La Cardio TC nella Malattia Coronarica Risultati del Progetto di Adozione della Regione Emilia-Romagna e Prospettive Future Parma 15 Gennaio 2010

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1 20 minuti

2 La Cardio TC nella Malattia Coronarica Risultati del Progetto di Adozione della Regione Emilia-Romagna e Prospettive Future Parma 15 Gennaio 2010 Dr. Filippo Cademartiri,, MD, PhD EMC Rotterdam, NL & AO Parma, IT

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4 Cardiac CT is Team-work Best Technology + Best Human Resources

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6 Coronarografia TC Requisiti hardware ELEVATA RISOLUZIONE SPAZIALE Visualizzazione dei piccoli vasi coronarici ELEVATA RISOLUZIONE TEMPORALE Riduzione artefatti da movimento ELEVATA RISOLUZIONE DI CONTRASTO Visualizzazione della parete dei vasi ELEVATA VELOCITA DI SCANSIONE Completare l esame in apnea SINCRONIZZAZIONE CON IL CICLO CARDIACO Fermare il cuore in una fase del ciclo cardiaco

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8 * * MSCT 175 Stress-ECG 33 Germany *p<0.05 Dewey, et al. Eur Heart J 2006

9 Goldstein JA et al. JACC 2007

10 Mowatt G et al. HTA 2008

11 Mowatt G et al. HTA 2008

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13 Coronary CT Dose >20mSv Stress ECG Stress ECO Cardio-RM 0 msv 14-18mSv 18mSv 10-15mSv 15mSv 4-7mSv 8.6mSv 7-9mSv * 2-5mSv/yr 1-3mSv 4.3mSv * 0.1mSv CXR * ECG-Pulsing Natural background CT* CCA 16-CTA 64-CTA Stress Tc99 Stress Tal Picano E, BMJ 2003; Jakobs, Eur. Radiology 2002; ; Hirai, Radiology 2008; Shuman, Radiology 2008 ;Stolzmann, Radiology 2008

14 Fazel R. NEJM, 2009

15 Fazel R. NEJM, 2009

16 >50% Fazel R. NEJM, 2009

17 X-ray Dose in the real world Chest X-ray Screening chest CT (low dose) Standard chest CT Standard abdomen 3-phase Thoraco-Abdominal CT (staging) Cardiac CT (standard) 0.06mSv 0.3-1mSv 3-8mSv 10-20mSv 25-35mSv 8-20mSv

18 Mean = 12 (8-18) msv

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21 High definition imaging at up to 230 micron resolution Up to 47% improvement in cardiac resolution Up to 50% dose reduction, with improved image quality Spectral imaging and functional imaging (101 selectable spectral energy images) Gemstone detector to produce sharper and brighter images Up to 500 slices of 4D dynamic coverage Faster scintillator enables higher resolution Produces 2.5 times more views per rotation, improving overall resolution Improved signal with reduced noise from the Volara HD digital DAS Featuring a Performix HD tube which enhances resolution through dynamic control Familiar Xtream interface with more power and capabilities to meet increasingly demanding clinical challenges 2.1mSv

22 Lifecycle benefits Key performance drivers matched to specific clinical needs now and in the future Compatible with the Extended Brilliance Workspace and Portal Server Advanced applications to fuel tomorrow s research discoveries Essence and Intelligent technologies Proprietary X-ray tube, detector, and reconstruction advancements Revolutionary AirGlide Gantry for whisper-quiet performance NanoPanel 3D spherical detectors with unique ClearRay Collimator for resolution up to 24 lp/cm Scalable imrc X-ray tube and generator system improve image quality in patients with higher BMIs and in cardiac imaging RapidView Reconstruction with quad-core processors and Fast Preview Mode DoseWise Eclipse DoseRight Collimator IntelliBeam Filtration Step & Shoot Cardiac Dedicated Pediatric Protocols 1-2mSv

23 Toshiba s signature Aquilion Series CT Systems All our Aquilion CT systems feature the benefits of Toshiba s Quantum Advantage, resulting in the industry s best image quality, whatever the choice, from 4 to 64 to 320 slices. * 0.5mm slice * 350 micron isotropic resolution * 2mm low contrast resolution * 32mm volume coverage Using the same detector platform, Aquilion are the only CT systems on the market that offer the choice between high speed image acquisition (up to 16cm width per rotation) and high resolution with either 4, 8, 16 32, 64 or 320 x 0.5mm per rotation. In addition, by a wide variety of dose control tools enable clinicians to minimise radiation exposure to both patients and staff up to 80 percent compared to previous scanners. 3-5mSv

24 Split-second thorax Scanning the thorax incl. the heart needs 0.6 s, taking the burden of breath-holding off the patient and allowing functional imaging for body regions up to 48 cm. Sub-mSv heart Temporal resolution of 75 ms and scan speed of up to 43 cm/s make heart-scanning without beta-blockers possible and for the first time breath-hold optional with dose levels <1 msv. Single dose Dual Energy With the Selective Photon Shield Dual Energy scans are now dose neutral. Together with dramatically increased energy separation and a wide range of FDA-cleared applications, it s now perfect for routine clinical use. Organ-sensitive dose protection The SOMATOM Definition Flash prevents clinically irrelevant dose for spiral examinations and introduces for the first time organ-sensitive dose protection. 0.9mSv

25 Cardiac CT New Technologies MORE SLICES + MORE SPATIAL RESOLUTION FASTER ROTATION SPEED HIGHER TEMPORAL RESOLUTION TISSUE SPECTRAL IMAGING LOW DOSE NEW APPLICATIONS (PERFUSION, )

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27 Arthur Robins ACS

28 CT CAG Stress Tests

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31 Segment 2-3 Non calcific plaque

32 RI = 1.8

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35 Pundziute G, et al. JACC 2007

36 Pundziute G, et al. JACC 2007

37 FRS FRS Hadamitzky M, et al. JACC CVS Img 2009

38 AOPR, Radiology (in press) Results MACE and Hard Events Stratified for Diabetes and Prior History of CAD % MACE % Hard Events Log-rank p value <o.ooo DM + CAD + DM + CAD - DM - CAD + DM - CAD Log-rank p value o.ooo

39 AOPR, Radiology (in press) Results Multivariate Independent Predictors of MACE Diabetics HR (95% IC) p value Obstructive CAD 7.61 ( ) < No. of segments with nonobstructive CAD 1.10 ( ) 0.01 Nondiabetics Obstructive CAD HR (95% IC) p value ( ) <0.0001

40 Van Werkhoven, et al. Eur Heart J 2009

41 Van Werkhoven, et al. Eur Heart J 2009

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43 Prospect Retrospect p < mSv 18.1mSv Prospect Retrospect p < mSv 20.0mSv Next: sub-msv msv? <1mSv Prospect mSv 2.6mSv

44 Chest + Cardiac 1.6mSv Cardiac 0.8mSv

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49 Thank you Contacts: Filippo CADEMARTIRI,, MD, PhD