UIC's EBT CAC program is nationally recognized for it's extensive experience in performing coronary calcium exams. Since 1985, UIC's EBT systems have performed in excess of 60,000 exams. Since 1999, UIC's EBT laboratory is registered as a research and training center. The laboratory conducts coronary calcium screenings in addition to other functional cardiac and pulmonary imaging studies.

EBT coronary calcium screening is used to detect early, subclinical cardiovascular disease. It utilizes special electron beam computed tomographic techniques to visualize the coronary arteries. The examination is noninvasive, and the entire study takes less than fifteen minutes. The early detection of subclinical cardiovascular disease identifies individuals who will benefit from aggressive cardiovascular risk factor modification. Recommended patients to be evaluated include men and women over forty years of age with at least one traditional cardiovascular risk factor.

By promoting prevention, Electron Beam Computed Tomography gives UIC cardiologists the advantage of early detection of heart desease.

Introduction to heart disease

Heart disease is the leading cause of death among both American men and women. In fact, more Americans die from heart disease than from all other diseases combined! The Coronary Artery Scan for Calcification is the only noninvasive test capable of detecting the heart disease process before symptoms occur or before cardiac function is impaired.

Here are some other important facts about heart disease:

• Nearly one million Americans die each year from heart disease, and another 1.5 million are disabled.
• Every 33 seconds, someone in the United States dies of cardiovascular disease.
• For approximately 150,000 Americans each year, the first sign of heart disease is SUDDEN DEATH! No symptoms, no warning signs, no way to know their lives were in danger!
• Heart disease is very treatable disease at virtually every stage. However, before the proper treatment plan can be customized for you, the state of your coronary arteries must be known. This is the only non-invasive procedure which can provide you with this information.

  Nature of the test

  Coronary Artery Scanning for Calcification (CASC) is a procedure designed to take a rapid series of x-ray pictures of the heart to detect and measure coronary calcium, which is the marker for atherosclerosis (the accumulation of plaque within the blood vessels which bring blood and oxygen to the heart muscle). Untill recently, imaging of the heart and coronary arteries in a non-invasive fashion was impossible. The heart's constant motion/beating was too fast for conventional CT (computed axial tomography) and MRI the (magnetic resonance imaging) scanners. Attempts to image coronaries using conventional CT and MRI would result in blurred, and therefore, unusable images.

  The development by Imatron, Inc. of South San Francisco, California (NASDAQ symbol: IMAT) of the EBT (Electron Beam Tomography) scanner, which acquires images in 1/10 of a second as compared to 1-2 seconds for other imaging technologies makes it possible to "freeze" the motion of the heart and obtain crisp, clear images.

  The procedure is totally non-invasive - no needles, no dyes, no injections. You simply lie on a table under the arch shaped scanner (your head is totally in the open, so there's no feeling of claustrophobia), hold your breath, and a series of pictures of your heart is taken. For the patient, it's as simple and painless as having x-rays taken. The entire process takes only a few minutes.

