“Improved access to cardiac CT allows us to move towards a ‘one-stop’ clinic for imaging and diagnosis on the same day,” Roobottom says.
In March 2010, the UK’s National Institute for Health and Clinical Excellence (NICE) published clinical guidelines aimed at saving thousands of lives by improving early diagnosis in patients presenting with chest pain. The recommendations help physicians diagnose suspected acute coronary syndrome (ACS) and refer patients for appropriate further tests for Coronary Artery Disease (CAD).
Consultant Radiologist Professor Carl Roobottom at Plymouth’s Derriford Hospital, one of the UK’s leading centres for cardiac care, says the guidelines helped formalize clinical best-practice and highlighted the crucial role that increased access to cardiac CT (computed tomography) imaging plays in helping to potentially improve outcomes for patients and reducing costs for the National Health Service (NHS).
“Improved access to cardiac CT allows us to move towards a ‘one-stop’ clinic for imaging and diagnosis on the same day,” Roobottom says. “This goal is better for the patient because they get a diagnosis and plan straight away, rather than having to come back to the hospital three or four times, and it makes it substantially cheaper for the health economy of the NHS as a whole.”
CT in the Emergency Department?
With half of patients presenting with chest pain to Emergency Departments turning out to have no trace of CAD, Roobottom thinks there is a case for CT imaging to be available round-the-clock in proximity to the ER so that these patients can be efficiently and accurately diagnosed and discharged. “It’s economically sensible and good for patient management,” he says. “The problem is the logistics of setting up such a 24/7 service.”
“Putting upfront money into early diagnosis and therapeutics will save money in the long term, yet it needs investment in financially difficult times. That is the challenge,” Roobottom says. “Most people think it’s a good idea, but how we get there is as much a problem for policy-makers as it is for doctors.”
The NICE guidelines tell cardiologists to drop exercise electrocardiogram (ECG) tests due to how they score on sensitivity and specificity, and instead use patient symptoms to assess patients’ risk of CAD, sending high-risk patients to cardiac catheterisation, medium-risk to functional imaging, and low to medium risk patients to CT imaging.
The importance of low dose technologies
While the NICE guidelines recommend that patients at a low to medium risk of heart disease receive a cardiac CT scan, it is important to ensure that patients in this group are exposed to as little imaging-associated radiation dose as reasonably possible, Roobottom says. “Because they are typically younger, and we may also want to follow up with a repeat scan, it is important to keep the dose low.”