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Coronary CT angiography came of age in the last decade. This occurred because CT technology moved into the 16- and 64- detector era.

Coronary CTA really works, but why isn't its use soaring?

In the October 2006 issue of Diagnostic Imaging, I wrote a brief article describing the benefits of using prospective gating when performing coronary CT angiography.

Low-dose 'quadruple rule-out' portends era of half-body CTA

By reducing radiation exposure while maintaining image quality, technique could make coronary CTA viable as screening tool

Prospectively gated CTA dramatically reduces dose

Coronary CT angiography (CCTA) was initially performed on four-slice multidetector CT scanners. These examinations were confined to evaluation of the proximal coronary arteries because the studies were limited in spatial and temporal resolution and were plagued by long acquisition times that required intolerably long breath-holds. Sixteen-slice scanners produced revolutionary improvements in CCTA technique: For the first time, complete coronary circulation exams with breath-holds in the 15 to 20-second range could be routinely obtained.

Coronary CTA takes giant leap with 64-slice scanners

Emphasizing enhanced workflow efficiency for mammography exams, GE HealthCare will unveil the Pristina Via mammography platform at the Radiological Society of North America (RSNA) conference.

In addition to offering zero-click acquisition to facilitate streamlined workflow, the 

 incorporates prior image comparison, irrespective of mammography vendor, to aid in mammography assessments, according to GE HealthCare.

The company adds that the Pristina Via system offers image to image cycle time for digital breast tomosynthesis (DBT) that is up to twice as fast as other mammography platforms, as well as the lowest radiation dose for all breast thicknesses.

“Simplifying, automating, and streamlining the mammography exam to improve in-room workflows is critical to driving patient compliance and access to screening,” said John Simon, M.D., the CEO of SimonMed. “The enhancements offered by Pristina Via are part of our mission of making advanced technology accessible.”

The new mammography system reportedly offers features that promote workflow efficiency as well as patient comfort.

Topic

GE HealthCare Introduces Pristina Via Mammography System at RSNA

The use of artificial intelligence (AI) tools to provide quantitative coronary tomography (AI-QCT) and coronary plaque analysis (AI-CPA) based on coronary computed tomography angiography (CCTA) will soon be covered by four Medicare administrative contractors (MACs).

Starting on November 24, the MACs Palmetto GBA, National Government Services (NGS), CGS Administrators and WPS administrative groups will cover the use of AI-QCT and AI-CPA for Medicare beneficiaries with acute or stable chest pain, and no known coronary artery disease (CAD), according to a recently updated local coverage determination (LCD) issued by the Centers for Medicare and Medicaid Services (CMS).

The LCD noted coverage of AI tools will be provided for the testing of patients deemed to be at intermediate risk for CAD, or those classified by the Coronary Artery Disease Reporting and Data System (CAD-RADS) as having CAD-RADS 1, CAD-RADS 2 or CAD-RADS 3, based on CCTA findings. The coverage will also apply for those who have had negative or inconclusive evaluation for acute coronary syndrome (ACS), according to the LCD.

The use of the FDA-cleared AI modalities 

“Coronary artery disease is the underlying cause of about 50% of deaths,” noted Ron Blankstein, M.D., the director of cardiac computed tomography at Brigham and Women's Hospital and a professor of medicine at Harvard Medical School in Boston. “Medicare coverage of HeartFlow Plaque Analysis is a major step forward in improving coronary artery disease management. The earlier we can diagnose and use tools to provide accurate plaque quantification, the earlier we can provide tailored treatments, potentially improving outcomes for patients.”

“We are also extremely thankful to the many physicians and medical society partners who used their voices to advocate for this essential AI-QCT technology. Until Cleerly, health-care providers have not had a way to easily and completely assess the primary cause of heart attacks, atherosclerotic plaque burden and type in a non-invasive way, which is especially important for our senior population,” noted James L. Kim, M.D., the CEO and founder of Cleerly. “This decision by the MACs represents a significant step in advancing the field of cardiology and providing the best possible care for our seniors.”

(Editor’s note: For related content, see “

FDA Clears Software for Enhancing CCTA Assessment of Atherosclerosis

Coronary CT Angiography Study Shows Link Between Major Cardiovascular Events and High Lipid Core Burden

Meta-Analysis Shows Superiority of CT Angiography Over SPECT and Functional Testing for Obstructive CAD

1. Centers for Medicare and Medicaid Services (CMS). Artificial intelligence enabled CT based quantitative coronary topography (AI-QCT)/coronary plaque analysis (AI-CPA). Available at: 

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39851&ver=10

 . Published October 10, 2024. Accessed October 14, 2024.

2. Cleerly. Medicare administrative contractors approve coverage of Cleerly heart scans to Medicare recipients. Business Wire. Available at: 

https://www.businesswire.com/news/home/20241014694634/en/Medicare-Administrative-Contractors-Approve-Coverage-of-Cleerly-Heart-Scans-to-Medicare-Recipients

 . Published October 14, 2024. Accessed October 14, 2024.

