Better is possible: the fruits of a joint programme in cardiovascular imaging shared by radiologists and cardiologists

Better is possible. It does not take genius. It takes diligence. It takes ingenuity. And above all, it takes a willingness to try.

Atul Guwande, MD

Historically, cardiovascular imaging programmes have been organized around modalities [echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), nuclear cardiology, and vascular imaging] and divided between radiology and cardiology departments. While this structure reflects the technical expertise required to perform and interpret these advanced imaging techniques, it has also created silos that hinder the ability to deliver integrated, patient-centred care. This fragmented approach often results in disjointed workflows, limited interdisciplinary engagement, and missed opportunities for collaboration between radiologists and cardiologists and imagers and clinicians.

Challenges of a siloed approach

The delineation of responsibilities between cardiology and radiology in cardiovascular imaging has further contributed to these challenges. Radiologists bring expertise in imaging techniques and cardiac and cross-sectional anatomy, while cardiologists possess in-depth knowledge of cardiac physiology and pathophysiology. However, the lack of formalized collaboration between these disciplines often leaves multimodality imaging studies interpreted in isolation, with little integration into a comprehensive clinical context. For patients, this traditional structure can translate into delays, inefficiencies, and a sense that their care is secondary to departmental organization.

Adding to these limitations is the challenge of training. Cardiovascular imaging rotations during core training in both cardiology and radiology are often brief, typically lasting no more than 2–4 months, and lack the depth needed to achieve mastery in interpreting complex, multimodality studies. Dedicated subspecialty training is therefore essential for both cardiologists and radiologists to acquire the competencies and develop the expertise required for accurate imaging interpretation and effective patient-centred care. Unfortunately, the traditional modality- and specialty-driven training structure does little to encourage such advanced learning. Furthermore, long-standing turf battles between radiology and cardiology have historically dampened interest in cardiovascular imaging, particularly among radiology trainees, who perceive limited opportunities and uncertain career prospects in this field.

A collaborative solution

To overcome these challenges, cardiovascular imaging programmes must embrace a new model: one that is built on collaboration and integration and one that is organized around the patient, not the modality or a particular department. In 2007 at Brigham and Women’s Hospital (BWH), the Departments of Medicine and Radiology, along with hospital leadership, launched one of the few fully integrated, multimodality, multidisciplinary cardiovascular imaging programmes in the country. This programme unites all modalities—echocardiography, cardiac CT, cardiac MRI, nuclear cardiology, positron emission tomography/CT, and vascular imaging—and integrates expertise from cardiology, radiology, and nuclear medicine into a single, cohesive framework. Successful integration relies on collaboration on every level ranging from institutional leadership and imaging faculty, to training programmes for advanced imaging fellows, radiology residents, and cardiology fellows. This was also facilitated by having faculty members who have multimodality expertise and clinical and academic appointment across both cardiology and radiology. In addition, having multimodality conferences and a cardiovascular imaging reading room where trainees and faculty from all modalities can discuss and interpret cases together has facilitated the patient centeredness focus of the program. The institutional leadership recognizes the merits of faculty based on clinical contributions and expertise regardless of their training disciplines, thus encouraging collaboration and patient-centred care.

Transforming clinical care

The transition from an insular system to an integrated organizational structure has proven transformative. Under this new model, cardiovascular imaging specialists and trainees work closely with referring clinicians to determine the most appropriate diagnostic strategies for each patient’s clinical needs. This patient-centred approach minimizes unnecessary and serial testing, reduces costs, and improves the efficiency of care. Multimodality imaging is used in a coordinated and comprehensive manner, enabling specialists to address complex clinical questions and improve diagnostic accuracy. This model has proven particularly valuable in managing patients with acute and stable chest pain syndromes, infiltrative cardiomyopathies, infective endocarditis, vasculitis, and other complex conditions such as structural and congenital heart disease. Indeed, rather than merely requesting a study, many clinicians have come to regard the non-invasive imaging interaction in our joint reading room as a consultation among professionals who have complementary skill sets.

Training future leaders in cardiovascular imaging

The success of this integrated approach extends beyond clinical care. Our training programme is one of the largest multidisciplinary cardiovascular imaging programmes in the USA, and it stands out for its ability to train cardiologists and radiologists side by side in a single, integrated curriculum. This collaborative environment enables trainees to develop not only technical proficiency across all imaging modalities but also the skills needed to provide patient-centred consultations and integrate imaging results into broader care strategies. In 2010, our programme received one of the very few National Heart, Lung, and Blood Institute T32 grants for research training in cardiovascular imaging—a testament to its excellence and scope. Graduates of our clinical and research training programmes have gone on to lead their own cardiovascular imaging programmes, clinical and translational research laboratories, and fellowship programmes.

Pioneering research and advancing the field

The achievements of our programme highlight the potential of interdisciplinary collaboration and team science to advance the field of cardiovascular imaging. By fostering an environment of innovation and shared purpose, the programme has become a magnet for young talent, attracting trainees and professionals eager to contribute to cutting-edge advancements in care. Furthermore, our integrated programme is well positioned to optimize resource utilization, refine risk stratification, and guide therapeutic decision-making for improved patient outcomes.

Conclusion

In summary, by embracing integration, patient-centred care, and a commitment to training the next generation of leaders, the BWH Cardiovascular Imaging Programme has created a model that not only serves our patients better but also paves the way for a more collaborative and innovative future in cardiovascular imaging. Energy and time too often expended in territorial concerns in traditional structures are now devoted to productive and constructive programme building. As Atul Gawande aptly said, ‘Better is possible. It does not take genius. It takes diligence. It takes ingenuity. And above all, it takes a willingness to try’. Our journey has shown that through persistence, creativity, and a shared vision, it is indeed possible to transform cardiovascular imaging into a field where cooperation breeds success and where the pursuit of excellence in care, education, and research continues to inspire the next generation and, most importantly, serves patients best.

Acknowledgement

I would like to thank the invaluable comments and suggestions of Drs Ron Blankstein, Sharmila Dorbala, Raymond Kwong, Justina Wu, Sanjay Divakaran, Ayaz Aghayev, Michael Steigner, and Peter Libby.

Declarations

Disclosure of Interest

All authors declare no disclosure of interest for this contribution.