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‘Super X-rays’ show promise for finding heart disease but produce high radiation dose

Rating

5 Star

‘Super X-rays’ show promise for finding heart disease but produce high radiation dose

Our Review Summary

The concept of cardiac CT sounds like a great one: to be able to get high resolution images of the coronary arteries in a non-invasive way. One potential use of the scans would be to identify those without blockages to save them from getting the more invasive angiography procedure. Unfortunately, cardiac CT scans are being performed on those without symptoms or suspicion of heart disease, and in the absence of evidence to support its use in this population, the harms of the test (including radiation exposure) may not be worth its benefits. 

According to the 2006 American Heart Association Guidelines, "For CT angiography, the higher radiation doses suggest the need for greater forethought when using these tests, and use of these higher radiation exposure tests in asymptomatic persons for screening purposes is not currently recommended."  In particular, "Use of CT angiography in asymptomatic persons as a screening test for atherosclerosis (noncalcific plaque) is not recommended".

This story reports on a recent presentation of the results of a study comparing cardiac CT to angiography in high-risk individuals. The story accurately represents the availability, novelty, and costs of the scan. The story quotes multiple independent experts who provide valuable commentary on the implications of the new findings.

By not exaggerating the seriousness or prevalence of heart disease, the story avoids disease mongering. However, the story could have been more clear about who the CT scans are intended for. The study in question was in those with suspected heart disease, not the assymptomatic or "worried well". The use of CT scans in the larger asymptomatic population is controversial.

The story correctly describes radiation exposure as one of the harms of the heart CT. The story could have described other harms, such as the implications of false positive or false negative test results.

The story adequately quantifies the benefits of Cardiac CT by describing the percentage of patients with blockages that were identified with either the CT scan or the angiogram. The story should have also described the probability of having blockages with a positive scan (positive predictive value). This is the more important piece of information to a consumer. Also not described in the story is whether the CT scans had any impact at all on downstream outcomes, such as heart attacks, deaths, or procedures.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story provides the cost of the CT scan as well as angiography. However, the story should have discussed insurance coverage for the scans.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story describes the percentage of patients with blockages that were identified with either the CT scan or the angiogram. The story should have also described the probability of having blockages with a positive scan (positive predictive value). This is the more important piece of information to a consumer. Also not described in the story is whether the CT scans had any impact at all on downstream outcomes, such as heart attacks, deaths, or procedures.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story correctly describes radiation exposure as one of the harms of the heart CT. The story could have described other harms, such as the implications of false positive or false negative test results.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story adequately describes the design of the current study, including a criticism from one expert that the study "cherry-picked" patients to include in the study in order to maximize the findings.

Does the story commit disease-mongering?

Satisfactory

The story does not exaggerate the seriousness or prevalence of heart disease. However, the story could have been more clear about who the CT scans are intended for. The study in question was in those with suspected heart disease, not the assymptomatic or "worried well". The use of CT scans in the larger asymptomatic population is controversial.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes multiple independent experts who provide valuable commentary on the implications of the new findings.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions angiography as the alternative to the heart CT.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story clearly states that the CT scans are relatively new and available in many hospitals, however it is not clear how many hospitals have purchased these machines.

Does the story establish the true novelty of the approach?

Satisfactory

The story adequately describes the novelty of the scans.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Because the story quotes multiple experts, the reader can assume that the story did not rely on a press release as the sole source of information.

Total Score: 10 of 10 Satisfactory

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