Transcript EBCT Screening and Survival, A Successful Niche Scanning Business

EBCT Screening and
Survival,
A Successful Niche Scanning
Business
Dr. Roger White
Medical Director Holistica Hawaii Medical Scanning
Center
EBCT remains the standard for
coronary calcium scoring
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Fast speed and high resolution.
Independent of heart rate and regularity
Established standard, Agatston score
Coronary calcium very useful as predictor
for cardiac events
Established research tool for epidemiology
studies
Established relative low radiation exposure
Coronary arterial calcification very easy to see on
EBCT and get accurate density and volume score.
Reproducible , with less motion artifact than MDCT
Coronary calcifications in Japanese
Men in Japan and Hawaii
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Follow up study of Honolulu Heart Study
1965
EBCT Japanese Males 40-49 without
history of heart disease
311 males in Japan and 300 males of
Japanese background in Hawaii
Japanese paradox
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Japan men compared to Hawaii had 4X
increase in smoking (49.5 % vs 12.7%) yet
have a significantly lower level of CAD and
cardiac events for similar levels of
cholesterol, blood pressure, and diabetes.
Results: Average CAC Japan (All scores)
3.4 vs Hawaii 51.4
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Compared men Japan to Hawaii,
Hawaii men had 3X excess of CAC >10
32% vs 11.6% p<0.001)
Compared men Japan to Hawaii
Hawaii had 6X excess of CAC >100 13.3%
vs 2.3% p<0.001)
Main difference in risk factor was BMI and
increase of sugar in diet.
Noninvasive EBA coronary imaging
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Easy to do with faster heart rates and
irregular heart rates.
Able to use NTG to dilate arteries without
increasing heart rate
Do not have to wait for beta blockers
Much less radiation than MDCT (ALARA)
77 year old woman with atypical chest pains,
hypertension, and ST depression on TST
Close up superior view, Minor obstruction in proximal diagonal,
otherwise coronary anatomy is normal
78 year old male with chest tightness and ST T wave abnormality on ECG.
Enzymes negative for MI. 95% occlusion of LAD. Calcified RCA with
remodeling but patent.
Evaluation of CABG Grafts
Patent vein grafts to Distal RCA and Mid LAD
Cross section to see
Left Main and proximal LAD and Circumflex before by pass
anastomosis
53 year old male with high triglycerides. Remodeling in LAD
and minor obstruction
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Marked calcification and dilation of coronary arteries without
obstructions with cardiomyopathy
60 year old woman with chest pains and passing out, Normal
coronary arteries, Had non sustained ventricular tachycardia
treated with beta blocker
62 year old woman with Minor chest pains, ST depression on
TST, and Hypertension. Coronary arteries are normal
62 year old male with normal TST test but having chest pains. Angiogram
demonstrated severe disease in LAD, Diagonal. And Posterior Descending
Artery. He was treated with two stents and medications.
45 year old male with hypertension and high cholesterol,
Coronary calcium score 295
95+% occlusion of LAD prior to LIMA graft
LIMA graft to Distal LAD
LIMA to LAD in VRX 3D Mode
47 year old male with elevated cholesterol, high blood pressure, and mild chest
pains.
Picture (left) 50% obstruction LAD
Picture (right) one year later after aggressive control of cholesterol and blood
pressure No significant obstruction ? Regression
EBCT and Body Scanning for
Screening
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Low radiation compared to MDCT (ALARA)
Excellent screen for CAD, Cancers, and
baseline abnormalities
Review with patient and interface with
clinician is very important
49 year old male routine body scan, No Symptoms
Scan demonstrated 2.8 cm mass left kidney
Biopsy confirmed renal carcinoma
57 year old female Right Renal cell carcinoma, No
Symptoms
62 year old male with fatigue for three months, no pain
Scan demonstrates advanced left sided renal cell carcinoma
Metastasis of cancer from renal cell carcinoma to left lower lung
47 year old woman with changing left lung nodule
86 year old Chinese woman with cough, shortness of breath, and fatigue
Chronic bronchiectatsis related with infiltrates from tuberculosis
Coronary calcium score 880.7 without symptoms of chest pain or abdominal
pain.
Aortic dissection below the kidneys
59 year old male routine screening.
Cystic mass in tail of pancreas
Resectable pancreatic cancer
59 year old with headaches and nausea, cerebral aneurysm
70 year old male, previous CABG, Mental Slowness
Extensive CVA left posterior brain
Stomach tumor without barium
oral contrast
42 year old male. Mild stomach discomfort.
Part of Honolulu Heart Study (Normal)
Stomach mass, Biopsy rare neural tumor of gastric wall
51 year old for screening (Heart/Prostate)