JNC: Cardiac positron emission tomography and other modalities for coronary artery disease assessment: A snapshot from the medicare data-Cardiac positron emission tomography and other modalities for coronary artery disease assessment: A snapshot from the medicare data

Cardiac positron emission tomography and other modalities for coronary artery disease assessment: A snapshot from the medicare data

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The study examines the use of positron emission tomography (PET) compared to other imaging modalities for assessing coronary artery disease (CAD) using Medicare data between 2018 and 2022. Despite the advantages of PET, its overall adoption remains limited due to factors such as the scarcity of experts in the field. In 2022, PET handled 212,106 procedures, making it the second most frequently used modality after single-photon emission computed tomography (SPECT), which accounted for 1,343,519 procedures. Stress echocardiography and coronary computed tomography angiography (CCTA) had lesser utilizations, while stress MRI was the least used.<br /><br />Although PET utilization increased by 25% from 2018 to 2022, it remains underutilized especially its PET/CT combination and myocardial blood flow (MBF) assessment capabilities, which are less exploited in practice, limiting diagnostic accuracy. For PET myocardial perfusion imaging (MPI), only 46% involved PET/CT scans and 39% included MBF assessments. By contrast, more cardiologists interpret PET scans, with 86% of PET readings done by cardiologists compared to lower percentages for other modalities like CCTA.<br /><br />Notably, a significant issue highlighted in the study is that a substantial number of PET interpreters handle a limited volume of cases, with 23% reading less than 25 studies annually, raising concerns about maintaining clinical competency. This is consistent across modalities, where low reading volumes are noted, affecting diagnostic proficiency.<br /><br />The findings emphasize the dominance of SPECT and PET for CAD assessments, yet they also call for increased PET utilization, given its diagnostic potential, especially when combined with CT and MBF assessments. Enhancing education on PET’s benefits and addressing access barriers are critical for maximizing its clinical impacts and improving patient outcomes.

Keywords

positron emission tomography

PET

coronary artery disease

CAD

Medicare data

SPECT

myocardial blood flow

PET/CT

diagnostic accuracy

cardiologists