FAQ


Why Should I Have an CT Examination?
Coronary artery disease is the number one cause of death among both men and women in this country. It is a silent killer. In many cases, its first, last and only symptom is a fatal heart attack. The good news is that coronary artery disease can be treated, and even reversed, if you catch it in time. CT provides the only non-invasive test that has found hidden heart disease in thousands of people who are alive today. In less than 10 minutes, it can detect coronary artery disease in its earliest stages. Long before you feel any symptoms and in time for you and your doctor to do something about it. The test is easy, you simply lie down, take a few deep breaths and it's over. No claustrophobia, no undressing, nothing to drink. 

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  • Coronary heart disease kills more Americans than all other diseases combined.
  • Every 49 seconds someone has a heart attack.
  • Every three minutes someone dies from coronary disease.
  • This year the American Heart Association estimates that 1,100,000 Americans will have a heart attack and that about one-third will die.
  • 80% of deaths from coronary artery disease in people under 65 comes during the first attack.
  • 48% of men and 63% of women who died suddenly from a heart attack showed no previous symptoms.

Why Is It Important to Detect Coronary Disease Early?
The buildup of plaque (atherosclerosis) is a silent disease that represents the number one killer of Americans. For as many as 150,000 people each year, a fatal heart attack represents the first and only symptom. There are millions of Americans at great risk for a heart attack, and yet have very few, if any major risk factors. There have been tremendous advances proving that atherosclerosis can be halted (an occasionally reversed) once diagnosed, but the problem of early detection has remained elusive. Risk factor modification with lifestyle changes and/or medications have been demonstrated to save lives and decrease heart attacks in high-risk individuals. 

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What Is Coronary Artery Imaging by CT?
CT is a very rapid advanced x-ray system, which can take multiple pictures of a moving object (e.g., your heart) in a few seconds. By detecting and measuring the amount of plaque calcification, this revolutionary scanner represents the most accurate way to determine if an individual has early atherosclerosis before the development of symptoms. It has become clear that the majority of sudden coronary events arise from disease that is to early for stress and other tests to detect. Recent reports in cardiology journals have shown CT to be far more powerful that any other test of risk factor in predicting individuals' likelihood for a coronary attack  

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CT Coronary Artery Screening Examination
Recommended for all patients between 40 and 65 who have two or more cardiac risk factors.
What are the risk factors for coronary artery disease?

Cardiac Risk Factors:

  • Family history of heart attack or coronary artery disease
  • High cholesterol levels:
  • High LDL - greater than 160 mg/dl
  • Low HDL - less than 35 mg/dl
  • High HDL -greater than 60 mg/dl - is a negative risk factor
  • Men: 45 years or older 
  • Women: 55 years or older or premature Menopause without estrogen-replacement therapy
  • Current smoker 
  • High blood pressure
  • Diabetes 
  • Inactive life style 
  • Overweight 

Chronic stress (usually job related) 

What can be done if I do have calcified plaque?
First, everyone should realize that most people will have some plaque in their coronary arteries. A look at the table of values shows how calcium artery scores were distributed among 19,000 patients who did not have symptoms. The level of the calcium score, corrected for age and sex, will indicate whether you are at low, moderate or high risk for a heart attack in the next several years. 

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Your physician should correlate the results of your test with all other tests, including a physical examination.
A ZERO score indicates no calcified plaque in the coronary arteries and is desirable for everyone. This
score indicates that you should follow basic concepts, as indicated by your physician, to be sure that you do not develop coronary artery disease in the future. At present there is very little risk of a heart attack.
A mild calcification score, as corrected for age and gender, means that you have the earliest stages of coronary artery disease. In consultation with your physician you should make modifications to diet or an exercise program to insure that the deposition of plaque does not continue, and hopefully, will even reverse itself. A moderate score indicates a moderate amount of plaque, and while there may not be an immediate concern about a heart attack, more diligent steps must be taken to make sure that plaque build-up does not continue. Your physician may recommend additional testing, such as a stress test, to document the extent of the effect of the plaque on the functioning of the heart. Severe calcification, over the 90th percentile, is strongly suggestive of significant coronary artery disease and should be aggressively treated. This would involve additional testing and a program arranged by your physician to minimize risks. IN AN EXTREME CASE, angiography and possibly even bypass surgery may be indicated. ALTHOUGH THIS MAY INITIALLY APPEAR AS TRAGIC NEWS, BYPASS SURGERY WILL SAVE YOUR LIFE. IT IS BETTER TO HAVE THE BYPASS SURGERY BEFORE HAVING A HEART ATTACK. 

