Skip to main content
Top
Published in: The International Journal of Cardiovascular Imaging 3/2007

01-06-2007 | Editorial Comment

Ethical considerations in CT angiography

Authors: Samuel Wann, Andy L. Nassef, Justin Jeffrey, Joseph V. Messer, Norbert M. Wilke, Andre J. Duerinckx, James C. Blankenship, Michael K. Rosenberg, Donald H. Dembo

Published in: The International Journal of Cardiovascular Imaging | Issue 3/2007

Login to get access

Abstract

The rapid development and clinical deployment of CT angiography raises several important issues, including assurance of professional competence and technical quality, self-referral, the relative role of radiologists and cardiologists, appropriateness and proper indications, the detection and disposition of unexpected or incidental findings and the concern for the rapidly increasing costs of health care and imaging. These questions are properly addressed within the framework of medical ethics, including principles of beneficence, autonomy and justice.
Literature
1.
go back to reference Looking back on the millennium in medicine (2000). New Engl J Med 342:42–49 Looking back on the millennium in medicine (2000). New Engl J Med 342:42–49
2.
go back to reference Abrams HL (1996) History of cardiac radiology. Am J Radiology 167:432–438 Abrams HL (1996) History of cardiac radiology. Am J Radiology 167:432–438
3.
go back to reference Starr P (1982) The social transformation of American medicine. Basic Books, New York, p 126 Starr P (1982) The social transformation of American medicine. Basic Books, New York, p 126
4.
go back to reference Friedson E (1988) Profession of medicine – a study of the sociology of applied knowledge. University of Chicago Press, Chicago, p 137 Friedson E (1988) Profession of medicine – a study of the sociology of applied knowledge. University of Chicago Press, Chicago, p 137
5.
go back to reference Beauchamp TL, Childress JF (2001) Principles of biomedical ethics. Oxford University Press, New York, p 57 Beauchamp TL, Childress JF (2001) Principles of biomedical ethics. Oxford University Press, New York, p 57
6.
go back to reference American College of Radiology. Code of Ethics. http://www.acr.org/s_acr/doc.asp?CID=1539&DID=15502 American College of Radiology. Code of Ethics. http://​www.​acr.​org/​s_​acr/​doc.​asp?​CID=​1539&​DID=​15502
7.
go back to reference Popp RL, Smith SC (2004) Cardiovascular professionalism and ethics in the modern era. J Am Col Cardiol 44(8):1722–1761CrossRef Popp RL, Smith SC (2004) Cardiovascular professionalism and ethics in the modern era. J Am Col Cardiol 44(8):1722–1761CrossRef
8.
go back to reference ACR Practice Guideline for the Performance and Interpretation of CT Angiography. October 1, (2005). http://www.acr.org/s_acr/bin.asp?CID=546&DID=22486&DOC=FILE.PDF ACR Practice Guideline for the Performance and Interpretation of CT Angiography. October 1, (2005). http://​www.​acr.​org/​s_​acr/​bin.​asp?​CID=​546&​DID=​22486&​DOC=​FILE.​PDF
9.
go back to reference Budhoff MJ, Cohen MC, Garcia MJ. Hodgson JM. Hundley WG, Lima JAC, Manning WJ, Pohost GM, Raggi PM, Rodgers GP, Rumberger JA, Taylor AJ (2005) ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance. J Am Col Cardiol 46:383–402CrossRef Budhoff MJ, Cohen MC, Garcia MJ. Hodgson JM. Hundley WG, Lima JAC, Manning WJ, Pohost GM, Raggi PM, Rodgers GP, Rumberger JA, Taylor AJ (2005) ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance. J Am Col Cardiol 46:383–402CrossRef
10.
go back to reference Borgstede JB. Testimony Before the Subcommittee on Health of the House Committee on Ways and Means Health Subcommittee March 17, (2005) http://waysandmeans.house.gov/hearings.asp?formmode=view&id=2554 Borgstede JB. Testimony Before the Subcommittee on Health of the House Committee on Ways and Means Health Subcommittee March 17, (2005) http://​waysandmeans.​house.​gov/​hearings.​asp?​formmode=​view&​id=​2554
12.
go back to reference Kouri BE, Parsons RG, Alpert HR (2002) Physician self-referral for diagnostic imaging: review of the empiric literature. Am J Radiol 179:843–850 Kouri BE, Parsons RG, Alpert HR (2002) Physician self-referral for diagnostic imaging: review of the empiric literature. Am J Radiol 179:843–850
13.
