Hyper Advanced Technology and Imaging
Pillar 2: Hyper Advanced Technology and Imaging
The Highest Image Resolution
At our facility, we specialize in advanced cardiac imaging that few in the world can match. We are proficient in four major fields of cardiology:
- Cardiac MRI
- CCTA (Coronary Computed Tomography Angiography)
- PET/CT (Positron Emission Tomography/Computed Tomography)
- 3D Echo with Speckle Tracking Strain Echo
Each of these modalities requires at least six months of specialized training, which is challenging to obtain in a one-year fellowship. Most specialists only master two of these modalities, but I have learned and now teach all four.
Our facility uses the Arineta Cardiographe SpotLight Duo for CCTA, chosen for its low radiation, high resolution, and high number of slices. This non-invasive method is a preferable alternative to high-risk cardiac catheterization. Traditional nuclear stress tests, which have a 40% false positive and 65% false negative rate, are often overused because they generate higher payments.
Ensuring Accurate Imaging
Echocardiograms often have a 50% error rate due to technician errors or equipment issues. At the Mayo Clinic, this rate is zero, thanks to their experienced echo techs and real-time oversight. We aim to achieve similar accuracy.
Early Cancer Detection
As Cardio-Oncologists, we prioritize early detection of cancer. Blood biopsy samples, though currently with low yields, are a simple and evolving method. More promising is the use of Total Body PET/CT scans, which have shown a 3% yield in detecting cancer in individuals over 65, based on a study involving 155,000 people in Japan. We prefer using low radiation PET/CT scanners, like the United Imaging long PET/CT, which has radiation exposure comparable to a round trip flight from NYC to London.
Total Body 3T MRI is also invaluable, offering a 2.6% cancer detection rate in older adults. PET/CT and MRI scans complement each other, as each can detect different types of cancers.
Superior Image Review: Sherlock and Others
Reviewing these advanced images requires extensive training and anatomical knowledge. Radiologists often lack the cardiac-specific expertise required, while cardiologists may lack technical knowledge. I have had the privilege of learning from top experts in each modality:
- Cardiac PET/CT: Dr. Marcelo De Carli, Dr. Shamila Dorbala, Dr. K. Lance Gould
- Cardiac CCTA: Dr. Pim J. de Feyter
- Cardiac MRI: Dr. Gerald Pohost
Echocardiology, particularly speckle tracking strain imaging, requires highly skilled technologists. Dr. Dennis Nelson, founder of MimSoftware, excels in superimposing PET with MRI and CT scans, a technique often overlooked due to the time it takes.
Advanced Cardiac Imaging Software
We have developed our own CCTA imaging software, starting with 16-slice scanners in 2004. This field is still underutilized, with only 1% of doctors engaging in it due to financial incentives favoring traditional tests. We also collaborate with AI developers, including HeartFlow, Cleerly, Elucid, and Caristo, to improve our technology. Our Sherlock software surpasses these with advanced engineering, such as using Navier-Stokes equations for convergent-divergent double cones, aligning perfectly with AI capabilities.
Case Study – ‘Thrombolytic Cocktail, Shaken but Not Stirred!’
Having retired in 1992, Canadian-born Father George Stuart Burchill is a legend in the city for being the first headmaster of a scholarly school of classics for 38 years, known for its academic rigor. He has married many prominent families’ children and graduated or taught many future Gasparilla Krewe members of Tampa’s elite. Despite being a happy retired professor, he was often irritated by prank phone calls…
