European Society of Radiology: Could you please give a detailed overview of when and for which diseases you use cardiac imaging?
Llimia Bencomo Rodríguez: In the context of cardiology, cardiac imaging studies are used in both emergency and non-emergency care, in patients who have been referred to for cardiac coronary and non-coronary studies. Most cardiac non-coronary studies are prescribed in the emergency care, for example for acute aortic syndrome or pulmonary thromboembolism diagnosis.
ESR: Which modalities are usually used for what?
LBR: Computed axial tomography (CAT) is used to diagnose coronary artery disease in different clinical situations, for instance, to assess revascularised patients who are wearing stents and surgical implants, and to diagnose congenital heart defects – coronary artery anomalies, valves and cavities anomalies. CAT is also useful for:
- Left auricle anatomic study (especially pulmonary artery anatomy study before atrial fibrillation ablation)
- Left ventricle aneurysm study
- Cardiac mass evaluation (tumours and thrombi)
- Pericardial disease evaluation (tumour, constrictive pericarditis, cardiac surgery complications)
- In patients who cannot undergo transthoracic echocardiography and transoesophageal echocardiography or magnetic resonance (MR)
- For coronary artery anatomy study to implant biventricular pacemaker in cardiac insufficiency
- Aortic pathology study
- Pulmonary thromboembolism diagnosis
- Myocardiopathy study
- Ventricle function assessment in patients with acute myocardial infarct or cardiac insufficiency and who cannot be examined with MR, transthoracic echocardiography or transoesophageal echocardiography
MR has recently been installed in our centre, and we use it mainly to study most of the above-mentioned indications, to provide better image quality in myocardiopathy, patients with congenital anomalies, cardiac tumours and ventricle function studies.
Echocardiography and nuclear medicine are other key modalities in cardiac disease imaging.
ESR: What is the role of the radiologist within the ‘heart team’? How would you describe the cooperation between radiologists, cardiologists, and other physicians?
LBR: Radiologists are specialists in image interpretation and as such play an important role in the heart team. Their expertise in imaging and imaging study findings combined with their participation in conducting the examination leads to better and more accurate diagnosis to secure adequate decision-making. Cooperation between all the specialists involved in the heart team – cardiologists, imagists, intensivists, nephrologists, neurologists and surgeons – improves information and results, and therefore is highly encouraged in our institution.
ESR: Radiographers/radiological technologists are also part of the team. When and how do you interact with them?
LBR: We work together with radiographers during or prior to the examination to improve image acquisition. Cooperation between the imaging technologist and the radiologist is very important. We cooperate closely, especially for image acquisition in examinations involving contrast product administration.
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?
LBR: We have two teams of conventional radiology, one of which was recently digitalised, two teams working with CT, one MR team, and weekly working sessions in the ultrasound department. Cardiac imaging occupies most of my working time, but I also regularly carry out studies for cardiovascular pathology, as I am subspecialised in cardiovascular radiology. I have more experience in conventional and digital radiology, ultrasound, CAT and MR. We are three radiologists carrying out cardiac imaging in our centre.
ESR: Do you have direct contact with patients and if yes, what is the nature of that contact?
LBR: I have direct contact with patients to prioritise the examination and make sure they are well prepared. Patients are usually handed an informed consent, but I always make sure that they understand the information they are given and that they meet indications. If they present with any alteration before or during the study, I deliver first aid, being the first physician onsite, or communicate with them to solve the problem.
ESR: If you had the means: what would you change in education, training and daily practice in cardiac imaging?
LBR: I would suggest ways to achieve more interaction between all specialists involved in patient management, to obtain more accurate results. I would also find it very interesting to promote multimodality imaging during medical staff training and to create multimodality imaging labs.
ESR: What are the most recent advances in cardiac imaging and what significance do they have for improving healthcare?
LBR: In cardiac imaging, the most recent advances have been new software development, especially linked with CT, for instance flow fractional reserve, transcatheter aortic valve implantation (TAVI) or replacement (TAVR), image acquisition to merge with electrophysiology teams, and single-photon emission computed tomography (SPECT) and PET/CT.
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?
LBR: In my opinion, the subspecialty has changed with the introduction of new techniques and continuous technological development that have enabled faster image acquisition in the shortest possible time with the lowest possible movement artefacts, facilitating high-quality images to be collected while improving diagnosis and reducing negative effects for patients. The biggest future developments will occur in CT, MR and hybrid equipment.
ESR: Is artificial intelligence already having an impact on cardiac imaging and how do you see that developing in the future?
LBR: Artificial intelligence (AI) is starting to be used and in various countries it is becoming an advanced assistant in hospitals and medical universities for patient attention and radiology student training. With AI, for instance, a system’s algorithm can recreate the images obtained in a CT, MR, US or x-ray scan in 3D. This enables physicians to observe the image in exquisite detail, to detect unknown situations, to confirm prior diagnosis and to decide which intervention or treatment is necessary. This trend helps improve medicine, which becomes safer, cheaper and faster.
Artificial intelligence is going to be a great ally for the present and the future.
It’s important to emphasise that AI-based systems, although they are able to provide fast and accurate diagnosis, will never replace a person’s common sense and good judgement, the placebo effect produced by human contact and the empathy with the patients that characterises a good healthcare professional.
The future of medicine must be a combination of both AI and professionals’ knowledge. Professionals have real observation and their experience is based on years of clinical practice.
Dr. Llimia Bencomo Rodríguez is radiologist at the Cardiology and Cardiovascular Surgery Institute in La Habana, Cuba. She trained in general radiology at the Hermanos Amejeiras teaching clinical and surgery hospital from 2006 to 2008. She has been working in the radiology department of the Cardiology and Cardiovascular Surgery Institute since November 2008, especially in cardiac radiology, performing cardiac coronary and non-coronary CAT studies and vascular studies for other fields of imaging, such as brain CT angio and supra-aortic trunks. Dr. Bencomo Rodríguez possesses experience in general and vascular ultrasound, and MR, with a focus on cardiology. She has authored or co-authored over 10 publications in international journals. She has taken part in radiology and cardiology meetings since 2007 and 2009, respectively, and has been a speaker during the Cuban Cardiology congress in 2018. She is an active member of the Cuban Imaging Society, the Cuban Cardiology Society and the European Society of Radiology.