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What is coronary artery disease?
Coronary artery disease refers to a narrowing of the coronary arteries, usually by a buildup of plaque on the walls, which decreases the amount of blood that can flow through them to supply the heart muscle. It is the number one cause of death of both men and women in the United States, causing 43% of all deaths. One out of every four Americans suffers from coronary artery disease that is responsible for 1.5 million heart attacks annually. For over 100,000 people each year, the first, last and only symptom of coronary artery disease is a fatal heart attack. 

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What is a heart attack?
The heart is a muscle that pumps oxygen-supplying blood through the body. The heart itself is supplied with oxygen by the coronary arteries - four main arteries that surround the heart so that every part of it is constantly supplied with blood and oxygen. If one or more of these arteries becomes blocked, parts of the heart cannot obtain oxygen. Initially, there is ischemia, a lack of oxygen to the heart tissues, which causes severe pain. If the blockage is not removed quickly, the condition progresses to an infarct, or death of the affected parts of the heart muscle. This is what is meant by a heart attack, officially called a myocardial infarction, or MI, as physicians often refer to it. 
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Does a heart attack always mean that the patient will die?
NO. After a patient suffers a heart attack, the immediate prognosis depends upon how much of the heart muscle has infarcted. The part of the heart that is involved can no longer pump blood. The remaining normal heart muscle can continue to pump blood around the body. If too much of the heart muscle has been destroyed, the patient will die. If the amount of remaining normal tissue is able to pump blood through the body, it will continue to work, but much less effectively than it had been.  

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How does a heart attack start?
This is a complicated question and although many complex causes can be given, over 95% begin with build-up of plaque in the coronary arteries. The accumulation of plaque in the coronary arteries is a disease called atherosclerosis. This is a form of arteriosclerosis, which includes a variety of conditions, commonly called hardening of the arteries, as the walls of the arteries become thicker and lose their elasticity. 
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Does a heart attack have to block the entire artery to cause a heart attack?
No. 80% of heart attacks occur in patients with narrowing of less than 50%. As plaque builds up it narrows the diameter of the artery and also causes it to lose its natural elasticity, weakening the wall of the artery. During periods of unusual stress the heart is forced to work harder than it normally does. This can occur in someone who is "out of shape" suddenly deciding to play basketball or shovel snow. The heart is forced to pump harder to supply the muscles with blood bringing oxygen to the muscles, and the heart itself needs more oxygen. Blood flow through the coronary arteries is increased, but the arteries are not as elastic as they should be and a small rupture may develop at sites where there is a small amount of plaque. The body immediately begins to repair this tear in the artery by producing a clot, called a thrombus. The problem develops when this thrombus continues to grow, completely or almost completely blocking the artery, leading to ischemia and eventually a heart attack. 
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Does this mean that if I have some plaque in my coronary arteries I should never exert myself?
No, quite the contrary, sudden exertion should be avoided, but a program of gradually increased activity and/or exercise would be in order. By slowly increasing exertion in a controlled program muscles and blood flow are developed allowing the body and the heart to get used to more strenuous conditions. In a properly conditioned person the heart would then not have to reach dangerous levels as it would in someone who is not used to any type of strenuous activity. 
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What exactly is plaque and how does the CT detect it?
Plaque is a mixture of cholesterol, fatty deposits, fibrous strands of collagen and connective tissue that is deposited on the inner wall of the artery. After a period of time, which varies from person to person, this initial plaque deposit will add calcium (calcify) and harden, causing a hardening of the wall of the artery.  

