Matching the Clinical Question to the Appropriate Imaging Procedure: What a Cardiologist Wants from Cardiac Imaging

In modern medicine, we too often become enamored with technology and lose focus on the reason for per-forming a diagnostic study. Cardiac imaging may have advanced to point of replacing the physical ex-amination, but there is still no substitute for thought-ful planning of a diagnostic approach based on a hier-archy of clinical data, an appreciation of the pre-test likelihood of disease, realistic expectation from vari-ous imaging procedures, and a rational plan for utiliz-ing the information gained. Team work is required to effectively utilize all the capabilities of the modern medical environment. Communication is essential if patients are to receive the best care. As the power and complexity of imag-ing has increase, so has its over-utilization. This lec-ture will focus on maximizing useful diagnostic yield, while minimizing redundancy and excessive costs. While evidence based medical practice is ideally based on controlled randomized trials to show im-proved patient outcomes. Medical imaging has his-torically developed by improving the quality of im-ages, comparing new to existing technologist. Exam-ples will be given of applications of various imaging techniques to common clinical problems, pointing out areas where true evidence is lacking. Appropriate imaging in these situations must be defined by con-sensus of expert opinion. A variety of clinical vi-gnettes will be presented.