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Coronary Artery Disease: HELP
Articles by Jill E. Jacobs
Based on 13 articles published since 2008
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Between 2008 and 2019, Jill E. Jacobs wrote the following 13 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

2 Guideline ACR Appropriateness Criteria 2017

Anonymous3940905 / Akers, Scott R / Panchal, Vandan / Ho, Vincent B / Beache, Garth M / Brown, Richard K J / Ghoshhajra, Brian B / Greenberg, S Bruce / Hsu, Joe Y / Kicska, Gregory A / Min, James K / Stillman, Arthur E / Stojanovska, Jadranka / Abbara, Suhny / Jacobs, Jill E. ·Principal Author, VA Medical Center, Philadelphia, Pennsylvania. Electronic address: akerssco@me.com. · Research Author, Internal Medicine Resident, Henry Ford Allegiance Health, Jackson, Michigan. · Panel Vice-Chair, Uniformed Services University of the Health Sciences, Bethesda, Maryland. · University of Louisville School of Medicine, Louisville, Kentucky. · University Hospital, Ann Arbor, Michigan. · Massachusetts General Hospital, Boston, Massachusetts. · Arkansas Children's Hospital, Little Rock, Arkansas. · Kaiser Permanente, Los Angeles, California. · University of Washington, Seattle, Washington. · Cedars Sinai Medical Center, Los Angeles, California; American College of Cardiology. · Emory University Hospital, Atlanta, Georgia. · University of Michigan Health System, Ann Arbor, Michigan. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. · Panel Chair, New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #28473096.

ABSTRACT: In patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD), imaging has major and diverse roles. First, imaging is valuable in determining and documenting the presence, extent, and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions. Second, imaging findings are important in determining the course of management of patients with suspected chronic myocardial ischemia and better defining those patients best suited for medical therapy, angioplasty/stenting, or surgery. Third, imaging is also necessary to determine the long-term prognosis and likely benefit from various therapeutic options by evaluating ventricular function, diastolic relaxation, and end-systolic volume. Imaging studies are also required to demonstrate other abnormalities, such as congenital/acquired coronary anomalies and severe left ventricular hypertrophy, that can produce angina in the absence of symptomatic coronary obstructive disease due to atherosclerosis. Clinical risk assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk for developing CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

3 Guideline Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. · ·JACC Cardiovasc Imaging · Pubmed #27609151.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

4 Guideline CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology|St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Cardiovasc Comput Tomogr · Pubmed #27318587.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

5 Review ACR Appropriateness Criteria Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. 2015

Hoffmann, Udo / Akers, Scott R / Brown, Richard K J / Cummings, Kristopher W / Cury, Ricardo C / Greenberg, S Bruce / Ho, Vincent B / Hsu, Joe Y / Min, James K / Panchal, Kalpesh K / Stillman, Arthur E / Woodard, Pamela K / Jacobs, Jill E. ·Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: uhoffmann@partners.org. · VA Medical Center, Philadelphia, Pennsylvania. · University Hospital, Ann Arbor, Michigan. · Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. · Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida. · Arkansas Children's Hospital, Little Rock, Arkansas. · Uniformed Services University of the Health Sciences, Bethesda, Maryland. · Diagnostic Imaging, Los Angeles, California. · Cedars Sinai Medical Center, Los Angeles, California, American College of Cardiology. · University of Cincinnati Hospital, Cincinnati, Ohio. · Emory University Hospital, Atlanta, Georgia. · New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #26653833.

ABSTRACT: Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies.

6 Article Coronary artery calcification is common on nongated chest computed tomography imaging. 2017

Balakrishnan, Revathi / Nguyen, Brian / Raad, Roy / Donnino, Robert / Naidich, David P / Jacobs, Jill E / Reynolds, Harmony R. ·Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York. · Department of Radiology, New York University School of Medicine, New York, New York. ·Clin Cardiol · Pubmed #28300293.

