The patient's arteries had a rare anomaly. At least that's what her conventional angiogram showed. The patient faced risky surgery to re-implant a coronary artery. Without surgery she was at risk of sudden death. Or so doctors thought.

Enter advanced imaging technology. Using the new 64-slice computed tomography (CT) scanner at Fairfield Mercy Hospital, doctors found the coronary artery in question actually took a different course than indicated by the conventional angiogram. Surgery wasn't needed after all. "This prompted happy tears and a big hug when I reviewed the images with her," recalls Dr. Bradford Woodall, chief radiologist.

With conventional angiography, a special dye (contrast media) is injected into heart vessels, using a catheter that usually is routed up from the patient's upper thigh. X-ray images are examined to find arterial blockages. With CT angiography, more images are captured at different angles (each section called a "slice") and much more rapidly. This speed makes undergoing the exam easier for patients, and it produces richly detailed pictures of anatomy.

The advent of 16-slice CT made it practical for some cardiovascular work, but the 64-slice models are fast enough to capture and create three-dimensional images of a beating heart with much higher resolution. A cardiologist or radiologist can virtually tour the anatomy of a heart and coronary arteries.

Yes, the new technology is expensive, but Dr. Woodall points to the savings: all the other unnecessary tests and surgeries avoided. For example, other causes"”such as hiatal hernias"”cause up to 40 percent of chest pain in people who fear they're having a heart attack. The 64-slice CT produces dependable images of any area that may be the cause of chest pain, including the lungs and esophagus, so it can help rule out a cardiac cause and costly procedures.

"There are 2 million-plus angiograms performed in the U.S. per year, and about 500,000 of those could be avoided" with this advanced diagnostic tool. "Angiograms are expensive and invasive," he notes.

For all his excitement about this technology, Dr. Woodall is pessimistic about it being used to its best advantage. As he explains it, more than 600,000 Americans die each year from cardiovascular causes, and in more than half of those cases the first symptom is sudden death. The reason modern medicine hasn't affected that rate much is because most tests look for narrowing of blood vessels (called stenosis).

"Unfortunately, only about 20 percent of heart attacks come from those," he says. Research indicates a high percentage of sudden death cases result from coronary lesions, where soft plaque can accumulate and become inflamed. When a chunk breaks off, it can form a clot that causes a heart attack"”even in an artery that seems relatively clear based on other tests.

"It's the doughnut, not the hole," Dr. Woodall explains, using an old doctor's adage. The 64-slice CT is much better at evaluating the condition of arterial walls, and of the kind of plaque lining those walls.

Ideally, people with certain risk profiles would get this kind of CT screening before they experience what could be fatal symptoms, Dr. Woodall says. More of those people could use medications, diet and exercise to prevent hospitalization or surgery. But Medicare and private insurers are more willing to pay for more expensive emergency diagnostics and interventions, and reject reimbursement for preventative screening.

That's twisted logic, Dr. Woodall believes. When people see these "unbelievable" pictures of their unhealthy arteries, "the impact is huge," and it makes them more motivated to manage the condition, he says.

The technology keeps advancing rapidly. Leaps in magnetic resonance imaging (MRI) keeps it neck-and-neck with CT as the cardiovascular imaging tool of choice, and now a 256-slice CT system is in development.