by:Dr. Sobhi Abadi, Senior Radiologist, Department of Medical Imaging
Dr. Shmuel Rispler, Senior Cardiologist, Department of Cardiology
Dr. Ariel Roguin, Senior Cardiologist, Department of Interventional Cardiology     


Early diagnosis can save from death
Coronary atherosclerosis is the number one cause of death in Israel and in the Western world, among both men and women. This is a disease in which fatty deposits accumulate on the walls of the coronary arteries, which supply blood to the myocardium (heart muscle), thus leading to a narrowing of the arteries which may lead to myocardial infarction (heart attack).
Despite the substantial awareness about heart attacks, most people are not diagnosed on time. This might be due to fear of the tests or of the bad news associated with the discovery, or perhaps the belief that “this can’t happen to me”. But, in fact, every year, thousands of men and women who die from coronary atherosclerosis may have been saved by early diagnosis of the disease. This is the good news of the innovative cardiac CT scan: it shortens the diagnostic process in a painless manner, with minimal risk.

Diagnosis by catheterization
Till today, the only method enabling us to see inside the coronary blood vessels and to know whether there is coronary atherosclerosis, or whether there was “a false alarm”, has been diagnostic cardiac catheterization. Catheterization is an important  examination and it saves lives. However, catheterization is associated with a series of preliminary examinations, which can take weeks, and must be thoroughly and carefully considered due to its invasive nature and the risks associated with it.

Diagnosis by cardiac CT
Now, there is another fast track option for a thorough examination of the heart and the surrounding blood vessels, using an innovative and noninvasive test, called “cardiac CT”. In this examination, the CT system displays a 3-dimensional image of the heart and the blood vessels leading to it, thus enabling the exclusion or diagnosis of blood vessel narrowing and occlusions, their location and nature.

Research which validated the examination
Currently, the cardiac CT exam is offered at the Rambam Medical Center, only after completion of an extensive comparative study, which proved that the examination provides highly accurate and reliable information. The study, which was recognized by the medical scientific community, was published in one of the leading monthly journals in the field of medical imaging (Ghersin et al, American Journal of Roentgenology, 2006).

Examination by a cardiologist
Before the examination, the patient is invited for a consultation meeting with an expert cardiologist, which is an integral part of the examination itself. The cardiologist performs a general evaluation, taking into account the patient’s complaints, medical history, and risk factors, and the instruments’ level of accuracy versus the risks. Prior to the cardiologist’s evaluation, the patient completes a questionnaire concerning his sensitivity to iodine, performs a blood test for renal function evaluation (creatinine), blood pressure measurement and ECG. Only after performing these tests and the Cardiological evaluation, the cardiologist decides whether to perform the cardiac CT examination.

20 seconds and it’s done!!
Immediately afterwards, the examination begins, with an intravenous injection of contrast medium (which colors the blood vessels). In parallel, the CT machine begins scanning the heart. The examination consists of a scan lasting only 20 seconds! When the examination has been completed, the patient can return to his daily routine, with no restrictions.

Interpretation of findings
Interpretation of the findings obtained from the cardiac CT examination requires substantial knowledge and experience, and is performed by a radiologist. Upon completion of the interpretation process, the radiologist and the cardiologist discuss the examination findings together. These findings, combined with the clinical evaluation of the patient, enable the cardiologist to make a definite determination concerning the need for further assessment or treatment, and to obtain a complete and updated clinical picture of the patient’s condition. The cardiologist presents to the patient the results, the conclusions, and the actions to be taken.
The earlier the diagnosis is made, and the milder the symptoms, so the chances of treating the disease are increased, thus preventing the development of the disease, a moment before it’s too late!

Who is the cardiac CT examination meant for?
Since this is a CT examination using iodine contrast medium, it is not recommended for periodic screening of the general population, but only for people experiencing chest pain (angina) and for those belonging to risk factor groups for cardiac disease: hypertension, hypercholesterolemia (high cholesterol levels), obesity, smoking, diabetes and genetic predisposition to atherosclerosis, or for people who cannot undergo catheterization due to medical reasons. 
The final decision as to whether to perform a cardiac CT examination is made by the cardiologist.