ABSTRACT: BACKGROUND: Coronary artery calcification as assessed by computed tomography (CT) is a validated predictor of cardiovascular risk, whether identified on a dedicated cardiac study or on a routine non-gated chest CT. The prevalence of incidentally detected coronary artery calcification on non-gated chest CT imaging and consistency of reporting have not been well characterized. HYPOTHESIS: Coronary calcification is present on chest CT in some patients not taking statin therapy and may be under-reported. METHODS: Non-gated chest CT images dated 1/1/2012 to 1/1/2013 were retrospectively reviewed. Demographics and medical history were obtained from charts. Patients with known history of coronary revascularization and/or pacemaker/defibrillator were excluded. Two independent readers with cardiac CT expertise evaluated images for the presence and anatomical distribution of any coronary calcification, blinded to all clinical information including CT reports. Original clinical CT reports were subsequently reviewed. RESULTS: Coronary calcification was identified in 204/304 (68%) chest CTs. Patients with calcification were older and had more hyperlipidemia, smoking history, and known coronary artery disease. Of patients with calcification, 43% were on aspirin and 62% were on statin medication at the time of CT. Coronary calcification was identified in 69% of reports when present. CONCLUSIONS: A high prevalence of coronary calcification was found in non-gated chest CT scans performed for non-cardiac indications. In one-third, coronary calcification was not mentioned in the clinical report when actually present. In this population of patients with cardiac risk factors, standard reporting of the presence of coronary calcification may provide an opportunity for risk factor modification.

7 Article CAD-RADS™: Coronary Artery Disease - Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology, St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Am Coll Radiol · Pubmed #27318576.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

8 Article ACR appropriateness criteria asymptomatic patient at risk for coronary artery disease. 2014

Earls, James P / Woodard, Pamela K / Abbara, Suhny / Akers, Scott R / Araoz, Philip A / Cummings, Kristopher / Cury, Ricardo C / Dorbala, Sharmila / Hoffmann, Udo / Hsu, Joe Y / Jacobs, Jill E / Min, James K. ·Fairfax Radiological Consultants, Fairfax, Virginia. Electronic address: jpearls@yahoo.com. · Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri. · Massachusetts General Hospital, Boston, Massachusetts. · VA Medical Center, Philadelphia, Pennsylvania. · Mayo Clinic, Rochester, Minnesota. · Baptist Hospital of Miami, Kendall, Florida. · Brigham and Women's Hospital, Boston, Massachusetts, Society of Nuclear Medicine. · Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Kaiser Permanente, Los Angeles, California. · New York University Medical Center, New York, New York. · Cedars Sinai Medical Center, Los Angeles, California, American College of Cardiology. ·J Am Coll Radiol · Pubmed #24316232.

ABSTRACT: Atherosclerotic cardiovascular disease is the leading cause of death for both men and women in the United States. Coronary artery disease has a long asymptomatic latent period and early targeted preventive measures can reduce mortality and morbidity. It is important to accurately classify individuals at elevated risk in order to identify those who might benefit from early intervention. Imaging advances have made it possible to detect subclinical coronary atherosclerosis. Coronary artery calcium score correlates closely with overall atherosclerotic burden and provides useful prognostic information for patient management. Our purpose is to discuss use of diagnostic imaging in asymptomatic patients at elevated risk for future cardiovascular events. The goal for these patients is to further refine targeted preventative efforts based on risk. The following imaging modalities are available for evaluating asymptomatic patients at elevated risk: radiography, fluoroscopy, multidetector CT, ultrasound, MRI, cardiac perfusion scintigraphy, echocardiography, and PET. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

9 Article Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: a feasibility study. 2013

Srichai, Monvadi B / Barreto, Mitya / Lim, Ruth P / Donnino, Robert / Babb, James S / Jacobs, Jill E. ·Department of Medicine, Cardiology Division, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 5PHC, Washington, DC 20007, USA. srichai@alum.mit.edu ·J Cardiovasc Comput Tomogr · Pubmed #23545461.