  When developed The first EBT scanner, formerly known as the Ultrafast CT, was built in the early 1980's by a team of physicists at UC San Francisco. Cardiac applications for the scanner were developed in the mid-1980's but it was only in the early 1990's, after years of rigorous testing at major medical centers around the world and the publication of papers in major medical journals, that medical institutions began offering Coronary Artery Calcification Scans to the general public. Accuracy of the test Numerous papers have been published in major medical journals attesting to the accuracy of Coronary Artery Scanning. Perhaps the most widely quoted statistic is the approximate 95% reliability of this procedure in ruling out obstructive coronary artery disease. This means that a negative scan (no coronary calcium) indicates with 95% reliability that the patient does not have a significant coronary artery obstruction. It should be noted that the older the patient, the higher the degree of reliability of a negative scan. With respect to positive scans (those finding coronary calcium), it has been demonstrated in numerous studies that (1) the amount of calcium correlates very highly with the overall volume of plaque and (2) the overall plaque volume correlates very highly with event risk (heart attacks, bypass surgeries, angioplasties). In other words, the higher the calcium score, the greater the risk of an event. One of the leading researchers in this field, Alan D. Guerci, M.D., Executive Vice President and Director of Research at St. Francis Hospital (Roslyn, N.Y.), was quoted as follows in The Wall Street Journal on September 27, 1996: "Our data indicate that the electron beam CT-derived coronary artery calcium score predicts fatal and nonfatal heart attacks, as well as the need for coronary bypass surgery and coronary (balloon) angioplasty, with unprecedented accuracy." Safety of the test During the course of a Coronary Artery Scan, the patient is exposed to radiation approximately equal to that received in an abdominal x-ray. Robert G. Gould, Professor in the Department of Radiology at the University of California San Francisco has concluded: "In summary, an Ultrafast CT scan for detection of coronary artery calcium is a safe procedure. It exposes a limited portion of the body to a small amount of radiation. No hazardous effect of x-rays has ever been demonstrated at the dose levels that result from this procedure." For whom is this test appropriate According to the American Heart Association, advancing age brings increased risk of heart attack. This becomes significant in men over the age of 35 and women over the age of 40. Regardless of age, you may also be at increased risk if you have any of the following American Heart Association designated risk factors: High cholesterol High blood pressure Diabetes Family history of heart disease History of smoking Interestingly, and very importantly, approximately 30% of all heart disease cannot be explained by conventional risk factor analysis. This has led many physicians to recommend Coronary Artery Scans for patients who do not have any of the risk factors noted above. Their reasoning is that the Coronary Artery Scan is the only noninvasive procedure which will identify such individuals as being at increased risk for a coronary event. Comparison to other tests There are numerous tests in addition to a Coronary Artery Scan which a physician can use to asses the condition of a patient's heart: an EKG, a stress test (in all its different varieties - regular treadmill, thallium, echocardiography), a PET scan and Angiography. When there are so many different ways to examine the heart, it's natural to wonder which is best. The relevant question however, is which is the best test for the specific patient at the specific time. The Coronary Artery Scan is a screening test for the early detection of heart disease. It's capable of detecting the heart disease years before any of the above mentioned tests. Typically, once it's established by a Coronary Artery Scan that an asymptomatic (no symptoms) individual is building plaque at a greater than expected rate, it would be appropriate to perform some form of exercise testing to study cardiac function. If a significant functional abnormality is revealed, then the patient will often proceed to angiography. Payment At the time of scheduling you will be asked for a major credit card to reserve your appointment. On the day of your test, you may either sign an authorization for us to charge your card or you may pay by check. Insurance reimbursement Many insurance carriers will reimburse for this scan. Together with your test results, you will receive a superbill to submit to your insurance carrier, so you may obtain any reimbursement which is available under the provisions of your specific policy. Neither Heart Check America, Inc. nor the University of Illinois at Chicago accepts insurance assignments and neither makes any representation regarding the availability of insurance reimbursement for any particular claim. To Schedule an Appointment for Coronary Artery Screening Call: 1-800-NEW TEST (Heart Check America)   Body Scan Purpose: To combine the coronary artery scan and the lung scans with a scan of the abdomen (kidneys, liver, pancreas, gall bladder, abdominal aorta, adrenal glands, lymph nodes, and spleen). For whom appropriate: The same individuals for whom coronary artery scans and lung scans are appropriate. Significance: Cardiovascular disease and cancer are by far the two largest causes of death in the United States, accounting for almost 3 out of every 4 deaths. The body scan, performed in just a matter of minutes, screens for the presence of both heart disease and many types of cancer, as well as abdominal aortic aneurysm. The earlier heart disease is detected, the greater the likelihood it can be slowed, stopped or even reversed. The earlier a cancer is detected, the greater the likelihood it can be successfully treated (radiation, chemotherapy, surgery) before it has spread to other organs. Five percent of men over the age of 60 develop abdominal aortic aneurysms, most of which do not result in symptoms. Rupture of an Abdominal aortic aneurysm is a catastrophe, a highly lethal event typically resulting in immediate death.   