Smart CT Solutions Supports The Implementation & Optimization of Cardiac CT Imaging

This is the second part of a three-part series dedicated to sharing best practices for implementing smart solutions in the CT suite.

Cardiovascular disease is the leading cause of death for men and women in the United States, and the majority of those deaths result from coronary heart disease.¹

Coronary CT angiography (CCTA) is an excellent tool for diagnosing coronary heart disease, says Jill Jacobs, MD, section chief, cardiac imaging, at NYU Grossman School of Medicine and NYU Langone Health. CCTA has high sensitivity and is useful for plaque identification and assessment. Its high negative predictive value enables confident exclusion of coronary artery disease. Studies have shown that CCTA provides independent prognostic information over baseline clinical risk factors and calcium scoring in patients with known or suspected coronary artery disease.²

“High-quality CCTA production is essential to our patients and referring physicians. We need to produce consistent scans with minimal variation. Fortunately, improvements in contrast delivery systems aid our attainment of image optimization,” says Dr Jacobs.

Implementing Smart CT Solutions

To achieve the consistency necessary for diagnostic-quality contrasted CCTA studies, Dr Jacobs uses Bracco’s SmartInjectCT Solutions, including the EmpowerCTA⁺ Injector System.

Bracco’s SmartInjectCT Solutions are interconnected technologies that help radiologists, protocol managers, and technologists to monitor and manage patient records, to support compliance and standardization, and to track performance during contrast injection. The EmpowerCTA+ Injector system optimizes imaging capabilities, streamlines workflow and enhances patient care. Complementing the EmpowerCTA+ is the NEXO Contrast Management System, a software platform that seamlessly connects patient data through the modality worklist to the EMR and PACS. This technology tracks contrast delivery and manages CT imaging protocols for data-driven clinical support. NEXO automatically documents the contrast injection post procedure and reports via DICOM to the radiologist workstation for review along with the CT images.^3,4

“We want to make sure that no matter where a patient is imaged in our enterprise, they're going to get an optimized, high-quality scan. The use of smart CT injector capabilities and techniques really help with this important aspect of CCTA,” says Dr Jacobs. “The increasing technology is really a benefit to us by improving image quality and making sure that we're putting out standardized, optimized imaging every time we scan our patients.”

Strategies to Ensure High-Quality CCTA Scans

The cardiac CT angiogram protocol Dr. Jacobs utilizes includes performance of an initial calcium score to help assess heart health. To minimize radiation dose to the patient, the calcium score is used to help optimize the CT acquisition length and scanning parameters. The EmpowerCTA⁺ Injector System adjusts the contrast injection flow rate to meet the dual imaging needs, including a short exam time and high image quality. “We want to optimize our IV contrast delivery based on patient weight and scanning parameters,” she says.

Dr Jacobs utilizes a two-phase IV contrast administration technique. Contrast is injected in phase one, while phase two delivers a saline bolus via the EmpowerCTA⁺ Injector System. Administering saline immediately after contrast delivery permits the use of less iodine without compromising imaging quality.

“We use a saline chaser to maintain a tight contrast bolus. It gives us greater arterial enhancement, reduces streak artifact, and allows us to reduce the amount of contrast that we use by 15% to 20%, which potentially can decrease contrast induced nephropathy and help decrease costs. It helps wash away the bright contrast and allows us to achieve a greater degree of enhancement in the heart and coronary arteries,” she says.

Dr Jacobs says the Bracco SmartInjectCT solutions help her deliver consistent, high-quality CCTAs across her care network. “Happiness is a high-quality coronary CT angiography, and these techniques can help achieve routine high-quality scanning in our practices,” she says. “At the end of the day patient care is our priority and delivering it by providing high quality CCTA studies is our focus.”

References

1. https://professional.heart.org/en/science-news/heart-disease-and-stroke-statistics-2023-update#:~:text=In%202020%20in%20the%20United,of%20the%20arteries%20(2.6%25). Accessed June 28, 2023.
2. Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan K, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Kaufmann P, Maffei E, Raff G, Shaw LJ, Villines T, Berman DS; CONFIRM Investigators. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011 Aug 16;58(8):849-60. doi: 10.1016/j.jacc.2011.02.074. PMID: 21835321.
3. https://bracco-one.com/public/5633/15/EmpowerCTA+%20User%20Guide.pdf
4. https://www.itnonline.com/content/blogs/neda-simeonova-contributing-editor/blog-smart-injector-technology-delivers-effective. Accessed June 28, 2023.

To view a webinar with Dr Jacobs presenting more about this topic click here.