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Will it tell me how much blockage there is in my coronary arteries?
No. This can only be done by an angiogram, which is a highly invasive and expensive procedure. The scan measures coronary disease in a different way, and a way in which many physicians now believe is more important than the percentage of blockage (also referred to as stenosis or occlusion). The scan measures the amount of calcified plaque within your coronary arteries. This measurement is highly correlated with your overall level of atherosclerosis, i.e., the more calcium you have, the more plaque you have. And, the more plaque you have, the greater the likelihood you will suffer an event (heart attack or need for surgery) in the future.  
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Your advertising says this test can detect the heart disease process years earlier than any other test. Please explain.
Most other tests in cardiology, such as stress cardiograms (also known as treadmill tests) or thallium stress tests or echocardiograms, are testing heart function, and therefore can only reliably detect disease when the disease process is so far advanced that it's already impairing the function of your heart. The CT scan, on the other hand, is looking at coronary anatomy and not function. This provides an opportunity to detect and measure plaque accumulation from the point at which the very first speck of calcium is deposited in your arteries. Typically, this is many, many years before cardiac function might ever be affected.  
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How accurate is the test?
Numerous studies have shown that calcium measured by CT is highly reliable in ruling out obstructive Coronary Artery Disease. This means that if you test negative and are without symptoms, there is only a very small chance that you have Coronary Artery Disease.
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Is this test better than a stress test?
We tend not to think in terms of better or worse. Each test in cardiology serves a specific purpose. The proper question to ask is what test is the most appropriate for you. CT scan is a screening test, and typically is performed before any of the other cardiac tests, including a stress test. If your scan is negative (normal), then in most cases, it will be unnecessary for you to take any further heart tests.
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What if I've already passed a stress test?
This, of course, is very good news. It means that your heart function is normal, even when you are pushed to peak physical exertion. But, we still do not know if your coronary arteries are clean, if you have a moderate amount of plaque, or if you have an amount that may be a hair short of being obstructive. This is the additional information that a calcium scan can provide to you. Furthermore, it's important to understand that "the majority of patients destined to die suddenly will not have a positive exercise test." This evaluation, first published in The New England Journal of Medicine in 1989, runs contrary to popular belief. The general public assumes that heart attacks occur when you have built up a large amount of plaque at one particular point in your coronary arteries (the "98 or 99% blockage" that we hear about so often). In reality, most heart attacks occur when a smaller plaque (very often a non-obstructive plaque, i.e., one which does not impair heart function and therefore would not be detected by a stress test) ruptures and a blood clot forms on top of the ruptured plaque. Since the calcium scan is measuring all of your calcified plaque, and not merely those, which are large enough to affect heart function, it can identify individuals at risk of sudden death heart attack even if they have no symptoms or current impairment of cardiac function. 

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Does it replace a Thallium Test or a PET Scan or an Angiogram?
No. The primary use of coronary calcium is as an inexpensive screening procedure for asymptomatic individuals. These other tests are all invasive in nature and much more expensive than this test. Calcium is often used to determine if a patient should be subjected to such a procedure. In fact, in a 1994 article, which appeared in the journal Radiology, researchers from the National Institutes of Health recommended that calcium screening be performed in any patient for whom an angiogram is being considered. The reason for this is simple - approximately 25% of all angiograms turn out to be normal. This means there are hundreds of thousands of patients each year in the United States alone with "normal" coronary arteries that are subjected to an expensive, uncomfortable procedure, which carries with it the risk (albeit small) of stroke, heart attack or death. In many of these cases, having a calcium screen first would demonstrate that there is no real need to have an angiogram.