ABSTRACT: BACKGROUND: Obtaining diagnostic coronary CT angiography with low radiation exposure in patients with irregular heart rhythms such as atrial fibrillation (AF) remains challenging. OBJECTIVE: We evaluated image quality and inter-reader variability with the use of prospective electrocardiographic (ECG)-triggered sequential dual-source acquisition at end systole for coronary artery disease (CAD) evaluation in patients with AF. METHODS: Thirty consecutive patients with AF who underwent prospective ECG-triggered sequential dual-source acquisition were evaluated. Images were reconstructed every 50 milliseconds from 250 to 400 milliseconds after the R wave. Two independent, blinded readers evaluated the coronaries for image quality on a 5-point scale (worst to best) and stenosis on 5-point semiquantitative (none to severe) and binary scales (>50% or <50%). Diagnostic image quality was graded for each reconstruction. RESULTS: Eleven patients (37%) had significant (≥50% stenosis) CAD. Average heart rate was 82 ± 20 beats/min and variability range was 71 ± 22 beats/min. Mean effective radiation dose was 6.5 ± 2.4 mSv. Diagnostic image quality was noted in 97.9% of 304 coronary segments with median image quality of 3.0. The 300-millisecond reconstruction phase provided the highest image quality; 70% of patients showed diagnostic image quality. Combination of all phases (250-400 milliseconds) performed significantly better than single or other phase combinations (P < 0.0005 for all comparisons). Inter-reader variability for stenosis detection was excellent, with 98.4% concordance by using a binary scale (50% stenosis cutoff). CONCLUSIONS: Prospective ECG-triggered sequential dual-source CT acquisition with the use of end-systolic acquisition provides diagnostic image quality with potentially low radiation doses for evaluation of CAD in patients with AF. Use of multiple end-systolic phases over a 150-millisecond window improves diagnostic image quality.

10 Article ACR Appropriateness Criteria(®) acute nonspecific chest pain-low probability of coronary artery disease. 2012

Hoffmann, Udo / Venkatesh, Vikram / White, Richard D / Woodard, Pamela K / Carr, J Jeffrey / Dorbala, Sharmila / Earls, James P / Jacobs, Jill E / Mammen, Leena / Martin, Edward T / Ryan, Thomas / White, Charles S. ·Massachusetts General Hospital, Boston, MA, USA. uhoffmann@partners.org ·J Am Coll Radiol · Pubmed #23025871.

ABSTRACT: This document outlines the usefulness of available diagnostic imaging for patients without known coronary artery disease and at low probability for having coronary artery disease who do not present with classic signs, symptoms, or electrocardiographic abnormalities indicating acute coronary syndrome but rather with nonspecific chest pain leading to a differential diagnosis, including pulmonary, gastrointestinal, or musculoskeletal pathologies. A number of imaging modalities are available to evaluate the broad spectrum of possible pathologies in these patients, such as chest radiography, multidetector CT, MRI, ventilation-perfusion scans, cardiac perfusion scintigraphy, transesophageal and transthoracic echocardiography, PET, spine and rib radiography, barium esophageal and upper gastrointestinal studies, and abdominal ultrasound. It is considered appropriate to start the assessment of these patients with a low-cost, low-risk diagnostic test such as a chest x-ray. Contrast-enhanced gated cardiac and ungated thoracic multidetector CT as well as transthoracic echocardiography are also usually considered as appropriate in the evaluation of these patients as a second step if necessary. A number of rest and stress single-photon emission CT myocardial perfusion imaging, ventilation-perfusion scanning, aortic and chest MR angiographic, and more specific x-ray and abdominal examinations may be appropriate as a third layer of testing, whereas MRI of the heart or coronary arteries and invasive testing such as transesophageal echocardiography or selective coronary angiography are not considered appropriate in these patients. Given the low risk of these patients, it is mandated to minimize radiation exposure as much as possible using advanced and appropriate testing protocols. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

11 Article Low-dose, prospective triggered high-pitch spiral coronary computed tomography angiography: comparison with retrospective spiral technique. 2012

Srichai, Monvadi B / Lim, Ruth P / Donnino, Robert / Mannelli, Lorenzo / Hiralal, Rajesh / Avery, Ryan / Ho, Corey / Babb, James S / Jacobs, Jill E. ·Department of Radiology, New York University, 550 First Avenue, New York, NY 10016, USA. srichai@alum.mit.edu ·Acad Radiol · Pubmed #22366557.