go back to reference Cameron AA, Laskey WK, Sheldon WC (2004) Ethical issues for invasive cardiologists: society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 61(2):157–162PubMedCrossRef Cameron AA, Laskey WK, Sheldon WC (2004) Ethical issues for invasive cardiologists: society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 61(2):157–162PubMedCrossRef
14.
go back to reference Blankenship JC (2004) Point of view: ethics in interventional cardiology: combining coronary intervention with diagnostic catheterization. Am Heart Hosp J 2(1):52–54PubMedCrossRef Blankenship JC (2004) Point of view: ethics in interventional cardiology: combining coronary intervention with diagnostic catheterization. Am Heart Hosp J 2(1):52–54PubMedCrossRef
15.
go back to reference Hirshfeld JW, Messer JV, Peterson ED, Prystowsky EN (2004) Appropriate clinical care and issues of self-referral. J Am Col Cardiol 44(8):1740–1746CrossRef Hirshfeld JW, Messer JV, Peterson ED, Prystowsky EN (2004) Appropriate clinical care and issues of self-referral. J Am Col Cardiol 44(8):1740–1746CrossRef
16.
go back to reference DeMaria AN. (2004) Self-referral in cardiology. J Am J Cardiol 43(8):1500–1501CrossRef DeMaria AN. (2004) Self-referral in cardiology. J Am J Cardiol 43(8):1500–1501CrossRef
17.
go back to reference Parmley WW (2001) Changing guidelines on conflict of interest. J Am Col Cardiol 37:1749–1750CrossRef Parmley WW (2001) Changing guidelines on conflict of interest. J Am Col Cardiol 37:1749–1750CrossRef
18.
go back to reference Williams KA. Testimony before the U.S. House of Representatives Committee on Ways and Means Health Subcommittee May 17, (2005) http://waysandmeans.house.gov/hearings.asp?formmode=view&id=2555 Williams KA. Testimony before the U.S. House of Representatives Committee on Ways and Means Health Subcommittee May 17, (2005) http://​waysandmeans.​house.​gov/​hearings.​asp?​formmode=​view&​id=​2555
20.
go back to reference Wolk MJ, Popp R, Smith S, DeMaria A (2004) The trust imperative: ethical choice always puts patient first. J Am Coll Cardiol 44:1709–1711PubMedCrossRef Wolk MJ, Popp R, Smith S, DeMaria A (2004) The trust imperative: ethical choice always puts patient first. J Am Coll Cardiol 44:1709–1711PubMedCrossRef
21.
go back to reference For-Profit Enterprise in Health Care (1986) Institute of Medicine (IOM) http://www.nap.edu/books/0309036437/html/151.html For-Profit Enterprise in Health Care (1986) Institute of Medicine (IOM) http://​www.​nap.​edu/​books/​0309036437/​html/​151.​html
22.
go back to reference Gibbons RJ, Smith SC, Antman E (2003) American College of Cardiology/American Heart Association Clinical Practice Guidelines: part I: where do they come from? Circulation 107:2979–2986PubMedCrossRef Gibbons RJ, Smith SC, Antman E (2003) American College of Cardiology/American Heart Association Clinical Practice Guidelines: part I: where do they come from? Circulation 107:2979–2986PubMedCrossRef
23.
go back to reference Gibbons RJ, Smith SC, Antman E (2003) American College of Cardiology/American Heart Association Clinical Practice Guidelines: part II: Evolutionary Changes in a Continuous Quality Improvement Project. Circulation 107:3101–3107PubMedCrossRef Gibbons RJ, Smith SC, Antman E (2003) American College of Cardiology/American Heart Association Clinical Practice Guidelines: part II: Evolutionary Changes in a Continuous Quality Improvement Project. Circulation 107:3101–3107PubMedCrossRef
24.
go back to reference Contrast-Enhanced Cardiac Computed Tomographic Angiography for Coronary Artery Evaluation. Blue Cross Blue Shield Technology Assessment Program (2005):20(4) http://www.bcbs.com/tec/vol20/20_04.html Contrast-Enhanced Cardiac Computed Tomographic Angiography for Coronary Artery Evaluation. Blue Cross Blue Shield Technology Assessment Program (2005):20(4) http://​www.​bcbs.​com/​tec/​vol20/​20_​04.​html
25.
go back to reference Schragin JG, Weissfeld J, Edmundowica D, Strollo D, Furhrman CR (2004) Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging 19(2): 82–86PubMedCrossRef Schragin JG, Weissfeld J, Edmundowica D, Strollo D, Furhrman CR (2004) Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging 19(2): 82–86PubMedCrossRef
27.