Advanced Image Analysis Workstations, with 3-Dimensional Reconstruction Software, provide the latest refinements in Image Analysis capability for EBT Scans. "EBT is an effective tool for detection of solid renal tumors in healthy outpatient population (positive predictive value = 96%)." Mitchell TL, et al Incidental Detection of Preclinical Renal Tumors with Electron Beam Computed Tomography Journal of Computer Assisted Tomography November -December 2000 To Schedule an Appointment for Body Scan Call: 1-800-NEW TEST (Heart Check America)   ("QCT") Bone Density Scan Purpose: To detect osteoporosis (a silent disease characterized by low bone mass and structural deterioration of bone tissue) before a fracture occurs, and to monitor changes in bone density in response to treatment. For whom appropriate: 1. Postmenopausal women 2. Premenopausal women, perimenopausal women, and men with any of the following risk factors: Thin or small frame Family history of osteoporosis Diet low in calcium Cigarette smoking Excessive use of alcohol Inactive lifestyle Use of corticosteroids or thyroid medication Low testosterone levels in men             QCT isolates metabolically-active trabecular bone for greater anatomic accuracy than other methods Significance: Osteoporosis is responsible for 1.5 million fractures annually in the United States. The majority of such fractures are of the hip, spine and wrist. One in two women and one in eight men over age 50 will have an osteoporosis Related fracture in their lifetime. Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. In the U.S. today, 18 million individuals have low bone mass, placing them at increased risk for osteoporosis. Once bone loss is detected, numerous therapies (diet, dietary supplements, weight-bearing exercise, and medication) can be prescribed to slow or halt the progression of the process, and possibly even increase bone density. A series of axial scans are taken with the patient laying on a calibration phantom To Schedule an Appointment for Bone Density Scan Call: 1-800-NEW TEST (Heart Check America)   Lung Cancer Screening        Lung cancer is the leading cause of cancer deaths in the United States and smoking is associated with 87% of all lung cancer cases. Who Should Be Screened For Lung Cancer? Persons at the highest risk of lung cancer are those who have smoked cigarettes in their lifetime. At the present time there is not enough research to suggest exactly an age when a smoker or ex-smoker should be tested. However, existing data suggests that lung cancer is more prevalent among former smokers over 50 years of age. People exposed to second hand smoke are also at risk. Exposure to certain chemicals (such as asbestos) or metals due to one's occupation also increase the risk of lung caner. Who Should Not Have Lung Cancer Screening? Any person at low risk, non-smokers, low exposure to second hand smoke and no exposure to occupational hazards. Person who have already been diagnosed with known lung diseases. What Happens If a Finding Is Suspected To Be Cancerous? If there is sufficient suspicion that the lesion is a cancer, a biopsy can be performed without invasive surgery. This is a commonly performed outpatient procedure done using EBT scan while the patient is under local anesthesia. The biopsy is sent to pathologists who examine it for possible cancer. If needed, treatment is available. Early Detection of Lung Cancer is of Vital Importance to All People Who Smoked Cigarettes Heavily Over Long Period of Time Or to ALL People Exposed to Toxic Substances in the Workplace. When it is Found Early, Lung Cancer Can Be Successfully Treated. Who pays for the Test? At the time of scheduling you will be asked for a major credit card to reserve your appointment. On the day of your test, you may either sign an authorization for us to charge your card or you may pay by check. Medicare and Medicaid do not pay for this screening test. You should contact your insurance provider to find out whether they pay. The UIC Medical Center accepts private payment. What is Lung Cancer Screening? Lung Cancer Screening is a non-invasive test to detect lung cancer in its earliest, most treatable stage. The screening consists of an EBT scan, which is quick and painless, and a review by Medical doctors who are board certified radiologists. What are EBT Scans? EBT stands for Electron Beam Tomography, a high tech innovation which makes possible a three dimension image of the inside of the human body. A machine takes a succession of X-rays which are of low intensity and harmless. While the patient table moves through the scanner, the EBT machine is taking pictures from different points. It makes a humming noise. A typical test takes 5 minutes. A computer program saves the images and reconstructs them into a cross-section of the inside of the lungs. The final images are interpreted and explained by a medical doctor, a board certified radiologist who is specially trained. Why Is A Test Like Lung Cancer Screening Needed? Lung cancer is a major medical problem in the United States. Every year, close to 350,000 Americans die of lung disease. It is a costly disease. Many people started smoking before the connection between cigarette smoking and lung cancer was fully understood. Why Test For Lung Cancer When the Person Has No Symptoms? By the time a person shows symptoms (cough, weight loss, bleeding) the cancer has already advanced and the outcome for treatment is poor. A person whose lung cancer is found early and promptly treated has a good chance for survival. The value of early detection is proven by the increased cure and survival rates of other cancers for which screening tests are available. Tests for breast, prostate and colon cancer are widely used and have saved many lives. Why Has There Been No Effective Screening Test For Lung Cancer Before? Several types of tests have been tried but proved ineffective. Standard chest X-rays detect only some early cancers. The EBT scan is a recently invented tool. Early scans were too expensive to use for