Unlocking New Cardiac CT Potential with Aquilion ONE / PRISM Edition
North Shore Radiology and Nuclear Medicine (NSRNM) is a private radiology provider in Sydney. With a strong dedication to exceptional service and personalised care, NSRNM invested in an Aquilion ONE / PRISM Edition CT scanner for their North Shore Health Hub practice in 2022.
We spoke with Dr Rebecca Kozor and Dr Timothy Shore about the impact the system and it’s AI-driven features has had on their cardiac CT service.
We spoke with Dr Rebecca Kozor and Dr Timothy Shore about the impact the system and it’s AI-driven features has had on their cardiac CT service.
Dr Rebecca Kozor is a clinical cardiologist and non-invasive imaging specialist, with expertise in cardiovascular magnetic resonance (CMR), cardiac CT, and echocardiography. She is co-director of the Advanced Cardiovascular Imaging Group across the North Shore Hospital campus, and Director of the Rapid Access Chest Pain Clinic at Royal North Shore Hospital.
Dr Rebecca Kozor
Dr Tim Shore works as a staff specialist diagnostic and interventional radiologist and Royal North Shore Hospital and joined North Shore Radiology in 2019. His areas of expertise include chest and vascular imaging, and interventional procedures including vascular, hepatobiliary procedures, percutaneous biopsies and spinal, nerve and musculoskeletal injections. Tim is CTCA accredited and maintains a strong interest in neuroradiology and body imaging.
Dr Timothy Shore
NSRNM offers a comprehensive outpatient cardiac imaging service and provides inpatient services for North Shore public hospital. This includes scanning for patients who require pre-aortic valve replacement or aortic arch repairs, as well as an acute diagnostic service for patients from the hospital’s acute chest pain clinic, managed by Dr. Kozor.
Dr. Shore estimates that 20-25% of patients scanned at NSRNM have had previous coronary interventions, such as stenting or coronary artery bypass grafting (CABG).
He explained that prior to using the Aquilion ONE / PRISM Edition, it was challenging to visualise artery architecture and stent patency in patients who had undergone coronary intervention.
“In the past, it was difficult to accurately visualise vessels in patients with coronary devices. We often had to mention the presence of excessive artifact, which made it difficult to make an accurate diagnosis. Without a cardiac CT diagnosis, these patients would often require follow-up examinations, such as catheterisation, for further evaluation.”
“With Canon’s PIQE technology, the visualization of arteries on the curved planar reformats is impressive. Previously, I didn’t have the same level of confidence due to motion artifacts or streaking artifacts from stents or calcific plaque, which often hindered obtaining a clear picture of the patient’s condition. The Aquilion ONE / PRISM Edition, with AiCE and PIQE technology, makes it easier to confidently assess stent patency and restenosis.”
Dr. Kozor added that surgeons who refer CABG patients for coronary artery CT want to know if their grafts are patent. “Sometimes, artifacts prevent us from clearly visualising the point where the graft meets the native vessel or the runoff. However, with Canon’s PIQE technology, we are obtaining fantastic images of patients with previous CABG. The high image quality allows me to confidently assure surgeons that the grafts are fine.”
Dr. Shore estimates that 20-25% of patients scanned at NSRNM have had previous coronary interventions, such as stenting or coronary artery bypass grafting (CABG).
He explained that prior to using the Aquilion ONE / PRISM Edition, it was challenging to visualise artery architecture and stent patency in patients who had undergone coronary intervention.
“In the past, it was difficult to accurately visualise vessels in patients with coronary devices. We often had to mention the presence of excessive artifact, which made it difficult to make an accurate diagnosis. Without a cardiac CT diagnosis, these patients would often require follow-up examinations, such as catheterisation, for further evaluation.”
“With Canon’s PIQE technology, the visualization of arteries on the curved planar reformats is impressive. Previously, I didn’t have the same level of confidence due to motion artifacts or streaking artifacts from stents or calcific plaque, which often hindered obtaining a clear picture of the patient’s condition. The Aquilion ONE / PRISM Edition, with AiCE and PIQE technology, makes it easier to confidently assess stent patency and restenosis.”
Dr. Kozor added that surgeons who refer CABG patients for coronary artery CT want to know if their grafts are patent. “Sometimes, artifacts prevent us from clearly visualising the point where the graft meets the native vessel or the runoff. However, with Canon’s PIQE technology, we are obtaining fantastic images of patients with previous CABG. The high image quality allows me to confidently assure surgeons that the grafts are fine.”
Enhancing Cardiovascular Care:
The Impact of Aquilion ONE / PRISM Edition in Plaque Characterisation and Risk Assessment
Dr. Shore commented that the image quality of the Aquilion ONE / PRISM Edition allows for better characterisation of stenosis. Due to the improved image quality, reporting clinicians can now assess the degree, architecture, and composition of plaque. This includes identifying soft plaque, calcific plaque, fissures, positive remodelling, and other high-risk features.
