Last September, nearly 1,000 people—most of them cardiologists—took the first-ever board exam for cardiovascular CT and nearly 80 percent of applicants passed. One can only surmise that cardiovascular CT is here to stay.
With cardiovascular CT comes the need to understand advanced visualization techniques necessary for optimal interrogation of diagnostic images of the coronaries, in particular, and other cardiac structures, in general.
This month’s Advanced Visualization Portal features several interesting articles regarding coronary CTA (CCTA). One study tells us that the Framingham risk score comes up short compared with CCTA in predicting plaque burden. These findings also relate to a Dutch study that found some limitations of the weathered Framingham score. If one connects the dots, the Framingham risk score is possibly out of date and CCTA could potentially fill in the gaps. This has huge implications for cardiovascular medicine, not the least of which is the ever-increasing need for cardiologists who are thoroughly trained in advanced visualization techniques.
Another study found that the use of CCTA resulted in a reduction of cardiac catheter angiograms. This is exactly the type of outcomes that insurers need to see. These data suggest to them that CCTA would not be one of many layered tests for patients with chest pain, but could actually be a good triage tool that sends only those patients in need of catheterization to the cath lab.
The bad news is that CCTA tends to overestimate stenoses, resulting in a false-positive rate that some interventional cardiologists find disconcerting. But the drumbeat of progress moves on, and with each new generation of CT scanner, earlier drawbacks are surmounted. This is evident in our article on dynamic volume CT, which is the term Toshiba has affixed to the imaging performed by its new 320-detector row CT scanner. This scanner eliminates or reduces many disadvantages of the 64-slice generation scanner.
It’s an exciting time for cardiovascular CT and incorporating this modality into private practice might be a way for cardiologists to keep their bottom line from slipping too low in these trying economic times. If you are interested, the next board exam for CV CT will be September 2009. Register early and get onboard the fast-moving CV CT express.
On these or any other topics, please feel free to contact me.
Chris P. Kaiser, Editor