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Latest X-rays improve chest pain diagnosis

Dr. Jennifer Malpeso and Dr. Sanjay Doddamani speak

Dr. Jennifer Malpeso and Dr. Sanjay Doddamani speak with a patient before having a scan done with the new 320-multi slice cardiac CT angiography machine in the Emergency Department at the hospital in East Meadow. (Feb. 24, 2012) Credit: Nancy Borowick

Chest pain -- sometimes a telltale signal of a heart attack -- is becoming easier to diagnose at two Long Island medical centers where sophisticated X-ray technology obtains multiple cardiac images in less than a second.

Nassau University Medical Center and Stony Brook University have turned to multimillion-dollar CT scanning to quickly distinguish heart attacks from other causes of chest pain.

The noninvasive procedure known as coronary-computed tomographic angiography utilizes 320-slice CT technology, which gives doctors a real-time view of the heart and inside the coronary arteries. If a blockage is causing a heart attack, it will be clearly -- and quickly -- seen, hospital officials say.

"You can obtain all the data you need in a single heartbeat," said Dr. Jennifer Malpeso, director of cardiac imaging at NUMC. A complete scan takes anywhere from .175 to 0.35 of a second.

Scanning, Malpeso said, eliminates invasive procedures for many chest-pain patients, leaving it only for those who have obstructions revealed through imaging.

"It will definitely improve triage," she said of scanning's capacity to help direct patients to treatments that best suit them.

Only 33 patients as of late last month have been scanned at NUMC, which purchased the Toshiba-manufactured device for about $2 million and installed it late last year.

"This is a very important development for us," said Dr. Sanjay Doddamani, NUMC's chairman of cardiology, because chest pain is a growing medical complaint on Long Island and elsewhere.

"There are over 5 million [hospital] admissions in the United States for chest pain," he said. "This test streamlines the [diagnostic] process."

As NUMC prepares to expand the use of its scanner, Stony Brook has already demonstrated the technology reduces the admission of emergency room patients to the hospital.

Dr. Michael Poon, director of Stony Brook's advanced imaging program, presented a paper at a conference last year revealing how his hospital saved money scanning emergency room patients with chest pain.

A scan, he said, costs patients or their insurers about $700. But each unnecessary admission costs the hospital about $5,000.

For every 250 patients who do not have to be admitted, the hospital saves about $1.25 million, Poon said.

With routine cardiac screening, only 15 percent of the 1,089 people in 2010 with acute chest pain were admitted to the hospital, the study found.

Before the use of cardiac CT scanning at Stony Brook, about 50 percent of emergency room patients with acute chest pain were admitted.

Stony Brook has both a 320-slice scanner, which it purchased in 2010, and a conventional 64-slice device, which it has had for years. The word "slice" refers to each image captured in a single procedure.

Scanning has not been without critics in recent years who've pointed to radiation exposure.

Yet one of those critics is now a convert who touts the procedure's benefits.

Dr. Andrew Einstein, director of cardiac CT research at Columbia University Medical Center in Manhattan, noted in 2007 that 64-slice scanners posed potential radiation dangers.

Now, he's convinced that with highly trained experts -- and newer machines -- patients benefit from the technology.

New 320-slice scanners deliver half the radiation dose of older models, manufacturers and Einstein say. And experts, such as Malpeso, who specialize in cardiac scanning, know how to minimize radiation dosages.

"We've been able to reduce the amount of radiation our patients receive," Einstein said of his center, where a 320-slice scanner helps triage patients.

"This is certainly a reasonable approach to patients' chest pain in the emergency department," he said.






  • Cardiac computed tomography, or cardiac CT, is a painless test that utilizes X-ray technology to take detailed pictures of the heart.



  • New 320-slice machines produce half the radiation exposure of older 64-slice devices. Although the radiation amount is considered small, it's similar to the amount people are naturally exposed to over a 3-year period.



  • The examination allows doctors to see a risky obstruction or a heart attack in progress.



  • During a scan, the machine moves around the patient in a circle.


  • The machine takes a picture of each part of the heart. A computer puts the pictures together to produce a three-dimensional image.


  • Sometimes an iodine-based dye (contrast dye) is injected into a vein during the scan. The contrast dye helps highlight the coronary arteries on x-ray images.


  • The electromagnetic energy is calibrated to penetrate about 2 inches into the brain in a diameter about the size of a quarter.


  • In addition to pinpointing coronary blockages, scanning can also zero in on a blood clot in the lungs -- a pulmonary embolism. An embolism can travel to the lungs from one of the legs, a serious but treatable condition.


    Source: National Heart, Lung, and Blood Institute