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Interventional Cardiology

Radiology Services

Computer Tomography (CT)

Computer tomography (CT scan), also known as computer axial tomography (CAT), is an X-ray technique that uses a computer to create cross-sectional (or slice-like) pictures of the heart. The CT scanner is a large X-ray machine that has a short open-ended tube in the middle. The patient lies on a scanning table, which slides through the middle of the CT scanner. The scanner takes multiple X-ray pictures of thin slices of the patient's heart. A computer then puts these images together to make one detailed picture. In some cases, a contrast dye is injected into the bloodstream to help doctors get a clearer picture.

Computer Tomography Angiography (CTA) This technique uses x-rays to visualize blood flow in blood vessels and create a computerized analysis of the images. Beams of x-rays are passed through the area of interest in the patient's body from several different angles to create cross-sectional images. A computer assembles these images into a three-dimensional picture of the area being studied.

CTA is less invasive than catheter angiography, which involves inserting a catheter and injecting contrast material into a large artery or vein. In CTA, contrast material is injected into a small peripheral vein using a small needle or catheter.

The procedure can be used to detect aneurysms - life-threatening, weakened blood vessel walls that bulge out - in the aorta. It can also help reveal a "dissection "in the aorta or its major branches - in which the layers of the artery wall peel away from each other, like the layers of an onion. Dissection can cause pain and may be life-threatening.

Spiral Computer Tomography (Spiral CT) This procedure, also known as a helical CT scan, is another faster type of scan that takes an X-ray of the heart in about one-tenth of a second. With ordinary CT scanning, many X-ray pictures are taken of thin slices of the heart. A computer then puts these images together to make one detailed picture. To get these slice-like pictures, the technician takes a picture, moves the table a fraction of an inch, takes another picture, and so on. With spiral CT, the scanner takes nonstop images as the patient is moved through the machine. Spiral CT scans can help doctors diagnose aneurysms and blood clots in the lungs (pulmonary emboli).

Electron Beam Computer Tomography (EBCT or Ultrafast® CT)

EBCT or Ultrafast CT is a faster type of CT scanning that takes an X-ray of the heart in about one-tenth of a second. Ordinary CT scanning can take from one to 10 seconds. EBCT captures images so quickly that it can avoid blurred pictures caused by the beating of the heart, a problem with a regular CT scan.

This type of scanning can also detect calcium buildup in the coronary arteries - which is has been found to be a marker for the presence of coronary artery disease (atherosclerosis). When identified, a Calcium Score is assigned based on the degree of calcium present. Calcium scoring is a reliable method of identifying calcification in the heart arteries and identifying the risk of a heart attack in its earliest stages. Early detection makes it possible to implement measures such as dietary and lifestyle changes and appropriate medication to help prevent the disease from progressing.

Magnetic Resonance Angiography (MRA)

MR angiography (MRA) is a magnetic resonance imaging (MRI) study of the blood vessels. MRI, also called nuclear magnetic resonance (NMR) imaging, uses radiofrequency waves and a strong magnetic field, rather than x-rays, to provide clear and detailed computer-generated images of internal organs and tissues. It can provide detailed images of blood vessels without using any contrast material, although a special form of contrast material is often given to make the MRI images even clearer.

MRA provides a fast, noninvasive alternative to x-ray angiography for diagnosing problems of the heart and cardiovascular system and avoids exposing the patient to radiation. From images generated of the heart muscle, physicians can examine the size and thickness of the chambers of the heart, identify and determine the extent of damage caused by a heart attack or progressive heart disease, and diagnose certain cardiovascular defects.

The electromagnetic energy that is released when exposing a patient to radiofrequency waves in a strong magnetic field is measured and analyzed by a computer, which forms two- or three-dimensional images that may be viewed on a TV monitor. The procedure is painless, and the magnetic field is not known to cause tissue damage of any kind.

The conventional MRI unit is a closed cylindrical magnet in which the patient must lie totally still for several seconds at a time. However, new designs that are more patient-friendly are coming into routine use. Patients with implanted pacemakers and cardiac defibrillators (ICDs) may not undergo MRA because they may be affected by the strong magnetic field.

