When we opened in 2006, CCTA was the most exciting new application available via 64-Slice CT. It was certainly, however, unchartered territory for us. None of the payers, including Medicare, paid for the exam at the time and we were unclear whether the local market was ready to adopt a procedure as far out on the "bleeding edge" as this one. Our radiologists and the rest of the clinical team had never performed the exam previously but had spent extensive time training all over the country with the hope of building a successful CCTA practice in our community.

Now, three years into it, we have performed over 1,000 of these studies and become a regional leader in CCTA. The life-changing and life-saving stories which have emerged from these 1,000+ cases have been amazing and very rewarding for our team (read about 1 particular case in MD News).

As always, any questions about our CT operation can be directed to our team at
603-898-3129.

The Basics   CCTA, sometimes also called Cardiac CT, offers doctors and their patients a powerful tool in assessing coronary artery disease and heart attack risk. Our scanner is capable of providing as many as 4,000 detailed images of the heart and coronary arteries (view sample images) through an exam lasting just five heartbeats and as such, offers physicians the ability to view the coronary arteries at a level of detail and from angles not previously available. Most critically, these amazing views allow physicians to examine and evaluate the buildup of plaque (hard and soft) on the walls of the coronary arteries that is indicative of CAD.

CCTA can be used to identify CAD at its earliest stages and to assess the extent of more advanced CAD as well as the associated risk of heart attack CAD presents. This remarkable information - which in many cases is simply not available through existing cardiac studies - can play a vital role in a physician's efforts to help patients manage CAD and reduce their risk of a heart attack.

While CCTA exams inherently focus on the arteries in and around the heart, a CCTA performed at SACT is a much more comprehensive exam which includes evaluation of cardiac anatomy and function including the myocardium (heart muscle) and the pericardium (the sac surrounding the heart). The study also allows for evaluation of all of the other organs in the chest, including the major vessels, the esophagus, the trachea, the lungs and the pleura.

The broad nature of this exam offers tremendous value in that it may serve as a one-stop shop for physicians. Physicians may use CCTA in evaluating not only patients with a history of CAD and/or multiple other risk factors but also patients with more common symptoms or indications of a potential heart problem - such as chest pain, shortness of breath, fatigue and/or an equivocal result in another cardiac exam such as a stress test.

For many patients, CCTA offers the additional and very tangible benefit of avoiding a cardiac catheterization, historically the standard procedure used for assessing coronary artery blockages and disease.

What is Calcium Scoring? A Calcium Score is a number, obtained through a fairly basic CAT Scan of the chest, that reflects the level and extent of calcified plaque present in a person's coronary arteries. Calcified plaque is becoming an increasingly valuable tool used by physicians to assess an individual's risk (or level) of coronary artery disease (CAD) and in turn, their risk of a cardiac event such as a heart attack. The Calcium Score, in conjunction with other factors such as age, gender, family history and other medical conditions, is used by physicians to develop care plans designed to manage or reduce those risks.

At Salem Advanced CT Imaging, Calcium Scoring is performed as part of every Coronary CT Angiography (CCTA) study, the much more comprehensive exam of the heart and the coronary arteries. A Calcium Scoring exam may, however, also be performed as a stand-alone exam; in fact, these exams are extremely quick and easy to perform. CCTA exams are usually performed on symptomatic patients or those with a personal or family history of cardiovascular problems. A stand-alone Calcium Scoring exam, on the other hand, is more frequently considered a "screening" exam - meaning that the patient has no particular symptoms and is simply having the exam performed as a preventive measure.

As with most screening exams (with the notable exception of mammography), the vast majority of insurance companies do not cover calcium scoring when performed separately from CCTA. SACT does perform Calcium Scoring exams on a stand-alone basis but these exams must be paid for by the patient at the time of the exam.

Patient Preparation   Included below are some basic preparation instructions for a CCTA exam but you should feel free to speak with your doctor or our staff to make sure you understand how to prepare for your exam:

• Please do not eat for 4 hours prior to appointment.
• Please do not drink any caffeine for 12 hours prior to appointment.
• You may drink water and take prescribed medications.
• Please do not take Viagra, Cialis, or Levitra for 48 hours prior to appointment.
• Please do not smoke the day of your appointment.
• Please do not do any heavy exercise before appointment.
• Arrive 30 minutes prior to your scheduled appointment time.
• If you were unable to schedule a separate consultation visit (see below), please arrive 1 hour prior to your scheduled exam time.

For your exam, please also bring a copy of your insurance card and any information from a similar or related exam performed in another location (e.g., films, CDs, reports). If you have questions about your CCTA exam or any aspect of the preparation, please feel free to call our office at 603-898-3129.

What Can I Expect?   Patients who have been referred for a Cardiac CT Angiography (CCTA) exam require a bit more preparation than most other exams in order to ensure optimal results.

