Cardiac CT Angiography (CCTA)

The Basics of CCTA

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 produced by CCTA scans) 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 Coronary Artery Disease, or 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 that 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 Salem Advanced CT Imaging (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 (SACT), 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. While SACT is able to perform Calcium Scoring exams on a stand-alone basis, these exams must be paid for by the patient at the time of the exam.

CCTA Patient Preparation

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 15 minutes prior to your scheduled appointment 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 603-893-4352.

What can I expect from a CCTA exam?

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 CCTA 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 exam, when you arrive at Salem Radiology, you may check in with one of our receptionists who will ask you 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 radiology technologists. 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, answer any questions and address any concerns you may have.

CCTA 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 may need a simple blood test to ensure their kidneys are working well since the kidneys eliminate the contrast from the body. Salem Radiology 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.

Length of a CCTA 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 CCTA Results

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