When your neighbor covets your possessions, you can do one of three things: you can burn his house down, you can hope that he will move away, or you can attempt to resolve the problem through strategic planning and negotiation.

Reason, years of history, and current events counsel against war: it should be undertaken only as a last resort and after every other avenue of approach has been exhausted. So when you read the article on coronary CT angiography by George Wiley, set your testosterone aside and focus on option number 3: Cardiologists are not going away. Au contraire, cardiologists are currently plotting the eventual ownership of CTA and all of the professional and technical revenue that goes along with it. The report CT Angiography Outlook, Five-Year Technology and Investment Assessment , prepared by The Advisory Board Company, Washington, DC, for the Cardiovascular Roundtable, presents the evidence.

The report is quite comprehensive and includes projections for break-even, revenue line items generated by multislice CT, and several models for ownership. Suffice it to say that radiology's role in the scenarios portrayed is entirely secondary. At best, radiology provides malpractice insurance at $25 per overread. At worst, radiology provides the technology on which cardiology can cut its teeth until such time as it is economically feasible for cardiology to own its own 64-slice, or whatever the slice-count available at the time of purchase. There is strong suggestion for placement in the emergency department, for which cardiologists would supply the reads.

The advent of the 64-slice scanner and its ability to spin an x-ray tube around a body at 30 mph, capturing the heart in a 10-second breath-hold, has clearly unleashed a surge of excitement and ambition. For radiology, this may well be the holy grail. For cardiology, it foretells tectonic change and the potential for some professional and technical obsolescence. Surely there are plenty of cardiologists out there who would like to vaporize the 64-slice. The conflict around coronary CTA will be less about turf and more about a complete redrawing of the landscape.

What is radiology to do? It would be irresponsible for radiology to step aside and let unqualified physicians blunder into chest imaging, even if they do have expertise in one of the region's major organs. As for the suggestion that vendors will provide cardiologists with a way out of the medicolegal hassles by writing software that excludes all information but that relevant to the heart, hospital administrators, their boards of directors, and payors likely will put the kabosh on that.

The American Board of Radiology has just reinstituted a cardiac section to the Oral Boards Examination for radiology residents as part of the renewed emphasis on cardiac imaging. Although this is a requisite step in preparing new radiologists to read CTA, the problem will not be resolved by organized radiology four years hence with a batch of freshly trained recruits. The question of whether radiology will play a role in CTA is in the hands of every radiology practice in the land. Each one needs to designate a person to ready its practice for the clinical demands. Each practice must begin discussions with hospital administrators on technical strategy. And your radiology group must also be ready to deal with the local cardiology group.

Cheryl Proval