Consult Visit   When scheduling your CCTA exam with our office, you will also be asked to schedule a "consult" appointment with one of our CT Specialists. This additional appointment, which may be scheduled either on a day prior to the actual exam or earlier on the same day as your exam, provides an opportunity for our clinical staff to collect important information relative to your medical history. The "consult" is scheduled in a separate time slot in order to provide patients and their families ample time to ask questions and express their concerns without having to worry about the pressure of a scheduled appointment time. It also allows our clinical team some additional time to follow-up with a patient's physician if necessary prior to performing the exam.

Arrival   Whether for a "consult" or the actual exam, when you arrive at the offices of Salem Advanced CT Imaging (same office as Salem Radiology), you may check in with one of our receptionists who will ask for some basic information (for example, your insurance card, copies of any previous studies). Following a brief check-in, you (and any friends or family members) will be escorted to a private, well-appointed reception area where you will be met by one of our CT Specialists (a technologist). The technologist, in addition to being the person who actually performs the consult/exam, is responsible for guiding you and ensuring your comfort throughout the entire process. The technologist will explain the reason for the consult and/or the exam which is going to be performed, answer any questions and address any concerns you may have.

Exam Preparations   Optimal results of a CCTA exam require that a patient's heart rate be at a relatively low rate of beats per minute (55 to 65). For some patients, medication (a beta blocker) will be given orally to achieve this heart rate. Typically, the beta blocker is given to the patient at the time of their consult appointment. In these instances, patients are instructed to take the beta blocker 1 hour prior to the scheduled exam time (the pill may be taken prior to arriving for the exam). Patients whose schedules require that their consult occur just prior to their exam must arrive at least one hour before the exam in order to allow the beta blocker time to take effect. In a limited number of circumstances, the radiologist may recommend that a beta blocker be administered intravenously. Regardless of the method of administration, the beta blocker serves to steady and reduce the heart rate in order to optimize the quality of the images generated by the exam.

As always, please bring copies of any prior exams or related studies from other locations (images and reports) as these play a critical role in the overall success of your exam. And, please remember to bring a copy of your insurance card with you.

Intravenous Contrast Agents   All CCTA exams require the use of an intravenous contrast agent in order to ensure the maximum resolution and accuracy of the CT images. As a result, patients will experience a "pin-prick" similar to what one experiences when having blood drawn at the time that the IV is administered. Other than this, patients should expect their exams to be painless, fast and comfortable.

Blood Tests   Some patients receiving IV contrast will also require a simple blood test (performed in real time at SACT) to ensure their kidneys are working well since the kidneys eliminate the contrast from the body. SACT uses the highest quality contrast available which further minimizes the chance of any undesired reaction to the contrast.

The Exam   Once you have completed any last minute preparations, the technologist will escort you into the CT Scan room located right next to the reception area. The technologist will assist you in getting comfortable on the exam table and make sure that your body is correctly positioned for the exam. An IV contrast injection will be administered at this time. For the exam itself, which in most cases lasts just a few minutes, the technologist will exit the room into the Scanner Control room which is located right on the other side of a large glass window. The technologist will inform you through a speaker when the exam is about to begin -- you may be asked to hold your breath briefly during a portion of the exam. At no time will the Scanner itself touch you during the exam.

Once the exam is complete, the technologist will escort you back to the private reception area and provide you with any necessary instructions prior to your departure. The technologist will recommend that you consume plenty of water and other non-caffeinated liquids to help flush the contrast from your body.

An Important Note About Comfort:   Patients with concerns about experiencing claustrophobia while inside the machine should understand two things about a CT Scan. First, the time spent "in the machine" is extremely short (anywhere from just a few seconds to a few minutes). Second, unlike an MRI machine which can seem very deep and enclosed to some patients, a CT Scanner's "hole" is very wide. One should not experience any sensation of being closed in as is sometimes the case for patients undergoing an MRI.

Length of Exam   The scan itself takes only 5 or 10 minutes; including the time to get situated on the table and some additional "prep time" (e.g., blood pressure set-up, beta blocker administration), CCTAs typically take 30 to 45 minutes to complete.

Obtaining the Results   Patients should consult with their doctor to obtain the results of their exam.

Urgent and Complex Cases   When doctors require the results quickly due to the nature of the case, our clinical team will provide the doctor with a "preliminary read" (sometimes called a "STAT" or "WET" read) either on a hand-written fax or via a telephone call to the doctor's office. It is also common on these cases and in particular, on complex cases, for our radiologists to consult with the patient's doctor directly. This direct line of communication provides the referring doctor with prompt and actionable diagnostic information which they in turn can use in recommending an immediate course of treatment. After the preliminary findings are reported to the patient's doctor, these cases follow the standard process described below for non-urgent cases, with a final report going to the physician's office within approximately 24 hours.

Non-Urgent Cases   For those exams which are not urgent in nature, transcribed reports are typically available within 24 hours. Our radiologists review the images taken during an exam, consult prior images or other related clinical information, and dictate a report of their findings. Our onsite transcriptionists then type the reports which are faxed and / or mailed to the doctor's office based on that doctor's particular preferences.

Your doctor also has the ability to access your images and reports online via the Internet. Doctors may also obtain copies of their patient's images on a disk or on high quality color glossies.