NICE draft guidance gives green light for new generation cardiac CT scanners

5 Sep 2011 11:43 AM

Draft guidance from NICE´s Diagnostics Assessment Programme on four new generation cardiac computed tomography (CT) scanners is issued today for public consultation. The provisional recommendations support the use of Somatom Definition Flash CT scanner (Siemens AG Healthcare), Aquilion ONE (Toshiba Medical Systems), Brilliance iCT (Philips Healthcare) and Discovery CT750 (GE Healthcare) in the NHS in England for people with suspected or known coronary artery disease in whom imaging is difficult with earlier generation CT scanners.

Coronary artery disease, which is characterised by narrowing of the coronary artery, leads to reduced blood flow to the heart which can result in angina and myocardial infarction. In 2007, coronary artery disease was estimated to have caused 91,000 deaths in the UK. 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.

The recent NICE clinical guideline on chest pain of recent onsetⁱ recommends CT coronary angiography and invasive coronary angiography to assess the state of arteries and identify significant narrowing in people with an estimated probability of coronary artery disease of 10-29% and a calcium score of 400 or less People with a calcium score above 400 are considered difficult to image using earlier generation CT technologies. Other reasons that make CT imaging difficult are obesity, arrhythmias (irregular heart beat), high heart rates (above 70 beats per minute) or previous coronary stents or bypass grafts.

The new generation cardiac CT scanners have advanced technical features which can overcome these difficulties. These include the ability to acquire images much faster than earlier generation CT scanners, better image quality and reduced radiation doses.

The draft NICE guidance recommends the use of new generation CT scanners for first line imaging of the coronary arteries in people with suspected stable coronary artery disease who are difficult to image with earlier generation CT scanners and whose estimated probability of having coronary artery disease is 10-29%. In addition, the draft guidance recommends their use in people with known coronary artery disease for first line evaluation of disease progression to establish the need for revascularisation where imaging with earlier generation CT scanners is difficult.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: "The independent Diagnostics Advisory Committee concluded that new generation cardiac CT scanners are good value for money for hard to image patients instead of proceeding directly to initial angiography. The Committee acknowledged that, from a patient perspective, a non-invasive cardiac diagnostic test is preferable to invasive coronary angiography because of the risks associated with this type of test. The provisional recommendations on the use of this important new technology are now open for consultation and we look forward to receiving comments from health professionals, industry and patient groups. In particular we would welcome the opportunity provided by this consultation to provide comments in the context of the existing NICE clinical guidelines on diagnosing chest pain and the management of stable angina."

More information on the diagnostics draft guidance consultation for CT scanners for cardiac imaging is available at http://guidance.nice.org.uk/DT/3. The consultation closes on 3 October 2011.

Notes to Editors

About the draft guidance

1. Because earlier generation CT scanners are not considered viable for imaging some people, the comparator used in this assessment is invasive coronary angiography. Invasive coronary angiography uses a contrast dye and X-rays to provide anatomical information about the degree of stenosis in the coronary arteries. A catheter is generally inserted into an artery in the groin or wrist and is moved up the aorta and into the coronary arteries. Once in place, the dye is injected through the catheter, and a rapid series of X-ray images is taken to show how the dye moves through the branches of the coronary arteries. Any narrowing of the arteries will show up on the X-ray images.

2. Invasive coronary angiography is considered the reference standard for providing anatomical information and defining the site and severity of coronary artery lesions. Some rare but serious complications include death, myocardial infarction, cerebrovascular accident, arrhythmia, vascular complications, allergic reaction to contrast media, haemodynamic complications and perforation of the heart chamber.

3. Final guidance on this topic is expected to be published in January 2012.

About the NICE Diagnostics Assessment Programme

4. Further information about the NICE diagnostics assessment programme can be found at: www.nice.org.uk/diagnostics

5. Topics to be considered by the Programme are routed through the related Medical Technologies Assessment Programme. Further information about this can be found at: www.nice.org.uk/mt

About NICE

6. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

7. NICE produces guidance in three areas of health:

public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

8. NICE produces standards for patient care:

quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

9. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.