New scanners and strategies for the ‘golden age of CCTA’
As coronary CT angiography (CCTA) continues its rapid expansion, scanner vendors are now offering more economical solutions to ensure access to imaging technology beyond premium systems most often only found at flagship hospitals and academic centers. To conquer CCTA’s technical challenges, new technologies and AI are being incorporated into a new scanner to simplify acquisition and consistently improve image quality.
Cardiac CT has seen a rapid rise in adoption since it was included as a Class 1A recommendation in the 2021 ACC/AHA Chest Pain Guidelines.1 Further fueling this is a doubling of hospital outpatient CCTA Medicare reimbursement in 2025 to $357, as well as increased payments for AI coronary plaque and fractional flow reserve CT (FFR-CT) assessments. Private insurance has in some ways already implemented some of these changes, but Medicare is taking a lead here to push the growth in reimbursement.
"We're definitely at a point right now where this is the beginning of a golden age of CCTA, where any CT scanner we offer at GE HealthCare can do high-quality CCTA," says Ty Bode, strategy director for CT at GE Healthcare. He sees many centers adopting a CCTA-first strategy, not just large hospitals and cardiology centers, but across community care, in small rural hospitals and outpatient clinics and imaging centers. This growth has required vendors to rethink their CT scanner strategies and create new solutions that fit the needs of all of these types of end-users.
With a focus on improving workflow and patient outcomes, GE Healthcare is addressing a four-fold need for high image quality, automated post processing and simplifying technologist workflow and what data is sent to the radiologist/cardiologist or physician. GE HealthCare's Unlimited 1-Beat acquisition and reconstruction technology obtain high-quality CCTA and structural heart exams in a single cardiac cycle. It can adapt to any heart rate and scan patients with large body habitus and those who have an arrhythmia or have difficulty holding their breath. Fast scanning streamlines the cardiac CT workflow by eliminating the possible need to administer beta-blockers. One-stop cardiac protocols allow coronary evaluation in exams indicated for structural heart disease, congenital heart diseases and myocardial evaluation. Combined, the features also decrease overall imaging time.
“We've gotten to a point where it's not cost prohibitive or access prohibitive to do CCTA. That's also leading to the proliferation of CCTA.”
Ty Bode, Strategy Director for CT, GE HealthCare
“We’re creating what we call intelligent assets and applications that help streamline and automate the process so technologists can run the scanner exactly the same way they're used to, and the system augments for them,” Bode says. “There are no additional workflow steps required, the system is just more intelligent. Machine learning is automatically selecting protocols based on the use cases of prescriptions from an institution over time. We also can adjust protocols for different patients to optimize image quality and provide personalized medicine."
“We've gotten to a point where it's not cost prohibitive or access prohibitive to do CCTA,” he notes. “That's also leading to the proliferation of CCTA.”
And thus, GE HealthCare is focused on making sure they’re providing the right level of access—especially for acute care solutions like cardiac CT. “It needs to be able to be something we can deploy in multiple settings,” he says. “This is a population health solution. This is something that can really help with how we're more efficient in managing overall patient care in the cardiac workflow. And so, trying to figure out more efficient ways to deliver really high-quality imaging solutions helps to be more efficient and more cost effective in how we're delivering to the community."
To meet this goal, Bode says GE HealthCare plans to address the need for greater access to high-end cardiac CT imaging at smaller hospitals and outpatient centers with the launch of a next-generation CT scanner this week at ACC.25, the annual meeting of the American College of Cardiology.
AI is improving cardiac CCTA and risk assessment
AI is playing a large role in improving CT image quality, reducing radiation dose through better low-dose image reconstruction and automating imaging protocols. AI also can perform automated, deep, complex analysis on images beyond what the human eye can detect to aid the human readers.
GE HealthCare released its deep learning-based image construction technology True Fidelity in 2019. "We can get so much quality off of traditional recon algorithms and traditional hardware,” Bode explains, “but now with AI, we can create more complex models where we can provide better images and clinical outputs than we ever could before. We've done this with deep learning for image construction, for contrast enhancement, and for salvaging extended fields of view.”
GE HealthCare also uses AI it its scanners to help make them more intelligent with algorithms to streamline and automate the process so that any technologist can run the scanner. No matter the staff members level of experience, the system is there to help them by augmenting steps that historically may have been needed resulting in a simplified workflow with no additional steps required. The systems use machine learning to automatically select protocols based on the use cases of prescriptions that it sees at that institution over time. The AI can also adjust protocols for different patients based on their actual body habitus and anatomy, to optimize image quality and provide personalized medicine.
"Certain vendors have brought to market FFR-CT and plaque analysis solutions, which are really changing the marketplace," Bode says.
Partnerships with these key AI vendors also enable seamless integration with the GE scanners. This includes automated, detailed plaque analysis and reporting, and CT-FFR of the entire coronary tree to quickly identify areas of ischemia and culprit lesions to aid risk assessment or help preplan and guide percutaneous coronary interventions (PCI). Bode notes these technologies offer new ways to translate the imaging data into risk quantifications.
Plaque analysis and FFR-CT require high quality imaging
The Achilles heel of AI image assessments for FFR-CT and non-calcified plaque is poor image quality, Bode says. "That will throw off all the model calculations, so things like motion artifacts and image quality all hurt the ability to translate the data effectively. So, we need to have ways for our scanners to adapt to the most challenging cases more effectively.”
This is what GE HealthCare's 1-Beat Cardiac technology has accomplished, and it helps take away some of the failure mechanisms that can exist for post-processing.
"With FFR-CT, if there's discontinuity within the coronary artery, it's hard to tell what the flow pattern might look like,” Bode says. “If we can avoid there ever being that sort of discontinuity, then you can get a better acceptance rate for FFR-CT. That is really where we're trying to use some of these workflow-based AI solutions and the hardware itself to make it easier to provide better outputs to support those AI companies to ensure that post-processing side of things.”
Looking to the future of CCTA
The pace of CCTA adoption has been fast and that growth and momentum is expected to continue for many years to come.
“Certainly, we're seeing growth in the emergency department because of the potential cost effectiveness of doing a CCTA first exam in the ED when chest pain presents there,” Bode explains. “We do expect it to become be a more common test, especially coronary CTA for potential screening in the future.”
GE HealthCare also is closely watching the current clinical trials looking at CCTA plaque AI assessments as a way to direct preventive care years before a patient may become symptomatic.
And while CCTA for emergent chest pain in the ED is not reimbursed, institutions that have piloted chest pain CCTA-first protocols find that it drives better efficiency, triaging to the cath lab and reduces costs and unnecessary imaging. These sites, as Bode says, are reducing their admission rates, which decrease bed utilization and length of stay and making patient encounters much more cost efficient.
He cites a study from Miami Baptist that found an average cost avoidance of $1,321 per patient*, and a lot of that was driven by reducing their inpatient admission rates. The cath lab also was reimbursed for more higher-value PCI procedures rather than for diagnostic angiograms.
“All of these factors are working together to drive the large rise in CCTA volume and we’re starting to see the outcomes improve too,” Bode says. “We're bullish on what this is going to mean for the overall cardiology care path. Reimbursements going up along with this is allowing facilities to accelerate some of their plans and make a better economic case for why they should be implementing this technology.”
1. Gulati, M., et al., 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021.
2, *Based on Average CMS Cost from 2014-2022
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com