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Frequently Asked Questions
— Questions relating to Heart Scans —My doctor has never told me about this procedure...why?
Electron Beam (Ultrafast) CT is a relatively new, highly specialized and sophisticated imaging tool mostly located at major university hospital centers around the world (Mayo Clinic, Baylor, UCLA, etc.) and its arrival in Denver represents the very first center in our Rocky Mountain region. There are now hundreds of published papers and numerous textbook chapters concerning coronary artery calcification and its importance as it relates to electron beam CT. However, most of this information is in sources read primarily by cardiologists. Please keep in mind that it is quite likely that your physician does not yet know a great deal about this technology, or the implications of the test results.
If it is new to this region, then how can the results be understood?
Fortunately, there is a great worldwide experience with this scanner, and its accuracy and predictive ability have been proven in numerous scientific papers. We, at Colorado Heart & Body Imaging have access to the results from thousands of patients studied throughout the world so we can best match your score with others by age and sex. It has become clear that most patients develop some degree of atherosclerosis as they get older, and this instrument is the only way to determine if an apparently healthy person has begun the process at above or below the expected rate. Our team of physicians is in constant communication with the nation's top cardiologists involved in this area so that newer aspects of preventive cardiology can be made available to you.
What is the significance of calcification and the Coronary Artery Calcium (CAC) score?
Coronary calcification is a marker for coronary plaque and typically appears years before the development of symptoms of heart problems. This is truly "hardening of the arteries". The score that you receive represents the total amount (based on size and density) of the calcium deposits found in all of your coronary arteries. For all age groups, the higher the score, the more coronary disease is present and the greater the likelihood that it may result in a heart attack or chest pain in the future, if left untreated. Most men of over the age of 40 and women over 50 will have some degree of calcification, so do not be alarmed if your score is not zero.
My doctor told me that worrisome plaque is often noncalcified...but aren't you only measuring the calcified plaque?
That is correct. There are no current noninvasive methods that will identify all plaque. However, the calcified portion (measured by ultrafast CT) is a useful marker for total plaque. There are numerous studies in the medical literature that have shown the relationships between calcified plaque and total plaque. Calcium is important because it signifies the "tip of the atherosclerotic iceberg". The higher one's calcification score, the more likely the person has extensive plaque, some of which may give rise to future problems.
I have no major risk factors for heart disease, I exercise regularly and I am very careful about my diet. Does the test have the same value for me?
It is important to continue to follow a prudent "heart-healthy" lifestyle and it is likely that your heart has benefited from your diligence. There are a few factors that we can never control...for example our age, sex and family history. For some individuals, a coronary calcification score is the only indication that they may be at higher than expected risk for a heart attack.
Why would I (or my doctor) want to know this information? What can be done?
There have been tremendous advances in medicine over the last two decades proving that heart attacks and other coronary problems can to a large extent be prevented in individuals who have been appropriately identified, generally through medication and lifestyle changes. We at Colorado Heart & Body Imaging want to take advantage of the results from thousands of patients who have benefited by these management strategies...but first we need to know exactly who is at risk.
I recently had a stress test that was perfectly normal but I have some coronary calcium on the ultrafast "CardioScan" test. Does that mean that this test or the stress test was wrong?
No. Although both tests were looking for heart disease, they are doing it in different ways. Your normal stress test indicates that the plaque buildup which was seen on the heartscan has not yet reached the point where it is interfering with the blood supply to your heart. Your CardioScan tells us that the process has indeed begun, and there is an opportunity to modify all controllable risk factors to minimize the chance that you'll ever have a heart problem.
Can you tell me how much blockage there is in my coronary arteries?
Although it is possible for us to make some generalizations about the degree of coronary narrowing that likely exists, it is not a primary purpose of this test. The primary purpose of the test is to detect disease before there is much narrowing. Doctors now know that more than half of all heart attacks occur at sites of less than 50% narrowing. No other noninvasive test in cardiology can detect this type of early disease.
What kind of report will be created based upon my score?
A board certified radiologist and his staff will examine the series of pictures obtained by the scanner and calculate the total amount of calcification (the "calcium score") present. From the information available, he will report the location and degree of anatomy may be recorded. A further cardiology panel report will also be included revealing the overall significance and general recommendations based upon your score. The report will be useful to you and your doctors to review recommendations to patients. Ultimately, your personal physician (not Colorado Heart & Body Imaging) will be the best individual to determine the proper course of action for you. We are always available to you and your doctor for consultation.
I have a normal cholesterol reading. Can I still have coronary disease?
Having normal cholesterol puts you at a lower risk than average for heart disease. However, most people who just had heart attacks have average cholesterol. It is now clear that some people with average cholesterol need further lowering by medications or diet.
Should I obtain a physician referral for this test or should I make an appointment independently of my doctor?
This is largely a personal decision. We, at Colorado Heart and Body Imaging believe that it is much more likely that the information provided at our center will be best utilized if your personal physician is aware of the test results. In general, he (she) is best able to understand the overall importance of this test in the context of his understanding of your medical history and physical exam. He (she) may also have access to other important medical records that could help in the overall assessment of your situation. In addition, it is much more likely that insurance companies will participate in the reimbursement of this procedure with an appropriate physician referral. In the majority of circumstances, the general recommendations on therapy or further testing will necessitate physician involvement and review of our findings. Some patients would rather keep the information confidential to all entities (including their doctors) and we respect those wishes.
— Questions relating to lungscans — coming soon— Questions relating to body—My bodyscan was entirely normal….does that mean I am totally healthy?
A bodyscan is an anatomic (radiologic) survey of the major structures in the chest and abdomen and should be regarded as a possible opportunity to find early structural abnormalities, masses and vascular plaque. Although a normal bodyscan should be regarded as generally reassuring, it is certainly true that there are many diseases that can only be detected by other methods, if at all (blood testing, antigen testing). In addition, a bodyscan does not involve intravenous contrast material. Therefore, it should be considered a rather inexact science especially for detection of certain abdominal conditions.
The radiology report mentioned a problem with my lungs, chest or an organ in my abdomen. What do I do now?
Hopefully, our report offered general recommendations for followup with your doctor and sometimes mentions further testing that could be useful. We are available to you and your doctor to clarify our report. In some circumstances, we will speak with your doctor directly and provide films for his/her review.
Is the bodyscan ever covered by insurance?
Although a bodyscan may be provided as a special "perk" by some employers, in general, it will not likely be covered by insurance. In general, the total bodyscan is not considered medically necessary. The heartscan component is often necessary to help a doctor make lifelong decisions and will sometimes be covered by your insurance company.
— Questions relating to Colon— coming soon