Eric Williamson, MD, MSCCT, the 2021-2022 president of the Society of Cardiovascular Computed Tomography (SCCT) and professor of radiology at Mayo Clinic, shares his key takeaways from the SCCT 2022 conference. His top 6 take aways include:
• The biggest trend was a large amount of discussion on new technology to perform detailed evaluations of soft coronary plaques. These make up the bulk of atherosclerosis lesions and are the source of vulnerable and ruptured plaques that cause heart attacks, but they are difficult to accurately quantity in a report beyond the exam reader's overall impression of plaque burden. However, new artificial intelligence (AI) algorithms showed in sessions and on the show floor, including a couple that now have FDA clearance, can automate the tedious process of quantifying these soft plaques in a reproducible way and reporting the data in detailed reports. This will enable settings a patient baseline and performing serial exams over time to accurately assess plaque progress, or regression due to drug therapies. The majority of thought leaders at the conference identified this trend as a possible vehicle and paradigm sift in how patients are screened and treated preventively.
• The new ACC/AHA 2021 Chest Pain Evaluation Guidelines now gives cardiac CT angiography (CCTA) a class 1A recommendation as a frontline imaging modality. This has spurred a lot of interest in CCTA and was the subject of numerous sessions at this years meeting.
• A new CAD-RADS 2.0 reporting criteria for cardiac CT exams was released, updating the original 2016 document. This includes more information about the coronary plaque, which is now seen as a key piece of information needed for assessing patients and monitoring them over time.
• This first in-person meeting in two years beat all other previous in-person meeting attendance, showing a growing interest in CTA.
• SCCT had the most technologists it has ever had for its technologists track at the 2022 meeting. Due to rising interest and realizing many technologists may not be able to attend the meetings, SCCT is developing online training resources.
• With the increasing interest in cardiac CT the society is also launching the SCCT Starter Kit website to help clinics and hospitals with resources to start a cardiac CTA program.
"Soft plaque evaluation is something we have been talking about for nearly two decades, but the limitation always have been how to overcome the large amount of post-processing times," Williamson explained. "Previously it was very time and labor intensive. But, with the advent of AI and machine learning, this process can be automated."
He said these recent advances led to several sessions at this year's meeting on the importance and evaluation of soft plaque and new technologies to automate the process.
"We have developed a lot of new technologies that are driving down radiation dose levels, and are getting to the point where we could certainly do a coronary CT angiography, maybe not quite at mammogram doses, but close," Williamson said. "When you think about the success of our cancer screening programs, as we start to think about our risk and benefits, coronary athrosclerosis disease kills a lot more people than these other diseases."
The ACC/AHA chest pain evaluation guidelines, released in the fall of 2021, gave cardiac CT the highest 1A recommendation as a front-line imaging modality to evaluate patients presenting with chest pain. While some hospitals were already using CT in emergency departments (ED) for triage, a large number of new centers are now looking too begin more comprehensive cardiac CT angiography (CTA) programs since the recommendations were announced. This trend appeared evident at SCCT with more active discussions on the expo floor and mention of the guidelines in nearly every session at the meeting.
Williamson is also associate chair for radiology informatics at Mayo Clinic Rochester and supervises the radiology artificial intelligence program at Mayo. He is the former division chair of cardiovascular radiology and medical director of CT operations at Mayo Clinic. He also serves as co-director of Mayo Clinic's structural heart disease imaging lab.
Related SCCT and Cardiac CT Content:
VIDEO: The new role of cardiac CT under the 2021 chest pain evaluation guidelines — Interview with Eric Williamson, MD
VIDEO: Cardiac CT now recommended as a front-line chest pain assessment tool — Interview with Leslee Shaw, PhD
VIDEO: Office-based cardiac CT and FFR-CT offer a new business model
VIDEO: The new role of cardiac CT in chest pain evaluation — Interview with Brian Ghoshhajra, MD
PHOTO GALLERY: Duly Health adopts outpatient cardiac CT as a standard of care
VIDEO: Use of CT to assess coronary plaques — Interview with Leslee Shaw, PhD
Expert panel recommends coronary CTA as first choice when evaluating for stable CAD
New CAD-RADS 2.0 reporting for coronary CTA offers patient management recommendations
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