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Diapositiva 1

The Future of Nuclear Cardiology:
The Practical

Nuclear Cardiology
The Numbers
There are 6,067,272,000 people in the world.
There were 5,866,000 nuclear cardiology studies performed worldwide in 2000.

The Practice of Nuclear Cardiology
Europe-2000

The Practice of Nuclear Cardiology
Outside of US and Europe-2000

The Practice of Nuclear Cardiology
USA-2000
The population is 275,600,00.
There were 4,500,000 studies performed.
There were 16,328 studies/million population.

Trends in US Nuclear Medicine
1997 to 2002
5% increase to 5,870 nuclear medicine sites
14% increase to 14.7 million procedures
7.1 million nuclear cardiology procedures represent 48% of nuclear medicine volume
There has been a 17-23% yearly increase in number of nuclear cardiology procedures

The Practice of Nuclear Cardiology
Current Status
Equilibrium blood pool imaging is being replaced by echocardiography
In the USA 95% of all nuclear cardiology is myocardial perfusion imaging
Infarct imaging is not being performed
Cardiac PET has potential but limited due to cost
No new imaging agents will be available for at least the next 3 years

Trends in US Nuclear Cardiology
6.5 Million Nuclear Cardiology Studies
99% were performed with stress
43% were performed with Pharm stress
77% (5 million) were ECG Gated

Nuclear Cardiology Growth in USA
Reasons for Growth
Greater involvement by cardiologists who control the patients and they have been allowed to perform procedures
Increase in outpatient facilities
Efficient facilities operation
Lack of a competitor for perfusion market

Trends in US Nuclear Medicine
Out Patient Facilities
Increased 20% (1,520 to 1,820) and performed 2.8 million procedures (19%)
Established within Cardiology practices
91% perform nuclear cardiology procedures
Nuclear cardiology is 75% of all procedure volumes compared to 42% in hospitals

Promoting of Nuclear Cardiology
Who is the customer?
Referring MDs
General Cardiologists, primary care
Nuclear medicine physicians
Radiologists
Nuclear Cardiologists
Practice managers

Promoting of Nuclear Cardiology
What are the customers CME needs?
Referring MDs -Familiarity with studies
General Cardiologists, primary care
Nuclear medicine physicians Understanding of clinical utilization
Nuclear Cardiologists -Better technical training
Practice managers –Find and train

Nuclear Cardiology
Weaknesses and Threats to Growth
Exclusive reliance on perfusion market
Lack of new products
Government scrutiny
Competition from Contrast Echo and Cardiac MR

Best Practice Nuclear Cardiology
Components of Best Practice
Time
Quality
Service
Reimbursement

Best Practice Nuclear Cardiology
Components of Best Practice: Time
How do you minimize time?
Standardize/simplify protocols
Maximize efficiency
Consistent and early imaging times
Minimize reimaging
Shorter acquisition time

Best Practice Nuclear Cardiology
Components of Best Practice: Quality
Laboratory accreditation
Accuracy of results
Correlation with angiography
Marketing to providers

Best Practice Nuclear Cardiology
Components of Best Practice: Service
One phone call
Immediate availability
Be good to patients
Direct and personnel contact
Timely and effective reports

Providing Basic Nuclear Cardiology
Protocols
Consider stress only sequence for low risk patients
Provide flexibility
Bottom Line: One day Tc-99m stress/rest exercise protocol

Providing Basic Nuclear Cardiology
Manpower
Too few well trained physicians
Too few well trained technologists
Too few well trained medical physicists radiochemists and radiopharmacists
Bottom line: Need to train more people

Providing Basic Nuclear Cardiology
Learning how to play well together
Issues of turf: Clinicians vs. Imagers
Clinicians
Become familiar with technology for referring for clinical studies
Train how to perform quality studies
Imagers
Train in the clinical context of studies
Train how to assimilate ancillary information

Basic Nuclear Cardiology
How to Make the Future Bright
Keep it simple/practical/relevant
Institute quality control
Maintain manpower
Lobby for acceptance and involvement by clinicians
Get adequate reimbursement
Develop new applications