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One Cardiac Platform. Triple the Impact - Part 3

Mon, 23 Mar 2026 10:00:00 GMT

Clinical Wins and Daily Practice

Introduction

A single cardiovascular imaging platform like Circle’s cvi 42 changes daily work for cardiologists and radiologists from “tool juggling” to focused clinical practice. But it also asks for effort and carries real, though manageable, risks. Seeing this change from your perspective, the people interpreting images and shaping programs, makes it easier to decide whether adopting a unified platform is worthwhile.

What clinicians gain from one platform

Less friction, more clinical time
With one platform across MR, CT, structural heart, and EP:

You spend less time deciding which tool to open and more time deciding what the data means.
One login, one interface, and one workflow logic govern all modalities.
Measurements, annotations, and reports behave consistently, so you aren’t constantly switching “UI languages.”
AI and automation (e.g., contours, plaque, TAVR workflows) are applied the same way regardless of scanner or modality.

This creates cognitive ease, a predictable environment where your brain can focus on nuance and complex decisionmaking instead of navigation.

Better consistency and confidence

A single platform builds one mental model for cardiac data: acquisition, processing, quantification, and reporting.
Standardized protocols and templates reduce variability between readers and sites.
Quantification tools remain the same across cases, deepening expertise in one toolkit.
Shared measurement formats simplify heartteam discussions and QA reviews.

This strengthens diagnostic confidence and supports defensible, consistent decisions.

Stronger positioning for advanced and reimbursed work

With MR, CT, structural heart, and electrophysiology workflows unified:

Advanced workflows (perfusion, strain, plaque) feel like natural extensions of current practice.
New reimbursed features (like AIbased plaque quantification) integrate smoothly into routine CCTA reads.
Research and innovation benefit from standardized, unified data exports.

This positions programs to stay clinically advanced and financially competitive.

Less burnout, more sustainable practice

Fragmented tools mean more clicks, context shifts, and afterhours work. Integrating platforms can:

Reduce duplicate actions via shared worklists and structured reporting.
Lower cognitive load through interface consistency.
Simplify coverage and crosstraining, so expertise isn’t isolated to one person.

Behavioral science shows that reducing friction and restoring control is as important as cutting workload—key factors for preventing burnout.

Stay tuned for Part 4: The Effort, Risks, and Why It’s Worth It. While the clinical and operational gains are clear, shifting to a single platform isn't "zero effort". In our final installment, we’ll have a candid discussion about the implementation valley—addressing common concerns like short-term slowdowns and vendor dependence—and show how these risks are mitigated to create a safer, fairer, and more transparent environment for everyone.

Circle Cardiovascular Imaging Expands cvi42 Platform with Advanced Vascular CT Capabilities

Wed, 18 Mar 2026 19:50:00 GMT

New solution brings advanced vascular analysis into the cvi42 cardiovascular imaging ecosystem.

Highlights

Circle Cardiovascular Imaging (Circle CVI) has expanded its cvi42 platform to include advanced Vascular CT analysis, integrating Astute Imaging’s AI-driven vascular analysis technology.
This enhancement enables comprehensive cardiovascular workflows, allowing clinicians to perform cardiac, vascular, and structural heart analysis within a single, unified platform.
This integration supports greater efficiency and collaboration across cardiology, radiology, and vascular surgery teams, advancing the use of quantitative, AI-enabled imaging for diagnosis, procedural planning, and post-treatment management

Calgary, AB — March 18, 2026 — Circle Cardiovascular Imaging (Circle CVI) today announced the expansion of its cvi42 cardiovascular imaging platform to include advanced Vascular CT analysis, further extending the platform’s capabilities across cardiovascular imaging workflows. The new solution is enabled through a collaboration with Astute Imaging, whose AI-driven vascular analysis technology has been integrated into the cvi42 ecosystem.

The addition of Vascular CT capabilities allows clinicians to analyze complex vascular anatomy for diagnosis, endovascular procedure planning, and post-treatment surveillance, all within the same platform used for cardiac imaging and structural heart planning.

Advancing Quantitative Cardiovascular Imaging

As healthcare systems increasingly adopt quantitative imaging and AI-enabled workflows, clinicians are seeking integrated platforms that can support the full continuum of cardiovascular care — from diagnosis to procedural planning and long-term disease management.

The new Vascular CT capabilities extend the scope of cvi42 beyond cardiac imaging, enabling automated vascular analysis within the same environment trusted by cardiovascular teams worldwide.

The technology powering these capabilities was developed by Astute Imaging, whose advanced algorithms support automated segmentation, quantification, and visualization of vascular structures.

“Fragmented imaging workflows can slow collaboration and decision making between cardiovascular teams,” said Dr. Kevin Steel, Chief Medical Officer, Circle CVI. “By bringing vascular CT analysis into the cvi42 ecosystem, clinicians can work from the same platform across cardiac and vascular cases, helping improve efficiency and coordination of care.”

Cardiac and vascular analysis within a unified workflow helps multidisciplinary cardiovascular teams collaborate more effectively across cardiology, radiology, and vascular surgery.

ABOUT CIRCLE CARDIOVASCULAR IMAGING

Circle Cardiovascular Imaging Inc. (Circle CVI) is a Canadian-based company founded in 2007 with a mission to develop innovative software solutions that enhance cardiovascular and cerebrovascular imaging analysis and ultimately improve patient care. Circle’s flagship platform, cvi42 , delivers best-in-class image reading and reporting tools for quantitative and qualitative assessment of cardiac MR, cardiac CT, vascular CT, and neuro CT .

At the core of Circle’s work is a relentless commitment to empowering healthcare providers with advanced, intuitive tools that lead to better healthcare outcomes. This passion for innovation, rooted in both medicine and technology, drives Circle’s global impact and fuels a culture of excellence.

Today, millions of medical imaging exams each year, across 1,700+ hospitals in over 90 countries, are interpreted using Circle’s cvi42 platform.

For more information, please visit www.circlecvi.com or contact: marketing@circlecvi.com

About Astute Imaging

Astute Imaging Inc. is a U.S.-based company founded in 2022 with a mission to become a best-in-class provider of AI-enabled vascular imaging and care management software for healthcare providers and MedTech companies. Astute Imaging delivers a fully automated, AI-enabled workflow supporting diagnostics, surgical planning, and longitudinal patient follow-up. The platform covers all major vascular anatomies, including the aorta, carotid arteries, and peripheral vasculature.

