PHOTO GALLERY: Duly Health adopts outpatient cardiac CT as a standard of care

Dave Fornell | | Radiology Business | Computed Tomography

Duly Health and Care in suburban Chicago recently opened a new outpatient cardiac evaluation center equipped with a dedicated cardiac computed tomography (CT) system. It offers advanced CT imaging in an office setting. This is part of a trend in cardiology that is expected to greatly accelerate because of the 2021 chest pain evaluation guidelines released late last year. This gives cardiac CT a 1A level of evidence to be used as primary imaging modality. Duly is part of this shift toward office-based cardiac CT evaluations for more detailed cardiac screenings, evaluation of stable chest pain and pre-procedural structural heart workups.

The guidelines also gave a high rating for fractional flow reserve CT (FFR-CT). This technology uses the CT scan to create a computer model 3D coronary tree that shows hemodynamic pressure drops in each vessel segment to pinpoint culprit lesions or identify long-diffuse disease causing ischemia. Duly now routinely uses FFR-CT for any patient with a blockage of 30% or more. This can help determine if a patient needs to be revascularized in a cath lab or if they can be treated medically. 

The business model is designed to offer referring physicians in the Duly health system an alternative to sending patients to hospitals for full evaluations. This Lisle, Illinois, CT-equipped clinic is the first of its kind in the Midwest.

"We have been finding that as the technology of CT angiography has improved more and more over the years, we also are finding we are leaning on it more for diagnosis of coronary artery disease and chest pain syndromes in patients. We also found we were sending patients to the hospital environments to obtain that imaging, but we have had such a robust volume of cases for our large practice, we started investigating if it made sense to bring CT imaging in-house," explained Evans Pap­pas, MD, chair of the Duly Depart­ment of Car­di­ol­o­gy.

The GE Cardiographe scanner they installed is only half the size of conventional CT systems, but has much faster acquisition speeds to freeze the motion of the heart, even at higher heart rates, said Sujith Kalathiveetil, MD, FACC, Duly's direc­tor of cardiac imaging.

"The 2021 American College of Cardiology Chest Pain Guidelines really moved coronary CTA to become our first-line test for the evaluations of patients with chest pain with no previous diagnosis of coronary artery disease," Kalathiveetil said. 

Hear more in the VIDEO: Office-based cardiac CT and FFR-CT offer a new business model — an interview with Kalathiveetil and Pappas and a tour of their CT scanner. 

A technology preps a patient for a pre-procedural LAA occlusion workup scan on Duly Health and Care's Cardiographe cardiac CT scanner.

A technology preps a patient for a pre-procedural LAA occlusion workup scan on Duly Health and Care's Cardiographe cardiac CT scanner.

Entrance into the CT suite at the clinic. Duly Health and Care's Cardiographe cardiac CT scanner.

Entrance into the CT suite at the clinic.

A technologist performs a cardiac CT scan on the Duly Health and Care's outpatient, dedicated cardiac CT scanner. #yesCCT #CCTA #CTA

A technologist performs a cardiac CT scan on the Duly Health and Care's outpatient, dedicated cardiac CT scanner.

Patient is prepped and positioned in the cardiac CT scanner. The Duly Health and Care's outpatient, dedicated cardiac CT scanner.

Patient is prepped and positioned in the cardiac CT scanner.

Patient being scanned on the Duly Health and Care's outpatient, dedicated cardiac CT scanner in Lisle, Illinois.

Patient being scanned on the Duly Health and Care's outpatient, dedicated cardiac CT scanner in Lisle, Illinois.

Patient being scanned on the Duly Health and Care's outpatient, dedicated cardiac CT scanner in Lisle, Illinois.
An example of a patient's FFR-CT 3D rendering of their entire coronary tree from their CT scan. The technology uses AI and computational fluid dynamics to determine the hemodynamic flow inside the vessels. It color codes areas of reduced flow. The radiologist or cardiologist can pick any location along a vessel to see the FFR values. This can determine if a patient needs to be revascularized, or managed with medications.

