Our cardiac CT program at Scripps Clinic Anderson Medical Pavilion offers our patients coronary calcium scoring, coronary CT angiography, and structural heart CT (e.g. pre-TAVR). It is anchored by a premier cardiac CT scanning system which employs single heartbeat 256 slice volumetric acquisition, second generation coronary vessel motion correction, automated selection of best cardiac cycle phase, and state of the art noise reduction based upon on-the-fly machine learning image reconstruction. Based upon our research1,2, noise reduction currently achieved with vendor machine learning technology has reduced image noise by over 40% compared to the older iterative reconstruction methods, with stunning improvement in image quality crucial accurate diagnosis in cardiac CT. We have three highly experienced cardiac CT technologists, and two dedicated cardiac CT nurses, dedicated to this single cardiac CT system. We are one of the few sites in the world to archive raw projection sinogram coronary CT angiography data. We perform over 1700 coronary CT angiogram studies per year. Factoring in all of the above, to the best of our knowledge, we are the only site in the world who has achieved 100% image quality acceptance from the fractional flow reserve CT (FFR-CT) company Heartflow, with over 300 patients submitted in the timeframe 2017-2020. This commitment to image quality is matched with an equal commitment to low radiation dose. We are blessed with outstanding support in medical physics, along with Monte Carlo analysis of ICRP-103 CT dosimetry, and on average, 90% of our patients receive less than annual background radiation in San Diego (3 mSv). For women, mid glandular breast radiation dose is equivalent to 1.5 digital mammograms3.
A secure external website allows for research collaboration with both Los Angeles Biomedical (Dr. Matthew Budoff) (funded by the Scripps Clinic Medical Group Research and Education Foundation), and the commercial image processing laboratory used by our institution, 3DR labs in Kentucky. Research areas include coronary CT angiography image quality and dosimetry, pericoronary adipose tissue (PCAT) contrast enhancement, expanding to impact of image quality on accuracy of fractional flow reserve as measured by CT versus pressure wire4, and now further expanding to radiomics analysis of the EVAPORATE trial. Recent data from our collaborative efforts with UCLA investigated the association of the precise magnitude of “normal” iodine contrast media enhancement of PCAT. We demonstrated that PCAT can be reliably measured from thin slice pre-contrast calcium scans and can be used to quantify PCAT enhancement after contrast administration for the thin slice CCTA, potentially explaining some of its risk-predictive capabilities5.
These paracrine properties of epicardial and peri-coronary fat are likely physiologic factors contributing to the causal relationship between HIN1-influenza infection and susceptibility to atherosclerosis resulting from macrophage translocation across the arterial wall, endothelial dysfunction, and increased plasma viscosity and prothrombotic cytokines activation. A similar biologic-radiographic association between inflammation and peri-coronary fat and CT texture changes is potentially present in SARS-CoV-2.
Vessel wall extraction of the coronary data sets is performed using QANGIO-CT and QANGIO-Workbench from MEDIS at UCLA. Segmentation of the volume of interest of the PCAT is performed using Terarecon at 3DR. Radiomics analysis is performed at LA Biomed using the RIA open source package developed at Semmelweiss University in Budapest by Márton Kolossváry, a collaboration developed by Wesbey. Current research at Scripps is using the same Kolossváry- Semmelweiss radiomics software to analyze the pulmonary circulation in SARS-COV-2.
We will soon be going live with CLEERLY CORONARY MAPPING ™ medical software for generating cardiovascular advanced coronary lumen and plaque analysis and predictions based on medical images and machine learning.
- Udoh, E, et al. The Effect Of Deep Learning Noise Reduction Image Reconstruction On CT Coronary Artery Calcium Agatston Score . Abstract submitted to the 15th Annual 2020 Scientific Meeting of the Society of Cardiovascular Computed Tomography (In press)
- Cohoon, T, et al. Reconstructing Zero: The Impact Of Filtered Back Projection, Iterative Reconstruction, Deep Learning Reconstruction On Coronary Calcium Scoring Near Zero Abstract submitted to the 15th Annual 2020 Scientific Meeting of the Society of Cardiovascular Computed Tomography (In press)
- Newlander S et al. Individualized Gender- and Size- Specific Monte Carlo Simulation Estimates of Whole Body and Organ-Specific Effective Radiation Dose in Coronary CTA on the Revolution CT. Journal of Cardiovascular Computed Tomography 12 (2018) :S43-44.
- Rajbir Sidhu, Ricardo Kosturakis, Shone Almeida, Eranthi Jayawardena, April Kinninger, Afiachukwu Onuegbu, Emem Udoh, Michael Salerno, Richard Schatz, Paul Teirstein, Curtiss Stinis, Matthew Budoff, Matthew Price, Jeffrey Cavendish, Martin Charlat and George Wesbey Journal of the American College of Cardiology Volume 74, Issue 13 Supplement, October 2019 DOI: 10.1016/j.jacc.2019.08.263. TCT-202 Predicting Revascularization Rate of Positive CT-FFR vs. Invasive FFR in Elevated Coronary Calcium Score.
- Almeida S, Pelter M, Shaikh K, Cherukuri L, Birudaraju D, Kim K, Modi J, Shekar C, Sheikh M, Kinninger A, Hill E, Mutchler C, Tabb L, Falk R, Dey D, Gonzalez J, Karlsberg R, Wesbey G, Budoff M, Feasibility of Measuring Pericoronary Fat from Precontrast Scans: Effect of Iodinated Contrast on Pericoronary Fat Attenuation, Journal of Cardiovascular Computed Tomography, https://doi.org/10.1016/j.jcct.2020.04.004.
