Healthcare Imaging & IT - July 2008 - (Page 28)

modAliTy review By Sarah Lamberti Cardiac CT Angiography A Clear Pathway to Better Cardiac Patient Management Supported by a growing base of clinical studies, cardiac CT angiography (CCTA) has shown its utility in improving cardiac patient management and ruling out heart disease with greater than 99 percent accuracy, while also offering fiscal benefits that can be found by limiting unnecessary diagnostic cardiac catheterization procedures on low- to intermediaterisk patients presenting with acute chest pain. It’s no wonder CCTA system installations have surged in recent years, in university hospitals and medical centers as well as in community hospitals and outpatient imaging center settings. There were approximately 4.3 million CTA procedures performed in 2007, according to IMV Medical Information Division. Diagnostically, CCTA is a good fit for patients with low to intermediate likelihood of coronary artery disease (CAD) with atypical chest pain and/or prior equivocal or nondiagnostic other tests (e.g. stress testing, nuclear myocardial perfusion imaging). It also has proved valuable in the detection and exclusion of obstructive CAD, the severity of stenosis, as well as plaque volumes, composition and remodeling. Clinical evidence suggests CCTA will revolutionize patient management for the treatment of heart disease. However, the future implications of the procedure remain unclear as CMS noted in its final ruling that “questions remain on the indications of use.” CCTA in clinical practice One question that has been answered is whether there is enough evidence to justify incorporating CCTA into clinical practice for assessing heart disease. The answer is unanimous and unequivocal—absolutely. “If used appropriately, CCTA is an extremely beneficial tool in clinical practice,” says U. Joseph Schoepf, MD, cardiac radiologist, Medical University of South Carolina (MUSC). “The main reason is that it has an extremely high negative predictive value—almost 100 percent.” From the patient viewpoint, the value is in replacing one invasive procedure, invasive coronary angiography, with a non-invasive one. For the institution, value is gained by inserting CT into the clinical algorithm for patients with suspected CAD. A substantial number of patients with normal arteries can be eliminated from the cath lab schedule, creating a much more specific selection of patients who need interventional procedures meaning time can be more cost-effectively spent on the more lucrative coronary interventions. For the healthcare system, signifiHealthImaging.com [ The left anterior descending artery (LAD) seen here in a curved planar reformat view shows a fairly tight high-grade stenosis caused by a mixed plaque. This examination was acquired with a 0.5mm x320 wide area detector on Toshiba’s Aquilion ONE dynamic volume CT using a single prospectively triggered acquired in less than one heart beat. ] 28 Health Imaging & IT | July 2008 http://HealthImaging.com

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Healthcare Imaging & IT - July 2008 On the Web The Enterprise News Update Convention Spotlight: AHRA 2008 Cover Story: Driving Metrics to Drive Business: Digital Dashboards Deliver Mammography CAD Comes of Age Breast MR CAD: Earlier Detection, Increased Efficiency Lung CAD Earning a Spot in Day-to-Day Practice Colon CAD: Breaking Down Barriers Modality Review: Cardiac CT Angiography: A Clear Pathway to Better Cardiac Patient Management Practice Management: RIS Rights Efficiency & Productivity Wrongs In Practice: Advanced Visualization Across the Enterprise Regulatory Update: Beware: Recovery Audit Contractors Poised for Permanent Status Technology Outlook: Compressing Images for Remote Transmission Reader's Resource Stat Sheet

Healthcare Imaging & IT - July 2008

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