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European Society of Radiology: Could you please give a detailed overview of when and for which diseases you use cardiac imaging?

Sanja Hadžović Šehović: Cardiac imaging is used in emergencies and in everyday practice. In urgent cases, CT is used to diagnose pain in the chest, when we are not sure from where it originates.In this way, we can exclude pulmonary thromboembolism, nearby organ diseases, aneurysm and thoracic aortic dissection as well as acute events in coronary arteries.In day-to-day practice, cardiac imaging is used for CAD detection, congenital and acquired heart defects, arteriovenous malformation (AVM) and shunts. We also detect cardiac tumours as well as changes in the pericardium. 

ESR: Which modalities are usually used for what?

SHŠ: Standard radiography is used as an introduction to diagnostics, to gain insight into the condition of thoracic organs.MSCT coronary angiography is used to determine Ca score, assess coronary artery disease (stenosis, occlusion), as well as to exclude coronary heart disease. It is also a reliable tool in determining the patency of stents and aortic coronary bypass.MR of the heart is used for the analysis of the thoracic aorta (aneurysm, dissection, congenital anomalies), for a detailed estimate of the congenital and acquired heart defect and cardiac tumours.

ESR: What is the role of the radiologist within the ‘heart team’? How would you describe the cooperation between radiologists, cardiologists, and other physicians?

SHŠ: In our institution, a cardiologist and a radiologist work together in a team. The cardiologist sets the indication for the examination and preparation of the patients. The radiologist makes the diagnosis on the grounds of a CT coronary angiography or an MRI of the heart. At the end of the procedure, the cardiologist determines any further treatment for the patient.

ESR: Radiographers/radiological technologists are also part of the team. When and how do you interact with them?

SHŠ: In our establishment, the radiological technician is constantly present in our cardiac image team.

In the performed CT coronary angiography, the radiological technician determines the type of screening, the amount of contrast media, the time delay etc.

When performing an MRI of the heart, they determine the most suitable sequences for certain diseases.

ESR: Please describe your regular working environment (hospital, private practice). Does cardiac imaging take up all, most, or only part of your regular work schedule? How many radiologists are dedicated to cardiac imaging in your team?

SHŠ: I work at a private clinic. Cardiology diagnostics is just a part of every day’s work. I also work on other diagnostics. Two radiologists are involved in the cardiology team.

ESR: Do you have direct contact with patients and if yes, what is the nature of that contact?

SHŠ: In our daily work we are not in direct contact with the patient. The cardiologist has a conversation with a patient because he or she is setting an indicator for the examination.

ESR: If you had the means: what would you change in education, training and daily practice in cardiac imaging?

SHŠ: In our institution, the training and education of young radiologists is not performed because it is a private clinic. In everyday practice, the CT coronary angiography will be introduced as a screening method in people with positive risk factors for coronary disease.

ESR: What are the most recent advances in cardiac imaging and what significance do they have for improving healthcare?

SHŠ: The advantage of modern cardiac imaging is the possibility to diagnose heart diseases in a non-invasive and reliable way.

ESR: In what ways has the specialty changed since you started? And where do you see the most important developments in the next ten years?

SHŠ: Since my initial decade, there has been quite a change in CT coronary angiography, thanks to the development of new CT machines, software and bringing this method to technical perfection. Also, the development of new advanced software and special sequences on MRI enables the demonstration of cardiac anomalies that previously were proven in a highly invasive way.

ESR: Is artificial intelligence already having an impact on cardiac imaging and how do you see that developing in the future?

SHŠ: As in other branches of radiology, computer systems and their improvements are significantly assisting the doctor in performing cardiological procedures. But an experienced doctor is unreplaceable.

Dr. Sanja Hadžović Šehović is a general radiologist and works in a private polyclinic in Sarajevo, Bosnia and Hercegovina. Her main research interests are in cardiac imaging. She is a member of the European Society of Radiology. She has been invited speaker at the Balkan Congresses of Radiology on the topic of cardiac imaging. She is currently working on her doctoral dissertation in that field and has authored or co-authored more than 20 peer-reviewed publications.

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