S Mark Taper Foundation Imaging Centre
</b> Welcome to the Emcure WCCICC TV live coverage. You are watching me on the RightDoctors.com. I am honored to have with me none other than Dr. Daniel Berman. Sir is the director for Nuclear Cardiology and Cardiac Imaging, Cedars Sinai. Welcome to the show sir. Sir I would like to begin with asking you, can you just throw some light on the technological improvements in the cardiac imaging, the value based and demonstration of value and surviving this technology?
</b> What is important is that our testing provide value. That means we either have to improve quality or reduce cost. The good news is the technology has been advancing rapidly and regardless of which field we look at from nuclear cardiology, cardiac CT, cardiac MRI, and echocardiography, everything is improving dramatically.
</b> So sir what are the challenges you would like to see or you can encounter (01
</b> Well, I think what we have to do is we need to use the test in the right patient at the right time. To illustrate that we should look at coronary artery disease. This disease ranges from prevention of acute coronary syndromes, stable disease or heart failure. In the patient who needs prevention, the more expensive techniques, the stress imaging or angiographic techniques really do not play a role, but imaging atherosclerosis whether coronary calcium imaging or ultrasound evaluation of the carotid or femoral arteries can identify an individual patient whether they have atherosclerosis. This approach has been shown to be far superior to looking at simple risk scores in evaluating a patient and guiding their subsequent therapies (02
</b> Okay, right sir, what are the most important PSI in each clinical settings?
</b> In the conference, I told you that I already started once, I will have to rephrase.
</b> So sir, as you mentioned in your data, in the NICE guideline in 2006
</b> I am really sorry. I would like to if you can allow me to look at prevention, chest pain and then I will get to the CT angiography and then finally also if CT does not work in some patients. Is it okay?
</b> So sir, the preventive measures and the diagnostic measures?(03
</b> Prevention and diagnosis.
</b> So sir, I would like to ask you what are the preventive and diagnostic recommendations of such kind of clinical settings?
</b> These tests have to provide value by improving outcomes or decreasing cost. When we look at prevention, that is where atherosclerosis imaging plays an important role. It is a marker in an individual patient as to how much atherosclerosis has built up. It could be performed with calcium scanning by CT or with ultrasound methods that are less expensive and these methods are likely to provide value in guiding the patient management.
</b> Okay, right sir. So sir, as you have mentioned in your talk that even NICE guidelines 2016 has recommended coronary CTA, so what amount of or what strength of data is available for such kind of recommendations sir?(04
</b> This is very important because in the acute setting or in stable disease, there are multiple randomized trials that have shown that coronary CTA is effective and improves outcomes while keeping cost low. It is the first set of trials that were performed in the emergency department where there was an improvement in the frequency of discharging patients from the emergency department and a decrease in time in the emergency room. Also, there is a decrease in downstream testing as many of these patients have normal studies completely. In the stable chest pain patients the NICE guidelines have now been based again on multiple clinical trials. The most important one is the Scot heart trial. In that trial it was demonstrated that there is an improvement in outcomes if one takes into account the delay that occurred between (05
</b> So sir are there any subset of patients where coronary CT does not work actually?
</b> There are and that is an important question. When there is too much calcium in the arteries or in patients having renal failure as examples, CT is not effective. In those patient the stress imaging modalities are highly effective in guiding patient management. If we wanted to put all of this information together (06
</b> Okay. Thank you.