CTA: Coronary Artery Angiography

Working in teleradiology allows us to see the new advances across all modalities which enables both radiologists and the technologists learn at an accelerated rate. Since we are doing reads "remotely" we have to utilize technology to do it faster and better. So as we learn of systems that can help, our quest for knowledge expands.

This is a relative new breakthrough in Computed Tomography. It allows for 3D visualization of the heart and the arteries that supply it. It started with the advent of Electron Beam CT (EBCT) in the early '90s, but since the slice thickness was relatively large, visualization of the coronary arteries was limited, though promising. Then came 4 slice with better resolution, but still inadequate by today's standards. Now with 64-slice CT and near isotropic pixels, better gating and smaller FOVs, CCTA has taken the non-invasive technique to the next level.

With the percentage of people that are having coronary angiography (it has grown to 373% or 1.4 million exams by 2003 since 1979), this "non" invasive technique will be huge in diagnosing CAD and allowing preventative medicine to finally make a stand. This modality is becoming the test of choice, not only in an outpatient setting, but also in the emergency room as the "triple" rule out exam for acute chest pain. It can diagnose PE, aortic dissection and CAD (though the field of view is extended for this to be definitive)

As a technologist, knowing the anatomy, knowing the techniques, having the ability to do image manipulation and the tools to do so is very important. Not only do you improve patient care you also enable the radiologist/cardiologist to make extremely accurate diagnosis while cutting down the "interpretation times." As you know the image files for these exams are very large to say the least. The more information (anatomy, physiology) the technologist can digest and understand the more they can be effective in the clinical setting.

I am writing this Blog submission to encourage feedback and hopefully make us all better prepared for this new technology.

The first questions I am seeking feedback on are the following: What do you see as near and distant possibilities for this procedure? Do you see this replacing the current coronary procedure performed in the catherization labs?

What are your best injection rates? What technology or software is available to make mapping vessels or do vessel probes work best. Is there an easier way to do this? I am looking forward to hearing from you.