High-Speed, 64-slice Computed Tomography (CT)
Computed Axial Tomography (CT or CAT scan) is a way of looking inside your body and/or head through the use of a special camera. The images (pictures) it produces are cross-sectional – like the slices of a loaf of bread.
During a CT exam, the scanner will take several cross-sectional images of you. The scanner’s computer can combine these pictures to show a view of your body from almost any angle. This greatly enhances the radiologist’s ability to diagnose a medical condition.

The advent of high-speed, multislice CT scanning has opened avenues fro expanding clinical applications in area such as trauma, pediatrics, vascular and cardiac imaging.

CT scans (exams) offered at our outpatient imaging center:

• Coronary CTA/Calcium Scoring
• Virtual Colonoscopy
• Whole Body CT Angiography (CTA)
• 3D Reconstruction
• Neuro Imaging and Orthopedic Imaging

How Does a CT Scan Work?
The CT scanner features a large ring which your body slowly passes through on a moveable table. During this time, the scanner takes a 360-degree image which it sends to its computer. Then the table moves a small distance to position you for the next series of images.

Before the test begins, the technologist will position you on the moveable table. The technologist will keep in contact with you through an intercom and will watch you through a window. Try to relax during the scan and remain still, because movement will blur the images.

The CT Scan is painless. However, to make a clearer picture of certain parts of your body, some types of CT will require the use of “contrast materials”. Two types of contrast materials used are barium, which you drink, and iodine, which is injected.

How long will the exam take? How do I prepare?
Preparation and length of the exam varies with the type of study you are having. Please check with us for more information.

Receiving Your Results
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your referring physician, who will share the results with you. In some cases the radiologist may discuss results with you at the conclusion of your exam.

Coronary CTA (CCTA)
Patient Information Guide

Coronary heart disease is the most common form of heart disease, the leading cause of death in Americans. About 1.1 million Americans suffer a heart attack each year.

What is a Coronary CTA?
Using a 64-slice CT scanner, a CCTA is a minimally invasive procedure using IV contrast to generate images of the heart and coronary arteries. The high sensitivity and specificity of CT imaging can assist in ruling out or determine the presence of coronary artery disease (CAD) in symptomatic and asymptomatic patients.

What are the advantages of having a Coronary CTA?
A Coronary CTA is done on a multi-slice or multi-detector CT machine. This means that during the exam, X-rays pass through the body and are picked up by special detectors.
The information collected during the Coronary CTA exam is used to identify the coronary arteries and, if present, plaques in their walls with the creation of 3D images on a computer screen. The images are then reviewed and interpreted by a radiologist.

Who should consider a Coronary CTA?
It is recommended that patients considering a coronary CTA first consult with their primary physician. This is because some Coronary CTA uses are more appropriate than others. In general, this exam has been found to be valuable in those patients who 1) may have a strong family history of heart disease but are asymptomatic, 2) patients who are having abnormal symptoms and are at moderate risk and 3) patients who have had a negative stress test but are having symptoms. Again, an initial consultation with their primary physician is recommended for patients determining the appropriateness of CCTA.

Who should not have a Coronary CTA?
Patients with strong evidence of narrowing of the coronary arteries should not be considered for this exam. Such patients would include those with a history of a positive stress-test results, a known history of coronary artery disease or heart attack and those patients with a history of chest pain during heavy physical activity. Coronary CTA also is of limited use in patients with extensive areas of old calcified, or hardened, plaque, which is often the case in older patients. Imaging quality is also compromised with patients who are extremely overweight or who have abnormal heart rhythms.

You should not have this exam if you have had severe allergic reactions to IV contrast dye, you are actively wheezing or have very low blood pressure, you are pregnant or your doctor determines that this is not the correct test for you.

Why do I have to take a beta blocker?
You will be asked to take an oral medication, called a beta blocker, prior to your exam. Because the CT scan will be taking pictures of your heart, if your heart is beating too fast, the pictures may be blurry. The blurring can interfere with the radiologists’ ability to see the vessels clearly. A beta blocker helps to slow the heart rate and make the pictures more accurate. If you are already on a beta blocker for a heart condition or high blood pressure, you will need to talk with your physician to discuss any further instructions with respect to taking any additional medication.

