Cardiac Computed Tomography in Private Practice Settings - A Changing Landscape

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Abstract

Continued advances in computed tomography (CT) hardware and computer software and changes in reimbursement policies in the US are altering the application of this technology. For example, prospective gating, computationally sophisticated iterative reconstruction algorithms, and other refinements are drastically lowering the radiation dose to the patient. Other changes are improving image quality and reliability as well as laboratory workflow. However, the business model for providing cardiac CT services in the outpatient setting is challenging, and there are dynamic cardiologist workforce issues. Continued technical advances and clinical experience in select patient subgroups promise to lead to further changes in the use of this technology in patient care. In practice models where CT scanners can be kept very busy performing a combination of cardiac and perhaps non-cardiac CT imaging, cardiologists can offer increasingly refined and impressive diagnostic services using these technologies.

Disclosure
Randall C Thompson, MD, FACC, FASNC, serves on a speaker's bureau for Astellas Pharma US and on an international speaker's bureau for Siemens.
Correspondence
Randall C Thompson, MD, FACC, FASNC, 4330 Wornall Rd, Suite 2000, Kansas City, MO 64111. E: rthompson@cc-pc.com
Received date
26 January 2010
Accepted date
08 April 2010
Citation
US Cardiology - Volume 7 Issue 2;2010:7(2):16-19
Correspondence
Randall C Thompson, MD, FACC, FASNC, 4330 Wornall Rd, Suite 2000, Kansas City, MO 64111. E: rthompson@cc-pc.com

Pages

“But doth suffer a sea-change Into something rich and strange” William Shakespeare, The Tempest
The term ‘sea-change’ is an idiom or poetic phrase meaning profound transformation, and was coined by Shakespeare in The Tempest. The term is appropriately applied to the complex transformation that the clinical practice of cardiac computed tomography (CT) continues to undergo. In the early and mid part of the first decade of the 21st century, coronary CT became established as a clinical tool following serial engineering advances, especially in CT hardware such as the number of detector rows. Very recently, continued advances in CT hardware and computer software and changes in reimbursement policies in the US have been altering the application of this technology. Continued clinical experience in select patient subgroups and issues related to the physician workforce promise to lead to further changes in the use of this technology in patient care.

 

Technical Advances

Each of the four major manufacturers of CT equipment has released significant advances every year for the past several years. Recent developments that have very quickly become standard of care for coronary CT angiography include new strategies for radiation dose reduction, smaller detector width, and improved gantry rotation speed. Currently, the following are considered minimal for performing consistent high-quality coronary CT angiography (CTA):1

 

 

  • 64 detectors or greater;
  • gantry rotation speed of 400ms or greater;
  • detector width of 0.6mm or less; and
  • a well-prepped and co-operative patient.

In addition, based on the rapid adoption of new technology, a cardiologist’s or radiologist’s equipment is now considered out-of-date for coronary CTA if it does not have the capacity to perform:

 

 

  • electrocardiogram (ECG) radiation dose modulation;
  • prospective ECG gating; and
  • selective reduction in tube voltage for individual cases.

Physicians whose equipment has these capacities but who do not regularly use them have not kept up with current practice.1

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