Supply and demand for US cardiologists is upside down and the Journal of the American College of Cardiology forecasts this shortage will call for the number of cardiologists to double by 2050 to meet the increasing demands of an aging baby-boomer population, epidemics in obesity, and growing rates of diabetes mellitus. At the time of this report, there is a shortage of more than 1,600 general cardiologists and almost 2,000 interventional cardiologists in the country. And with more patients with chronic heart disease are living longer and needing CT scans, the demand for cardiologists in America is expected to continue so that if these trends persist, the US may be short approximately 16,000 cardiologists in forty years.

Current statistics are not keeping up with increasing demand for more cardiology specialists qualified to perform proper 64 slice CT scans for patients

The study revealed that only 750 to 800 new cardiologists graduate from training programs each year, and that internal-medicine residents looking to do a cardiology fellowship don’t always get the chance to become cardiologists because of the strong competition for these positions. To worsen matters, many institutions say they lack the funding to take on any more cardiology fellows.

The research suggested that the current shortage is partially due to the significant shortages in the number of women and minorities in the field of cardiology. While there are an equal number of women and men in medical school, only 12% of the current cardiology workforce is female. Also, African Americans and Hispanics represent just 6% of cardiologists in active practice while constituting 25% of the total US population. In addition, in 2006-2007, black and Hispanic fellows represented only 13% of internal-medicine residents and 10% of cardiology fellows. In addition, more than 43% of US cardiologists who perform full body scans for heart conditions are currently older than 55 years, and there are concerns that these doctors might retire early, especially with the proposed cuts to cardiology payments in the Medicare physician fee schedule for next year.

A recent Science Daily article reports a team of researchers led by Massachusetts General Hospital (MGH) radiologists has developed a computed-tomography-based heart scan protocol that identifies both narrowing of coronary arteries and areas of myocardial ischemia – restricted blood flow to heart muscle tissue – giving a better indication of clinically significant coronary artery disease. This is among the first demonstrations of the use of cardiac CT [computed tomography] to detect both coronary artery stenosis and resulting myocardial ischemia simultaneously in a single examination, according to a cardiac imaging specialist at the MGH Heart Center.

A CT scan uses conventional X-rays to produce cross-sectional images of anatomic structures and can detect plaques in coronary arteries. But the appearance of plaques on CT images may not indicate whether or not they actually compromise the heart muscle’s blood supply.

More detailed full body scan images obtained via invasive cardiac catheterization give a better picture of how obstructive a plaque may be

Perfusion studies utilizing technologies such as MRI scans or the nuclear medicine technologies SPECT and PET reveal areas where limited blood flow has damaged the heart muscle, information that can determine whether a patient can be treated with drugs or requires surgery.

Previous studies showed that CT heart scans can identify areas of restricted coronary blood supply in resting individuals. The MGH-led study was designed to see whether a comprehensive cardiac CT examination could incorporate myocardial perfusion studies in both resting and stress situations provided by CT imaging.

CT-based perfusion imaging’s accuracy in diagnosing coronary artery narrowing that significantly affected myocardial perfusion was virtually the same as SPECT stress imaging, and the results of coronary CT angiography also compared favorably to those of cardiac catheterization. The radiation dose of the three CT scans did not exceed the dosage involved in the SPECT stress perfusion study because the cardiologists in the study used new radiation-dose-reduction techniques.

Nuclear perfusion, while providing imaging information that can help guide patient treatment, has limitations that can lead to either false negative or false positive findings. The ability to acquire anatomical visualization of coronary artery stenosis together with physiological assessment of myocardial perfusion in a single study could improve diagnostic accuracy while potentially reducing costs and radiation exposure. The study was relatively small, and further tests must be conducted a larger multicenter trial to investigate the additional value of CT perfusion studies.