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We continue to be both amazed and intrigued by the hype showered on cardiac CT angiography and the corresponding lack of hype given to peripheral vascular CTA. No doubt, 64-slice cardiac or coronary CTA is potentially a revolutionizing technology, but PV-CTA has already revolutionized the comprehensive diagnosis and treatment of peripheral vascular disease.

CTA revolutionizes treatment of peripheral vascular disease

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 “

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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 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

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. 

Image IQ: 12-year-old Boy With Acute Medial Elbow Pain

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

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Image IQ: Patient Presenting with Multiple Abdominal Radio-Opacities

Emphasizing the preventative benefit of computed tomography angiography (CTA), C. Alberto Morales, M.D., discussed a friend whose father had a heart attack in his mid-30s. Given the family history, the friend had annual stress testing with cardiologists and was told he was in good shape and even had a zero coronary artery calcium (CAC) score.

However, a CTA scan in Dr. Morales’s office revealed that his friend had diffuse coronary artery disease and a 70 to 80 percent blockage in the mid-right coronary artery (RCA). After aggressive management, follow-up CTA imaging at one year showed a 36 percent decrease in the RCA blockage and stabilization in other arteries, according to Dr. Morales, the owner of South Tampa Cardiology and Advanced Imaging Center in Tampa, Fla.

In a recent interview, Dr. Morales said advances in CTA scanning has led to a significant shift in preventive capabilities with CTA. In addition to significantly lower and more consistent radiation dosing (approximately three millisieverts (mSvs) per CTA scan), Dr. Morales cites the enhanced resolution going from a traditional 64-slice CT scanner to the 560-slice SpotLight CT scanner (Arineta).

“ … The resolution is so much crisper (and) the coronaries are almost still. Now you're able to identify things … such as these soft, 15-mm, 15 percent stenotic plaques that are within the wall that you are missing with the 64-slice CT. The resolution is just so much sharper and, as a result, now you're able to add other pieces of the puzzle, such as artificial intelligence (AI),” noted Dr. Morales.

Dr. Morales said the emergence of adjunctive AI tools with CTA has provided sharper analysis of plaque volume and characteristics.

“AI is leading the way with these advanced CT scanners in a completely new approach to patient care where we can actually identify disease, such as in a screening manner, treat patients, and then we can perform serial surveillance imaging to ensure that treatment is following the path of stabilization or, even in some cases, regression,” posited Dr. Morales.

Can Cardiac CTA be a Viable Alternative for Post-Op Assessment of Left Atrial Appendage (LAA) Closure?

Can Emerging AI Software Offer Detection of CAD on CCTA on Par with Radiologists?

Meta-Analysis Shows Merits of AI with CTA Detection of Coronary Artery Stenosis and Calcified Plaque

For more insights from Dr. Morales, watch the video below.

In a recent interview, C. Alberto Morales, M.D., discussed the impact of advances with computed tomography angiography and AI, and a shifting emphasis in cardiac risk stratification from stenosis to plaque burden.

Combining Advances in Computed Tomography Angiography with AI to Enhance Preventive Care

In a recent interview, C. Alberto Morales, M.D., discussed the impact of advances with CTA imaging and AI, and a shifting emphasis in cardiac risk stratification from stenosis to plaque burden.

David E. Allie, MD

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