In addition, Astute Imaging provides AI-enabled virtual device simulation, allowing surgeons to visualize and automatically identify the most appropriate device for a patient’s anatomy, enabling highly personalized procedural planning and care management. Astute Imaging’s technology is also used by medical device companies for regulatory and research applications, including core lab services and R&D support.

For media inquiries, please contact: marketing@astuteimaging.com

Beyond the Calcium Score: How AI-Enabled Coronary Plaque Analysis is Redefining Heart Health

Tue, 17 Mar 2026 14:00:01 GMT

For years, the Coronary Artery Calcium (CAC) score has been the gold standard for a quick, non-invasive look at heart disease risk. It’s a vital tool that has helped millions of patients understand if they have "hardening of the arteries." But while a calcium score tells us that plaque is present, it only tells part of the story.

As medical technology evolves, we are moving beyond simply identifying the presence of calcium to a much more detailed understanding of heart disease. With the advent of AI-enabled coronary plaque analysis, such as cvi42 | Plaque , patients and physicians now have access to a deeper level of insight that was previously impossible to achieve through standard screening alone.

What is AI-Enabled Coronary Plaque Analysis?

While a traditional calcium score measures the amount of mineralized (hard) plaque in your coronary arteries, AI-enabled plaque analysis looks at the "soft" or non-calcified plaque as well.

The procedure utilizes a Coronary CT Angiography (CCTA)—a common imaging test—and applies advanced Artificial Intelligence algorithms to "map" the entire wall of the artery. The AI identifies, categorizes, and quantifies different types of plaque with precision. This process is now recognized by the medical community with the dedicated CPT code 75577 , allowing imaging centers to provide this advanced analysis as a standard part of cardiac care as of January 2026.

The Science: Why "Soft" Plaque Matters

The primary limitation of a calcium score is that it only detects plaque that has already calcified. However, the most dangerous type of plaque is often "soft" or lipid-rich plaque. This type of plaque is more unstable and prone to rupturing, which is the leading cause of heart attacks.

The science behind AI-enabled analysis supports a "phenotypical" approach to heart health. Recent data from the CONFIRM2 Registry demonstrates that AI-guided plaque quantification—specifically non-calcified plaque volume—is a significantly more effective predictor of major cardiovascular events than traditional clinical risk scores or the calcium score alone. Furthermore, the landmark SCOT-HEART trial found that "low-attenuation" (soft) plaque burden was a stronger predictor of heart attacks than either calcium scores or the severity of artery narrowing.

What are the Benefits for the Patient?

If you are a patient concerned about your cardiac risk, AI-enabled plaque analysis offers several distinct advantages:

A Clearer Picture of Risk : You may have a low calcium score but still possess significant amounts of soft, unstable plaque. Research suggests that many patients with a "zero" calcium score still harbor non-calcified plaque that AI can detect.
Personalized Treatment : Knowing exactly what kind of plaque is in your arteries allows your cardiologist to tailor your treatment. This might mean more aggressive statin therapy, specific lifestyle changes, or further diagnostic testing.
Prognostic Value : Studies show that patients with high volumes of non-calcified plaque can have a nearly five-fold increase in the risk of a heart attack. This analysis gives you and your doctor better insight into your heart health.
Tracking Progress : Because AI can quantify plaque volume so accurately, it can be used in follow-up scans to see if your plaque is stabilizing or shrinking in response to treatment.

What Does the Procedure Entail?

For the patient, the experience is nearly identical to a standard CT scan—it is entirely non-invasive, meaning no needles are threaded into your heart and no surgery is required.

When you arrive at the imaging center, you’ll lie comfortably on a table that slides into the CT scanner. A small IV will be placed in your arm to deliver a contrast dye, which helps the heart's arteries show up clearly on the images. The technologist will ask you to hold your breath for a few seconds while the scanner captures high-resolution 3D images of your heart.

The "magic" happens in the background. The imaging data is processed by the AI-enabled cvi 42 | Plaque, which performs millions of calculations to create a detailed report. Because cvi 42 | Plaque runs locally at your hospital or clinic, your data remains secure within their environment while giving your doctor interactive control over the final interpretation.

Precision Medicine for Your Heart

We have entered a new era of preventive cardiology. In late 2025, the American College of Cardiology (ACC) issued a scientific statement confirming that quantitative plaque analysis is a powerful tool for enhancing risk assessment and guiding preventive therapies.

While the calcium score remains a helpful starting point, AI-enabled coronary plaque analysis provides the definitive roadmap for understanding your specific risk. By identifying disease in its earliest, most treatable stages, AI is helping patients and doctors stay one step ahead of heart disease.

Taking Action: How to Ask Your Doctor for a "Circle Report"

If you have a family history of heart disease, have received a concerning calcium score, or simply want the most comprehensive view of your cardiovascular health, it’s important to be your own advocate.

AI-enabled plaque analysis is a specialized tool, and not every imaging center uses the same software. If you want the precision and security of a Circle Report , here are a few specific questions to bring to your next appointment:

"I’ve read about the prognostic value of 'soft' plaque. Can we perform an AI-enabled plaque analysis (cvi 42 | Plaque) instead of just a standard calcium score?"
"Does this facility use the AI tools recognized by CPT code 75577 to quantify my total plaque volume?"
"Can I receive a 'Circle Report' that maps out my specific plaque burden so we can tailor my preventive therapy?"
"If we start a new treatment plan today, can we use AI-driven plaque quantification in the future to see if my plaque is stabilizing or shrinking?"

By requesting a Circle Report , you are asking for a higher standard of clarity. It moves the conversation from "Do I have heart disease?" to "How are we going to treat my specific type of heart disease?"

The Unified Cardiac Workflow: Bridging the Gap Between Anatomy, Function, and Inflammation

Thu, 12 Mar 2026 16:00:04 GMT

The Clinical Challenge & the cvi42 Solution

Executive Summary

Cardiovascular disease remains the leading cause of global mortality, yet diagnostic workflows remain fragmented. Traditionally, clinicians have been forced to navigate disconnected systems to assess a patient’s heart: one for anatomy (CCTA), another for function (CMR/Strain), and a third for vascular inflammation (PCAT/Plaque). This "siloed" approach creates diagnostic friction, increases costs, and delays life-saving interventions.

