Cardiac CT Angiogram

Earlier this year we acquired a 128-slice CT scanner. One purpose of this scanner, among many, was to be able to perform Cardiac CT Angiograms (CCTA). Over the last six months we have perfected the process of CCTAs and are now offering the service to our referring physicians.

CCTAs are not an imaging study for everyone. In fact, standard cardiac angiograms are still the gold standard for diagnosing coronary artery disease. However, for a specific subset of patients it is a very good alternative for ruling out cardiac disease.

Specifically, CCTA is a good choice for the following outpatient groups:

1. Unexplained or atypical chest pain in a patient with low to intermediate likelihood of coronary artery disease based on age, gender and other risk factors.
2. Typical or atypical chest pain with normal or equivocal stress test and normal or equivocal ECG findings.

Radiation exposure should always be taken into account as a risk when ordering any x-ray study, including CCTA. (Radiation is measured in millisieverts, mSv). Because of the speed of our 128-slice CT, we have the ability to minimize the radiation exposure for patients undergoing a CCTA. We have successfully been able to perform the CCTA studies using less than 6 mSv (considered low risk for lifetime chance of malignancy). In comparison, we are all exposed to about 3 mSv annually from the natural radiation in our environment.

To achieve this low exposure to radiation, it is important to make sure the patient’s heart rate is low, and a dose of a medication to slow the heart rate down, such as a beta blocker, is usually recommended prior to the study. This will be done prior to the CT if the heart rate is higher than recommended.

Scheduling a CCTA is done through our Central Scheduling office at (248) 471-8100. The scheduler will advise the patient about the preparation for the test. If you have any further questions regarding a CCTA you should discuss this with a Cardiologist prior to recommending the study to your patients.

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Comparative Effectivenss Analyasis

Rationing has turned into a politically charged word which immediatly causes visceral repulsion for most americans. Cost effective analysis is a tool by which we may choose to ration a particular treatment or procedure.

Who should make rationing decisions in the US is an issue that separates the left and the right in our country along legitimate philisophical differences.

Rationing at the cash register is what we are accostomed to in the US. Not everyione gets a Cadillac, but we are comfortable with that within reason. Problem is that the consumers (patients and physicians) are no were near the healthcare cash register.

Rationing through a central power structure makes many in the US suspicious, and hence one of the reasons the Democrats struggle.

Even though I am philosophically a believer in rationing through the market, the goverment is so far into healthcare already I do not see any way that we can feasably unwind it enough to even try a true market solution.

By the way,  Botsford now has a Davinci - Hey, we can't compete on price, so we have to compete with technology!

So here is the question: if you had to have a prostatectomy, would you choose to have it done using a Davinci, or the 'old fashion way' as an open procedure (assuming that you have good insurance and price is no object)? It is the question I had to ask myself as we contemplated the purchase of a Davinci. My honest answer: I personally would choose a robot because even though you are right in that there is no data regarding a cost effectiveness benefit, there is a huge benefit in recovery time; with an open prostatectomy recovery can be weeks, but with a Davinci it is usually days. Hey, I'm a wimp and I do not like pain. This is not measured in most cost effectiveness studies.

But, if I had to pay an extra $20,000 out of pocket...?