[Need and quality assurance: can the introduction of the new generation mobile systems change the reference standards?]. / Fabbisogno e VRQ: l'introduzione dei sistemi portatili di nuova generazione può modificare i parametri di riferimento?

The new generation of radiological mobile systems, by lowering the installation and depreciation expenses, has led to start new low volume catheterization laboratories. These equipments allow to obtain good quality images, but they are not so reliable for extended performances, so that they are not suitable for interventional procedures. On the other hand, the extension of the indications to coronary angiography and angioplasty, with the related increase in the population needs, leads the resetting of the reference areas to start new catheterization laboratories. Anyhow lowering of expenses and of the extension of the reference areas does not change the need for maintaining high activity levels of centers and first operators in order to guarantee the quality of diagnostic and interventional procedures. The optimal levels of centers in national standards are 800 coronary angiographies and 400 coronary angioplasties per year: these numbers indicate the experience necessary to warrant the quality of procedures, with optimal results and low rate of complications, therefore they should not be changed. The spreading of laboratories due to the new low cost radiological equipments leads to an increase in inappropriate procedures and in the total expenses for the management of cardiac patients, without a proportional advantage in prognosis and quality of life. In order to ensure a quick diagnostic and therapeutic process to all the patients who need invasive procedures, instead of starting new centers, it is worthwhile to perfect the efficiency of links among small and main centers following shared pathways.