Cardiovascular imaging: who does it and how important is it to the practice of radiology?

Our research was conducted to ascertain the importance of noninvasive cardiovascular imaging to the practice of radiology and to determine what percentages of noninvasive cardiovascular imaging are performed by radiologists and by other types of physicians.

Using the national 1998 Medicare Part B database, we reviewed all 460 procedure codes pertaining to noninvasive diagnostic imaging and identified 65 that were specifically related to the cardiovascular system. These 65 codes were grouped in five categories: cardiac MR imaging, MR angiography, cardiovascular nuclear medicine, echocardiography, and vascular sonography. For each code and category, we determined the nationwide examination volume, the utilization rate per 1,000 Medicare fee-for-service enrollees, Part B physician reimbursements, and the percentages of examinations performed by radiologists, cardiologists, surgeons, and other physicians.

During 1998, 19,244,001 noninvasive cardiovascular imaging studies were performed on Medicare enrollees, which accounted for 17.7% of all Medicare diagnostic imaging studies carried out that year and 33.6% of all Part B imaging-related reimbursements paid. The utilization rate for noninvasive cardiovascular imaging was 603 per 1,000 Medicare enrollees per year. Echocardiography alone accounted for 63.4% of these examinations. Radiologists conducted 16.7% of all noninvasive cardiovascular imaging, whereas cardiologists conducted 61.5%, surgeons 4.8%, and other physicians 16.9% of the examinations. The strong role of cardiologists was largely attributable to their dominance in echocardiography. Radiologists had a substantial role in all categories except echocardiography.

Noninvasive cardiovascular imaging represents an important component of the practice of radiology. Radiologists have substantial participation in all aspects of the field with the exception of echocardiography.