3. HeartFlow. HeartFlow announces favorable coverage determination for plaque analysis by four Medicare administrative contractors. GlobeNewswire. Available at: 

https://www.globenewswire.com/news-release/2024/10/11/2962144/0/en/HeartFlow-Announces-Favorable-Coverage-Determination-for-Plaque-Analysis-by-Four-Medicare-Administrative-Contractors.html

4. Elucid. Elucid announces favorable Medicare coverage of AI coronary plaque analysis. Business Wire. Available at: 

https://www.businesswire.com/news/home/20241015489543/en/Elucid-Announces-Favorable-Medicare-Coverage-of-AI-Coronary-Plaque-Analysis

 . Published October 15, 2024. Accessed October 15, 2024.

Four Medicare administrative contractors (MACs) will provide coverage of AI-enabled coronary plaque analysis and quantitative coronary tomography assessment of coronary computed tomography angiography (CCTA) for Medicare beneficiaries starting in November 2024.

Medicare to Cover AI-Powered, CCTA-Based Coronary Plaque Analysis and Quantitative Coronary Topography 

The Food and Drug Administration (FDA) has granted 510(k) clearance for AngioFlow™, an artificial intelligence (AI)-enabled perfusion imaging software that may facilitate more timely assessments of perfusion status prior to endovascular procedures.

Offering color-coded perfusion mapping that identifies regions with reduced cerebral blood flow and blood volume, 

 provides results within minutes of a cone-beam computed tomography (CT) scan, according to RapidAI, the manufacturer of AngioFlow.

In addition to potential cost savings by reducing redundant imaging, RaidAI emphasized that AngioFlow’s timely assessments may reduce long-term disability risks and facilitate life-saving interventions for patients in need of acute stroke care.

“AngioFlow by RapidAI will allow physicians to assess the need for additional imaging immediately in the interventional suite. By avoiding unnecessary scans, stroke patients can receive the timely care that can be the difference between being able to walk out of a hospital to their homes versus being discharged to a skilled nursing facility,” said Abhishek Singh, MD, DABPN, DUCNS, who is affiliated with the Creighton University School of Medicine in Omaha, Nebraska.

The company added that AngioFlow has been validated in more than 10 clinical trials.

Reportedly validated in more than 10 clinical trials, the AngioFlow perfusion imaging software enables timely identification of brain regions with cerebral blood flow reduction and those with significant hypoperfusion.

FDA Clears AI-Powered Qualitative Perfusion Mapping for Cone-Beam CT

A new study estimates that computed tomography (CT) exams performed in the United States in 2023 will lead to over 100,000 future cases of radiation-induced cancer.

, researchers reviewed data from an estimated 93,000,000 CT exams performed in 2023 for an estimated 61,510,000 patients, including 58,940,000 adults and 2,570,000 children, as well as data from the University of California San Francisco (UCSF) International CT Dose Registry.

Based on current use and radiation dosing levels with CT exams, the study authors estimated that exposure to CT exams performed in 2023 will lead to radiation-induced cancer in 103,000 patients.

While acknowledging that the risk of radiation-induced cancers with CT scans is relatively low, lead study author Rebecca Smith-Bindman, M.D., in a recent interview, emphasized that the projection of radiation-induced cancers is a significant number when considering other risk factors for cancer.

“If we look in the context of cancer in general, if these (CT) dosing practices and utilization practices continue, CT will account for a ballpark of 5 percent of all cancers,” noted Dr. Smith-Bindman, the director of the Radiology Outcomes Research Laboratory and a professor of epidemiology and biostatistics at the UCSF School of Medicine.

“It's not 95 percent, it's not 50 percent but it's a meaningful (number), and it's a number that's comparable to other cancer risk factors that we really think about (like) alcohol consumption (and) obesity, (that) both account for five to 7 percent of cancer. So those are modifiable risk factors that we want to modify to reduce cancers. CT scanning is in that category.”

Dr. Smith-Bindman noted that abdominal and pelvic CT exams accounted for 32 percent of the total number of CT exams in 2023 and were projected to cause 37 percent of the estimated future cases of radiation-induced cancer. Extraneous use of multi-phase scans for routine abdominal CT could be a key target, according to Dr. Smith-Bindman.

“Reducing those multiple phase scans could have a huge impact on reducing the number of future cancers,” maintained Dr. Smith-Bindman.

Deep Learning Denoising May Facilitate Up to a 75 Percent Reduction in Radiation Dosing for Head CT

Can AI Facilitate Single-Phase CT Acquisition for COPD Diagnosis and Staging?

Emerging Strategies for Managing the Acute Shortage of Iodinated Contrast Media

(Editor's note: Graphic in video courtesy of JAMA Internal Medicine.)

For more insights from Dr. Smith-Bindman, watch the video below.

In a recent interview, Rebecca Smith-Bindman, M.D., offered key insights on new research examining the link between computed tomography scans and projected future cases of radiation-induced cancer.

What New Research Reveals About Computed Tomography and Radiation-Induced Cancer Risk

Case submitted by: Saeed Rad M.D., radiologist, to radRounds Radiology Network

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

Image IQ: Patient Presenting with Multiple Abdominal Radio-Opacities

A 12-year-old boy presents to the emergency department with acute pain in the medial aspect of his right elbow after pitching in a baseball game. He also complains of dull lateral elbow pain that has been present for weeks. AP, oblique, and lateral radiographs of the right elbow were obtained.

Medial and lateral epicondyle avulsion fractures

Medial epicondyle avulsion fracture and osteochondritis dissecans of the capitellum

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David A. Dowe, MD

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