The Physician Perspective: Precision and Autonomy

For the radiologist and cardiologist, the transition to a unified platform offers three primary advantages:

Elimination of Diagnostic "Blind Spots": Traditional CCTA identifies stenosis (anatomy) but often fails to identify the vulnerability of a lesion. By integrating Plaque Analysis and PCAT (Pericoronary Adipose Tissue), physicians can identify active inflammation—the "hidden" driver of rupture—without leaving the workspace.
Workflow Continuity and Reduced Burnout: Jumping between disconnected systems leads to "swivel-chair" medicine. cvi 42 integrates directly into existing PACS and reporting systems (like PowerScribe One) without expensive HL7 interface, allowing for high-throughput analysis that reduces the time from "scan to report".
Financial Sustainability and Reimbursement: With the 2026 transition to a Category I CPT code (75577) for AI-enabled quantitative plaque analysis, hospitals can now retain 70% of the technical and professional reimbursement fee. cvi 42 enables the facility to perform these advanced analytics in-house, rather than outsourcing to costly third-party core labs who retain most of the reimbursement.

The Patient Impact & Strategic Outlook

The Patient Perspective: Safety and Certainty

From the patient's point of view, the diagnostic journey is often fraught with anxiety and repetitive testing. A unified workflow changes the experience fundamentally:

The "One and Done" Experience: By assessing anatomy, function, and inflammation in a single sitting, patients avoid the "diagnostic odyssey" of stressful weeks spent waiting for multiple follow-up tests.
Early Detection of the "Hidden" Risk: Many patients who appear "low risk" on standard CT scans harbor high levels of vascular inflammation. cvi 42 ’s research capabilities—such as the analysis of pericoronary adipose tissue ( PCAT) allows researchers to better understand these risks. This work is essential in the shift from reactive surgery to proactive prevention.
Personalized Clinical Clarity: A patient is more likely to adhere to a treatment plan (statins, lifestyle changes) when they can see a unified, color-coded map of their own heart's health. cvi 42 provides the visual evidence needed to drive patient compliance and trust.

Strategic Value for the Healthcare System

In a value-based care environment, the "All-in-One" approach of cvi 42 serves the Quadruple Aim:

1. Lower Costs: Reducing redundant imaging and unnecessary invasive catheterizations.

2. Better Outcomes: Comprehensive results to inform diagnoses.

3. Improved Patient Experience: Faster answers and less travel between specialists.

4. Provider Satisfaction: A modern, intuitive toolset that works at the speed of the clinician.

cvi42 empowers the clinical team to see the whole picture of Anatomy, Function, and Inflammation all in one place. This isn't just a software upgrade; it is a new standard of care for the modern heart center.

Strategic Financial Analysis: The Imaging Department & CFO Perspective

For an imaging department, by consolidating Anatomy, Function, and Inflammation into a single on-premise application, the institution secures immediate financial advantages through new reimbursement streams and significant operational efficiencies.

Revenue Capture: The 70% Retention Model

The primary financial catalyst is the 2026 activation of Category I CPT codes for AI-enabled quantitative plaque analysis. While traditional outsourcing models often result in the loss of technical fees to third-party labs, the cvi 42 on-premise solution allows the hospital to maintain a commanding share of the revenue.

cvi 42 by Circle Cardiovascular Imaging disrupts this paradigm. It is the industry’s first unified platform capable of reading Cardiac MRI and Cardiac CT, including AI-enabled Plaque and research-use PCAT analysis, within a single application. By combining Anatomy + Function + Inflammation , cvi 42 provides a holistic view of patient health in one seamless workflow.

By keeping these advanced analytics in-house, the facility avoids the high costs of third-party processing, ensuring that approximately 70% of the total reimbursement remains within the hospital's bottom line.

Performance Improvements & Capacity Expansion

The unified workflow directly addresses "swivel-chair" medicine, where clinicians lose productive time navigating disconnected systems.

• Reduction in Analysis Time : Integrated reporting and automated AI tools reduce the time from "scan to report".

• Expansion of Patient Capacity : The facility can treat more patients without increasing headcount.

• Reduced Diagnostic Friction : Reduces the administrative burden of scheduling multiple follow-up tests, further lowering the cost per patient.

• Enhanced Provider Retention : Providing a modern, intuitive toolset that works at the "speed of the clinician" mitigates burnout, a major indirect cost for healthcare systems.

Summary of Strategic Financial Value

The future of cardiac care isn't just about faster software; it’s about providing a clearer picture of patient risk when it matters most. By bridging the gap between anatomy, function, and inflammation, cvi 42 empowers clinicians to move beyond simple detection toward true prevention. As we transition into this new era of AI-enabled diagnostics and standardized reimbursement, the unified workflow stands as the new gold standard for heart health—transforming complex data into life-saving clinical confidence.

One Cardiac Platform. Triple the Impact - Part 2

Tue, 10 Mar 2026 10:00:00 GMT

Clinical and Financial Wins that Scale

From Single Platform to Strategic Advantage

Clinicians, department heads, and executives each win differently from consolidation. Circle’s cvi 42 turns integration into tangible impact across MR, CT, structural heart, and electrophysiology programs.

Why Circle’s platform stands apart

For clinicians: Market-leading MR and CT tools in one workspace, with AI-driven workflows for function, tissue, plaque, and procedural planning—faster, reproducible reads and intuitive tools for edge cases.
For department heads: Consistent multimodality workflows, research-grade quantification, and data exports supporting registries and AI projects.
For finance leaders: Shared investment across MR and CT service lines, volumealigned pricing, and new reimbursable procedures like AIenabled coronary plaque analysis.

Additional proof points:

Multimodal AI: From LV contours to coronary plaque analysis—advanced analytics integrated into everyday workflows.
Vendor neutrality: Works across all major scanner vendors and enterprise architectures without lock-in.
Global expertise: Circle’s focus on cardiovascular imaging and clinical partnerships ensures your roadmap aligns with future cardiac care.

Why now is the time

The reimbursement window is open. AI-enabled coronary plaque analysis already has an active CPT code. Each month delayed is lost reimbursable revenue and underused scanner time.
Capacity—not demand—is the bottleneck. One platform boosts throughput and enables new programs without needing new staff or capital.
Platform decisions are sticky. Once workflows are standardized, switching becomes costly. Choosing correctly now sets your foundation for the next decade.

A foundation for growth

Positioning a unified platform as a strategic foundation aligns teams and budgets:

Users gain a coherent, modern workspace with advanced tools.
Operational leaders gain control of quality and performance.
Finance teams gain a scalable, revenue-aligned asset.

Circle’s cvi 42 makes this transformation tangible helping cardiovascular imaging programs achieve technical efficiency, clinical consistency, and financial sustainability across every modality.