go back to reference Swenson SJ, Jett JR, Hartman TE, Midthun DE, Mandrekar SJ, Hillman SL, Sykes A, Augenbaugh GL, Bungum AO, Allen KL (2005) CT screening for lung cancer: five-year prospective experience. Radiology 235:259–265CrossRef Swenson SJ, Jett JR, Hartman TE, Midthun DE, Mandrekar SJ, Hillman SL, Sykes A, Augenbaugh GL, Bungum AO, Allen KL (2005) CT screening for lung cancer: five-year prospective experience. Radiology 235:259–265CrossRef
28.
go back to reference Swensen S, Aberle CD, Kaxzerooni EA, Patz N, Galvin JR, Henschke CI (2005) Society of Thoracic Radiology Ad-Hoc Committee on lung cancer screening with CT. J Thorac Imaging 20(4):321CrossRef Swensen S, Aberle CD, Kaxzerooni EA, Patz N, Galvin JR, Henschke CI (2005) Society of Thoracic Radiology Ad-Hoc Committee on lung cancer screening with CT. J Thorac Imaging 20(4):321CrossRef
29.
go back to reference Henschke CI, Austin JH, Berlin N, Bauer T, Giunta S, Gannis F, Kalfer M, Kopel S, Miller A, Pass H, Roberts H, Shah R, Shaham D, Smith MV, Sone S, Turner R, Hankelevitz DF, Zulueta J. (2005) Minority opinion: CT screening for lung cancer. J Thorac Imaging 20(4):324–325PubMedCrossRef Henschke CI, Austin JH, Berlin N, Bauer T, Giunta S, Gannis F, Kalfer M, Kopel S, Miller A, Pass H, Roberts H, Shah R, Shaham D, Smith MV, Sone S, Turner R, Hankelevitz DF, Zulueta J. (2005) Minority opinion: CT screening for lung cancer. J Thorac Imaging 20(4):324–325PubMedCrossRef
30.
go back to reference Henschke CI, Yankelevitz DF, Libby DM, McCauley D, Pasmantier M, Altorki NJ, Smit JP, Miettinen OS (2001) Early Lung Cancer Action Project – annual screening using single-slice Helical CT. Ann New York Acad Sci 952:124–134CrossRef Henschke CI, Yankelevitz DF, Libby DM, McCauley D, Pasmantier M, Altorki NJ, Smit JP, Miettinen OS (2001) Early Lung Cancer Action Project – annual screening using single-slice Helical CT. Ann New York Acad Sci 952:124–134CrossRef
31.
go back to reference Bogot NR, Kazerooni EA, Kelly AM, Quint LE, Desjardins B, Nan B (2005) Intraobserver and intraobsrver variability in the assessment of pulmonary nodule size on CT using film and computer display maethos. Acad Radiol 12(8):948–956PubMedCrossRef Bogot NR, Kazerooni EA, Kelly AM, Quint LE, Desjardins B, Nan B (2005) Intraobserver and intraobsrver variability in the assessment of pulmonary nodule size on CT using film and computer display maethos. Acad Radiol 12(8):948–956PubMedCrossRef
32.
go back to reference Humphrey LL, Teutsch S, Johnson M (2004) Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update for the U.S. Preventive Services Task Force. Ann Intern Med 140(9):738–739 Humphrey LL, Teutsch S, Johnson M (2004) Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update for the U.S. Preventive Services Task Force. Ann Intern Med 140(9):738–739
33.
go back to reference U.S. Preventive Services Task Force (2004) Lung cancer screening: recommendation statement. Ann Intern Med 140(9):738–739 U.S. Preventive Services Task Force (2004) Lung cancer screening: recommendation statement. Ann Intern Med 140(9):738–739
34.
go back to reference American College of Radiology statement on CT screening exams. http://www.acr.org/departments/pub_rel/press_releases/total-body CT.htm American College of Radiology statement on CT screening exams. http://​www.​acr.​org/​departments/​pub_​rel/​press_​releases/​total-body CT.htm
35.
go back to reference Berlin L (2001) Malpractice issues in radiology – defending the “Missed” radiographic diagnosis. AJR 176:317–322PubMed Berlin L (2001) Malpractice issues in radiology – defending the “Missed” radiographic diagnosis. AJR 176:317–322PubMed
36.
go back to reference Budoff MJ, Achenbach SA, Fayad Z, Berman DS, Poon M, Taylor AJ, Uretsky BF, Williams KA (2006) Task Force 12: training in advanced cardiovascular imaging (computed tomography). JACC 47(4):915–920PubMed Budoff MJ, Achenbach SA, Fayad Z, Berman DS, Poon M, Taylor AJ, Uretsky BF, Williams KA (2006) Task Force 12: training in advanced cardiovascular imaging (computed tomography). JACC 47(4):915–920PubMed
37.
go back to reference Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, Brennan TA (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. J Am Med Assoc 293:2609–2617CrossRef Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, Brennan TA (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. J Am Med Assoc 293:2609–2617CrossRef
