a variety of imaging strategies, from conventional tools used in new ways to various combinations of conventional and emerging techniques. A key concern through all of this\u2014and the focus of Dr. Douglas\u0027s Presidential Address\u2014is that bioengineering and technological progress in CV imaging has generally outpaced research and randomized clinical trial data. State-of-the-science assessments and meta-analyses have been confounded by this schism between accelerated progress vs. data in which even recently published reports lag behind available technology.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAs one expert observer has noted, medical imaging is a moving target. With that in mind, \u201cWe must demand better imaging research, develop pragmatic research methods, create imaging standards for trials, define imaging quality and outcomes, and improve imaging effectiveness and efficacy in practice,\u201d Dr. Douglas said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EIn citing rapid growth of technologies, widespread applications, inconsistent use, few regulatory controls, and a paucity of evidence for outcomes, Dr. Douglas pointed to a lack of consensus on the definition of quality as a prime reason why the cardiovascular community must take the lead on quality in imaging. \u201cImproving quality cardiovascular imaging is a professional imperative,\u201d she said.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/31.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm641\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm641\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}