ABSTRACT: RATIONALE AND OBJECTIVES: Cardiac computed tomographic angiography algorithms emphasize radiation reduction while maintaining diagnostic image quality (IQ). The aim of this study was to evaluate IQ and interreader variability using prospective electrocardiographically triggered high-pitch spiral cardiac computed tomographic angiography (FLASH-CT) compared to retrospective electrocardiographic gating (RETRO-CT) for coronary artery disease evaluation in a patient population including overweight and obese individuals. MATERIALS AND METHODS: Seventy patients (24 women; mean age, 60 years) matched for gender, age, body mass index (27.4 ± 5.5 kg/m(2)), and calcium score (184 ± 328) underwent cardiac computed tomographic angiography, 35 with FLASH-CT (Definition Flash) and 35 with RETRO-CT (Somatom Definition). Images were reconstructed using standard protocols and least motion phase for RETRO-CT acquisitions. Two independent, blinded readers evaluated the coronary arteries using an 18-segment model, grading IQ on a 5-point, Likert-type scale and coronary stenosis on a 5-point semiquantitative and binary scale. RESULTS: Effective radiation dose (1.50 vs 17.3 mSv, P < .0001) and mean heart rate (58 vs 62 beats/min, P < .05) were significantly lower for FLASH-CT compared to RETRO-CT. Seven hundred forty segments (> 1.5 mm) were evaluated. There was no significant difference between FLASH-CT and RETRO-CT scans in overall per-segment IQ (3.11 ± 0.75 vs 3.10 ± 0.82, P = .94). FLASH-CT had noninferior IQ relative to RETRO-CT (95% confidence interval, -0.25 to 0.26). There was no significant difference in interreader variability in diagnosis between FLASH-CT and RETRO-CT for all coronary segments (77.5% vs 78.2%, P = .83). CONCLUSIONS: FLASH-CT is an acceptable coronary computed tomographic angiographic method for reducing radiation dose without compromising IQ for a patient population including overweight and obese individuals.

12 Article Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). 2012

Hachamovitch, Rory / Nutter, Benjamin / Hlatky, Mark A / Shaw, Leslee J / Ridner, Michael L / Dorbala, Sharmila / Beanlands, Rob S B / Chow, Benjamin J W / Branscomb, Elizabeth / Chareonthaitawee, Panithaya / Weigold, W Guy / Voros, Szilard / Abbara, Suhny / Yasuda, Tsunehiro / Jacobs, Jill E / Lesser, John / Berman, Daniel S / Thomson, Louise E J / Raman, Subha / Heller, Gary V / Schussheim, Adam / Brunken, Richard / Williams, Kim A / Farkas, Susan / Delbeke, Dominique / Schoepf, Uwe J / Reichek, Nathaniel / Rabinowitz, Stuart / Sigman, Steven R / Patterson, Randall / Corn, Carolyn R / White, Richard / Kazerooni, Ella / Corbett, James / Bokhari, Sabahat / Machac, Josef / Guarneri, Erminia / Borges-Neto, Salvador / Millstine, John W / Caldwell, James / Arrighi, James / Hoffmann, Udo / Budoff, Matthew / Lima, Joao / Johnson, James R / Johnson, Barbara / Gaber, Mariya / Williams, Julie A / Foster, Courtney / Hainer, Jon / Di Carli, Marcelo F / Anonymous4200716. ·Cleveland Clinic Foundation, Cleveland, Ohio, USA. ·J Am Coll Cardiol · Pubmed #22281249.

