The future of cardiovascular magnetic resonance in Greece: expectations and reality

The latest advances in cardiovascular magnetic resonance (CMR) have established this technique as the gold standard imaging modality for many cardiac diseases. However, cardiologists seem to be reluctant to use CMR in their everyday clinical practice.

In an attempt to identify some of the reasons for this discrepancy, we conducted a survey employing a written questionnaire completed by 60 trained cardiologists in the third most populated region of Greece.

Cardiologists would refer patients for CMR rarely (71.6%) or never (28.3%). The most frequent indications for CMR were congenital heart disease (46.7%) and aortography (28.3%). Only 13.3% were familiar with cardiac computed tomography and 8.3% with CMR. Participants would like CMR to be able to clarify coronary artery anatomy (81.3%). Only 3% answered correctly all the questions regarding contraindications of CMR. The main reasons for not referring a patient for CMR were non-availability (75%), lack of familiarity (60%), and high cost (55%). The most appropriate physician for conducting/interpreting a CMR examination is a cardiologist (31.7%), radiologist (10%), both (51.7%), or not important (6.7%). The method is going to expand a lot (41.6%), moderately (46.7%), or not at all (1.2%) in the future.

A complex interplay between the lack of trained physicians and technicians, non-availability of scanners for CMR, high costs, and lack of adequate education of cardiologists, leads to a vicious circle with the final odds against CMR. Actions to bypass these issues are required on behalf of all scientists involved in CMR imaging. Training of more physicians and technicians, establishment of dedicated CMR programs, and in-depth education of cardiologists regarding the indications and advantages of CMR over other imaging modalities, will be required if CMR is to become established in everyday clinical practice.