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