Dear Patient and/or Visitor:
Many of our patients and physicians ask us about the issue of Radiation. This is not a topic that we hide from as Electron Beam Tomography (EBT) has the lowest radiation in the industry and is frequently the choice for children and women.
The question almost always comes down to the new 64 Slice MDCT. We at Inner Imaging have gone to great lengths to protect our partners, patients and physicians from any adverse or negative comments regarding our screening program and especially negative comments relating to radiation. This is evidenced by the volumes of data that we openly provide to reassure those that question us on this issue.
As Inner Imaging and Beth Israel have assisted your members and patients with their health care needs we feel responsible to comment on what is being offered in both our market and in others, if only to alert you. It is our experience that while the progress and significance of the 64 Multislice CT is extolled, little of the downside of this diagnostic equipment is mentioned and to a great extent not yet known. Furthermore, our patients and your members ask us frequently about this equipment. What is it? Do we use it? How significant is the radiation? What does it mean?
The concern in the various media articles that have appeared is that the 64 Slice is being used for screening purposes when it was designed for diagnostic studies. According to the last published (2006) American College of Cardiology Appropriateness Criteria, the 64 Slice CT is not recommended for the screening of asymptomatic patients. The 2007 ACCF/AHA statement, regarding coronary calcium, recognizes the clinical appropriateness for screening the asymptomatic, intermediate risk population using Electron Beam Tomography (EBT).
EBT, the science used by Inner Imaging, remains the lowest radiation dose and the most clinically proven technology recognized by the American Heart Association and the ACCF for identifying asymptomatic patients for true cardiovascular risk.
| Some of the differences: |
EBT |
64 Slice-CT |
| Accuracy (calcium) |
99% |
58% |
| Radiation (Angiography) |
1.1 mSv |
11.3 to 18 mSv |
| Radiation (Calcium) |
0.5 mSv |
5.2 mSv |
| Temporal Resolution |
100 msec |
270-550 msec |
| Beta Blockers |
None needed |
Must be given |
| Heart Rate |
Any |
Below 70 |
| Arrhythmia Patients |
Yes |
No |
| Prognostic Data |
Yes |
None |
From a clinical perspective Inner Imaging utilizes EBT scanning for the following reasons:
- 99% sensitive in identifying early stage coronary artery disease
- Reliable for progression studies (it can measure the annual growth of disease)
- Published Prognostic Outcome Data
- Published Clinical Guidelines
- Nineteen Years of Research
- Over 2,300 clinical studies and 2,000 white papers supporting EBT for screening
410K FDA Approval for Wide Spread Patient Use
- Superior to Nuclear Stress Testing in identifying disease
- Utilizes a fraction of the radiation compared to other diagnostic testing including the 64 Slice MDCT
- Recommended by the American Heart Association, the American College of Cardiology and the Society of Atherosclerotic Imaging
Radiation dose and accuracy remain the big issues concerning the 64 Slice in calcium scoring. In addition, for some cardiovascular surgeons, another issue is growing; damage and potential damage to the chordae tendinae. These are the very thin chords that provide support to the tricuspid and mitral valves of the heart, helping them to open and shut properly. Damage to them can require a heart valve replacement. Another growing concern is the rise in breast cancer in both men and women. If we were to compare the radiation dose the 64Slice is 8 to 22 times greater.
Dr. Poon, formerly of Mt. Sinai and one of the foremost authorities in the use of the 64 Slice, has publicly noted that, “EBT will always be the gold standard for calcium scoring”.
We are providing this information so that when you are in discussion with a friend or need to make a choice you will be able to make an informed choice. The media will again attack the 64 Slice on its’ high radiation dose, as it did in 2006, 2007 and 2008. The following societies have voiced concern and warning of the use of the 64 Slice for screening; American Heart Association, American College of Cardiology Appropriateness Criteria, The Journal of the American Medical Association, American College of Cardiology Foundation, The Society of Atherosclerotic Imaging and The Association of Cardiovascular Computed Tomography.
Sources for this discussion are available on request.
Remember “The importance of a test is
whether it can prevent disease, rather than the one that discovers it when it is already too late.”
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