Stay tuned for Part 3: Clinical Wins and Daily Practice. Now that we've covered the strategic and financial advantages of consolidation, we’ll take a closer look at what this change means for the person behind the screen. We’ll explore how a unified workspace creates cognitive ease—moving from "tool juggling" to a focused clinical practice where you can spend less time navigating and more time deciding what the data actually means.

AI Coronary Plaque Analysis: Reimbursement, Risk Stratification, and What You Need to Know

Thu, 05 Mar 2026 15:00:06 GMT

The activation of Category I CPT code 75577 on January 1, 2026, has transformed the reimbursement landscape for AI-enabled coronary plaque analysis, such as Circle Cardiovascular Imaging's FDA-cleared cvi 42 . This FAQ addresses key questions on payers, coverage, coding, payments, opportunities, threats, and value-based care impacts to guide adoption in cardiovascular imaging practices that ultimately lead to commercial viability.

For Circle Cardiovascular Imaging customers deploying cvi 42 for plaque analysis, the new CPT 75577 landscape means reliable revenue streams (~$900-1,000 per case) with expanded payer access, but it requires refined billing to navigate bundling and denials. Overall, it accelerates the ROI on cvi 42 by enabling onsite AI processing that captures professional and technical fees hospitals previously outsourced.

Who is paying for the technology?

New plaque reimbursement codes like CPT 75577 enable Circle CVI's cvi 42 for AI-enabled coronary plaque analysis from CCTA, effective January 1, 2026. Payers including Medicare and major insurers like Aetna, UnitedHealthcare, and Cigna now cover this technology.
Medicare pays via OPPS (APC 1511 at ~$951 in hospital outpatient settings) and PFS (~$1,012 national average in physician offices/imaging centers). Commercial payers such as Aetna, Humana, UnitedHealthcare, and Cigna provide coverage, reaching ~70% of insured Americans. Circle CVI's on-premise cvi 42 allows sites to retain reimbursement rather than outsourcing.

Is there coverage already?

Coverage exists through the new Category I CPT code 75577, replacing prior Category III codes (0623T-0626T). Medicare LCDs and billing articles support AI plaque analysis for indications like chest pain with intermediate stenosis. Major commercial policies align, with Aetna issuing immediate coverage post-2026 activation.

What coding exists? Are there coding gaps?

Primary code: CPT 75577 for quantitative/characterization of coronary plaque from CCTA data, including physician interpretation/report.
Related codes: 75580 (FFR-CT), C9762 (strain MRI).
There are no major gaps noted; Category I status fills the prior temporary code limitations.

Is payment likely based on existing rates and practices?

Payments follow established rates: $951 OPPS (hospital outpatient), $1,012 PFS (non-facility), based on RUC work RVU 0.85.
Payments are likely stable as this Category I code integrates into standard practices, with CMS recognizing the clinical value.

What opportunities exist (new CPT codes, NTAP…)?

New CPT 75577 is driving adoption for AI analysis; there is the potential NTAP for inpatient use but has not yet been confirmed for plaque yet and so conducting these exams as an outpatient services should be considered.
This new reimbursement enables Circle's cvi 42 to scale CCTA workflows, provides for higher CCTA base payments (~$357), and insurer expansions.
The on-premises analysis capabilities boosts site revenue capture without the need for outsourcing, while also providing physicians more control over results.

What threats exist (bundling, denials, low rates)?

Under the Hospital Outpatient Prospective Payment System (OPPS), CPT 75577 is assigned to APC 1511 , packaging the AI plaque service into a bundled payment of approximately $951 rather than as a separate line item. Hospitals receive a fixed rate regardless of additional AI analysis performed alongside CCTA.
Circle's cvi 42 sites benefit from bundled OPPS payment for CPT 75577, which covers plaque analysis alongside foundational CCTA (CPT 75574). cvi42 enables efficient delivery within this payment, stacking with professional component fees. Hospital outpatient sites bill single APC 1511 claim including both services, paid $950.50
cvi 42 integrates AI plaque quantification directly into CCTA protocols: scan with 75574 (APC 5572, ~$357 base), then process onsite for 75577 plaque metrics (fatty/calcified volume, stenosis risk) within APC 1511's resource threshold. This captures comprehensive value in one outpatient encounter, avoiding outsourcing losses.
Physicians bill 75577-26 separately (~$41 RVU) for interpretation/report generated by cvi 42 .
Add perfusion (78431 APC 1522 ~$2,250) or strain if applicable; cvi42 unifies across MR/CT for multi-procedure sessions under MPFS/OPPS. Elevate subscription scales licensing, turning bundled payments into margin via higher volumes.

Payers require explicit evidence linking plaque analysis to indications like intermediate-risk chest pain or CAD-RADS 1-3 stenosis, per Medicare LCDs and commercial policies. Incomplete reports lacking quantitative plaque metrics (e.g., volume, composition) or physician interpretation trigger ~20-30% denial rates initially, necessitating appeals with structured templates.
Sites using Circle's cvi 42 can mitigate denial risks by leveraging its built-in AI quantification, interactive controls, and customizable report templates to produce LCD-compliant documentation linking plaque to indications like intermediate-risk chest pain or CAD-RADS 1-3. This ensures explicit evidence of medical necessity with quantitative metrics, slashing initial denial rates from 20-30% to under 5%.

Implement pre-billing QC checklists ensuring reports include quantitative plaque metrics, CAD-RADS linkage, and medical necessity (e.g., chest pain with 1-3 stenosis).
Use root-cause analysis on denials dashboards to triage documentation gaps, then standardize reporting templates for LCD compliance.
Secure prior authorizations upfront for commercial payers like Cigna.
Multiple Procedure Payment Reduction (MPPR) cuts reimbursement by 50% for subsequent imaging codes in the same session, potentially dropping 75577 payments below $500 when bundled with CCTA (75574). Productivity adjustments in PFS further erode physician office rates to ~$800-900 nationally.
cvi42 users can mitigate MPPR impacts (50% cut on 75577 TC when following 75574) and PFS productivity adjustments through optimized sequencing, on-premise efficiency, and multi-modality scaling that offsets reductions while maximizing reimbursable volume. This preserves net payments above $500/case despite cuts, leveraging cvi42's workflow speed for higher throughput.

