As the U.S. government works to strengthen its global nuclear security strategy by eliminating potential sources of bomb-grade highly enriched uranium (HEU), it has eyed the production of medical isotopes for nuclear imaging, which rely on HEU.  To encourage reliable supplies of medical radioisotopes produced from non-HEU sources, President Obama signed into law on Jan. 2, 2013, the American Medical Isotopes Production Act of 2011 (AMIPA). It should be noted that it was part of the 2013 National Defense Authorization Act, so the measure goes beyond interest in just making sure patients have access to radiopharamceutical tracers to enable myocardial perfusion imaging (MPI) scans.  The effort is designed to make HEU sources less available on the world market to reduce the threat of nuclear weapons proliferation or the building of a “dirty bomb.”

Brigham and Women’s Hospital in Boston conducted a pilot study of a Web-enabled computerized physician order entry (CPOE) system (another Stage 2 requirement) with embedded imaging decision support. In an effort to reduce the inappropriate use of medical imaging and improve quality of care, it was phased into clinical use between 2000 and 2010 across outpatient, emergency and inpatient departments. The study, published in the Journal of the American College of Radiology in February 2012, showed significant increases in meaningful use for electronically created studies (from 0.4 percent to 61.9 percent) and for electronically signed studies (from 0.4 percent to 92.2 percent) and the adoption of CPOE (from 0.5 percent to 94.6 percent).

Oklahoma Heart Hospital (OHH), Oklahoma’s first dedicated heart hospital, has excelled at creating quality outcomes through an integrated approach to patient care. To maintain this culture of quality, its team of more than 60 physicians, including interventional cardiologists, general cardiologists, cardiothoracic surgeons and electrophysiologists, practice a systematic process of patient care that includes high adherence to a set of core measures or indicators. Specifically, managing a patient’s risk for sudden cardiac death (SCD) is a critical piece of the care.  

Over the past decade in the United States, there has been growing interest in transradial artery percutaneous access as a way to significantly reduce bleeding rates and access site complications. However, adoption in the United States has been slow compared to other parts of the world, partly due to lack of training in interventional programs until recently. In articles and sessions at various cardiology conferences, I have heard varying U.S. adoption rate percentages.