38.
go back to reference The Council on Ethical and Judicial Affairs, American Medical Association (2002–2003) Code of Medical Ethics. Chicago, IL, 91 The Council on Ethical and Judicial Affairs, American Medical Association (2002–2003) Code of Medical Ethics. Chicago, IL, 91
39.
go back to reference American College of Physicians (1996) Ethics manual, 4th ed. Ann Intern Med 128:576–594 American College of Physicians (1996) Ethics manual, 4th ed. Ann Intern Med 128:576–594
40.
go back to reference Ayanian JZ (2006) Rising rates of cardiac procedures in the United States and Canada – too much of a good thing? Circulaton 113:333–335CrossRef Ayanian JZ (2006) Rising rates of cardiac procedures in the United States and Canada – too much of a good thing? Circulaton 113:333–335CrossRef
41.
go back to reference Lucas FL, DeLorenzo MA, Siewers AE, Wennberg DE (2006) Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993–2001. Circulation 113:374–379PubMedCrossRef Lucas FL, DeLorenzo MA, Siewers AE, Wennberg DE (2006) Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993–2001. Circulation 113:374–379PubMedCrossRef
42.
go back to reference Alter DA, Stukel TA, Newman A (2006) Profileration of cardiac technology in Canada – a challenge to the sustainability of medicare. Circulation 113:380–387PubMedCrossRef Alter DA, Stukel TA, Newman A (2006) Profileration of cardiac technology in Canada – a challenge to the sustainability of medicare. Circulation 113:380–387PubMedCrossRef
43.
go back to reference Levin DC, Parker L, Intenzo CM, Sunshine JH (2002) Recent rapid increase in utilization of radionuclide myocardial perfusion imaging and related procedrues: 1996–1998 practice patterns. Radiology 222:144–148PubMedCrossRef Levin DC, Parker L, Intenzo CM, Sunshine JH (2002) Recent rapid increase in utilization of radionuclide myocardial perfusion imaging and related procedrues: 1996–1998 practice patterns. Radiology 222:144–148PubMedCrossRef
44.
go back to reference Levin DC, Parker L, Rao VM, Sunshine JH (2003) Radiologists and nonradiologists in utilization of noninvasive diagnostic imaging among the medicare population 1993–1999. Radiology 238:795–801 Levin DC, Parker L, Rao VM, Sunshine JH (2003) Radiologists and nonradiologists in utilization of noninvasive diagnostic imaging among the medicare population 1993–1999. Radiology 238:795–801
45.
go back to reference Ayanian JZ (2006) Rising rates of cardiac procedures in the United States and Canada. too much of a good thing. Circulation 113:333–335PubMedCrossRef Ayanian JZ (2006) Rising rates of cardiac procedures in the United States and Canada. too much of a good thing. Circulation 113:333–335PubMedCrossRef
46.
go back to reference Alter DA, Stukel TA, Newman A (2006) Proliferation of cardiac technology in Canada – a challenge to the sustainability of medicare. Circulation 113:380–387PubMedCrossRef Alter DA, Stukel TA, Newman A (2006) Proliferation of cardiac technology in Canada – a challenge to the sustainability of medicare. Circulation 113:380–387PubMedCrossRef
47.
go back to reference Woolhandler S, Campbell T, Himmelstein DU (2003) Costs of health care administration in the United States and Canada. N Engl J Med 349(8):768–773PubMedCrossRef Woolhandler S, Campbell T, Himmelstein DU (2003) Costs of health care administration in the United States and Canada. N Engl J Med 349(8):768–773PubMedCrossRef
49.
50.
go back to reference Jonsen AR (2000) A short history of medical ethics. Oxford University Press, New York, p 153 Jonsen AR (2000) A short history of medical ethics. Oxford University Press, New York, p 153
Metadata
Title
Ethical considerations in CT angiography
Authors
Samuel Wann
Andy L. Nassef
Justin Jeffrey
Joseph V. Messer
Norbert M. Wilke
Andre J. Duerinckx
James C. Blankenship
Michael K. Rosenberg
Donald H. Dembo
Publication date
01-06-2007
Publisher
Kluwer Academic Publishers
Published in
The International Journal of Cardiovascular Imaging / Issue 3/2007
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-006-9177-5

Other articles of this Issue 3/2007

The International Journal of Cardiovascular Imaging 3/2007 Go to the issue