NICE guidance on cardiac CT scanners

The guidance, produced as part of NICE’s diagnostics assessment programme, recommends Somatom Definition Flash CT scanner (Siemens AG Healthcare), Aquilion ONE (Toshiba Medical Systems), Brilliance iCT (Philips Healthcare) and Discovery CT750 (GE Healthcare) as options for first-line imaging of the coronary arteries in people with suspected stable CAD (with an estimated likelihood of coronary artery disease of 10% to 29%) and for first-line evaluation of disease progression to establish the need for revascularisation in people with known CAD in whom imaging with earlier generation CT scanners is difficult. CT scans are performed to evaluate the arteries of the heart, and can also be used to assess the function of the heart, the anatomy of the heart, and the degree of coronary calcification in the heart. However, in some people, imaging the heart and surrounding blood vessels is difficult with older types of CT scanners. This can be due to a number of reasons, including obesity, levels of coronary calcium higher than 400 and heart rates greater than 65 beats per minute that cannot be lowered with drugs. New generation cardiac CT scanners have advantages over older types of CT scanners for these people because they can produce better images in a shorter time (within one or two heartbeats). Professor Carole Longson, NICE Health Technology Evaluation Centre director, said: “From a patient perspective, a non-invasive cardiac diagnostic test is more appealing than the current alternative for people in whom imaging is difficult – invasive coronary angiography – because of the greater morbidity and mortality risks associated with angiography. New generation cardiac CT was found to be more cost-effective than angiography because of its lower imaging costs and the lower risk of adverse outcomes and associated reduced downstream healthcare costs from dealing with complications. “The independent Diagnostics Advisory Committee concluded that the evidence presented indicated that new generation cardiac CT was more cost-effective for people in whom imaging is difficult than proceeding directly to invasive angiography. Service providers in England, working with commissioners and cardiac networks, should take into account the benefits of new generation cardiac CT scanners for use in the circumstances described in this guidance when selecting CT scanners.”