Local Coverage Determinations (LCDs) differ by jurisdiction (e.g., stricter Noridian criteria vs. broader Palmetto policies) while commercial payers like Cigna may demand prior authorization despite Category I status. This inconsistency complicates standardization for cvi 42 users scaling plaque workflows.
Circle customers mitigate LCD/payer inconsistencies by deploying configurable templates, a centralized compliance matrix, and automated prior auth workflows that standardize documentation across jurisdictions like Noridian (stricter) and Palmetto (broader), while handling Cigna's PA demands. This enables seamless scaling of plaque workflows with <5% variation in approval rates.

Will value-based care (bundles, ACOs, HMOs) create obstacles or opportunities?

Bundles/ACOs/HMOs pose obstacles via fixed payments that may undervalue add-ons like plaque analysis, encouraging only essential services.
Opportunities arise if plaque analysis demonstrates outcomes (e.g., reduced MACE), justifying inclusion in risk-adjusted models or shared savings. Plaque analysis can be positioned as a preventative tool for CAD-RADS 1-3 to align with value-based care incentives.

With CPT 75577 now live and payer coverage expanding, Circle’s cvi 42 positions clinics to capture reimbursements while advancing precise plaque characterization. Review local payer policies and documentation requirements to maximize these opportunities and mitigate risks in the evolving cardiac CT ecosystem.

One Cardiac Platform. Triple the Impact

Tue, 24 Feb 2026 12:00:00 GMT

Why a Unified Cardiovascular Imaging Platform Wins

A single cardiovascular imaging post-processing platform like Circle’s cvi42 turns fragmented workflows into a unified, scalable engine for clinical, technical, and operational performance while reducing the hidden risks of a “best-of-breed” tool stack.

Why a single platform beats best-of-breed

The best-of-breed approach sounds appealing: you pick the “perfect” tool for every modality. However, it creates friction at every layer. Complex integrations, security management, and user experience gaps between multiple vendors erode efficiency. A single cardiovascular platform consolidates these functions, so you optimize once and benefit everywhere.

Technical and operational gains

For IT and operations teams, a unified platform delivers:

One architecture to secure and monitor: unified authentication, standardized hardening, and fewer exposed endpoints.
Simplified integrations: one connection for PACS/VNA, EMR, DICOM, HL7, and Reporting interfaces.
Predictable performance: tested deployment patterns and stable turnaround times across MR and CT.
Streamlined support: one vendor, one ticketing path, and fewer “finger-pointing” cycles.

For users and department leaders, benefits include:

A consistent workspace across MR, CT, structural heart, and EP.
Shared AI-driven tools that behave the same way for any case.
Standardized protocols and reports supporting collaboration and guideline adherence.

This consistency reduces variation, simplifies cross-coverage, and creates clearer levers to improve throughput and quality.

The effort and risk of going single platform

Consolidating onto one platform isn’t “zero effort.” Migration, data mapping, and user training take planning. Decision makers often worry about vendor dependence or shortterm disruption.

Yet these are finite risks while the costs of staying fragmented compound every year. Leaders often overestimate the pain of change and underestimate the ongoing “tax” of complexity. A phased rollout, superuser model, and structured training plan turn risk into a manageable project, while the status quo continues to erode capacity and margins.

Why wait?

Every month with multiple systems is a month lost to inefficiency: repeated data entry, switching tools, and unused automation. These slow the adoption of reimbursable capabilities like AI-enabled coronary plaque analysis and add invisible burnout risks for your staff.

Stay tuned for Part 2: Clinical and Financial Wins that Scale. Now that we’ve explored the technical and operational foundations of a unified platform, we’ll shift our focus to the bigger picture of strategic advantage. We’ll discuss how consolidation creates tangible impact for everyone from clinicians to executives—exploring volume-aligned pricing and the opening window for new reimbursable procedures like AI-enabled coronary plaque analysis.

Expanded Insurance Coverage Validates Circle’s AI Approach to Coronary Plaque Evaluation

Tue, 20 Jan 2026 23:26:51 GMT

Coverage unlocks reimbursable AI plaque quantification, advancing coronary risk assessment in everyday cardiology practice.

Highlights

New permanent Category I CPT code 75577 for AI-enabled coronary plaque analysis took effect January 1, 2026
Major payers, including Aetna, alongside UnitedHealthcare, Cigna, Humana, and others, now cover AI-enabled coronary plaque analysis, extending access to tens of millions of commercially insured patients
Circle’s FDA-cleared, on-premise cvi 42 |Plaque solution integrates directly into CCTA workflows, giving physicians hands-on control of AI plaque analysis and retains more of the plaque analysis reimbursement

Calgary, Alberta – Circle Cardiovascular Imaging Inc. (Circle CVI), the market leader in cardiovascular imaging postprocessing, announced that clinical practices using its FDA 510(k)-cleared cvi 42 with AI-enabled plaque analysis solution are well positioned to benefit from newly activated reimbursement for AI-enabled coronary plaque analysis under permanent Category I CPT code 75577, effective January 1, 2026. Major insurance companies have also announced that they are also reimbursing the costs of this analysis.

New Category I CPT Codes Now in Effect

Beginning January 1, 2026, AIdriven quantification and characterization of coronary atherosclerotic plaque derived from coronary CT angiography (CCTA) is reimbursed under a permanent Category I CPT code, 75577, replacing prior Category III codes. This transition enables nationally valued payment for quantitative plaque assessment across hospital outpatient departments, imaging centers, and physician offices.

Growing Payer Support for AI Plaque Analysis

Major commercial payers, including Aetna, UnitedHealthcare, Cigna, Humana, and others, now cover AI-based quantitative coronary plaque analysis , extending access to tens of millions of commercially insured patients and building on prior Medicare coverage decisions. This expanding reimbursement is expected to accelerate adoption of CCTA-based plaque assessment.

AMA/ACC Guidance on When to Use Plaque Analysis

In December 2025, a major scientific statement published in the Journal of the American College of Cardiology : Cardiovascular Imaging provided consensus recommendations on how and when to use quantitative coronary plaque analysis (QCPA) in practice. Their recommendations stated that among patients who have visual evidence of plaque on coronary CTA, adding QCPA may be useful for enhancing risk assessment and guiding the initiation or intensification of preventive therapies.

