Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging.

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multidetector CT is discussed.

Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging.

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed.

MRI of congenital heart disease: a paradigm of collaboration. new suggestions for a team approach from Madigan Army Medical Center.

Over the past decade, there has been increasing use of cardiac MRI in the evaluation of children with congenital heart disease. There has also been an increased number of radiologists and pediatric cardiologists desiring to perform cardiac MRI in the evaluation of these patients. At the present time, the number of pediatric cardiologists and radiologists fully trained in the use of MRI studies for CHD is inadequate to provide this modality at all institutions with MRI capabilities. This article describes the collaborative approach between pediatric cardiology and radiology at Madigan Army Medical Center and its implications for patient care and credentialing.

Ethical considerations in image-based screening for coronary artery disease.

Despite marked advances in the treatment and prevention of coronary artery disease (CAD) during the last decade, CAD and its complications continue to account for 20% of all deaths in the United States, more than other cause of death. Moreover, half of those who die suddenly of an acute myocardial infarction have no prior symptoms or overt manifestations of their underlying CAD. As our understanding of the pathophysiology of coronary atherosclerosis improves, diagnostic tests utilizing magnetic resonance (MR) imaging and gated computed tomography are being developed to screen for significant CAD in symptomatic individuals and in those who are preclinical or asymptomatic. Patients with known or suspected CAD might be candidates for MR studies of myocardial perfusion, myocardial contraction under stress, MR coronary arteriography, and plaque characterization. One rationale would be to uncover patients before they have a silent heart attack to institute preventative therapies. Although clinical studies have not definitively demonstrated the efficacy of these modalities, screening sites are proliferating and patients are demanding screening tests for CAD. Radiologists interpreting these tests should understand their underlying rationale, the data referenced to substantiate their use, and their responsibility to inform the patient of the results. This review describes current concepts of the pathophysiology of CAD, the rationale for the various screening tests for CAD that are in use or in development, and the potential value of the results of screening to individual patients. The ethical issues embodied in the performance of screening tests for CAD are placed in the context of the appropriate role of the radiologist as a physician interacting directly with a patient.