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RADIOLOGY REPORT - PowerPoint PPT Presentation

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RADIOLOGY REPORT. 64 Detector CT P.A.C.S. Stroke Program Update Neuro Interventional Update. LightSpeed VCT 64-Slice CT Scanner. Helps us obtain the information we need to diagnose disease and life-threatening illnesses, including cardiovascular disease, chest pain and stroke.

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Ccta contraindications


  • 64 Detector CT

  • P.A.C.S.

  • Stroke Program Update

  • Neuro Interventional Update

Ccta contraindications

LightSpeed VCT

64-Slice CT Scanner

  • Helps us obtain the information we need to diagnose disease and life-threatening illnesses, including cardiovascular disease, chest pain and stroke.

  • The world’s first volume CT (VCT) system, captures images of a beating heart in five heartbeats, an organ in one second, and performs whole body trauma in ten seconds, more than twice as fast as conventional multi-slice CT scanners.

Appropriate ct angio indications
Appropriate CT Angio Indications

  • Chest pain, intermediate pretest probability, and either

    • uninterpretable ECG or unable to exercise

    • No ECG changes and serial enzymes negative

  • Suspected anomalous coronary artery anatomy or other complex congenital heart disease

  • Evaluation of coronaries for etiology of new onset heart failure

  • Evaluation of cardiac mass, tumor or thrombus, or pericardial disease when echo, TEE or MRI technically limited

Appropriate ct angio indications continued
Appropriate CT Angio Indications-continued

  • Evaluation of pulmonary vein anatomy prior to RF pulmonary vein isolation

  • Mapping of old bypass grafts prior to re-do CABG

  • Mapping of coronary veins prior to bi-V pacer implantation

  • Evaluation of aortic dissection, thoracic aortic aneurysm, or pulmonary embolus

Uncertain ct angio indications
Uncertain CT Angio Indications

  • Chest pain, intermediate pretest probability of CAD, able to exercise with interpretable ECG

  • Chest pain, low or high pretest probability of CAD, no ECG changes and enzymes negative

  • Chest pain, post coronary stent or CABG procedures

  • Triple rule out (ECG and enzymes negative)

  • Detection of CAD in asymptomatic patients at moderate or high risk (Framingham)

Uncertain ct angio indications continued
Uncertain CT Angio Indications-continued

  • Preoperative assessment before intermediate or high-risk noncardiac surgery (intermediate risk patient)

  • Evaluation of LV function (technically limited echocardiogram)

  • Evaluaiton of native or prosthetic cardiac valves (technically limited echo, TEE or MRI)

Inappropriate ct angio indications
Inappropriate CT Angio Indications

  • Chest pain and

    • High pretest probability of CAD

    • ST elevation or positive enzymes

    • Ischemia on stress testing

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Ccta contraindications

  • Atrial fibrillation (permanent or AF at the time of the study)

  • Bigeminy, trigeminy, high degree heart block

  • Severe asthma

  • Creatinine > 1.8 (eGFR < 60)

  • Failed steroid prep for contrast allergy

  • Morbid obesity (BMI > 40)

Ordering physician
Ordering Physician

  • Cardiologist

  • CT surgeon

Interpreting physician
Interpreting Physician

  • ACC/AJR credentialed physician

  • Interpreting physician also responsible for supervision of the study

Cardiology participation
Cardiology Participation

  • Ordering Physician +/- review with radiologist

  • Interpreting Physician ( pending CPT codes )

Patient preparation
Patient Preparation

  • Prior to procedure patient receives preparation packet

  • Packet includes cardiac, medical history forms, and a brief description of what to expect when having CCTA

  • Instructed to take meds in am as usual, including (especially) beta-blocker

Patient preparation1
Patient Preparation

  • No caffeine for 12 hrs prior to exam

  • Metoprolol 100mg po one hour prior to study

  • Second dose of Metoprolol 50 mg if HR > 71

  • Nitro spray 1/150 gr. sl.

    NTG contraindications

    - allergy

    - Viagra,Cialis,Levitra

Target heart rate
Target Heart Rate

  • Ideal rate is < 70bpm

  • Can be done up to 80 bpm if they have a regular rhythm ( images not as good )