Previously, if a patient had a calcium score of zero, it was assumed that their symptoms were not cardiac-related. However, the image quality of the Aquilion ONE / PRISM Edition enables us to evaluate the nature and characteristics of plaque. This is particularly important for younger patients.
“Coronary artery CT is excellent for assessing established cardiac and coronary artery disease. However, the ability to characterise a patient’s soft plaque allows cardiac CT to provide greater benefits in preventative medicine and disease modification. This can help reduce the need for coronary artery bypass surgery or intervention, or at least delay it by 10-15 years. This has significant benefits for patients, especially those in the younger patient cohort.”
We are now encountering patients aged 30-50 with clinically insignificant calcium scores, but with the level of detail in our CT images, we can diagnose the presence of significant soft plaque. These findings are clinically significant as these patients have an increased risk of the plaque rupturing and occluding a vessel. The improved characterisation of plaque can have a significant impact on their clinical outcomes. When we provide this level of information to referring cardiologists, they can medically manage the patient, attempt to reduce the impact of plaque, and hopefully transition it from an unstable picture of plaque to a more stable one, reducing the risk of rupture.
Previously, if a patient had a calcium score of zero, it was assumed that their symptoms were not cardiac-related. However, the image quality of the Aquilion ONE / PRISM Edition enables us to evaluate the nature and characteristics of plaque. This is particularly important for younger patients.
“Coronary artery CT is excellent for assessing established cardiac and coronary artery disease. However, the ability to characterise a patient’s soft plaque allows cardiac CT to provide greater benefits in preventative medicine and disease modification. This can help reduce the need for coronary artery bypass surgery or intervention, or at least delay it by 10-15 years. This has significant benefits for patients, especially those in the younger patient cohort.”
We are now encountering patients aged 30-50 with clinically insignificant calcium scores, but with the level of detail in our CT images, we can diagnose the presence of significant soft plaque. These findings are clinically significant as these patients have an increased risk of the plaque rupturing and occluding a vessel. The improved characterisation of plaque can have a significant impact on their clinical outcomes. When we provide this level of information to referring cardiologists, they can medically manage the patient, attempt to reduce the impact of plaque, and hopefully transition it from an unstable picture of plaque to a more stable one, reducing the risk of rupture.
“ With AiCE and PIQE you can have your cake and eat it too - great image quality at significantly lower radiation doses ”
The doses from the Aquilion ONE / PRISM Edition are significantly lower, including minuscule doses for calcium scoring, without compromising image clarity. Dr. Shore mentioned, “A good indication of the consistency of image quality is that I don’t even notice patients with large BMI until I’m assessing for extra cardiac findings on the 1mm slices.”
“We have observed a significant reduction in radiation doses for patients with high heart rates and high BMIs,” Dr. Shore stated. “While we still prioritise heart rate control, even in patients with slightly elevated heart rates, we can obtain highly diagnostic images.
“We have observed a significant reduction in radiation doses for patients with high heart rates and high BMIs,” Dr. Shore stated. “While we still prioritise heart rate control, even in patients with slightly elevated heart rates, we can obtain highly diagnostic images.
Previously, on other scanners, image quality would deteriorate when the heart rate exceeded the optimal range by 3-4 beats, limiting our ability to make accurate assessments.”
Dr. Shore added, “In the past, accurately reporting high BMI patients was challenging due to artifacts caused by high attenuation. It was difficult for our team to determine the optimal radiation dose and contrast amount required for a diagnostic scan. The Aquilion ONE / PRISM Edition eliminates this guesswork by consistently delivering high image quality while keeping radiation doses low.”
Dr. Shore added, “In the past, accurately reporting high BMI patients was challenging due to artifacts caused by high attenuation. It was difficult for our team to determine the optimal radiation dose and contrast amount required for a diagnostic scan. The Aquilion ONE / PRISM Edition eliminates this guesswork by consistently delivering high image quality while keeping radiation doses low.”
Furthermore, Dr. Shore noted that the clarity of images in patients with pacemakers, which previously could be obstructed by blooming artifacts from pacing leads, is excellent thanks to the system’s advanced Single Energy Metal Artifact Reduction (SEMAR) technology. Additionally, the impressive single-beat acquisition eliminates motion artifacts and makes it difficult to produce an undiagnostic scan.
“Cardiac CT traditionally required careful patient selection, considering factors like BMI, heart rate irregularities, and previous coronary interventions. However, with the Aquilion ONE / PRISM Edition, we can now offer referring cardiologists the confidence to expand their cardiac CT referrals at NSRNM. Our advanced technology allows us to generate diagnostic images for a broader patient cohort, removing previous limitations” Dr Kozor.
“Cardiac CT traditionally required careful patient selection, considering factors like BMI, heart rate irregularities, and previous coronary interventions. However, with the Aquilion ONE / PRISM Edition, we can now offer referring cardiologists the confidence to expand their cardiac CT referrals at NSRNM. Our advanced technology allows us to generate diagnostic images for a broader patient cohort, removing previous limitations” Dr Kozor.
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