A simple test can transform your heart disease prevention.

After years of planning by the think team, in February 2024, we replaced our original CT Scanner with a brand new model, a Fujifilm Scenaria View. The new scanner comes with upgraded benefits, such as:

Enhanced Workflow Speed: Experience faster and more efficient scans, allowing for quicker diagnosis and treatment planning.
Clear Image Quality: Enjoy unparalleled clarity and detail in your CT images, providing our physicians with the precise information they need for accurate diagnoses.
Lower Dose: Our scanner boasts remarkably low radiation doses, prioritizing patient safety without compromising image quality.
Open Design: With its spacious 80cm gantry aperture, our CT scanner offers a comfortable and accessible imaging experience for patients of all sizes.

It also has advanced clinical modules, extended coverage Shuttle Scanning, Cardiac CT, and Dual Energy examinations, ensuring comprehensive care for our patients’ diverse needs.

We had the opportunity to meet with Dr. Douglas Russell to discuss the new scanner and one of its features, the CT Calcium Score Exams.

Let’s go to the interview. If you would like to watch the interview, click here.

Interviewer:

Thank you, Dr. Russell, for sitting with us today between patient visits. In February, we replaced our original CT Scanner with the new FijiFilm Scenaria View Scanner, which has some upgraded features. Today, we want to highlight one of those features: the Calcium Scoring Exam. Before we get into Cardiac Calcium Scoring, why are you excited about the new CT Scanner and why should patients at think care?

Dr. Doug Russell:

Well, it’s the latest technology, best pictures that you can get from a CT and this new added on technology of calcium coronary screening is quite a feature to have and it’s becoming a standard of care, it’s not quite there yet. We don’t have an accepted United States Preventative Task Force guideline on this topic yet, but it’s coming.It’s to the point now where there’s enough data to support us doing this, that the American Heart Association actually has produced a guideline on coronary CT scanning.

Interviewer:

Lets jump into CT Cardiac Calcium Scoring, what is it?

Dr. Doug Russell:

The Cardiac Calcium Scoring Exam is a non-contrast CT scan that takes about five minutes to do the scan itself. It will take you longer to check in to get the scan performed. So it’s a painless exam to do. It enables us to take a CAT scan picture of your thorax. So we get all the structures within your chest, whether it’s the lungs, the vascular structures, the aorta, the heart, specifically the coronary artery anatomy, and then locations of calcified plaque within your coronaries. This technology has been around for a while but has not been widely available until recently.

The amazing thing about it is that it’s a relatively harmless exam; the information is good, and the findings are significant. I remind patients that when we do this, it is a very proactive decision to make as opposed to being reactive. Proactive means that we will try to identify whether we have a problem and then aggressively address it if we need to. Reactive would be doing chest compression on Uncle Eddie because he had a cardiovascular event at the family picnic. One’s far better than the other and I believe that this is something that we should consider.

Interviewer:

How does a CT calcium scoring exam compare to other methods for assessing heart disease risk?

Dr. Doug Russell:

We do all these screenings, blood pressure screenings and lipid screenings, and we have smoking cessation programs and all these other things that approach cardiovascular risk factors. But with this tool we’ve actually got a screening test we can do now that will stratify you even further and tell you where you sit and whether or not we have concerns. So the amazing thing about it is that it’s a relatively harmless exam to do, the information is good, and the findings are significant.

From a risk stratification standpoint, the American College of Cardiology says that all intermediate individuals that have intermediate risk for cardiovascular disease should be thought about in this screening process and that’s using the American Heart Association cardiovascular screening tool that they have. But that’s an algorithmic screening tool, of which there have been others in the past and it’s effective and it works. But it also has some weaknesses. So for example, the American Heart Association screening tool does not consider family history. So that’s probably something they’ve been criticized a bit for. And it’s significant, especially if you had significant early coronary disease and your family doesn’t seem to matter with the screening tool. But it might matter for you.

Interviewer:

Who are the ideal candidates for a CT calcium scoring exam and are there any age restrictions or health conditions that would make this test unsuitable for someone?

Dr. Doug Russell:

It depends on your family history and your personal history. If I have someone that has 2 or 3 cardiovascular risk factors and they’re curious and want to know, I think those people should be candidates for it. I’ve had extremely healthy patients, but they’re of the age. You have a 55-year-old male, and their lipids have been slightly off, so we offer the exam, do a scan, and might find something of significance. Then, all of a sudden, you have to introduce them to a cardiologist.

For better or worse, I would say about half the scans I do will involve some action. If you have a significant lesion, we need to go meet the cardiologist. Or if your numbers are in the indeterminate middle ground, where you have some coronary artery plaque, and I don’t like the location of this because this is in your left main, I think you probably ought to get on a treadmill. I know you haven’t had a change in your exercise tolerance, but you’ve got some anatomical things that are of significance that we need to look at closer, and you’ve got a score of 100. That’s not terribly high, but that’s not great either. And we’ve been ignoring these lipids that are borderline, but we really need to treat these aggressively now.

