Coronary CTA, Radiation Exposure & Post-Processing

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C.P. Kaiser, Editor

As you know, coronary CT angiography (CCTA) has made great inroads in the care of chest pain patients in the emergency department. As you also know, the tradeoff for a fast CT scan , as opposed to MRI or echo, for example, is greater radiation exposure. There will come a time—and many say the time is now—when the tradeoff is negligible.

In our cover story, we’re highlighting various scanning techniques available today that significantly reduce exposure—sometimes by as much as 75 percent. Depending on the clinical question, a CCTA exam can be performed with less than 5 mSv of radiation—that’s significantly less than a conventional SPECT perfusion scan.

In the heady days of CCTA, many were concerned that the new kid on the block would supplant SPECT and make cardiac cath a money loser. Those fears have not materialized and CCTA has emerged as the perfect gatekeeper: triaging chest pain patients to the most appropriate test. Studies have shown that the use of CCTA results in more positive SPECT and cath exams. 

Many cardiologists have shied away from this powerful diagnostic test, however, because they dread the post-processing aspect. While post-processing does take training and an acute spatial sense, it is not rocket science. In fact, today’s sophisticated workstations automatically perform many 3D modeling tasks in the background while the system is booting up. But as noted CCTA educator Tony DeFrance says in our feature on advanced visualization, the automation does not absolve cardiologists from having an in-depth knowledge of the process—from acquisition to post-processing.

The real power of CCTA comes from the ability to review images in an unlimited number of angles. But this is also the technique’s Achilles heel. One angle can make an artifact resemble a lesion and another can make an insignificant stenosis look hemodynamically significant. The cardiologist who is well trained in the power and pitfalls of CCTA post-processing will be able to utilize this exam to its fullest diagnostic extent.

While CCTA is exciting, there are many other areas within cardiovascular medicine where technology has made a significant impact on the ability of cardiologists to better manage their patients and to keep their bottom line healthy as well. In this issue of Cardiovascular Business, you can read about them including how automated CPR makes it possible to take cardiac arrest patients without ROSC directly to the cath lab and what to expect in the next-generation of drug-eluting stents—an exciting area as vendors tailor stents to ever-more complex lesions and disease states.

There is much more in this issue of Cardiovascular Business and I look forward to your comments and suggestions.