CCTA’s Emerging Role as a Primary CAD Modality

Recent analyses from cardiovascular imaging experts highlight how CCTA, augmented by AI-enabled plaque analysis, is poised to become the foundational imaging modality for the diagnosis and management of coronary artery disease. As reimbursement stabilizes and technology matures, CCTA is increasingly viewed as the frontline test that can characterize both stenosis and atherosclerotic burden, informing preventive strategies long before invasive procedures are required.

cvi42|Plaque: FDA-cleared, On-premise AI for Coronary Plaque

cvi 42 |Plaque, cleared by the U.S. FDA in late 2025, is an on-premise, AI-enabled coronary plaque analysis module that integrates directly into existing cvi 42 and CCTA workflows. The software automatically segments the coronary lumen and vessel wall, quantifies plaque burden and composition, and generates structured lesion- and vessel-level metrics to support risk stratification, preventive therapy decisions, and revascularization planning. Because the solution runs locally, image data, AI processing, and reporting remain within the institution’s environment, giving physicians interactive control over contouring and final interpretation while allowing programs to retain a larger share of reimbursement compared with outsourced, cloud only services.

Localized AI and Circle’s Elevate Pricing Advantage

“With the new Category I CPT code for coronary plaque analysis now in effect, and the major insurance players reimbursing plaque analysis, the economics and clinical evidence are finally aligned,” said Chris Bazinet, Chief Commercial Officer at Circle CVI. “cvi 42 |Plaque gives practices an on-premise, FDA-cleared AI solution that fits directly into their existing CCTA workflows, enabling guideline consistent plaque reporting, improved risk stratification, and better capture of the reimbursement now available for quantitative coronary plaque analysis.”

cvi 42 |Plaque is available as part of the broader cvi 42 platform for cardiac CT and MR. Clinical sites interested in implementing AI-enabled coronary plaque analysis can contact Circle to assess readiness, workflow integration, and revenue potential.

- ENDS -

About Circle Cardiovascular Imaging

Circle Cardiovascular Imaging Inc. (Circle CVI) is a Canadian-based company founded in 2007 with a mission to develop innovative software solutions that enhance cardiovascular and cerebrovascular imaging analysis and ultimately improve patient care. Circle’s flagship platform, cvi 42 , delivers best-in-class image reading and reporting tools for quantitative and qualitative assessment of cardiac MR, cardiac CT, vascular CT, and neuro CT.

Today, millions of medical imaging exams each year—across 1,700+ hospitals in over 90 countries—are interpreted using Circle’s cvi 42 platform.

For media inquiries, please contact:
marketing@circlecvi.com

Unlock Practice Growth: Experience cvi42 at RSNA 2025

Mon, 24 Nov 2025 19:08:37 GMT

Highlights

The latest release of cvi42v6.4 focuses on workflow efficiency and leveraging artificial intelligence
In-house post-processing speeds reporting time and captures more reimbursement
Circle’s vascular capabilities expand with the addition of cvi42 | Vascular CT
New business models increase the flexibility and accessibility for reporting physicians

Calgary, AB – Circle Cardiovascular Imaging (Circle CVI) , the market leader in cardiovascular imaging post-processing will unveil its latest release at the Radiological Society of North America (RSNA) Annual General Meeting being held November 30 – December 4 in Chicago, IL. Circle CVI will demonstrate its newest release, cvi42v6.4.

Radiology leaders know that efficiency, accuracy, and practice growth are non-negotiable. At RSNA 2025, Circle Cardiovascular Imaging invites you to experience the new cvi42 release - a solution engineered to grow your CCT and CMR business.

What cvi42 can do for your practice:

Reduce Reporting Times:
Native integration with PowerScribeautomates transcription, minimizing error risk and freeing clinical teams to focus on interpretation rather than manual data entry.
Accelerate Patient Care:
In-house plaque analysis with cvi42 enables faster turnaround times, supporting timely diagnosis and allowing you to deliver a higher standard of care.
Drive Confidence and Adoption:
cvi42 | Vascular CT follows best practices with automated contouring, lowering barriers to using advanced CT vascular analysis - so teams adopt new capabilities faster.
Increase Revenue Capture:
With cvi42 | Plaque you pay for what you process at a fraction of the price of outsourcing and increase your throughput with a streamlined workflow.
Elevate Value and Flexibility:
Our new subscription model provides scalable access to CMR and CCT functionalities ensuring your team has unlimited access to work from anywhere.

“With our latest cvi42 release, we’re helping practices unlock greater efficiency, deliver faster patient care, and build a scalable foundation for the future of cardiovascular imaging while supporting business growth” said Chris Bazinet, Chief Revenue Officer of Circle CVI. “We are excited to see how our customers respond to the latest innovations and hear from them how we are solving their challenges”

Benefits for Radiology Leaders and Decision Makers:

Minimized risk of errorin reporting
Improved workflow efficiency, leading to reduced burnout
Faster reporting speeds, translating to greater practice performance
Flexibility to scale and capture new revenue streams
Technology that aligns with evolving best practices and reimbursement guidelines

Join Us at RSNA 2025 - Shape the Future of Cardiovascular Imaging
Nov. 30 – Dec. 3 | Booth #7961, North Hall
Secure your demo now - see how cvi42 can help you lead with confidence and results.

Circle CVI Announces FDA Clearance for cvi42 | Plaque for Coronary Artery Disease Evaluation

Wed, 29 Oct 2025 19:08:37 GMT

CALGARY, CANADA, OCTOBER 29, 2025 – Circle Cardiovascular Imaging Inc. (Circle CVI), a global leader in cardiovascular imaging solutions, today announced that its cvi42 | Plaque solution has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) and is now available for clinical use in the United States. This innovative, AI-enabled solution allows clinicians to perform comprehensive coronary plaque analysis directly on-premise, enhancing diagnostic workflows and patient care.

“The clearance of cvi42 | Plaque marks a significant advancement for cardiology departments and imaging centers,” stated Erkan Akyuz, CEO of Circle CVI. “As a secure, on-premise solution, it allows for the evaluation of coronary artery disease without the need to send patient data to an external reading service. This provides clinicians with greater control over their data, improved study processing times, and enhanced workflow efficiency.”

The AI-enabled technology within cvi42 | Plaque delivers fast, accurate, and reproducible results for quantifying total, calcified, and non-calcified plaque. This detailed analysis supports more precise risk stratification and helps inform personalized treatment plans.

“With the new cvi42 | Plaque, I now have immediate and interactive control over my anatomic coronary CCTA imaging analysis,” said Dr. James Thompson, DO, Adult Congenital Heart Disease at Johns Hopkins All Childrens. “Circle CVI truly comes full circle — continuing to invest, innovate, and impress by advancing imaging applications and enhancing our cardiac CTA workflow.

