Cardiac CT is hot. According to Health Imaging & IT’s most recent Top Trends Survey, CT is the top technology buying priority for facilities nationwide. What’s more, nearly three-quarters of sites budgeting for CT plan to invest in a 64-slice system.
The rationale is clear. Sixty-four slice scanners open the door to non-invasive CT angiography, providing hospitals, cardiology practices and imaging centers a new means of diagnosing coronary artery disease. Scans are more economical than invasive angiograms, and they can provide clearer results than stress tests. What’s more, they may allow cardiologists to diagnose and treat cardiac disease at earlier stages, potentially improving outcomes.
There are other benefits as well. Medicine is a business, and owning a state-of-the-art CT scanner can differentiate a practice or facility from its competitors. A well-managed cardiac CT program can boost business, better the bottom line and open the doors to other works such as peripheral vascular scanning.
Cardiac CT: Past and present
CT angiography is not exactly new, but 64-slice systems make it clinically viable and relevant for most patients and many practices. Take for example Grapevine Cardiology, a 70 cardiologist practice in Dallas. The practice has performed CTAs for about six years. “In the early days, resolution wasn’t great, and software was primitive. And the scan required a 60 to 70 second breath hold,” recalls John Osborne, MD, director of non-invasive angiography and preventative cardiology. Despite the drawbacks of early technology, the promise of CT angiography was apparent, says Osborne.
Fast forward a few years. Sixty-four slice scanners have made CT angiography nearly routine and are reinventing cardiovascular medicine. The new systems offer dramatic gains in resolution; it’s improved to an exquisite 0.4 mm isotropic spatial resolution. And breath hold is a manageable 12 to 25 seconds.
The advances translate into improved diagnosis and a golden era for some cardiology practices. “Cardiac CT is a paradigm-shifting technology,” says Tony DeFrance, MD, medical director of CVCTA Education Center in San Francisco, Calif. Grapevine Cardiology, for example, has seen its practice grow 30 percent since December 2005, when it deployed four Philips Medical Systems Brilliance 64-slice scanners. On the patient care end, fewer patients are referred for invasive angiograms.
On the flip side, the clinical advantages and practice gains are associated with some challenges. The primary considerations stem from the massive size of CT datasets. Sites need to develop an image storage and management plan before deploying cardiac CT.
CT = early diagnosis and intervention
DeFrance was an early convert to cardiac CT. DeFrance began using CT in 2001 to image the coronary arteries and detect cardiac disease at earlier stages. Last year, DeFrance’s practice invested in Toshiba America Medical Systems Aquilion 64-slice CT scanner. DeFrance also teaches radiologists and cardiologists how to perform and interpret cardiac CTA studies at CVCTA Education Center.
“The primary patient benefit of cardiac CT is that it allows physicians to look into the arteries and detect plaque decades earlier than other studies such as an invasive angiogram,” reports DeFrance. Earlier detection can correlate with more treatment options and improved outcomes.
On the practice side, 64-slice CT can generate new revenue and provide a competitive advantage. And because the images facilitate assessment of peripheral vascular disease, installing a scanner can drive a hefty peripheral vascular business.
Finally, cardiac CT is economical. An average invasive angiography costs $6,000 to $8,000 compared to $600 to $800 for a coronary CTA, says DeFrance. As practices learn about the financial and clinical benefits of 64-slice CT, more are turning to the technology; some are using it to re-create their practice.
Enabling point-of-care cardiology
In 2004, Grapevine Cardiology surveyed the cardiac CT landscape. “The 16-slice scanners were on the cusp of delivering viable every day CT angiography,” notes Osborne. But the practice opted to wait for 64-slice scanners. “We knew 64 slices would hit the sweet spot of high-resolution, reliable imaging of the coronary arteries,” says Osborne.
The other key consideration at Grapevine Cardiology was the practice model. The practice aimed to implement point-of-care testing for its patients, reconstructing and sharing