Heart scans are often controversial

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Monday, October 6, 2008
— You don't need a doctor's referral to get your heart scanned at Mercy Hospital.

The procedure is "revolutionizing the diagnosis of heart disease," according to a Mercy advertisement.

It's also controversial.

For around $500 at Mercy, you can go through a painless, relatively quick procedure that will produce sharp images of the arteries around your heart.

Those images can show buildup of fatty deposits on artery walls, a condition that can lead to heart attack.

If the images show no problems, you've eliminated the need for more invasive procedures.

If the images show a blockage, you can get treatment to head off a heart attack.

The procedure is called computed tomography angiography—CTA for short.

"It's the first time we've got a noninvasive way of looking at the arteries in the heart," said Dr. Robert Bonow, the chairman of cardiology at Northwestern University's Feinberg School of Medicine.

The imaging procedure requires a new kind of CT machine. The controversy nationwide centers on two issues: the effect on health-care costs and radiation.

Dr. Gene Gulliver, one of two Mercy cardiologists trained to use the technology, said radiation is a concern, and a cardiac CTA is not a good idea for younger adults.

"We're interested in men 35 or older, women over 40, especially with risk factors, such as a family history of hypertension," Gulliver said.

The value of knowing about heart disease and getting treated outweighs for many people the radiation risk, in Gulliver's opinion.

Bonow noted that if a CTA locates a problem, the next step often is a catheterization, which also involves X-rays—more radiation.

Mercy director of radiology Jere Johnson said a Mercy CTA exposes a patient to 8 or 9 milisieverts of radiation, which is lower than some other scanners because the machine uses technology that gathers the images more efficiently.

Eight or 9 milisieverts is about 400 times greater than the radiation dose from a simple chest X-ray.

That's not considered a dangerous dose, Johnson said, adding that it's equivalent to the altitude-related background radiation dose from a flight to the West Coast or living in Colorado for two years.

Bonow said CTAs are so new that science has not yet conclusively demonstrated they can help people live longer or better.

In Chicago, health insurance companies "have become very concerned and often won't reimburse" for a CTA without strong indications of a heart condition, Bonow said.

Medicare, which sets the tone for many insurers, has qualms.

In response to a question from The Janesville Gazette, the Centers for Medicare and Medicaid Services issued a statement that included this:

"Imaging performed on patients without chest pain would be considered screening and is not an available benefit in the Medicare program."

Concerns remain about overuse.

One cause of rampant health-care cost increases nationwide is believed to be the race to buy new technologies—and then to recoup those costs.

"If we start employing it widely, it's going to start increasing costs," Bonow said.

Mercy paid $1.99 million for its Siemens 64-slice, dual-source CT scanner, which can be used for a variety of purposes, including locating tumors.

Bonow said he didn't want to cast aspersions on any hospital, but he noted that cardiac CTAs can be great for generating revenue.

"When you bill Blue Cross, you may not get reimbursed 100 percent," but if someone pays out of pocket, the hospital gets full payment, Bonow noted.

More research is needed, Bonow said. A key question is whether the tried-and-true, cheaper tools—stress tests, regular monitoring cholesterol and blood pressure, or the invasive catheter angiograms—aren't just as good as a CTA scan.

Backers say a clean cardiac CTA scan can eliminate the need for catheterization, which can have serious side effects.

Gulliver said the hope is that someday the technology will advance to the point where catheter procedures won't be needed.

Despite the controversy, Bonow said most major big-city hospitals have the new multi-slice CT scanners.

Locally, Mercy is the only health-care agency to own one. Its nearest competitor, Dean/St. Mary's, doesn't have one. Meriter and University hospitals in Madison do.

Cost is about $1 million, according to news reports.

Bonow said the medical community remains divided over cardiac CTAs. Some want to slow down until more is known. Others want to speed up their use.

For those who have gotten the scans, they can be a comfort. Johnson is an example. He's an avid cyclist, but his father died in his 40s from heart disease. So he got a scan. It turned up clean.

"I feel a lot better about it, Johnson said.

Last updated: 10:47 pm Thursday, December 13, 2012

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