Journal of Nuclear Cardiology | 2021
Nuclear cardiac imaging between implementation and globalization: The key role of integration
Abstract
It has now been 5 years since we had the privilege of writing our first annual Editor Page. Since then, many things have changed in the world of science, from diagnostics and prognostic stratification to therapeutic approaches. Nevertheless, above all changes due to successful scientific research activities, during the last 2 years Covid-19 pandemic has dramatically and radically modified the way we interact and establish relationships with colleagues and patients, as well as our own family members. While Covid-19 outbreak has pushed the maximum towards social distancing, at the same time it has highlighted how much the globalization process has now breached, perhaps irreversibly, in the daily life of each of us, for better and for worse. The pandemic has severely affected all areas of health care. The impact has been terrific especially in preventive medicine, limiting the access to diagnostic investigations, including cardiac imaging modalities, such as single-photon emission computed tomography (SPECT) and positron emission tomography (PET). On the other hand, the increasingly extensive use of World Wide Web for medical information on patient side and the widespread utilization of digital technologies and artificial intelligence algorithms from physician side have contributed to revise the traditional doctor-patient relationship. Therefore, though artificial intelligence techniques aim to improve precision medicine approaches, there is concern on emerging concept of approaching a depersonalized patient, where diagnostic advice and therapeutic choices are centered on representations of the average stereotype of the patient who is hardly ever present in clinical reality. In this contest, while handling advances on radiopharmaceuticals development, software, hardware and algorithms implementation, also nuclear cardiology has been inevitably overwhelmed by pandemic tsunami, whereas the choice between different methods for the evaluation of coronary artery disease (CAD), such as coronary computed tomography angiography (CCTA) and nuclear cardiac imaging (SPECT and PET), became even more conflicting. As Randall C. Thompson recently pointed out in his message as President of ASNC: ‘‘There is also a theory that variability is bad and wasteful and, therefore, standardization will be good. We are even seeing campaigns promoting specific modalities first, for example #CTFirst in CAD diagnostic workups’’ highlighting the concept that a #PatientFirst Society would be more necessary. In this respect, the contribution of truly personalized medicine tools, such as the use of dedicated cadmium-zinc-telluride gamma cameras, to tailored diagnosis goal achievement made the #PatientFirst Society idea even closer to real practice. Beyond this debate on a multimodality wise and aware use of available cardiac imaging techniques, another task that must be addressed is a reliable estimation of the pre-test likelihood of CAD for subjects without known history of disease. The classic approach proposed by Diamond and Forrester in 1979 has been revised over years with different alternative models. Yet, the best pre-test approach choice is still a matter of debate. The main issue to take into account in such a complex dispute is that with pre-test estimation method improvements over time, also the target population changed. The Diamond and Forrester algorithm was estimated on a mostly male population with a mean age of 50 years and typical angina while current diagnostic Reprint requests: Alberto Cuocolo, MD, Department of Advanced BiomedicalSciences,UniversityFederico II,ViaPansini 5, 80131Naples, Italy; [email protected] J Nucl Cardiol 2021;28:793–5. 1071-3581/$34.00 Copyright 2021 American Society of Nuclear Cardiology.