An example of a patient's FFR-CT 3D rendering of their entire coronary tree from their CT scan. The technology uses AI and computational fluid dynamics to determine the hemodynamic flow inside the vessels. It color codes areas of reduced flow. The radiologist or cardiologist can pick any location along a vessel to see the FFR values. This can help physicians determine if a patient needs to be revascularized, or managed with medications.

Placement of an IV line in a cardiac patient for CT contrast delivery during their scan. Duly Health and Care's outpatient, Cardiographe dedicated cardiac CT scanner in Lisle, Illinois.

Placement of an IV line in a cardiac patient for CT contrast delivery during their scan.

The Lisle Duly Health and Care outpatient clinic has radiology and cardiology sections. Cardiology operates the dedicated cardiac CT scanner in its own area.

The Lisle Duly Health and Care outpatient clinic has radiology and cardiology sections. Cardiology operates the dedicated cardiac CT scanner in its own area.

The Cardiographe cardiac CT system was co-developed by GE Healthcare and Arineta. Its design included all the aspects of a CT scanner that are ideal for cardiac CT, and left out features included on workhorse CT systems for imaging other parts of the body. Both companies now sell the system. Arineta set up its own booth at RSNA 2021 because of a large amount of interest in its system after the ACC 2021 chest pain guidelines were released.

The Cardiographe cardiac CT system was co-developed by GE Healthcare and Arineta. Its design included all the aspects of a CT scanner that are ideal for cardiac CT, and left out features included on workhorse CT systems for imaging other parts of the body. Both companies now sell the system. Arineta set up its own booth at RSNA 2021 because of a large amount of interest in its system after the ACC 2021 chest pain guidelines were released.

Iodine contrast in storage in the CT suite.

Iodine contrast in storage in the CT suite.

Evans Pap­pas, MD, chair of the Duly Depart­ment of Car­di­ol­o­gy, leads a tour of the outpatient Lisle cardiology clinic, which includes sverela exam bays, echocardiography, ECG, point-of-care blood testing and CT.

Evans Pap­pas, MD, chair of the Duly Depart­ment of Car­di­ol­o­gy, leads a tour of the outpatient Lisle cardiology clinic, which includes sverela exam bays, echocardiography, ECG, point-of-care blood testing and CT.

One of the patient exam bays at the Duly Health and Care outpatient cardiac clinic.

One of the patient exam bays at the Duly Health and Care outpatient cardiac clinic.

The Duly Health and Care outpatient clinic in Lisle, Illinois.

The Duly Health and Care outpatient clinic in Lisle, Illinois.

Technologist sets up the CT contrast injector prior to a cardiac CT scan at the Duly outpatient cardiac clinic. The American College of Radiology (ACR) has released the latest edition of the ACR Appropriateness Criteria, which includes 221 diagnostic imaging and interventional radiology topics with more than 1,050 clinical variants covering 2,900 clinical scenarios. #ACR #AUC #appropriateuse

Technologist sets up the CT contrast injector prior to a cardiac CT scan at the Duly outpatient cardiac clinic.

Iodine contrast in the CT suite at the Duly outpatient cardiac clinic.

Iodine contrast in the CT suite at the Duly outpatient cardiac clinic.

Radiology Business/Cardiovascular Business Digital Editor Dave Fornell with Sujith Kalathiveetil, MD, FACC, Duly's direc­tor of cardiac imaging, and Evans Pap­pas, MD, chair of the Duly Depart­ment of Car­di­ol­o­gy, in front of their CardioGraphe dedicated CT scanner at their Lisle, IL, clinic.

Radiology Business/Cardiovascular Business Digital Editor Dave Fornell with Sujith Kalathiveetil, MD, FACC, Duly's direc­tor of cardiac imaging, and Evans Pap­pas, MD, chair of the Duly Depart­ment of Car­di­ol­o­gy, in front of their CardioGraphe dedicated CT scanner at their Lisle, IL, clinic.

Dave Fornell is a digital editor with Cardiovascular Business and Radiology Business magazines. He has been covering healthcare for more than 16 years.
Dave Fornell

Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com

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