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Coronary Computed Tomography Angiography

Article
Heart & Vascular Health
Health & Wellness
+2
Contributed byKrish Tangella MD, MBAJan 18, 2019

Background Information:

What are the other Names for the Procedure?

  • Computerized Tomography Coronary Angiogram
  • Coronary CT Angiography
  • Coronary CTA

What is Coronary Computed Tomography Angiography radiology procedure? (General Explanation)

  • A Coronary Computed Tomography Angiography procedure is used to evaluate narrowed arteries due to plaque (made of fat, calcium, or cholesterol) build-up
  • Plaque build-up occurs over time and decreases or completely blocks blood flow, to important organs or tissues
  • CT scanning is used in this procedure, which provides a more detailed and clear picture of the problem than regular X-ray exams

What part of the Body does the Procedure involve?

A Coronary Computed Tomography Angiography involves the heart and the region around the heart.

Why is the Coronary Computed Tomography Angiography radiology procedure Performed?

A Coronary Computed Tomography Angiography procedure is performed for the following reasons:

  • To produce detailed images of blood vessels in the heart
  • To identify lipid deposits or plaque in the coronary arteries
  • To identify diseases, such as atherosclerosis in the carotid artery, or aneurysms in the aorta

What is the Equipment used? (Description of Equipment)

The following equipment is used for Coronary Computed Tomography Angiography:

  • A CT scanner
  • An examination table
  • An X-ray tube electronic
  • X-ray detectors

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Coronary Computed Tomography Angiography procedure.

What is the Cost of performing the Coronary Computed Tomography Angiography radiology procedure?

The cost of the Coronary Computed Tomography Angiography procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Coronary Computed Tomography Angiography procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=angiocoroct (accessed on 08/02/2014)

Prior to Coronary Computed Tomography Angiography radiology procedure:

How does the Coronary Computed Tomography Angiography radiology procedure work?

  • A Coronary Computed Tomography Angiography scan is very similar to an X-ray exam
  • X-ray beams in CT scan follows a spiral path, as the examination table moves through the scanner
  • A two-dimensional cross-sectional image of the body is created by a computer program, by utilizing all the data generated by the scanner
  • The CT scan produces very detailed multidimensional view of the body’s interior
  • The scan produces images of the body in a way, as can be compared to looking at a loaf of bread, by cutting the loaf into thin slices

How is the Coronary Computed Tomography Angiography radiology procedure Performed?

The Coronary Computed Tomography Angiography is performed in the following manner:

  • The patient is asked to lay flat on their back, the intravenous (IV) line is inserted, and the patient’s heart activity is monitored with an electrocardiogram (ECG)
  • A beta blocker may be injected to slow down the patient’s heart
  • Nitroglycerin may be injected to dilate the coronary arteries
  • As motion affects the quality of examination, patients are asked to stay still on the table; children may be given sedation, to keep them still/motionless
  • In many exams, a contrast material is also used, which can be injected through the IV line, swallowed, or administered by enema
  • The patient is moved rapidly through the scanner and images are taken

Where is the Procedure Performed?

A Coronary Computed Tomography Angiography procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

A Coronary Computed Tomography Angiography procedure is usually done by a radiology technologist.

How long will the Procedure take?

Generally, the Coronary Computed Tomography Angiography procedure takes about 15-20 minutes.

Who interprets the Result?