What happens during a Coronary CTA?
If you have had a CT scan in the past, your CT coronary arteriogram experience will be very similar. After changing into a gown, you will be placed on the CT table on your back. Pillows and blankets are available for your comfort. An IV will be placed in your arm, near the elbow joint, A contrast, or dye as it is sometimes called, will be given through the IV. This dye helps outline the various organs inside your body, in this case the heart.

Once the exam begins, the table will move in and out of the CT scanner, which is shaped like a donut. You will be asked to hold your breath at various times during your exam. Each time you pass through the donut, images of your heart are being taken. This series of X-ray beams create hundreds of cross-sectional slices, or pictures that represent your body. Seconds later, the system’s computer assembles the slices into three-dimensional images that will be interpreted by the radiologist.

With the first pass through, the scanner is analyzing your body to decide how best to make your images. The second time, the scanner is taking pictures that will be used to determine how much calcium is present in your hearts’ blood vessels. This is called a “coronary calcium score”.

Before your third pass through the scanner, you will receive the injection of contrast through the IV in your arm. You will likely feel warm all over your body, and you may have a strange taste in your mouth. This sensation will pass very quickly. Holding your breath, you will pass through the scanner one more time so that your coronary CTA can be finished.

How long will my exam take?
Your study will take approximately 1 hour. Please plan on arriving 15 minutes early.

How will I obtain my results?
As soon as the report is complete, your results will be sent to your physician first. You may request that we also contact you with the results as soon as they are available.

Is Coronary CTA covered by my insurance?
Insurance companies generally do not cover screening studies. You will be asked to sign a waiver, allowing us to bill you directly for this exam. However, if you would like us to check with your insurance first, we would be happy to do so.

Coronary CTA (CCTA)
Patient Preparation Guidelines

A CT technologist will contact you prior to your exam to review the following instructions as well as ask you some questions about your medical history.
To prepare for your exam:

• Your physician will give you an order for a prescription called Lopressor 50 mg (that you swallow). Take one 12 hours prior to your exam, and the other one 2 hours before your exam. You may be given a nitro spray at the time of your study.
• No caffeine or nicotine the day of the exam (12 hours prior)
• Nothing to eat 4 hours prior to exam. We encourage you to stay well hydrated. Please drink plenty of water.
• Take all prescribed medications on time, as usual, with water only unless your physician tells you otherwise.
• Bring a listing of all medications to your exam
• Be sure to let our staff know of any allergies or if you suffer from asthma
• IF YOU ARE 50 YRS. OF AGE OR OVER, AND/OR DIABETIC, YOU WILL NEED TO HAVE CREATININE DRAWN (this is a blood test). Your physician will give you the script/order for this. This will need to be done prior to your scheduled appointment.

If you have had any of the following studies, it would be helpful for us to have copies of these reports prior to your scheduled appointment:

• Previous catherization reports
• Coronary Artery Bypass Graft (CABG) operative reports
• Echocardiogram report
• Stress test report
• Myocardial Perfusion Imaging (MPI) results
• EKG results

How Long Will My Exam Take?
Your study will take approximately 1 hour. Please plan on arriving 15 minutes early.

How Will I Get My Results?
Your heart images will be processed and reviewed by a board certified radiologist. As soon as the report is complete, we will send the results to both you and your physician.

CARDIAC SCORING
Coronary artery disease, also known as atherosclerosis, occurs when the arteries that carry blood and oxygen to the heart become clogged with plaque. The plaque build-up slows the flow of blood to the heart muscle causing ischemia and increasing the chance of fatal and non-fatal heart failure.

CT cardiac scoring, or calcium scoring, is the best non-invasive test for quantifying coronary artery calcium content in symptomatic and asymptomatic patients.

