Human / Large Animal

	Magnetic Resonance Committee for Magnetic Resonance Imaging and Spectroscopy (CAMRIS) » The Committee for Magnetic Resonance Imaging and Spectroscopy (CAMRIS) Committee works to establish policies and procedures for the research use of MR Scanners within the Department of Radiology. Its two-fold mission is to review proposed research protocols involving human or animal study. CAMRIS Facility Director: Norman Butler CAMRIS Coordinator: Alexandra Kilger, alex.kilger@uphs.upenn.edu
	Magnetic Resonance in Analysis Tools Cardiovascular Research Group » The Cardiovascular Research Group develops and applies novel MR imaging in analysis tools for the study of cardiovascular function and flow. We have developed a rapid 4D tagged imaging sequence, which combined with 3D optical flow analysis (OFM) allows direct tracking of myocardial deformation. Senior Programmer: Gamaliel Isaac, gamaliel.isaac@uphs.upenn.edu
	CACTIS - Center for Advanced Computed Tomography Imaging Services » CACTIS works to establish policies and procedures for the research use of Computed Tomography (CT) scanners within the Department of Radiology. Our mission is to oversee proposed research protocols involving human, animal, phantom or specimen studies. CACTIS Center Chair: Dr. Harold Litt (215) 662-3043 email: harold.litt@uphs.upenn.edu
	PET Center » Whole body TOF PET with 16 slice CT High resolution, FOV PET for brain and medium animals PET Center Directors: Joel Karp / Chaitanya Divgi Coordinator: Sallie Livingston (215) 349-8149, sallie@mail.med.upenn.edu
	Radiology Ultrasound Research Laboratory » The Department of Radiology at the University of Pennsylvania houses a state-of-the-art Ultrasound Research Laboratory for conducting clinical and pre-clinical research. The goals of the research laboratory are: 1. To develop new ultrasound technologies and clinical applications; 2. To bridge the gap between technology and clinical applications; and 3. To provide ultrasound imaging resources to other research groups within the university and in other institutions. Director: Dr. Chandra M. Sehgal PhD (215) 349-5461 email: sehgalc@uphs.upenn.edu

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Cardiology Ultrasound Research:

1) Small animal:
Visualsonics Vevo 770 ultrasound machine with 2D imaging, pulse wave Doppler, and M-mode capabilities. The system has imaging probes: 25 MHz (Rat), 30 MHZ (Mouse), and 40 MHz (Embryo/Vascular).

Contact: Dr. Victor Ferrari (215) 662-2912, (215) 452-4215 [ pager ]

2) Human:
Philips (IE33, 7500, and 5500 systems) and Siemens (512 and 256 systems) for transthoracic, transesophageal, and epicardial echo. 3D available on IE33, 7500, and 512 systems.
Strain and strain rate capabilities will be available with arrival of new GE system.

Contacts: Dr. Martin St. John Sutton (215) 662-2285, and Dr. Susan Wiegers (215) 662-2246

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For Clinical Practitioners:
About Coronary Artery Calcification Scanning and CT Coronary Angiography

Because of the increasing interest in both coronary calcification scanning and CT coronary angiography and uncertainty about their roles in clinical practice, we address here the differences between coronary artery calcification (CAC) scanning and CT coronary angiography and their respective roles in clinical practice.

Coronary Artery Calcification (CAC) Scanning -
Risk assessment of asymptomatic patient for the purpose of guiding intensity of medical therapy:

Coronary artery calcification (CAC) has been well documented in the literature to provide excellent noninvasive risk assessment for adults over age 40. This test is completely noninvasive, without even requiring an IV. Comparatively, EBCT technology uses a sweeping electron beam, while MDCT scanners use a rotating system. EBCT scanners typically use less radiation than MDCT scanners, with EBCT scanners using 0.6-1.3 mSv and MDCT using 0.5 to 2.5 mSv. Note that the average EBCT radiation exposure of 0.8 mSv is is about 3 months of background radiation in Pennsylvania, which is acceptably low for screening purposes. Thus CAC scoring is the preferred modality for the risk assessment of the asymptomatic patient for the purposed of guiding medical therapy. Both EBCT and MDCT can be used for this purpose but the radiation exposure is lower with EBCT.

CT Coronary Angiography -

Evaluation of selected symptomatic patients or patients with abnormal stress tests for the purpose of deciding whether invasive catheterization and angiography is indicated:

64 slice MDCT scanners can provide excellent coronary angiography when a patient is injected with iodine based IV contrast. CT coronary angiography may be a reasonable choice in selected patients with atypical symptoms and/or a indeterminate stress test as a tool to avoid invasive catheterization. However, this study uses 3 to 7 mSv, occasionally up to 13 mSv of radiation. The significantly higher radiation dose, combined with the IV contrast exposure, means that this study is not recommended for asymptomatic screening or risk assessment. According to a recent AHA scientific statement, "For CT angiography, the higher radiation doses prohibit the use of this test as a screening tool for asymptomatic patients. CT coronary angiography is not recommended in asymptomatic persons for the assessment of occult CAD."

In keeping with the different indications for these studies, one should note that coronary artery calcification results are limited to calcification scores for risk assessment, while CT angiography results may or may not provide coronary artery calcification scores, but they do provide other information about cardiac and non cardiac findings in the thoracic cavity. Furthermore, substantially elevated CAC scores pose technical problems in obtaining adequate CT angiography images.

At present CAC scoring for screening of asymptomatic individuals is not covered by most insurance companies or Medicare. CT coronary angiography is covered by most insurance companies and Medicare for evaluation of symptomatic patients, but not for screening purposes. When deciding upon where to send a patient for cardiac CT, a physician should consider both the experience of the performing and interpreting physicians as well as the technology used. According to the most recent AHA scientific statement on the Assessment of Coronary Artery Disease by Cardiac Computed Tomography, "Cardiac CT technology is rapidly evolving. On the basis of the substantial validation data, EBCT remains the reference standard for CAC measurement. MDCT-64 is the current standard for coronary CT angiography."

Douglas Jacoby, MD
Daniel J. Rader, MD

Cardiovascular Division
University of Pennsylvania Health System

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