This paper is a brief commentary on the nature and use of cardiac imaging technologies and is intended to provide a basis for further discussion.

There has been a significant increase in the number of investigations performed on patients with suspected heart disease. Over the period 1989-90 to 1991-92 there has been an increase of 118 per cent in the use of coronary angiography, nuclear medicine and ultrasound testing.  In this period, Medicare Benefits paid for these three categories of tests rose from $17.0m to $34.4m.

The increasing use of echocardiography, a non-invasive test, may be related to the repeated use of the test on the same patient for the purpose of physician reassurance.

There is little direct evidence that benefits, in terms of effect on patient outcome, are commensurate with the apparent increase in the use of cardiac imaging tests.

A proposed framework for the development of diagnostic algorithms is outlined, suggesting that a diagnostic matrix might be constructed to provide guidelines for the use of cardiac diagnostic tests.

A survey of cardiac imaging practice in both the public and private sectors to establish the numbers of diagnostic units and the existing patterns of practice would be desirable.

A number of newer cardiac imaging methods are becoming available. Their future role in relation to existing tests needs to be defined.