  • A radiologist interprets the results of the Coronary Computed Tomography Angiography exam
  • A follow-up examination may be needed, if there is anything suspicious during the exam, or to monitor the abnormality over time, or to check the treatment progress

What preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Coronary Computed Tomography Angiography scan:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • The patient may be asked to take beta blockers to lower the heart rate, in order to get better results
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
  • It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
  • The patient should inform his or her physician, if they have any dental implants, piercings, or pacemakers
  • The patient may also be asked not to take caffeinated drinks, Viagra, or any other substances that may increase heart rate, prior to the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for a Coronary Computed Tomography Angiography procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Coronary CTA procedure:

  • The procedure is fast, easy, and painless
  • CTA is non-invasive, unlike a cardiac catheterization procedure
  • It is possible to identify and fix the narrowing of blood vessels at the same time, with an angiography
  • The Coronary Computed Tomography Angiography procedure gives more detailed information of blood vessels than an MRI scan
  • CT angiography is a less invasive procedure than a catheter angiography procedure, as contrast material is injected into an arm vein in CT angiography, instead of into the groin artery

Following are the risks of the Coronary CTA procedure:

  • Over-exposure of radiation may cause cancer, though it is a very rare occurrence
  • The contrast material used in the procedure may rarely cause allergic reaction in some patients
  • If the contrast material leaks out under the skin, it may cause some skin damage
  • The Coronary Computed Tomography Angiography procedure could worsen an existing kidney problem
  • Pregnant women are not recommended to undergo CT scanning procedures

What are the Limitations of the Coronary Computed Tomography Angiography radiology procedure?

  • The Coronary Computed Tomography Angiography procedure is not recommended for patients with kidney problems or diabetes
  • Patients, who are obese may not be able to bodily fit into the scanner; they may need an open CT scanner

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is the Coronary Computed Tomography Angiography procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Coronary Computed Tomography Angiography radiology procedure:

What is to be expected during the Coronary Computed Tomography Angiography radiology procedure?

The following may be expected during  the Coronary Computed Tomography Angiography procedure:

  • The patient will feel slight pain due to insertion of the IV lines and the catheter
  • Slight pressure may be experienced, when the catheter tip is inserted
  • The patient may experience a warm feeling, when the contrast material is injected
  • Beta blocker administration slows down the heart rate, and so patient may feel a little dizzy
  • The patient may feel abdominal fullness or the need to expel the liquid, right after contrast material is in the body. However, this discomfort goes away very quickly
  • There might be some noise, as would be involved with any regular machine function
  • There might also be a little anxiety due to the noise generated by the computer, or due to staying still for a long time; though, there will be no associated pain

What kind of Anesthesia is given during the Procedure?

No anesthesia is administered during a Coronary CT Angiography procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss during the Coronary CT Angiography procedure. 

What are the possible Risks and Complications during the Coronary Computed Tomography Angiography radiology procedure?

The risks of the Coronary Computed Tomography Angiography procedure include:

  • Over-exposure of radiation may cause cancer; but, it is a very rare occurrence
  • The contrast material used in the procedure may rarely cause an allergic reaction in some patients
  • If the contrast material leaks out under the skin, it may cause some skin damage
  • Any existing kidney health problem could get worse
  • Pregnant women are not recommended this procedure

What Post-Operative Care is needed at the Healthcare Facility after the Coronary Computed Tomography Angiography?

There is no postoperative care necessary after a Coronary Computed Tomography Angiography procedure, at the healthcare facility.

After the Coronary Computed Tomography Angiography radiology procedure:

What is to be expected after the Coronary Computed Tomography Angiography radiology procedure?

The patient may perform their regular activities after the Coronary Computed Tomography Angiography procedure.

When do you need to call your Physician?

If the patient is experiencing an allergic reaction from the contrast reaction, then do contact the physician. 

What Post-Operative Care is needed at Home after the Coronary Computed Tomography Angiography radiology procedure?

There is no postoperative care necessary after a Coronary Computed Tomography Angiography procedure.

How long does it normally take to fully recover, from the Procedure?

The patient needs no recovery time after the Coronary CT Angiography procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue is extracted from the patient during a Coronary CT Angiography procedure.

When should you expect results from the pathologist regarding the tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from after the Coronary Computed Tomography Angiography radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Radiologist or neurologist, performing the procedure
  • Healthcare providers, physicians, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Coronary Computed Tomography Angiography procedure is performed.

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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