ABSTRACT: OBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging. BACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear. METHODS: We assessed the 90-day post-test rates of catheterization and medication changes in a prospective registry of 1,703 patients without a documented history of coronary artery disease and an intermediate to high likelihood of coronary artery disease undergoing cardiac single-photon emission computed tomography, positron emission tomography, or 64-slice coronary computed tomography angiography. RESULTS: Baseline medication use was relatively infrequent. At 90 days, 9.6% of patients underwent catheterization. The rates of catheterization and medication changes increased in proportion to test abnormality findings. Among patients with the most severe test result findings, 38% to 61% were not referred to catheterization, 20% to 30% were not receiving aspirin, 35% to 44% were not receiving a beta-blocker, and 20% to 25% were not receiving a lipid-lowering agent at 90 days after the index test. Risk-adjusted analyses revealed that compared with stress single-photon emission computed tomography or positron emission tomography, changes in aspirin and lipid-lowering agent use was greater after computed tomography angiography, as was the 90-day catheterization referral rate in the setting of normal/nonobstructive and mildly abnormal test results. CONCLUSIONS: Overall, noninvasive testing had only a modest impact on clinical management of patients referred for clinical testing. Although post-imaging use of cardiac catheterization and medical therapy increased in proportion to the degree of abnormality findings, the frequency of catheterization and medication change suggests possible undertreatment of higher risk patients. Patients were more likely to undergo cardiac catheterization after computed tomography angiography than after single-photon emission computed tomography or positron emission tomography after normal/nonobstructive and mildly abnormal study findings. (Study of Perfusion and Anatomy's Role in Coronary Artery [CAD] [SPARC]; NCT00321399).

13 Article Dual-source computed tomography angiography image quality in patients with fast heart rates. 2009

Srichai, Monvadi B / Hecht, Elizabeth M / Kim, Danny / Babb, James / Bod, Jessica / Jacobs, Jill E. ·Department of Radiology, New York University School of Medicine, 530 First Avenue HCC-C48, New York, NY 10016, USA. srichai@alum.mit.edu ·J Cardiovasc Comput Tomogr · Pubmed #19643693.

ABSTRACT: BACKGROUND: Dual-source computed tomography (DSCT) provides diagnostic quality images of the coronary arteries over a wide range of heart rates (HRs). Current dose reduction techniques, including electrocardiographic (ECG) dose modulation and prospective triggering, are optimized for use in patients with relatively slow (<70 beats/min) HRs by limiting radiation dose to the ideal phases of image acquisition. OBJECTIVE: We evaluated coronary vessel image quality (IQ) at different reconstruction phases in patients with fast HRs (>80 beats/min) to assess potential feasibility of prospective triggering techniques on DSCT. METHODS: Patients (n=101) underwent 64-slice DSCT with retrospective ECG-gating without beta-blocker premedication. Image reconstructions were performed at 10% R-R wave phase intervals (0%-90%). Patients were grouped by mean HR: group A, <60 beats/min (n=22); group B, 60-80 beats/min (n=57); group C, >80 beats/min (n=22). Coronary artery IQ was assessed by 2 readers in consensus on a 5-point scale. RESULTS: Optimal IQ occurred at 70% phase for all arteries in groups A and B. In group C, optimal IQ occurred at 30% and 40% phases. The 70% phase achieved diagnostic IQ in 97% of group A and 86% of group B. A widened reconstruction window (30%-50%) was necessary for diagnostic IQ in a similar high proportion (84%) of group C. CONCLUSION: Optimal IQ occurs during late-systolic phases for patients with fast HRs (>80 beats/min). Late-systolic phase prospective triggering is potentially feasible in these patients; however, given the widened reconstruction windows required, a higher radiation dose may be required compared with patients with slower HRs (<80 beats/min).