National Institute for Health and Clinical Excellence (NICE)
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NICE approves new generation CT scanners

Four new generation cardiac computed tomography (CT) scanners can now be used by the NHS to help diagnose and manage patients with coronary artery disease (CAD) who are difficult to image, says NICE.

CAD is a condition where plaque, made up of fat, cholesterol, calcium and other substances in the blood, builds up and hardens over time leading to a narrowing of the coronary arteries. This can lead to angina or a heart attack.

Around 2.6 million people in the UK have CAD, and an estimated 91,000 deaths were caused by CAD in 2007.

CT scanners are used to evaluate the function of the heart, its arteries and the degree of calcium build up. However, in certain people imaging can be difficult with older types of CT scanners. This can be due to obesity, and higher levels of calcium in the heart.

NICE has approved the use of the new generation CT scanners because they have a number of advantages over the older type CT scanners for people with CAD in whom imaging is difficult, allowing them to produce better images and in a shorter period of time, within one or two heartbeats

Somatom Definition Flash CT scanner, Aquilion ONE, Brilliance iCT and Discovery CT750 are all recommended as options for first-line imaging of coronary arteries in people with suspected stable CAD in whom imaging CT scanners is difficult with older scanners.

The scanners are also recommended for first line evaluation of disease progression to determine whether blood flow needs to be restored by replacing blood vessels in people with known CAD, and in whom imaging with older CT scanners is difficult.

Currently, invasive angiography is used to determine whether blood vessels have narrowed in a person in whom imaging is difficult. This is a procedure where dye is injected into the blood vessels to see whether they are narrowed.

NICE says that the new generation CT scanners are preferable to invasive angiography as they carry fewer risks, and are more cost effective.

Professor Adrian Newland, Chair of the independent Diagnostics Advisory Committee, said: "For patients with coronary artery disease who are difficult to image the current options for assessment are associated with increased morbidity and mortality.

"The newgeneration of CT scanners have a number of features that offer genuine improvements in assessment in these patients.

"Our evaluation confirmed not only the cost effectiveness of the technique but also its clinical benefits.

"We hope this guidance can be used for planning the development of facilities for the first-line imaging of this difficult to image group with suspected stable CAD, and for first-line evaluation of those with disease progression who may require revascularisation."

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."

She added: "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 as part of medium-term asset planning."

A list of diagnostic technologies guidance currently in development can be viewed on our website.

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