Cooperation over coronary CTA may doom EBCT

The recent creation of the Society for Cardiovascular Computed Tomography may give birth to a new era of cooperation among radiologists and cardiologists that might also sound the death knell for electron-beam CT.

The SCCT was born out of the merger in March of the American Society for Cardiac Computed Tomography and the Society for Cardiac Computed Tomography. These two fledgling organizations had been roughly divided along academic and private practice lines, said radiologist Dr. Lawrence Boxt, chief of cardiac imaging at North Shore University Hospital in New York.

"It was good for the two societies to join. It won't hurt the academic people to learn something about the real world, and it won't hurt the private practice people to have a nice credential," Boxt said.

Members of one group were more closely associated with EBCT and the Society of Atherosclerosis Imaging (SAI). Members of the other were hardcore multislice CTA practitioners. The fusion of the two groups means an end to EBCT, according to cardiologist Dr. Carter Newton, CT imaging consultant to South Carolina Heart Center in Columbia.

"The EBCT guys are all uniting behind the faster gantries," he said.

Zahi A. Fayad, Ph.D., president of the SAI, said the society supports the use of any modality to detect atherosclerosis. He expected that practitioners would continue to use EBCT as long as there is an industry supporting them.

For years, EBCT's advantage over MSCT was speed, but that is becoming less of an issue with each new generation of CT scanner. EBCT's primary use has been to measure coronary artery calcium. MSCT does that and more, and it doesn't make sense to spend millions of dollars on a scanner that essentially does one thing, Newton said.

GE Healthcare continues to sell, manufacture, and develop the eSpeed system, its current EBCT product. But some market analysts have lamented that GE's promotional push has slowed to a virtual halt. As of June, GE sold more than 500 64-slice CT scanners and no EBCT machines, said Dr. James Ehrlich, medical director of Colorado Heart and Body Imaging.

Erhlich and several dozen EBCT practitioners met with GE representatives in June to discuss support for the technology. The GE people suggested the group "upgrade" their EBCT scanners with 64-slice MSCT.

"We don't regard that as an upgrade, and we told them that," Ehrlich said.

In the meantime, cardiac CTA has become more popular than ever. The hands-on 64-slice CT cardiothoracic imaging courses at the Medical University of South Carolina are selling out. The mix of radiologists to cardiologists has been 50/50, according to program director Dr. U. Joseph Schoepf. Should radiologists be encouraged by the apparent congeniality, or should they be worried?

"I don't believe there are grounds for a generalized fear that radiologists will lose out to cardiologists," said Schoepf, a radiologist.

Schoepf expects two factors to influence who will do most of the cardiac CTA: local politics, including equipment ownership, and the greater political environment, such as the recent congressional hearings on imaging utilization that pitted the American College of Radiology against the American College of Cardiology.

Membership in the SCCT - nearing 500 - is predominantly composed of cardiologists, according to Dr. Norbert Wilke, a board member and an associate professor of radiology at the University of Florida at Jacksonville. In October, the SCCT will cosponsor a day of cardiac CTA imaging at the annual meeting of the North American Society of Cardiac Imaging, typically a stronghold of radiologists.

A priority for the SCCT for now is to develop multicenter trials validating 16-slice CTA. The data would then be presented to the Centers for Medicare and Medicaid Services so that reimbursement for the technique can be established and approved.

One such trial wrapping up could help the cause. The Coronary Assessment by computed Tomographic SCanning and catheter ANgiography (CATSCAN) trail enrolled more than 200 patients from 12 different hospitals worldwide. A third person in a remote location is analyzing the CT images, all performed on 16-slice scanners.

It is unknown whether EBCT will survive this push to advance the clinical use of coronary CTA. But two things are certain. Cardiologists are increasingly adding MSCT to their diagnostic armamentarium. And they are working side-by-side with radiologists to interpret scans and to develop guidelines for doing so.

For more information from the Diagnostic Imaging archives:

Cardiac CT's triple ruleout: Is it hype or real benefit?

Some cardiologists cling to catheter angiography

Cardiac CT practitioners create two new societies

Calling all cards