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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

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
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


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


Coronary calcifications in japanese men in japan and hawaii
Coronary calcifications in Japanese Men in Japan and Hawaii get accurate density and volume score.

  • 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


Japanese paradox
Japanese paradox get accurate density and volume score.

  • 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.


Results average cac japan all scores 3 4 vs hawaii 51 4
Results: get accurate density and volume score.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.


Noninvasive eba coronary imaging
Noninvasive EBA coronary imaging get accurate density and volume score.

  • 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)



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


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.


Evaluation of cabg grafts
Evaluation of CABG Grafts abnormality on ECG. Enzymes negative for MI. 95% occlusion of LAD. Calcified RCA with remodeling but patent.


Patent vein grafts to distal rca and mid lad
Patent vein grafts to Distal RCA and Mid LAD abnormality on ECG. Enzymes negative for MI. 95% occlusion of LAD. Calcified RCA with remodeling but patent.


Cross section to see left main and proximal lad and circumflex before by pass anastomosis
Cross section to see abnormality on ECG. Enzymes negative for MI. 95% occlusion of LAD. Calcified RCA with remodeling but patent.Left Main and proximal LAD and Circumflex before by pass anastomosis



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


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


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


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.



95 occlusion of lad prior to lima graft
95+% occlusion of LAD prior to LIMA graft Coronary calcium score 295


Lima graft to distal lad
LIMA graft to Distal LAD Coronary calcium score 295


Lima to lad in vrx 3d mode
LIMA to LAD in VRX 3D Mode Coronary calcium score 295


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


Ebct and body scanning for screening
EBCT and Body Scanning for Screening pressure, and mild chest pains.

  • Low radiation compared to MDCT (ALARA)

  • Excellent screen for CAD, Cancers, and baseline abnormalities

  • Review with patient and interface with clinician is very important


49 year old male routine body scan, No Symptoms pressure, and mild chest pains. Scan demonstrated 2.8 cm mass left kidney Biopsy confirmed renal carcinoma



62 year old male with fatigue for three months, no pain pressure, and mild chest pains. Scan demonstrates advanced left sided renal cell carcinoma




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


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


59 year old male routine screening cystic mass in tail of pancreas resectable pancreatic cancer
59 year old male routine screening. or abdominal pain. Cystic mass in tail of pancreasResectable pancreatic cancer



70 year old male previous cabg mental slowness extensive cva left posterior brain
70 year old male, previous CABG, Mental Slowness or abdominal pain. Extensive CVA left posterior brain



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



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