This is foundational to CCTA’s front-line role in cardiovascular disease prevention, driving early translational impact and transformative patient care. Empowering early detection of the high-risk plaque attack.”

Medicare now covers AI-enabled coronary plaque analysis from CCTA with a Category III CPT code, 0625T, and national payment set at $950under recent policy updates, alongside higher base payments for the underlying CCTA exam.With cvi42 | Plaque, cardiac imaging sites can retainmost of the reimbursement, rather than outsourcing analysis and reimbursement to external providers.

AI-enabled coronary plaque analysis has been assigned a permanent Category I CPT code, 75XX6, which takes effect in January 2026. This new code, replacing previous Category III codes,facilitates national pricing and enables physician reimbursement; the AMA’s update signifies that plaque quantification is now recognized as standard clinical care in cardiovascular medicine.

cvi42 | Plaque integrates seamlessly into existing CT workflows and is compatible with all major vendor systems, providing a complete solution for cardiac imaging teams. The FDA clearance reinforces Circle CVI's commitment to delivering innovative, reliable, and user-friendly solutions that empower clinicians to provide the best possible care for their patients.

Discover how Circle CVI’s cvi42|Plaque can elevate your practice. Visit https://www.circlecvi.com/get-started to learn more and book a demo today.

CAD-RADS: A Guide to the Evolving Framework

Wed, 15 Oct 2025 19:08:37 GMT

Decoding the Coronaries

CAD-RADS, or the Coronary Artery Disease Reporting and Data System, is a standardized reporting system designed to enhance the communication of coronary artery disease (CAD) findings from imaging studies. CAD-RADS represents a significant step towards a more systematic and evidence-based approach to the management of CAD. By standardizing reporting, guiding clinical decisions, facilitating research, and improving risk stratification, CAD-RADS not only holds the potential to improve the clarity of communication between the diagnostician and the downstream physician, but at a larger scale, it could contribute significantly to better cardiovascular health outcomes across populations.

Why CAD-RADS?

CAD-RADS was developed to establish a clear and consistent framework for reporting coronary artery disease findings from coronary computed tomography angiography (CCTA).

Prior to CAD-RADS, the reporting of coronary computed tomography angiography (CCTA) findings often lacked uniformity. This variability made it challenging for referring physicians to interpret results consistently and make informed decisions about patient care.

CAD-RADS was initially created in 2016 , as a result of a collaboration between the Society for Cardiovascular Computed Tomography (SCCT) , the  American College of Radiology (ACR) , and the North American Society for Cardiovascular Imaging (NASCI) . Subsequently it was also endorsed by the American College of Cardiology (ACC) .

CAD-RADS introduced a standardized classification system, providing a common language for radiologists, cardiologists and referring physicians, facilitating a more consistent understanding of CCTA results across different institutions and regions.

The system was then updated to CAD-RADS 2.0 in 2022 to incorporate several methods for the categorization including descriptors of overall coronary plaque burden, with additional options to include CT-FFR (CT fractional flow reserve) or myocardial CT perfusion results for the assessment of lesion-specific ischemia if obtained. It also now includes the description of non-atherosclerotic coronary abnormalities as a separate modifier “E” for exceptions.

CAD-RADS reporting ensures that all imaging studies are reported in a uniform manner, making it easier for referring physicians to interpret results. The use of clear categories (ranging from CAD-RADS 0 to CAD-RADS 5) allows for quick assessment of the severity of coronary artery disease. The incorporation of P1 to P4 descriptors into the CAD-RADS framework serves to provide a more nuanced understanding of plaque burden. Each descriptor corresponds to a specific level of plaque accumulation, allowing for a more detailed assessment of a patient's coronary artery health.

Since the original CAD-RADS have been developed in 2016, many technological advancements to CCT have been incorporated into routine practice and correspondingly, CAD-RADS guidelines have also been updated.

The latest updates to CAD-RADS 2.0 have focused on improving the specificity of reports and providing clear recommendations for patient management.

As the framework gets more comprehensive, it is unavoidable that it becomes more complex and therefore more time-consuming as well.

Nevertheless, by incorporating CAD-RADS into risk assessment, clinicians can better identify individuals at higher risk who may benefit from more intensive preventive therapies or closer monitoring, potentially improving long-term population health outcomes.

The integration of AI with CAD-RADS represents a significant advancement in cardiac imaging. AI can assist in automating the categorization of findings according to CAD-RADS criteria, reducing the potential for human error and ensuring consistency in reporting. Furthermore, AI-driven analytics can provide additional insights into patient data, enabling more personalized treatment plans and improving patient outcomes. At the same time, the stratification of CAD-RADS can aid the training of AI models that might lead to a better validated approach to cardiovascular risk prediction beyond traditional expert consensus approaches.

Beyond Stenosis: Understanding the CAD-RADS Categories

CAD-RADS isn't solely about quantifying luminal narrowing. It's a comprehensive system that categorizes CCTA findings based on the likelihood of causing myocardial ischemia. This risk stratification allows for more tailored management strategies.

The updated CAD-RADS 2.0 classifications follow a now well-established framework, while adding more detailed descriptors and modifiers to augment each CAD-RADS category. This added context improves clarity, helps referring physicians understand the implications of the findings.

The system labels findings into distinct levels, ranging from CAD-RADS 0 to CAD-RADS 5 as core categories, allowing healthcare providers to quickly assess the severity of coronary artery disease and make informed decisions regarding patient management.

CAD-RADS 0: No evidence of coronary artery disease. This category indicates that the coronary arteries are normal, and there are no significant findings on the imaging study.

CAD-RADS 1: Minimal non-obstructive CAD (1-24% stenosis).This category suggests the presence of coronary artery disease without significant stenosis, meaning that there are no blockages that would impede blood flow. Typically managed with lifestyle modifications and risk factor optimization.

CAD-RADS 2: Mildly obstructive coronary artery disease (25-49% stenosis). This indicates that there is a presence of stenosis (narrowing of the arteries), which may require monitoring but typically does not necessitate immediate intervention. Clinical context becomes crucial here. Further non-invasive testing may be considered based on symptoms and risk profile.

CAD-RADS 3: Moderately obstructive coronary artery disease (50-69% stenosis). This category suggests a higher risk for adverse cardiac events and often leads to further evaluation or intervention. Stress testing is generally recommended to assess functional significance.

CAD-RADS 4A: High-grade stenosis (≥70% stenosis) in ≤2 proximal segments. Functional assessment or invasive coronary angiography (ICA) is usually indicated.