Interviewer:

Let’s talk about the exam itself. Can you walk us through the procedure in more detail?

Dr. Doug Russell:

So, the scan itself is pretty benign and the availability is readily available. There’s no difficulty getting someone set up for a scan here. So I’ve had patients that I’ve sent out to schedule and they’re doing one within the week. We tell people not to take stimulants, not to drink coffee, before they come in for the exam, because it’s nice to have a nice resting heart rate when they’re being studied. But the exam itself is quick and easy and painless. You will lie on the table for just a few minutes, and the scanner spins around and makes some noises, and then all of a sudden you’re out of there.

Interviewer:

Some patients might be concerned with low-dose radiation or claustrophobia during the exam. Can you go into more detail including any potential risks or side effects associated with the low-dose radiation used?

Dr. Doug Russell:

So this is not an MRI scanner. It’s an open CT scanner. So you’re going through a ring, not through or into a tube. So claustrophobia is not a problem with this particular study. There is a radiation dose, but it’s a single scan and it’s minimal. So, compare it to a low dose CT scan. So, I think that the risk of any radiation exposure is minimized by the amount of information that you get from the study.

Interviewer:

How does it compare to, like, an X-ray?

Dr. Doug Russell:

It’s more radiation than a simple chest X-ray. I think the radiation equivalents would be 4 to 5 chest X-rays.

Interviewer:

If my calcium score indicates an increased risk of heart disease, what are some initial steps I can take to manage that risk? Are there any food or lifestyle recommendations you can give patients to maintain a healthy heart?

Dr. Doug Russell:

People don’t get this, but high-fiber diets are good for everything. That’s good for your gastrointestinal tract. Fiber binds cholesterol in your gut and is naturally excreted. And so if you had a heaping bowl of shredded wheat every morning, and eat whole grain breads and broccoli and get that right roughage in your diet, it’s going to lower your cholesterol 20 or 30 points easy. If you’re consistent with it.

The other thing we believe is that unsaturated fats, be omega-3s or monounsaturated olive oil, those molecules are different than saturated fatty molecules. Saturated fatty molecules are linear molecules, they stick together and are solid at room temperature. They can make solid hard plaque in your coronaries. But when you have a bend in the molecule because that fat is unsaturated, it takes up more space in three dimensions. They tend to be oils, not solids, at room temperature and body temperature. You can’t make a plaque in your coronarys from fish oil. You can’t make plaque in your coronaries from olive oil or peanut oil. So, almonds, avocados, peanuts, peanut butter, and eat more fish. That stuff is all good for you.

Cook in olive oil; it’s healthy for you. You can dip your bread in olive oil. However, smearing butter on your bread’s a different story, but dipping your bread in olive oil, it’s probably healthy for you.

If we pound omegas in our diet and we get more omegas and unsaturated fats in our diet and just get the fiber content up, that’s about as good as it gets.

Interviewer:

How does this test transform your heart disease prevention?

Dr. Doug Russell:

There’s data on cardiac CT scoring that suggests that it’s more predictive of coronary events than any other test that we have right now. In particular, any other noninvasive test. So stress testing will give you a five-year negative profile and negative predictive value, which is great. So if at four and a half years you’re starting to have some shortness of breath with exertion, we’d wonder, but the predictive length of time for a normal scan is ten years. That’s a good report card for a long time.

If you come back with a normal scan, it’s not a free for all to do whatever you want to do, but you’re highly unlikely to have a cardiac event in the next ten years of your life. So you can rest assured and be reassured that good news and go about your business.

We know that a score over 100 makes you seven times more likely to have a cardiovascular event in the next ten years of your life. And then we know that a score over 300 makes you ten times more likely to have a cardiovascular event in the next ten years of your life. And so these are people that are going to be watched closely, and probably periodically need to be thrown on a treadmill just to get an objective measurement of how well they can do. And possibly down the road doing another scan to see what kind of progress they’ve made.

There are other things involved with this as well. When you’re scanning someone’s chest, you’re not just looking at coronaries in the heart. You get lung fields and you get the vascular structures in the middle of your chest. And sometimes we accidentally fall into something of concern.

For example, I did a scan and I accidentally found a gentleman’s early lung cancer. So I sent him to the thoracic surgeon, the cancer doctors, where he had an early stage non-small cell lung cancer. He’s going to survive his lung cancer because we accidentally found it by doing an early scan. I’ve got a retired physician that I see that I made get a scan. We accidentally found his thoracic aortic aneurysm, and it was significant to the point where he had a surgical repair last year. And this was someone that was going to collapse at the family gathering and be dead. The good news is we did a scan, didn’t expect to find this, but we did. We found a thoracic aortic aneurysm, and now he’s been surgically repaired and he’s going to see his grandkids and have more birthday parties and graduations to go to.

