GE Healthcare’s Revolution CT Can Change the Cardiac Care Pathway

Revolution CT produces high quality images using lower doses of radiation for cardiac exams even with clinically-challenging patients, contributing to more confident diagnoses at lower patient doses.

The new technology means that the heart can be imaged in one beat, whatever the heart rate, while helping to reduce dose by up to 82% when the new reconstruction algorithm ASiR-V is applied. One acquisition is required, eliminating any issue with mismatched images. The Revolution CT provides complete confidence in image assessment.

Dr. Jean-Louis Sablayrolles, cardiovascular radiologist, from Centre Cardiologique du Nord (Saint Denis, France), led the clinical work related to Revolution CT. Together with GE Healthcare (Chalfont St. Giles, Buckinghamshire, UK) Dr. Sablayrolles and his institution have been conducting research to improve cardiac CT imaging since 2000. Development of the new Revolution CT system began in 2005, culminating in the launch of the Revolution CT scanner at this year’s European Congress of Radiology (ECR).

Dr. Sablayrolles’ extensive clinical experience has been key to the development of the Revolution CT scanner, which has the potential to change the care pathway for cardiac diagnostic imaging. “Because of the wider detector, the fast rotation as well as its ability to produce high quality images using lower doses of radiation even in clinically challenging patients, this is the only scanner of its kind and it looks set to change the cardiac care pathway,” he said.

Dose reduction is a key feature of the new system, and can be achieved without impairing image quality. “Dose reduction is so important for young patients and children, as well as for screening,” reinforced Dr. Sablayrolles in an interview with MII.

The Revolution CT is also able to deliver excellent clarity of cardiac images. “With other forms of imaging, 10%–20% of examinations are unreliable due to unclear images, in fact with a 64-slice detector, 16% of coronary segments are not assessable due to artefacts. With Revolution this figure drops to 1.5% non-assessable,” Dr. Sablayrolles explained. “Now, the remarkable improvement in image quality seen with the Revolution CT, gives us much greater clarity during analysis of the coronary artery. This is true for any patient with any heart rate.”

This is a welcome advance over invasive cardiac imaging (coronary angiography) and Coronary Computed Tomography Angiography (CCTA) on previous generation equipment for assessing Coronary Artery Disease (CAD). Before Revolution CT, with CCTA, patients with arrhythmia were difficult to diagnose because their high heart rates often introduce motion artefacts, making it is difficult to find an appropriate phase of the cardiac cycle suitable for the analysis of all coronary segments.

“The advantages in terms of diagnostic accuracy and clarity of image means we can modify the cardiac care pathway,” Dr. Sablayrolles added. “Effectively, the maturity of this new technology with respect to clinical outcomes means that cardiac CT can become the first line exam for the evaluation of CAD.”

Patients receive a lower dose, faster assessment, greater patient comfort, and there are economic savings for the hospital because it can be performed as an outpatient procedure.

Dr. Sablayrolles also pointed out that with Revolution CT, it was possible to assess functional activity as well as an anatomy of the heart. Other technology exists to perform this function but the patient is required to undergo several examinations. With the Revolution CT only one cardiac acquisition is required, which is faster and as such is preferable for the patient and more economical for the healthcare provider.

Illustrating the benefit of combining the functional and anatomical imaging capabilities in one CT system, Dr. Sablayrolles provided an example of how the new system is more reliable.

“If, for example, a patient has an intermediate stenosis, say 50%–70%, it is necessary to know whether this stenosis will cause a defect of myocardium perfusion. If this is not the case then medical treatment can commence, however if the stenosis is likely to cause myocardium defect perfusion then surgery or angioplasty are required.”

A small study of three patients further reinforced his point. All the patients had typical angina and were examined by a stress test, as per the guidelines, and the finding was negative. “Using Revolution CT, we found a severe stenosis upstream of the by-pass that required angioplasty for the patient, otherwise the vessel would have occluded and a severe infarction occurred,” remarked Dr. Sablayrolles. “The usual stress test provides too many false positives and negatives.”

Another study at the Centre Cardiologique du Nord scanned 58 patients with high heart rates (>65 bpm) to compare the image quality and radiation dose of the Revolution CT 512-slice scanner with the previous generation 128-slice technology (Discovery CT750 HD). The findings showed that the Revolution CT images ranked higher on a five-point Likert scale. The Revolution CT also successfully imaged a very high percentage of assessable coronary segments, even though this group of challenging patients had a mean heart rate 75.7 ± 9.9 bpm.

Also speaking to MII at the ECR, Valerie Brissart, Europe Marketing Director Molecular Imaging and CT at GE Healthcare said, “GE Healthcare developed the Revolution CT to help radiologists overcome many of their day-to-day challenges and to help them deliver high quality care to their patients,” she said, adding that, ”the combination of lower dose with robust and accurate imaging, even for clinically challenging exams, offers great possibilities for CT to become a more widely-used noninvasive diagnostic tool in cardiac care.”

The Centre Cardiologique du Nord was the first hospital in Europe to begin using the new system. Since installation in August 2014, the hospital has scanned more than 1000 cardiac patients and more than 4000 patients in total. The Revolution CT is fully approved in the European market with over 15 installations to date. A total of 50 installations globally are expected by the end of first quarter this year.

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