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What about individuals who have already had a heart attack, coronary angioplasty, bypass surgery, or coronary angiography?
This test is generally viewed as being not appropriate for anyone who has already had bypass surgery. However, for those who have had heart attacks, angioplasties or angiograms, it may be useful to provide a benchmark against which we can measure the future progression of disease. Anyone who has had a heart attack or angioplasty should be under the care of a cardiologist and it would be best to consult with such cardiologist to determine if the test will be appropriate for you. It is important to note here that anyone who has had a heart attack, coronary angioplasty or bypass surgery should inform his/her siblings and/or adult children about the availability of this test. As you probably know, there is often a genetic component to heart disease. Accordingly, if you have the disease, this increases the likelihood that your blood relatives have the disease as well. 

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Can anything be done to counter the effect of risk factors?
Yes, reducing and removing risk factors is very effective at lowing your overall risk for heart disease and or a cardiac event. These risk factors are ones that you can have direct control over.
Smoking - A smokers' risk of heart attack is more than twice that of nonsmokers. Cigarette smoking is thought to be the greatest single risk factor for sudden cardiac death: smokers have two to four times the risk of nonsmokers. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than are nonsmokers.

High blood cholesterol levels - The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and cigarette smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet.

High blood pressure - High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack increases several times.

Physical inactivity - Lack of physical activity is a risk factor for coronary heart disease. Regular, moderate-to-vigorous exercise plays a significant role in preventing heart and blood vessel disease. Even modest levels of low-intensity physical activity are beneficial if done regularly and long term. Exercise can help control blood cholesterol, diabetes and obesity as well as help to lower blood pressure in some people.

Obesity and overweight - People who have excess body fat are more likely to develop heart disease and stroke even if they have no other risk factors. Obesity is unhealthy because excess weight increases the strain on the heart. It's directly linked with coronary heart disease because it influences blood pressure, blood cholesterol and triglyceride levels, and makes diabetes more likely to develop. Many obese and overweight people are not able to change their condition. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.

Diabetes mellitus - Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes seriously increases the risk of heart disease and stroke. More than 80 percent of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it is critically important for you to monitor and control any other risk factors you can. 

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What Does the Procedure Involve?
The procedure is simple, safe and painless and takes only a few minutes. A CT technologist will apply a few EKG leads and will ask you to lie on a table and hold your breath a couple times. The radiation exposure is minimal and no intravenous injections are required. In most cases (unless there are certain types of buttons or bra metal involved), patients will be able to keep their shirt or blouse on while the 33-40 pictures are taken. Most patients will complete a risk factor questionnaire upon arrival.  
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What Do the Results Mean?
The scanner and its associated computer processor determine the number and density of coronary plaques in the entire coronary system and develop a coronary calcium score. After examining the entire chest (lungs, etc.), our staff determines the location and severity of coronary atherosclerosis. This information and the original pictures are then made available to cardiologists for further interpretation. Some patients will have minimal or no anatomic evidence of coronary disease and will be advised to continue with the routine public health recommendations on diet, exercise, etc. Other patients may have more extensive disease. Depending upon the calcium score and other factors, recommendations will be made by our team of physicians with regards to further lifestyle, medication or additional cardiac testing.

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When will I receive my test results?
Your final written report will be mailed to you within a few days from your test date. Results will also be mailed to your physician if you request that we do so. 

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What happens if I am positive, i.e., the test shows I have coronary calcium?
In all cases, whether the test result is positive or negative, you are urged to share these results with your personal physician. No test in medicine should be viewed in isolation. Test results are most meaningful when they are placed in the context of your entire medical profile, and typically it is your personal physician who is best able to do this. In general, however, the treatment prescribed by a physician will usually depend upon the extent of calcification detected, the patient's age, general health, symptoms (if any) and presence of controllable risk factors for Coronary Artery Disease. Treatments prescribed may be as simple as modifying these risk factors, including stopping smoking, improving diet, and starting an exercise program. Additional testing and more aggressive treatment, including medication, might also be required.
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Do I need a referral from my physician to schedule an appointment?
No. The test may be scheduled on a self-referred basis.  

