Cardiac computed tomography (CT), magnetic resonance imaging (MRI), echocardiography and nuclear myocardial perfusion imaging each offer advantages and disadvantages, and frequently at least two of these tests are required to get the full picture of a patient’s cardiac health.  However, in this age of cutting healthcare costs, declining reimbursements and improving efficiency, it would be advantageous to have a single gold standard exam. Technology advances are now making that possibility. 

 
McKesson Cardiology, CVIS, cardiovascular information system, cardiac PACS, ep reporting system

The biggest issue in electrophysiology (EP) is the disparate nature of patient tests, reports, images and waveforms, and the need to aggregate all this data in one place to more efficiently care for patients with arrhythmias. This is especially true as the need to meet government-required meaningful use criteria for electronic medical records (EMRs) pushes forward and healthcare reform necessitates a deeper data integration. 

As vendors develop, and hospitals shop for, electrophysiology (EP) information and reporting systems, there are several considerations that will contribute to the efficiency and longevity of these systems. 

August 29, 2012 — A new, daytime teleradiology company targeting urgent care, independent diagnostic testing facilities (IDTFs), mobile medical and physician offices is now serving clients in 10 states, is licensed in 20 and plans to expand with the growth of its customers. Teleradiology Specialists keeps overhead costs low and extends the savings to every customer while employing highly qualified radiologists who are available to read a wide variety of studies all day.
Use of transradial access for PCI can increase radiation exposure.
Percentage of radial access studies that look at patient radiation dose.
Summary of radiation exposure associated with transradial access.

Recently, concerns have been raised that transradial (TR) cardiac catheterization significantly increases radiation exposure when compared with the conventional transfemoral (TF) approach. The current rapid uptake of TR in the United States is mainly due to its economic benefits and overall favorable patient outcomes. Perhaps most importantly, TR provides a measurable reduction in vascular complications, which translates to shorter time for ambulation and post-procedural stay. The reduction in bleeding with TR likely lowers mortality in patients with ST-elevation myocardial infarction (STEMI). One potential reason for the slow adoption of TR may be the perceived concern about increased radiation exposure.
Verifynow platelet testing clopidogrel nonresponders

Patients with 2C19 that is less active due to loss of gene copies are poor metabolizers of clopidogrel, opening patients to the possibility of a higher rate of mayocardial infacrtion (MI). There are assays for platelet function response (VerifyNow) and genetic tests to measure patient response, which could help determine if generic clopdogrel or more expensive agents should be used.

 
Ticagrelor, Brillinta, is the newest antiplatelet agent on the market. Ticagrelor is a reversible nonthienopyridine P2Y12 receptor antagonist that prevents signal transduction and platelet activation.
Prasugrel, Effient, has a more rapid onset and better response than clopidogrel and is not affected by poor metabolizers or PPIs.

The standard-of-care for dual antiplatelet therapy (DAPT) for more than a decade has been clopidogrel (Plavix) plus aspirin. This standard is now being challenged by new agents — ticagrelor (Brilinta) and prasugrel (Effient). While the new agents are more effective at preventing platelet aggregation than clopidogrel, each has unique characteristics. Plavix went generic earlier this year, which may also impact decisions about which therapies to use. 

August 28, 2012 — Toshiba America Medical Systems Inc. has received U.S. Food and Drug Administration (FDA) clearance on its new Vantage Titan 1.5T series, which features the 8-, 16- and 32-channel MR (magnetic resonance) systems.

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