Calcium Scoring:

Calcium Scoring (LINK) Dept. of Radiology) is performed by CT scanning in the dept of radiology, Calcium Scoring is a reliable method for detecting heart disease long before patients become symptomatic. The procedure takes less than 15 minutes. The scan is reviewed by a board-certified radiologist and results are mailed or faxed to the patient’s physician within 24-48 hours.

Prevention starts with awareness and early detection. In fact, 85 percent of heart disease can be halted or prevented if the condition is diagnosed early enough.

Calcified plaque, more commonly known as hardening of the arteries, is a risk factor that may lead to heart disease. As the plaque builds, arteries become narrower thereby hindering the blood flow. The risk of sudden heart attack may then be increased.

SmartScore is a numerical value that indicates your risk of having a heart attack based on coronary artery calcification. It is a tool that can be used to detect heart disease long before patients become symptomatic.

LightSpeed CT technology, a quick scan provides a reliable method of identifying calcification in the heart arteries and identifying the risk of a heart attack. This advanced multi-slice technology delivers thinner slices, faster scanning and unprecedented image clarity, while simultaneously providing better patient comfort and service. These new detailed heart images allow radiologists to determine the amount of coronary calcium present in the heart.

Anyone interested in preventive care and who has not had a past cardiac incident or is currently suffering from coronary artery disease may benefit from Calcium Scoring. The characteristics of the most likely candidates for calcium scoring have two or more of the following risk factors:

•Men between the ages of 40 to 75
•Women between the ages of 45 to 75
•Family history of heart disease
•High Cholesterol
•High blood pressure

Calcium scoring is performed in the CT Lab. During a heart CT procedure, the patient lies on a table with EKG leads attached to the chest area. The tabletop then moves the patient through a framework which houses an x-ray tube and detector. The x-ray tube rotates around the patient and the x-ray passes through the patient to the detector and thousands of x-ray measurements are acquired. The computer then processes this information and displays the corresponding images on a computer screen. This imaging technique bypasses any images or reflections of organs or tissues upon one another that might occur during other types of x-ray tomographic studies.

Interpretation of calcium scores:

•No identifiable atherosclerotic plaque
•Very low cardiovascular disease (CVD) risk

•Healthy diet (low in saturated fat and cholesterol)
•Stop smoking
•Maintain recommended weight

•Minimal plaque burden
•Low CVD risk

All recommendations above PLUS:
•Tight control of Diabetes and Hypertension
•Consider use of Statins in case of high cholesterol

•Mild plaque burden
•Moderate CVD risk

All recommendations above PLUS:
•Estrogen for Post-Menopausal women
•Aspirin use
•Use of Statins in cases of high cholesterol

•Moderate plaque burden
•High CVD risk

All recommendations above PLUS:
•Exercise program
•Use of Statins in cases of high and borderline cholesterol levels
•Consider use of Folic Acid, Vitamin E, Fish Oils

•Extensive plaque burden
•Very high CVD risk

All recommendations above PLUS:
•Exercise test to rule out obstructive disease
•Consider angiogram for symptomatic patient or those in high risk occupations

While the benefits of early detection and treatment outweigh the risks, patients should be aware of the following issues: detecting a disease early may not mean it is curable or treatable, screening tests may miss diseases that are too small or hidden, having a screening test may cause anxiety: The screening CT scan uses radiation: There is only a small risk from the relatively small dose of x-rays used. This is about the same or less radiation than is used for other types of CT scans.

To schedule a SmartScore CT Scan: Call--
Physician office staff or patients themselves can call 293-8487. Although this procedure does not require a referral from a doctor, we encourage patients to include their physicians in any health care decisions.

Most insurance plans do not cover this cost. Patients will be responsible for paying for this service during their appointment. The cost is an all-inclusive $325 per CT scan and covers the cost of the screening as well as the radiologist’s interpretation.