Advanced cardiac imaging is quickly becoming the standard of care for diagnosing and treating cardiovascular disease. A recent study found that among Medicare beneficiaries, magnetic resonance imaging of the heart leapt 75.5% between 2012-2017, while cardiovascular computed tomography increased 97.4%. But despite increasing demand, there are a few challenges slowing adoption within the provider networks. Scanner and post-processing technology can be expensive, and shortages in trained cardiac CT and MRI physicians make it difficult to access the required expertise. These limitations make cardiac exams especially difficult to implement across larger hospital systems and in remote areas.
Dr. Rahul Sawlani, Cardiothoracic/Cardiovascular Radiologist and Associate Physician Diplomate at the University of California Davis, is helping healthcare facilities overcome these obstacles. After building a cardiopulmonary imaging program as Chair of Cardiothoracic Imaging at Advocate Aurora, he is now working with facilities across the country through the DocPanel platform. We spoke with Dr. Sawlani to learn more about his journey and hear how providers can leverage new technologies to bring advanced cardiac imaging to their communities.
[DocPanel] What are the biggest challenges healthcare providers face today in delivering advanced cardiac imaging services? What impact do they have on patient care?
[Dr. Sawlani] Managing and interpreting advanced cardiac exams requires additional, dedicated post-graduate training. But there is a major shortage of cardiovascular and cardiothoracic radiologists, even more so than other radiology specialties. In addition, there are not many institutions offering cardiothoracic imaging fellowships, meaning that we are not training enough of these radiologists or cardiologists every year to make up for the shortage.
As a result, cardiac studies are being read by nonspecialists and, more often, services are limited to specific hours or days or just altogether not available. In many places, a hospital may only have one physician available to interpret exams, meaning there is no one around when that physician is unavailable. This can be significantly limiting, especially for more urgent or emergent scenarios.
[DocPanel] You helped build the cardiac imaging program for Aurora, what was that experience like? What did you learn, and is your implementation method something that can easily be replicated at other facilities?
[Dr. Sawlani] Building the cardiac program was challenging, but very rewarding and definitely a joy. Aurora (now Advocate Aurora) is a large Wisconsin hospital system with a wonderful group of advanced cardiologists that are at the cutting edge of cardiac care across all subspecialties. As such, their expectations were high.
I learned a lot building and running that program, but the most important lesson was that a high-quality cardiac imaging program can truly have a positive impact on patient care. Once we deployed our imaging protocols and hired enough regional experts to cover the clinical volume, the program grew tremendously.
After that experience, I am confident that with the right tools and expertise, cardiac imaging can be deployed nationwide at any hospital or imaging center willing and able to put in the appropriate investment. In turn, patients can enjoy the benefits of a more confident diagnosis and targeted treatment plan.
[DocPanel] What new techniques and technology are available for facilities that may not have the in-house expertise to launch a cardiac imaging program?
[Dr. Sawlani] With recent improvements in technology, we were able to deploy remote monitoring, protocolling, and interpreting of advanced cardiac MRI at Aurora. Not a small task, but it is possible!
Scanners can now be equipped with remote control and monitoring software that allows the cardiac imaging physician to assist the technologist in getting the right images for that particular case. In addition, scanners are becoming faster and more automated, utilizing AI to automatically select complex imaging planes that are normally difficult to teach and prone to error. From there it requires a dedicated expert, or group of experts, willing to train hospital staff on the appropriate use and acquisition of those cardiac studies.
[DocPanel] What does a healthcare facility need to have in place to launch a cardiac program if they leverage remote subspecialty support through DocPanel?
[Dr. Sawlani] The biggest investment a healthcare facility needs is an appropriate scanner with the associated cardiac scanning software package. With this in place, as long as the facility has a good technologist or group of technologists willing to learn, we have the expertise to train those technologists and implement high-quality protocols to cover any clinical situation.
[DocPanel] What are the biggest pain points for cardiac imaging referring providers? How can imaging facilities best support their referring community?
[Dr. Sawlani] Referring providers want access for their patients and clinically effective results once the imaging has been performed. Cardiac imaging can be technically challenging, and sometimes we have to report with uncertainty due to image artifacts or quality issues. A good cardiac imaging program should minimize those issues while maintaining a reasonably short protocol which, in turn, improves access. It’s hard to fit too many patients in your schedule if your protocols are taking multiple hours, not to mention the discomfort for the patient.
In addition, it is very important that referring providers get useful results that answer the clinical question at hand. Cardiac imaging (cardiac MRI in particular) contains a gargantuan amount of data and many images to interpret. A good cardiac imager needs to synthesize this information with the available clinical history and the ordering clinician’s questions to provide a usable result that addresses the patient’s immediate needs. This is easier said than done, but there are many wonderful expert cardiac imagers in the world who have the training, expertise, and experience to do just that.
While there are not enough experts out there to staff all the institutions that need them, a remote consulting service like DocPanel is the perfect platform to disseminate that expertise across the country.
[DocPanel] What initially attracted you to cardiac imaging? Can you share a bit about your journey into the field?
[Dr. Sawlani] I started my undergraduate journey as an engineer. Through some twists and turns, I ended up in an MRI engineering tract and eventually switched to medicine. Being a radiologist and imaging expert became my dream after that, and I also always favored heart and lungs in my college and medical school coursework.
Cardiothoracic imaging was the natural next step for me in training. It combined my favorite body systems with all the great new technology that I love to tinker with, and the engineering background made it a perfect fit.
[DocPanel] What drives and inspires you in your work today? What are you most passionate about?
[Dr. Sawlani] Leaving Aurora was a tough choice, but when I left, I knew my mission would be to lend the expertise of cardiothoracic imagers to as many patients as possible. There is a significant shortage of cardiothoracic imagers, but it is our duty as physicians to make sure that patients have access to the right diagnosis in a reasonable timeframe as often as possible. This is a tall task, but when I set out with this goal in mind, it wasn’t long before I realized DocPanel was the perfect platform to carry it forward. This company was co-founded by a cardiothoracic radiologist who understands this issue, and it is clear in my short time working with them that we share the same values and goals in this regard.
When a patient sees a physician with expertise in the heart or lungs, it is a baseline expectation for that physician’s supporting cast to have intimate knowledge of that field as well. Whether it be radiologists, anesthesiologists, or pathologists, the supporting "behind the scenes" physicians need to have the same subspecialty mindset as the frontline physician. That is what we aim to provide.
Interested in learning how DocPanel can connect you with fellowship-trained Cardiothoracic and Cardiovascular Radiologists? Send us a note here and we’ll set up a time chat.