screening. Even after the price of scans went down, it took time for researchers to conduct comparison studies. Recently published studies (of persons not showing symptoms, but at high risk due to their smoking history) conclude that the low-dose CT scan is more accurate and sensitive than standard chest X-ray. It detects smaller lesions and nodules. The studies conclude that early detection is effective and saves lives. To Schedule an Appointment for Lung Cancer Screening Call: 1-800-NEW TEST (Heart Check America)   EBT Coronary Angiography Electron Beam Angiography Since the recent advent of helical and spiral CT scanners, physicians have had the ability to perform non-invasive angiograms throughout the body, except for region of the heart. This procedure is commonly referred to as Computed Tomography Angiography, or CTA. Imatron's EBT (Electron Beam Tomography) scanner's 100 millisecond acquisition speed is ideal for stop-action images of the heart. Imatron's promotion of EBA (Electron Beam Angiography) as an intended use of EBT, has just been cleared by the FDA (November 1999)to be marketed for minimally invasive angiograms, specifically including the coronary arteries. FDA clearance represents a breakthrough in patient care in that over 20% of more than 1,000,000 cardiac catheterization procedures performed in this country every year proves to be normal. A cardiac catheterization procedure "has a well-established mortality (0.15%) and morbidity (1.5%), and requires at least a short hospital stay" according to Dr. Matthew Budoff, cardiologist at Harbor-UCLA and Saint John's Cardiovascular Research Center in Torrance, California. Catheterization is not only invasive, requiring that 2-3 catheters be fed into the femoral artery through the groin and threaded up through the aorta into the heart, but also expensive. The cost varies from $3000 to $6000, depending upon the institution and length of hospital stay. The cost of coronary EBA varies from $1800 to $2000, roughly the same price as a CT scan of the chest with contrast injection. Coronary Artery EBA was first described by the Erlangen Group (Moshage, Achenbach et al) in an article published in Radiology in September 1995. (For a complete bibliography, please contact Imatron at (650) 583-9964 extension 337.) Since then, approximately 25 papers have been published and Coronary EBA has been compared with Coronary Angiography on more than 300 patients. According to Dr. Stephan Achenbach "Sensitivities from 73%-92% and specificities from 79%-95% were found in these investigations." Recent improvements in ECG triggering, memory capacity and post processing techniques have greatly improved the accuracy of evaluating these studies. The Acquisition Process Electron Beam Angiography is a very fast, simple and painless procedure and is as easy as performing a CT scan of the chest with and without an injection of contrast material. In EBA, however, the scans are precisely triggered by the patient's heartbeat. All scans are acquired during a single breath-hold. The patient is on the table only 20 to 30 minutes, or as long as it takes to start an IV, position the patient, and acquire the images. Patient prep before exam The patient's cooperation is vital to ensure the most successful study. Before performing any type of contrast study on a patient, the BUN and creatinine should be checked within the week preceding the test. The BUN should be less than 18 and Creatinine less than 1.5. No solid food should be eaten 4 hours before the study is performed, and patients should drink plenty of clear liquids so that they are well hydrated. Patient prep during exam - ECG Position patients supine, head first on the patient table. After scrubbing the patient's skin with alcohol and a gauze sponge to insure the best possible ECG signal, attach electrodes to the patient's chest. Patient prep - Contrast Injection Patients should have no known allergies to iodinated contrast material. Positioning an 18-gauge catheter in either the right or the left antecubital vein will give the most direct route to the heart. Inject 120 to 160 ml of a non-ionic contrast agent (30-35% iodine) at a rate of 4 ml/second. Post Processing of Image Data This past decade, workstation companies have been working frantically to provide physicians with tools to interpret contrast cross-sectional images easier, faster and more accurately. State-of-the-art workstations are now inexpensive, running on PC platforms with Microsoft Windows 2000 software. After image acquisition, the image data is transferred to the workstation. The image-analysis software is used to perform 3-dimensional reconstruction of the heart and heart vessels. A board-certified cardiologist reviews the reconstructed scan to detect any narrowings in the coronary arteries, which may cause oxygen depletion of the heart muscle. Clinical uses of EBA: Cardiac and Non-Cardiac To detect high-grade stenosis and occlusions of the coronary arteries. Monitoring revascularization procedures including angioplasty, stent placement, and coronary artery bypass grafts. Evaluation of congenital heart defects, including aberrant origin of coronary arteries and anomalous pulmonary veins. Evaluation and detection of pulmonary embolism. Renal artery stenosis. Diseases of the ascending and descending aorta, including coarctations, aneurysms and dissections.       Future Clinical Applications of EBA Future development of even newer and more advanced imaging techniques based on EBT scans may yield more exciting diagnostic value to the already robust clinical applications of EBA. These may include: the ability to detect and track soft plaques; "fly-through" visualization of the coronary arteries and other organs such as the colon; and quantifying low-grade luminal stenosis in the coronary arteries. The most exciting goal is not only to see coronary artery plaques, but to characterize them as stable vs. non-stable plaques, enabling physicians to identify patients most at risk for a coronary event. All the EBT Angiography Studies Require a Physician's Referral ! To Schedule an Appointment for EBT Coronary Angiography Call: 1-800-NEW TEST (Heart Check America)