First LI Community Hospital to Offer Cardiac CTA
When a patient arrives at Mather Hospital’s Emergency Department with symptoms such as palpitations, labored breathing, tightness or pain in the chest or abdomen, excessive fatigue or dizziness, time is crucial in determining whether the cause is a heart attack. If tests reveal that there is no heart attack, a new advanced imaging procedure may be used by the Mather Emergency Department physicians to quickly and safely determine whether the symptoms may be due to a blocked coronary artery.
Known as cardiac computed tomography angiography, or cardiac CTA, the procedure uses digital imaging to diagnose heart disease. Mather’s Emergency Department physicians are specially trained to identify patients who would benefit from the test.
Mather’s state-of-the-art 320-slice CT scanner creates 3-D images of the whole heart in significantly less time than other scanners and reduces the amount of radiation used. Cardiologist Michael Poon, MD, who is an ancillary staff member of Mather’s Department of Radiology, set up the cardiac CTA procedure with Mather’s Imaging team, headed by William Moore, MD. They also set up a unique remote diagnostic system that allows Poon and his team to supervise the scanning process and view scan results live from wherever they are located and quickly give a diagnosis, usually within an hour of the scan. This process significantly cuts the time needed to determine whether there is some type of coronary artery blockage or a less serious problem.
"This is a non-invasive way of looking at the heart and the blood vessels supplying blood to heart, the coronary arteries,” said Poon, an expert in cardiac CTA and Director of the Advanced Cardiovascular Imaging Program at Stony Brook. "It is very important for the community to know that Mather now has the most accurate diagnostic test available to rule out the presence of significant coronary artery disease, which is the number one killer in the United States." Poon said that Mather is the only community hospital on Long Island using this procedure, seven days a week, 12 hours a day.
The test is fast and extremely accurate, Poon said, with the entire procedure and diagnosis taking less than one hour. "If you go to a hospital that does not have cardiac CTA capability, you could be spending 17 hours or more waiting for repeat blood tests and EKGs and waiting for additional diagnostic tests. But if you have cardiac CTA, you can get a diagnosis in a matter of seconds and know whether you are having or at high risk to have a heart attack or not and, if not, you can go home.”
Physicians in Mather’s Emergency Department will order blood tests for a cardiac biomarker and an EKG to determine whether a patient is having a heart attack. If the tests are positive, the patient is immediately transferred for cardiac catheterization and revascularization procedure, the placement of a stent to open blocked arteries or coronary artery bypass surgery. If the tests are negative, the physician may order a cardiac CTA scan to determine whether the symptoms are being caused by plaque buildup leading to narrowing of the coronary arteries.
Before proceeding with the scan and the injection of contrast dye, their medical history and whether there have been problems with contrast materials. Blood tests are reviewed and the IV checked. Once in the CT room, a low dose scan is performed without contrast to determine whether there is any build-up of calcium – a component of plaque – in the blood vessels. A breathing test is done and blood vessel pressure is measured using a saline solution injection. If those tests show no problems, nitroglycerine is given to the patient to dilate the blood vessels. A contrast substance is then administered via injection for the scan.
Using what Poon said is the "only such system in the country,” he can remotely monitor the test, interact with the CT imaging team at Mather and provide a live diagnosis of results. Poon heads a team of three Stony Brook cardiovascular imaging specialists consisting of cardiologists and radiologists who read the cardiac CTA results. "The test is done at Mather but the secure remote supervision of the scanning and interpretation can be done anywhere in the world. We are able to give an accurate diagnosis back to the ER doctor within an hour of the scan,” he said. "The remote aspect of this procedure has never been done before.”
Poon and his colleagues reviewed the first 32 cardiac CTA patients at Mather, and he called the results "phenomenal” in terms of the high quality of the scans, the 100 percent accuracy of the diagnoses, and the very low radiation used. "The radiation dose is very, very low compared to a standard nuclear stress test; the cardiac CTA scan has only one-fifth of the radiation at slightly above 2 millisieverts." For comparison, each individual living on Long Island receives about 3 millisieverts of radiation from the sun alone annually, he said.
Michael Burghardt, Administrative Director of Imaging Services, said the cardiac CTA program was launched in July, about a year after Mather began using the 320-slice CT scanner. About 100 procedures were done in the first two months of the program.