Cardio-Thoracic Imaging Unit

The Cardiothoracic Imaging Unit at the Shaare Zedek Medical Center specializes in innovative simulation methods for different diseases of the lungs, aorta, pulmonary blood vessels and the heart. It also performs Computerized Tomography (CT) with the most advanced technology available, while using current protocols specifically adapted to each individual patient and symptom:

• CT at double energy for pulmonary artery diseases
• Detailed pulmonary examinations at high resolution
• Lung and chest biopsies
• Drainage
• Cardiac CT for coronary arteries (virtual catheterization)
• Examinations for evaluating heart structure before catheterization or cardiac intervention
• Detailed cardiac MRI tests

CT examinations are conducted using a sophisticated CT machine, with minimal radiation and as quick as the duraton of one heartbeat. The results are deciphered using a specially designed program. Cardiac tests are conducted and decoded in conjunction with Dr. Arik Wolak, Director of the Cardiac Imaging Unit [link]. Smooth cooperation between radiologists and cardiologists allows for the best interpretation of the results.
The Unit participates in multi-disciplinary meetings with doctors from related fields – such as chest enlargement, in which radiologists, pulmonologists, pulmonary surgeons, oncologists and pathologists discuss the issues together.

A CT of the heart presents a challenge because the heart is an organ in constant movement. The test must be performed very quickly while synchronizing (with the ECG) the imaging machine with the heart’s contractions. For some patients (with a slow and stable pulse) a CT can be performed on one heartbeat in less than a second, and with less than 1 millisievert (mSv) of radiation. For those patients unsuited for the one heartbeat scan, the test is performed over 3-4 beats, lasts a few seconds and the patient is exposed to radiation of approximately 2.5-5 mSv.
Cardiac CT is a possible (non-invasive) alternative to catheterization in cases of average/low risk of coronary arterial disease.
The main use of cardiac CT is for diagnosing coronary arterial diseases using a non-invasive procedure. The examination allows the radiologist to view the arterial space and assess blockage. One can also examine the blood vessel walls even to identify cases of early stage sclerosis, before the vessels become blocked. The test has very high sensitivity for identifying the sclerosis process, ie if the cardiac CT does not identify sclerosis one can rely on that invalidation.
To reduce the level of radiation, the CT scan does not usually show other elements in the thoracic cavity – lungs, pulmonary arteries and the aorta – in any significant way. Although if needed – in cases of diagnostic questions relating to these elements – a more extensive scan can be conducted but with greater radiation.

Cardiac CT in Emergency Medicine

When patients come to the hospital’s Emergency Medicine Department complaining of chest pains, we can conduct a quick, double or triple rule-out diagnosis, to negate or verify:

• Artery blockage
• Suture/damage to the aorta
• Pulmonary embolism

In contrast to catheterization, we cannot treat stenosis revealed during the examination. Having said that, we can identify early sclerosis or slight stenosis for which catheterization could be a solution. Unlike catheterization, this is a non-invasive test. Generally, a cardiac CT is appropriate for cases in which there is low/medium risk of sclerotic disease. In other cases it is preferable to catheterize and allow simultaneous diagnosis and treatment.