What is Cardiac Scoring?
Cardiac scoring is a fast, non-invasive way to evaluate for the development of blockage in the coronary arteries. It is extremely valuable in detecting coronary atherosclerosis. Discovering this at an early stage may help limit complications of coronary artery disease. Adjustments in a person’s diet, life-style and medications can be guided by the results of the test. Results can also be helpful in suggesting the need for further cardiac testing before the person is aware that CAD is present.

The images from cardiac scoring include various parts of the heart. The most useful at this time are views of the coronary arteries, which supply blood to the heart. The test detects the development of plaque in the coronary arteries by measuring the amount of calcium build up in these arteries. The appearance of calcium in the artery wall is associated with active atherosclerosis in many cases. This calcium may be present at a very early stage of the disease when it would be most useful to intervene, or later when more advanced blockage is present.

How does it work?
Cardiac scoring begins with a CT scan of the heart. The images obtained by the multislice CT scan are “timed” to the heartbeat allowing a “freeze frame” view of the heart. The scan measures calcification in the coronary arteries, which is associated with the presence of coronary artery plaque. With the advancement in this technology, it has become possible to detect even small amounts of calcium. This affords an opportunity to detect early coronary blockage, before the patient develops symptoms and possibly, at a stage prior to when a traditional stress test would indicate the blockage.

What happens during a CT exam?
During your exam, you will lie on the CT table as it slowly moves into the donut-shaped gantry. The scanner then takes an image or picture of your beating heart while you hold your breath for approximately 20 seconds. The procedure requires no injections, treadmills or preparation such as fasting.

The information acquired during the CT exam is then processed with a special cardiac scoring software package that evaluates and quantifies the amount of calcium in your coronary arteries.
All patients must have a physician to whom the results can be sent. Prevention and detection of coronary artery disease is complex. Medical decisions on coronary artery disease likelihood and decisions on risk factor modification should take into account multiple factors and should be made only in consultation with your physician.

Who should have Cardiac Scoring?

People with three or more of these factors may at increase risk of heart disease, and should talk with their primary physician about cardiac scoring:

• High blood pressure
• Sedentary lifestyle
• Diabetes
• Overweight by 20%
• High cholesterol
• High stress lifestyle
• Family history of heart disease
• Men over 45-years old
• Smoker
• Women over 55-years old

Cardiac scoring is only one of many diagnostic tools used to evaluate a patient’s heart health. In general, the test should be reserved for patients who have certain risk factors for CAD and in whom documentation of CAD would be expected to change or influence therapy. For example, patients with mildly elevated cholesterol, hypertension, etc. could benefit in the positive results may lead to more aggressive risk factor treatment. Patients with relatively early family history of CAD likewise may benefit, in that their traditional and non-traditional risk factors could be individually addressed and treated.

Who should not have Cardiac Scoring?

• Young, healthy individuals under the age of 35 would likely not benefit unless there was compelling reasons to worry about coronary artery disease such as very early family history.
• Patients who are over 70 often accumulate some calcium in their arteries on a routine basis, making interpretation difficult and rendering the test unhelpful in those patients.
• Patients with known coronary artery disease should not have the test.
• Patients who have a very fast or irregular heartbeat will not be able to have the test because the quality of the test depends on a steady rhythm.
• Patients who are pregnant or potentially pregnant.
• Extremely obese patients.

VIRTUAL COLONOSCOPY (VC)

Colorectal cancer happens when cells that are not normal grow in your colon or rectum. These cells grow together and form tumors. This cancer is also called colon cancer or rectal cancer. It is the third most common cancer in the United States, and the second leading cause of cancer deaths. When it is found early, it is easily treated and often cured. Fairly simple screening tests can prevent this prevent this cancer, but fewer than half of people older than 50 are screened.

Screening tests can prevent many cases of colon and rectal cancer. They look for a certain disease or condition before they appear. According to the American Cancer Society, if everyone were treated, tens of thousands of lives could be saved each year.

Virtual colonoscopy is just one screening test that is available. It is recommended that you discuss all screening options with your physician

WHAT IS VIRTUAL COLONOSCOPY (VC)?
Virtual colonoscopy is a CT scan that utilizes additional software to produce two and three-dimensional images of the colon from the rectum to the cecum. It is minimally invasive, safe, quick and a more comfortable procedure for colon screening.

