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RADIOLOGY REPORT

RADIOLOGY REPORT. 64 Detector CT P.A.C.S. Stroke Program Update Neuro Interventional Update. LightSpeed VCT 64-Slice CT Scanner. Helps us obtain the information we need to diagnose disease and life-threatening illnesses, including cardiovascular disease, chest pain and stroke.

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RADIOLOGY REPORT

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  1. RADIOLOGY REPORT • 64 Detector CT • P.A.C.S. • Stroke Program Update • Neuro Interventional Update

  2. LightSpeed VCT 64-Slice CT Scanner • Helps us obtain the information we need to diagnose disease and life-threatening illnesses, including cardiovascular disease, chest pain and stroke. • The world’s first volume CT (VCT) system, captures images of a beating heart in five heartbeats, an organ in one second, and performs whole body trauma in ten seconds, more than twice as fast as conventional multi-slice CT scanners.

  3. Target Audience: Community

  4. Coronary CTA-Overview

  5. Appropriate CT Angio Indications • Chest pain, intermediate pretest probability, and either • uninterpretable ECG or unable to exercise • No ECG changes and serial enzymes negative • Suspected anomalous coronary artery anatomy or other complex congenital heart disease • Evaluation of coronaries for etiology of new onset heart failure • Evaluation of cardiac mass, tumor or thrombus, or pericardial disease when echo, TEE or MRI technically limited

  6. Appropriate CT Angio Indications-continued • Evaluation of pulmonary vein anatomy prior to RF pulmonary vein isolation • Mapping of old bypass grafts prior to re-do CABG • Mapping of coronary veins prior to bi-V pacer implantation • Evaluation of aortic dissection, thoracic aortic aneurysm, or pulmonary embolus

  7. Uncertain CT Angio Indications • Chest pain, intermediate pretest probability of CAD, able to exercise with interpretable ECG • Chest pain, low or high pretest probability of CAD, no ECG changes and enzymes negative • Chest pain, post coronary stent or CABG procedures • Triple rule out (ECG and enzymes negative) • Detection of CAD in asymptomatic patients at moderate or high risk (Framingham)

  8. Uncertain CT Angio Indications-continued • Preoperative assessment before intermediate or high-risk noncardiac surgery (intermediate risk patient) • Evaluation of LV function (technically limited echocardiogram) • Evaluaiton of native or prosthetic cardiac valves (technically limited echo, TEE or MRI)

  9. Inappropriate CT Angio Indications • Chest pain and • High pretest probability of CAD • ST elevation or positive enzymes • Ischemia on stress testing • dkajflaksjfd

  10. CCTA-Contraindications • Atrial fibrillation (permanent or AF at the time of the study) • Bigeminy, trigeminy, high degree heart block • Severe asthma • Creatinine > 1.8 (eGFR < 60) • Failed steroid prep for contrast allergy • Morbid obesity (BMI > 40)

  11. Ordering Physician • Cardiologist • CT surgeon

  12. Interpreting Physician • ACC/AJR credentialed physician • Interpreting physician also responsible for supervision of the study

  13. Cardiology Participation • Ordering Physician +/- review with radiologist • Interpreting Physician ( pending CPT codes )

  14. Patient Preparation • Prior to procedure patient receives preparation packet • Packet includes cardiac, medical history forms, and a brief description of what to expect when having CCTA • Instructed to take meds in am as usual, including (especially) beta-blocker

  15. Patient Preparation • No caffeine for 12 hrs prior to exam • Metoprolol 100mg po one hour prior to study • Second dose of Metoprolol 50 mg if HR > 71 • Nitro spray 1/150 gr. sl. NTG contraindications - allergy - Viagra,Cialis,Levitra

  16. Target Heart Rate • Ideal rate is < 70bpm • Can be done up to 80 bpm if they have a regular rhythm ( images not as good )

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