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EBCT Screening and Survival, A Successful Niche Scanning Business

EBCT Screening and Survival, A Successful Niche Scanning Business. Dr. Roger White Medical Director Holistica Hawaii Medical Scanning Center. EBCT remains the standard for coronary calcium scoring. Fast speed and high resolution. Independent of heart rate and regularity

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EBCT Screening and Survival, A Successful Niche Scanning Business

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  1. EBCT Screening and Survival,A Successful Niche Scanning Business Dr. Roger White Medical Director Holistica Hawaii Medical Scanning Center

  2. EBCT remains the standard for coronary calcium scoring • Fast speed and high resolution. Independent of heart rate and regularity • Established standard, Agatston score • Coronary calcium very useful as predictor for cardiac events • Established research tool for epidemiology studies • Established relative low radiation exposure

  3. Coronary arterial calcification very easy to see on EBCT and get accurate density and volume score.Reproducible , with less motion artifact than MDCT

  4. Coronary calcifications in Japanese Men in Japan and Hawaii • Follow up study of Honolulu Heart Study 1965 • EBCT Japanese Males 40-49 without history of heart disease • 311 males in Japan and 300 males of Japanese background in Hawaii

  5. Japanese paradox • Japan men compared to Hawaii had 4X increase in smoking (49.5 % vs 12.7%) yet have a significantly lower level of CAD and cardiac events for similar levels of cholesterol, blood pressure, and diabetes.

  6. Results:Average CAC Japan (All scores) 3.4 vs Hawaii 51.4 • Compared men Japan to Hawaii, Hawaii men had 3X excess of CAC >10 32% vs 11.6% p<0.001) • Compared men Japan to Hawaii Hawaii had 6X excess of CAC >100 13.3% vs 2.3% p<0.001) • Main difference in risk factor was BMI and increase of sugar in diet.

  7. Noninvasive EBA coronary imaging • Easy to do with faster heart rates and irregular heart rates. • Able to use NTG to dilate arteries without increasing heart rate • Do not have to wait for beta blockers • Much less radiation than MDCT (ALARA)

  8. 77 year old woman with atypical chest pains, hypertension, and ST depression on TST

  9. Close up superior view, Minor obstruction in proximal diagonal, otherwise coronary anatomy is normal

  10. 78 year old male with chest tightness and ST T wave abnormality on ECG. Enzymes negative for MI. 95% occlusion of LAD. Calcified RCA with remodeling but patent.

  11. Evaluation of CABG Grafts

  12. Patent vein grafts to Distal RCA and Mid LAD

  13. Cross section to see Left Main and proximal LAD and Circumflex before by pass anastomosis

  14. 53 year old male with high triglycerides. Remodeling in LAD and minor obstruction.

  15. Marked calcification and dilation of coronary arteries without obstructions with cardiomyopathy

  16. 60 year old woman with chest pains and passing out, Normal coronary arteries, Had non sustained ventricular tachycardia treated with beta blocker

  17. 62 year old woman with Minor chest pains, ST depression on TST, and Hypertension. Coronary arteries are normal

  18. 62 year old male with normal TST test but having chest pains. Angiogram demonstrated severe disease in LAD, Diagonal. And Posterior Descending Artery. He was treated with two stents and medications.

  19. 45 year old male with hypertension and high cholesterol, Coronary calcium score 295

  20. 95+% occlusion of LAD prior to LIMA graft

  21. LIMA graft to Distal LAD

  22. LIMA to LAD in VRX 3D Mode

  23. 47 year old male with elevated cholesterol, high blood pressure, and mild chest pains. Picture (left) 50% obstruction LADPicture (right) one year later after aggressive control of cholesterol and blood pressure No significant obstruction ? Regression

  24. EBCT and Body Scanning for Screening • Low radiation compared to MDCT (ALARA) • Excellent screen for CAD, Cancers, and baseline abnormalities • Review with patient and interface with clinician is very important

  25. 49 year old male routine body scan, No SymptomsScan demonstrated 2.8 cm mass left kidney Biopsy confirmed renal carcinoma

  26. 57 year old female Right Renal cell carcinoma, No Symptoms

  27. 62 year old male with fatigue for three months, no painScan demonstrates advanced left sided renal cell carcinoma

  28. Metastasis of cancer from renal cell carcinoma to left lower lung

  29. 47 year old woman with changing left lung nodule

  30. 86 year old Chinese woman with cough, shortness of breath, and fatigue Chronic bronchiectatsis related with infiltrates from tuberculosis

  31. Coronary calcium score 880.7 without symptoms of chest pain or abdominal pain. Aortic dissection below the kidneys

  32. 59 year old male routine screening.Cystic mass in tail of pancreasResectable pancreatic cancer

  33. 59 year old with headaches and nausea, cerebral aneurysm

  34. 70 year old male, previous CABG, Mental SlownessExtensive CVA left posterior brain

  35. Stomach tumor without barium oral contrast

  36. 42 year old male. Mild stomach discomfort.Part of Honolulu Heart Study (Normal)Stomach mass, Biopsy rare neural tumor of gastric wall

  37. 51 year old for screening (Heart/Prostate)

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