What is Coronary Calcium Scoring

Coronary Calcium Scoring is a technique used to determine if coronary calcification is present in your coronary arteries. It is a CT scan that captures cross-sectional images of the heart at sub-second rates. This unique CT technology allows the detection of calcium in the coronary arteries which is directly related to the total atherosclerotic plaque burden and compares it to standards for your age and gender. Although available for the past decade coronary calcium scoring was limited to a few large centers that owned an electron beam CT scanner. With the advent of multidetector CT technology and faster gantry speeds in the past few years, Coronary Calcium Scoring is now widely available. This test, along with other indicators, helps present an overall picture of your heart health.

Why is Coronary Calcium Scoring a better alternative?

Unlike many medical tests, Coronary Calcium Scoring is fast, painless and non-invasive. This has been specifically designed with your comfort in mind. There is no preparation necessary for this type of scan and the entire process only takes about 30 minutes.

How is the procedure preformed?

Coronary Calcium Scoring takes only about 30 minutes. After you complete a brief personal and family health history, you will have a non-invasive, painless computed tomography (CT) scan of your heart and coronary arteries. The technologist will need to place electrocardiogram (ECG) leads on your chest so that the CT scanner can precisely measure the beating of your heart. This enables the scanner to take dozens of images during those fractions of a second between beats when your heart is still. Once completed, the data is sent to the Vitrea Workstation where powerful software enables our radiologists to calculate a total calcium score. This numerical score is compared to gender and age specific patient databases to determine your percentile ranking.

Who should consider getting the scan?

Individuals who exhibit a number of the primary factors that increase your risk of coronary heart disease such as the following can consider getting the scan:

  • Men over 45 or women who have passed menopause or are age 55 or greater
  • Abnormal cholesterol levels
  • Family history of heart disease
  • Diabetes
  • High blood pressure
  • Cigarette smoking
  • Obesity
  • Physical inactivity

How do I Schedule an Appointment?

This scan can be requested without a physician order, however, we encourage you to contact us or speak with your physician prior to getting the scan. Additionally, at this time the procedure is still not covered by insurance and payment will be requested at the time of the exam. The cost of the exam is $350.00 and payment is expected at the time of the exam. You can call 510-204-9400.

General Guidelines for Interpretation of Calcium Scores
MDCT Calcium Score Plaque burden & probability of significant CAD Implications for CV risk Recommendations
0-10 Cannot exclude the possibility of atherosclerosis. Although negative or extremely low, there is a five percent or lower probability of significant obstructive disease Very Low to Low No specific further work-up would be recommended in an asyptomatic group. Non-calcified atherosclerosis cannot be excluded, discussion of primary prevention of CV disease should be emphasized.
11-100 Consistent with mild atherosclerotic burden and despite the fact that the likelihood of significant obstructive disease is low (less than 20 percent) atherosclerosis is clearly present. Moderate Daily use of coated aspirin (81-325 mg) and NCEP1 guidelines for cholesterol reduction similar to patients with greater than or equal to two traditional CV risk factors should be considered. Antioxidant therapies could also be considered in this group.
101-400 Consistent with at least moderate atherosclerosis and a high likelihood of moderate non-obstructive CAD. Moderately High An aggressive approach to lipid lowering (similar to patients with documented CAD by angiography or previous cardiac events), strict control of diabetes and hypertension, smoking cessation, dietary counseling, daily coated aspirin use (81-325 mg), antioxidant therapies and regular aerobic exercise should be instituted. Exercise stress testing should be considered.
>400 Advanced atherosclerotic plaque present. There is high likelihood of at least one obstructive coronary stenosis and high CVD risk. High These patients should undergo the above outlined aggressive risk strategies and should be strongly considered for a stress imaging study such as stress nuclear or echo testing.
* NCEP-National Cholesterol Education Program
* If calcium score is greater than or equal to 75th percentile for age/gender, advance to recommendations for next calcium score range.
Percentile Rank 40-45 45-50 51-55 56-60 61-65 66-70 71+
10% 0 0 0 1 1 3 3
25% 0.5 1 2 5 12 30 65
50% 2 3 15 54 117 166 350
75% 11 36 110 229 386 538 844
90% 69 151 346 588 933 1151 1650
10% 0 0 0 0 0 0 0
25% 0.1 0.1 0.1 0.2 0.5 1 4
50% 0.1 0.1 1 1 3 25 51
75% 1 2 6 22 68 148 231
90% 3 21 61 127 208 327 698

How to prepare for your CTA exam

  • Avoid any caffeinated drinks on the day before or the day of your exam. Coffee, tea, energy drinks, or caffeinated sodas.
  • Avoid energy or diet pills on the day before or the day of your exam (ask your doctor if you have questions).
  • Do not use Viagra or any similar medication on the day before or the day of the exam. It is not compatible with the medications you will receive during the procedure (ask your doctor if you have questions).
  • On the day of your exam,do not eat for four hours prior to your scheduled appointment. You may drink water.
  • If you are diabetic, ask your physician how to adjust your medications the day of your test. If you think your blood sugar is low, tell the technologist immediately.
  • Tell your technologist and your doctor if you are:
    • pregnant
    • allergic to iodine and/or shellfish or any medications
    • undergoing radiation therapy
    • over 60 years old or have a history of kidney problems (you may be required to have a blood test to evaluate your kidney function prior to receiving any contrast agent)

What to expect:

  • You will change into a hospital gown.
  • A nurse will insert an IV line into a vein in your arm to administer contrast (dye) during your procedure.
  • You will lie on a special scanning table.
  • The technologist will clean three small areas of your chest and place small, sticky electrode patches on these areas. Men may expect to have their chest partially shaved to help the electrodes stick. The electrodes are attached to an electrocardiograph (ECG) monitor, which charts your heart’s electrical activity during the test.
  • You will lie on the scanner table, and you will be asked to raise your arms over your head for the duration of the exam.
  • During the scan, you will feel the table move inside a donut-shaped scanner. You will receive a contrast agent through your IV to help produce the images. It is common to feel a warm sensation as the contrast circulates through your body.
  • Once the technologist is sure that all the information is collected, the IV will be removed.

The CT scan takes about 15 minutes.

After the procedure:

  • You may continue all normal activities and eat as usual after the test.
  • Your physician will discuss the results of your test with you.

Please ask your doctor if you have any questions about the cardiac CT.

A note about CT and risk:

A CT scan is a low risk procedure. Occasionally, patients experience an adverse reaction to the contrast agent. Some patients develop itching or a rash following the injection. These symptoms are usually self-limiting and resolve without further treatment. Antihistamines can be administered if needed for symptomatic relief. Rarely, a more serious allergic reaction, called an anaphylactic reaction, occurs that may result in breathing difficulty. This reaction is potentially life-threatening and would require medications and treatment to reverse the symptoms. CT scanners use x-rays. For your safety, the amount of radiation exposure is kept to a minimum. Because x-rays can harm a developing fetus, however, this procedure is not recommended if you are pregnant.