A 'Slice' of Life

When someone arrives in the emergency department with a suspected heart attack, the rush begins. Patients are wheeled from the ED to the angiography suite to nuclear cardiology and the cardiac catheterization lab. Now an innovative imaging system so fast that it can capture images of an organ in seconds—and a beating heart and coronary arteries in only five seconds—is giving Hartford Hospital physicians a diagnostic edge.

 
The first in the state, Hartford Hospital’s LightSpeed VCTXTe scanner is many times faster than conventional multi-slice CT (“CAT”) scanners. In a single rotation lasting about a third of a second, the VCT captures 64 “slices” of anatomical data. The VCT (the “V” stands for volume) represents a significant technological leap in coverage area, image clarity and speed, creating spectacular three-dimensional views of organs, arteries and veins.
 
“The VCTXTe can be used for many clinical scenarios, including cardiac disease, stroke, chest pain and trauma,” says interventional radiologist Barry Stein, M.D., of Jefferson X-Ray Group, co-director of cardiovascular MRI and CT at Hartford Hospital. “The machine spins so fast that it ‘freezes’ the motion of the heart, providing clear images of the coronary arteries quickly and safely, potentially negating the need for an invasive angiogram to evaluate for coronary artery disease.”
 
The outpatient study requires only intravenous administration of contrast dye. The patient lies on a table as a rotating X-ray machine sends data to a computer display. With the new scanner, teams of specialists can view the images to plan procedures like stenting, balloon angioplasty or surgery.
 
Only a fraction of the five million Americans who arrive at the emergency department with chest pain are actually having a heart attack . “With a single VCT scan, clinicians can exclude the three most life-threatening critical conditions that cause acute chest pain—a tear in the aorta (dissection), a blood clot in the lung (pulmonary embolus) and coronary artery disease,” Dr Stein adds.
 
The VCTXTe’s negative predictive value of 97–98 percent means physicians can be very confident that no atherosclerotic coronary artery disease exists if a scan is normal. As part of the examination, a calcium score can also be acquired. A more powerful predictor of atherosclerosis than cholesterol levels, an elevated calcium score can help identify patients at risk for coronary artery disease.
 
“Until now, a CT scan was not fast or powerful enough to capture an image of a beating heart,” says Charles Primiano, M.D., an interventional cardiologist and co-director of cardiac CT at Hartford Hospital. “Now someone who may have a coronary blockage can have a noninvasive procedure instead of cardiac catheterization or angiography. They’re only in the scanner for a few minutes.”