Draft guidance from NICE paves way for next-generation cardiac CT
15 September 2011
Draft guidance from NICE’s Diagnostics Assessment Programme on
four new-generation cardiac CT scanners has been issued for public
consultation (till 3 October 2011).
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In addition, the draft guidance recommends their use in people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
The consultation closes on
3 October 2011.