Launch of the 2006 Guidelines on Cardiac CT in Singapore, and the 1st Singapore Cardiac CT Course

15 Jan 2006

By Prof K. Satku, Director Of Medical Services

Venue: The Conrad Centennial Hotel, Singapore

Dr Ho Kheng Thye & Dr Kwek Boon Han,

Joint Chairmen, Writing Committee for the Guidelines on Cardiac CT in Singapore;

Distinguished guests, colleagues,

Ladies and gentlemen,

The role of Cardiac CT in Singapore

It gives me great pleasure to join you this afternoon at the launch of the 2006 Guidelines on Cardiac Computer-assisted Tomography in Singapore.

While the traditional CT scan is a x-ray procedure that combines many x-ray images with the aid of a computer to generate cross-sectional views of the body, cardiac CT which employs advanced CT technology has significantly enhanced cardiac imaging, enabling us to acquire high-resolution and three-dimensional images of the moving heart, coronary vessels, pericardium and great vessels. Even as coronary angiograms performed with cardiac catheterization remain the current "gold standard" of coronary angiography, advanced CT technology is now enabling doctors to perform coronary angiograms non-invasively.

In addition, CT angiography is able to determine whether fatty or calcium deposits have built up in the coronary arteries;

Advancing Intercollegiality between Medical Colleagues 

Advances such as these help us to find new ways to care for our patients, but also force us amongst others to re-examine our existing role and our core competencies as medical professionals in the provision of new medical services. For example, one may ask, is it the cardiologists, with their innate understanding of diseases of the heart, who should champion a new technology such as cardiac CT, or should it be the radiologists, with their understanding of radiological equipment and imaging anatomy, who should interpret the imaging results in this new and rapidly advancing field? It is precisely because cardiac CT is new, vital and important to our patients' well being that we are ourselves mired in this dichotomy of views. We, who are in the business of care, are eager to trust that we would always have the necessary competencies, to provide the best possible treatment to our patients. But will this be the case all the time?

Some of you may be aware that these issues were first brought to light when a cardiologist applied for a license to perform cardiac CT imaging on his patients.

The Ministry of Health was asked to intervene and I tasked the Academy of Medicine to review this issue.

I am very glad that common sense has prevailed, and that both the College of Physicians and the College of Radiologists have agreed that it is the medical professional who has been appropriately trained who should be the champion for this new technology. Indeed, it is this spirit that has guided the development of this set of Guidelines on Cardiac CT that we will be launching today.

This joint effort summarizes the existing body of medical literature on cardiac CT, and makes suggestion to the training standards for all physicians intending to participate in the field. This is in contrast to the situation in some countries overseas where cardiac CT is guided by separate documents from different colleges.

Given that the body of knowledge in Cardiac CT, and indeed in all medical advances, will continue to grow rapidly, I am especially heartened that the guidelines have emphasized, and I quote, that "as with all rapidly evolving fields in medicine, physicians are reminded to update their knowledge in order to deliver the highest level of care to their patients".

The Singapore Medical Council's "Ethical Code and Ethical Guidelines" dictates that doctors should only practise in areas in which they are trained and competent. For other areas in which another colleague is more competent, we must defer care to our colleague in the interest of our patients.

While the majority of doctors will be able to conform to these requirements, there will always be a small minority that skirts along the borders of such good and common sense. Against the tide of an ever-expanding sea of medical advances, let us not be carried away, but remain vigilant of potential issues such as these, arising in new areas of care.

The Academy of Medicine must be prepared to involve all relevant colleagues, as you have done in this instance, to discuss and set the necessary training requirements that will enable all competent professionals to serve their patients to the best of their abilities.

Conclusion

These guidelines are a joint effort of the College of Physicians and College of Radiologists and represent far more than just the training standards of cardiac CT in Singapore. It is a significant milestone in professional collegiality. I cannot agree more with the approach the two Colleges have taken - to define the core competencies for cardiac CT, to create the training opportunities, and to accredit all those who fulfil these requirements.

I wish to thank Dr Ho Kheng Thye, Dr Kwek Boon Han, and members of the Writing Committee for their tireless efforts in this landmark publication. On this note, I am very happy to launch the 2006 Guidelines on Cardiac CT in Singapore.

Thank you.