Virtual Colonoscopy is an excellent option for patients that cannot be convinced to have a conventional (optical) colonoscopy, and for patients that have had a failed colonoscopy.

Some of the other advantages of virtual colonoscopy include:

• No sedation is needed
• No risk of perforating the colon
• No need to stop blood thinners
• Less invasive; More comfortable; No colonoscope is used
• In addition to evaluating the colon, the exam can detect abnormalities outside of the colon. This cannot be done on a conventional colonoscopy
• No reported incidence of complications
• No need to take time off of work
• A less expensive examination

WHAT VC CAN DETECT
Virtual colonoscopy has demonstrated a high degree of sensitivity and specificity in the detection of clinically significant polyps. Recent studies have shown it to be comparable to conventional colonoscopy for finding polyps larger than one centimeter. The risk of cancer in smaller polyps is almost negligible.

VC is currently endorsed as an accurate way of locating polyps and/or colon cancer by the American Cancer Society, The American Gastroenterology Association, the American Society for Gastroenterology Endoscopy, the America College of Gastroenterology and the American College of Radiology.

THE ROLE OF THE RADIOLOGIST
A VC will produce images of your colon. These images will then be viewed by a radiologist. He/she is a physician trained with a specialty in radiology.
In addition, he/she has received a certificate from the American College of Radiology endorsing their interpretation of virtual colonoscopies.

WHAT TYPE OF PREPARATION IS REQUIRED FOR A VC?
The preparation is designed to cleanse the colon of all fecal material. Fecal material can interfere with adequate visualization of the inner colon.
The patient will be asked to follow a patient-friendly prep that includes nutritional support two days before the exam and a liquid diet one day before the exam. Laxatives and specific instructions will also be provided.

WHAT HAPPENS DURING A VC?

The VC exam takes about 10 minutes and does not require sedatives. During the procedure:

• You will be asked to lie on a table.
• A thin tube will be inserted into your rectum, and air will be pumped through the tube to inflate the colon for better viewing.
• The table moves through the scanner to produce a series of two-dimensional cross-sections along the length of the colon. A computer program puts these images together to create a three-dimensional picture that can be viewed on the video screen.
• You will be asked to hold your breath during the scan to avoid distortion of the images.
• The scanning procedure is then repeated with you lying on your stomach.
• After the exam, the scanned images will then be placed on a computer which generates 3-dimensional images of the colon.
• The radiologist will evaluate the results to identify any abnormalities.

WHAT IS A DIAGNOSTIC VC?
A diagnostic VC is performed for clinical indications such as a failed colonoscopy due to an obstruction, occlusive cancer, GI symptoms or blood in stool.

WHAT ARE THE DISADVANTAGES OF VC?
With VC, colonoscopy tissue samples/biopsies cannot be obtained. If masses/polyps are detected, the patient must have a follow-up regular colonoscopy. In addition, VC cannot detect polyps less than 5-7 mm. current guidelines indicate that VC be performed every 3 years. In contrast, a negative regular colonoscopy should be repeated every 10 years.

INSURANCE COVERAGE AND COST INFORMATION
At this time, a screening VC is not covered by Medicare or by most commercial insurances . If it is performed for clinical indications such as a failed colonoscopy due to an obstruction, occlusive cancer, GI symptoms or blood in stool, it is considered to be for diagnostic reasons and may be covered by insurance. It is best to check with your insurance for additional information.

The cost of a VC (screening or diagnostic) is $700.00. A 40% discount will apply if payment if made at the time of the exam. If we bill your insurance for a VC, we will ask that you sign a form accepting responsibility for all or any portion of the exam that is not covered.

HOW TO SCHEDULE A VC
After discussing your options with your physician, he/she will write you an order form (or script) for either a screening or diagnostic VC. You can then call to schedule your exam for a time that is convenient for your schedule.

FOR MORE INFORMATION, call 419.841.2166 and ask to speak to our Screening Study Coordinator.