Interviewer:

I mean for $99 straight out of pocket. It’s not bad.

Dr. Doug Russell:

It’s a bargain screening test. You can’t get anything for 99 bucks these days. So to have a meaningful screening test done, that is screening for the number one cause of death in men and women in this country, for 99 bucks to either give you a clean bill of health or we need interventions to prevent this from getting worse with time. It’s huge.

Interviewer:

As a final thought, can you talk about the importance of early detection in heart disease? How can a CT calcium scoring exam help individuals to take control of their heart health? How does that fit into a whole-person wellness plan?

Dr. Doug Russell:

People don’t talk about this enough but in the body everything is connected. We talk about coronary disease, but coronary disease is vascular disease in one location in the body. But if we find it there, you’ve got it in your chest, your arms, your head, and other parts of your body. And some of those locations can be associated with other diseases like dementia. Raise your hand if you’d like to have dementia later in life..? Probably not. If we identify something that results in an aggressive intervention now and this is how we’re going to deal with it going forward, you have a better chance for a better long-term outcome. You could live independently longer, you could live a full 90 years or more. This is a big hitter. Number one cause of death of Americans. We should screen for it.

Let’s Recap…

What is CT Cardiac Calcium Scoring?

CT cardiac calcium scoring is one of the most advanced, non-invasive, methods available today to detect heart disease in its earliest stages. The procedure identifies the calcified plaque present in your coronary arteries. While other types of plaque exist, calcium deposits are a strong indicator of potential future problems and only calcified plaque is detected during this test. CT cardiac calcium scoring will provide two essential pieces of information:

The presence or absence of coronary calcium in your coronary arteries.
The degree of the coronary calcium in your coronary arteries.

While other types of plaque exist, calcium deposits are a strong indicator of potential future problems.

Who should get a Cardiac Calcium (CAC) Scoring?

A cardiac calcium scoring test can be beneficial for several groups of people. Adults aged 45 and over should consider getting the exam, especially if they have a family history of cardiovascular disease (CVD). However, discussing your risk factors with your doctor is important. They can assess your situation and determine if a CAC scan is right for you.

Why is a Cardiac Calcium Score Important?

Heart disease is often a silent killer, with symptoms sometimes appearing only when the condition is already advanced. Here’s why a cardiac calcium score can be beneficial:

Early Detection: Calcification in the arteries is one of the earliest signs of heart disease. This test can identify potential issues before symptoms arise, allowing for early intervention.
Risk Stratification: The calcium score helps determine your individual risk of a heart attack. A higher score indicates a greater likelihood of future problems.
Personalized Treatment: Knowing your risk allows your doctor to create a personalized treatment plan to manage your heart health, potentially including lifestyle changes or medications.

How should I prepare before the Exam?

The good news is that there’s minimal preparation needed for a cardiac calcium scoring exam! Here’s what you can expect:

Do not consume caffeine, nicotine, stimulants, or any medicine that acts as a stimulant four hours before the exam.
Refrain from using lotion or oils on your chest area.

What Should You Expect during the Exam?

Here’s what you can expect during the test:

You’ll lie comfortably on your back on a CT scan table for about ten minutes.
Electrocardiogram (ECG) patches will be placed on your chest. These patches monitor your heartbeat and ensure the scan captures clear images by synchronizing with your heart rhythm.
The actual scan is painless and uses only a small amount of radiation.

Your Test Results?

Your CT cardiac calcium scoring exam results hold valuable information about your future heart health. A low score can provide reassurance, indicating a low risk of heart disease in the coming years. However, if your score suggests an increased risk, it’s an opportunity for early intervention.Your think provider will work with you to create a personalized plan to manage your heart health. This plan could involve lifestyle modifications, for example, changes to your diet, exercise routine, or stress management. Medication might be recommended in some cases to lower cholesterol, blood pressure, or address other conditions that contribute to heart disease risk. Remember, your think provider is your partner in heart health. They’ll be able to explain your specific score in detail, answer any questions, and recommend the most appropriate treatment plan customized to your needs.

READY FOR YOUR CT CALCIUM SCORING EXAM? CONSIDER THINK YOUR GO-TO FOR BETTER HEART HEALTH.

Think Whole Person Healthcare is committed to maintaining your overall well-being through comprehensive preventative care and specialized treatments. To determine if a CT Calcium Scoring Exam is right for you, schedule an appointment with your think provider.

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Our dedicated team is here to support your health. To schedule an appointment, call us at 402.506.9049.