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Will insurance companies pay for these tests?
Some private insurance and HMOs do cover some preventative screenings. The patient pays upon arrival and gets reimbursed later by his or her coverage. Peace of Mind Scans neither takes responsibility for nor makes any representations regarding insurance reimbursement from any private insurance carrier.

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Will Medicare or Medi-Cal pay for these tests?
No. Both Medicare and Medi-Cal are not covering these new technologies when used for preventative screening at this time, but do cover for diagnostic tests. Inevitably, the current system will be forced to change as public opinion accumulates and further embraces preventative screening.

How and when is payment made?
Upon your arrival, we accept cash, check, Visa, and Mastercard, with the exception of POMS Alzheimers Detection Scan. Because of the radioactive isotopes, we ask for a large portion of the service cost two days in advance. Please review our Services and Pricing pages for specific information.

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Is CT scanning replacing current methods for identifying diseases?
More of a supplement, CT scanning offers a painless alternative to the old, invasive methods, which a patient might find personally undesirable. CT may catch a problematic health condition during the initial stages when the odds for recovery would be much higher.

How does the computer imaging of the CT work?
Metaphorically, the CT Scanner� basically views your body as a loaf of bread, cutting ultra thin, three-dimensional slices, continuously imaging for rapid review.

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What is the advantage of 64 slice CT scanning over and other CT scanning?
64 Slice CT scanners deliver the highest resolution, fastest scan time, and lowest x-ray dose.

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Why should I consider having the POMS Virtual Colonoscopy?
Shockingly, colon cancer is the second leading cause of cancer-related deaths in both women and men. Virtual Colonoscopy is equally effective as traditional colonoscopy in the detection of infiltrating cancers and polyps, and without physical discomfort or hospital stay.

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How is the GE Highfield 1.5T Signa MR/i better than other MRIs?
GE sets the standard for medical imaging in radiology. The lx/sx/cx has the strongest magnetic strength, which means faster scan times. This MRI uses next wave technology for the highest resolution in the reconstruction of image quality.

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� Physician Questions
Why Should I Use CT for My Patients?

  • It is the only test that will allow you to accurately identify which of your patients have coronary artery disease and tell you how severe it is.
  • Once identified, it will permit you to begin or modify treatment of those patients, usually much earlier and with more accuracy than ever.
  • It will allow you to monitor the effectiveness of treatment in patients with coronary artery disease, so that you can adjust treatment as necessary before they become symptomatic.

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How Do I Use CT Results?
Zero Score: No evidence of calcified plaque and virtually no risk of obstructive coronary artery disease. False negatives can occur in young (<35) patients, especially males- Recommend routine risk counseling.  
Low Score: Some calcified plaque in the coronary arteries, but within the 50th percentile when adjusted for age and sex. Low probability of obstructive coronary artery disease. Recommendations: risk factor modification and patient counseling. Repeat examination in 2-3 years to document no significant progression.  
Mild / Moderate Score: Mild/moderate plaque burden, with moderate non-obstructive coronary artery disease. Since research at the Mayo Clinic [JACC, 33:453(1999); NEJM, 339:1972(1998)] has demonstrated plaque can increase at 25% per year, aggressive therapy, as clinically indicated, is recommended.  
High Score: High probability of obstructive coronary artery disease. Further evaluation by stress testing is recommended to evaluate degree of obstruction. CT can determine as little as 15% occlusion, however stress testing will not be positive until at least 60-65% occlusion is reached.
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Which Patients Should Undergo CT Examination?
Based upon our results of positive findings in asymptomatic patients:

  • Anyone deemed high risk for coronary artery disease by his/her physician.
  • Men over 40, women over 45, with a positive family history and elevated or high-normal cholesterol levels.
  • Patients with equivocal stress tests for whom there is not a sufficiently high clinical suspicion to refer them for angiography.

Patients on statin therapy who may not be on a therapeutic dose.

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