CAD-RADS 4B: Moderate-to-severe stenosis (≥50% stenosis) in the left main artery, or 3-vessel disease with severe stenosis (≥70% stenosis). ICA is strongly recommended.

CAD-RADS 5: Total occlusion. Coronary artery disease with high-risk features. This category includes findings that suggest a high likelihood of significant coronary artery disease, such as extensive calcification or high-risk plaque characteristics. Requires further evaluation, often with ICA, to determine viability and potential for revascularization.

CAD-RADS N: Non-diagnostic study. This highlights technical limitations of the study whereby obstructive CAD cannot be excluded, necessitating repeat imaging or alternative modalities.

Plaque Amount Assessment

While the primary CAD-RADS category provides a strong foundation, the system's true strength lies in its descriptors and modifiers.

The recent incorporation of P1 to P4 descriptors into the CAD-RADS 2.0 framework serves to provide a more nuanced understanding of the overall plaque burden. A unique quality of cardiac CT when compared with other non-invasive tests, is its ability to not only detect the presence but also allow for the measurement of the amount of plaque present. It is now well established that beyond the existence or absence of anatomical stenosis, the overall amount of coronary plaque has a strong association with the incidents of coronary heart disease events and therefore the inclusion of P descriptors may, indeed, offer stronger prognostic value.

P1 Descriptor

Definition : Mild plaque burden.
Implication : Indicates the presence of non-obstructive plaque, suggesting a lower risk of significant coronary artery disease.

P2 Descriptor

Definition : Moderate plaque burden.
Implication : Reflects the presence of some plaque that may warrant monitoring but is not yet obstructive.

P3 Descriptor

Definition : Severe plaque burden.
Implication : Suggests a higher risk of coronary artery disease, with potential for obstructive lesions that may require intervention.

P4 Descriptor

Definition : Extensive plaque burden.
Implication : Indicates significant plaque accumulation with a high likelihood of obstructive disease, necessitating immediate clinical attention.

The addition of P1 to P4 descriptors to the CAD-RADS categories enhances the ability to assess and communicate the severity of plaque burden in patients. This improvement not only aids in the diagnosis and management of coronary artery disease but also supports more personalized patient care strategies. Understanding these descriptors is crucial for healthcare professionals involved in cardiovascular imaging and treatment.

The Power of Modifiers: Adding Clinical Context

Modifiers provide additional context for the findings, going beyond just the severity of stenosis and the overall amount of plaque, to include other relevant factors. In addition to a specific level of plaque accumulation, allowing for a more detailed assessment of a patient's coronary artery health, these crucial modifiers incorporate additional information that may significantly impact clinical decision-making:

N (Non-diagnostic):  Indicates that the study is not fully evaluable or non-diagnostic, which may be due to motion artifacts or other technical issues.

HRP (High-Risk Plaque):  In CAD-RADS 2.0, HRP replaces the previous "Vulnerable Plaque" designation from the original CAD-RADS and indicates the presence of specific plaque features that may be more likely to cause plaque rupture and subsequent events. The presence of such presentations as positive remodeling, low attenuation plaque, napkin-ring sign, and spotty calcification elevates risk and may warrant more aggressive management even in non-obstructive lesions.

I (Ischemia): indicates that either a CT-FFR or CTP was performed. The “I” modifier has three options:
"I+" = Ischemia present
"I-" = No ischemia detected
"I+/-" = Ischemia results indeterminate

S (Stent):  Indicates the presence of stents in the coronary arteries.

G (Graft): Indicates the presence of coronary artery bypass grafts.

E (Exceptions): Denotes potential coronary abnormalities not due to atherosclerotic plaque buildup, such as compression or stenosis caused by other factors like anomalous coronary arteries or dissection.

By consistently utilizing these modifiers, CAD-RADS classification moves beyond simply reporting stenosis percentages and paints a more complete picture of the patient's atherosclerosis and the overall coronary burden and risk. The information provided by modifiers can help guide patient management decisions, such as the need for invasive angiography or revascularization. As CAD-RADS continues to evolve, there is a high likelihood of more specific modifiers being incorporated in the future as well.

Importance of CAD-RADS in

Clinical Practice

The true value of CAD-RADS lies in its seamless integration into daily clinical practice. Consider these practical implications:

Standardization: By providing a uniform reporting system , CAD-RADS enhances communication among healthcare providers, ensuring that everyone involved in a patient's care understands the severity of their condition.

Multidisciplinary Collaboration: Discussion of complex CAD-RADS findings should be a routine part of cross-specialty team meetings to leverage the expertise of interventional cardiologists, cardiac surgeons, and imaging specialists. CAD-RADS can serve as a quantified “lingua franca” in these team discussions. CAD-RADS should be a critical pillar of peer-review, quality assurance and continuing education in CAD diagnosis and therapy planning.

Guided Management: The clear categorization of findings helps clinicians determine the appropriate management strategies for patients, from medication, lifestyle modifications to invasive procedures.

Risk Stratification: Utilizing CAD-RADS categories and modifiers in conjunction with clinical presentation, risk factors, and other diagnostic tools can guide further testing and treatment strategies.

Patient Communication: CAD-RADS provides a framework for explaining CCTA findings to patients in a clear and understandable manner, fostering shared decision-making. Using the power of “an image worth a thousand words” combined with quantified measurements, can facilitate an understanding of the severity of the clinical condition and the importance of adhering to the prescribed management routine.

Improved Patient Outcomes at Scale: Standardized diagnostic reporting can facilitate following CAD at the population health level. By assisting with timely and accurate diagnosis and treatment, CAD-RADS can contribute to better patient outcomes and reduced morbidity associated with coronary artery disease.

In essence, CAD-RADS represents a significant step towards a more systematic and evidence-based approach to the management of CAD. By standardizing reporting, guiding clinical decisions, facilitating research, and improving risk stratification, CAD-RADS has the potential to contribute to better cardiovascular health outcomes across populations. The ongoing updates to CAD-RADS, such as the introduction of CAD-RADS 2.0 incorporating plaque burden assessment and high-risk plaque features, further underscore its evolving role in optimizing patient care and population health.

CAD-RADS is a vital tool in the assessment and management of coronary artery disease. By standardizing the reporting of imaging findings, it enhances communication among healthcare providers and guides clinical decision-making.

Looking Ahead:

As the understanding of coronary artery disease continues to evolve, CAD-RADS will remain an essential component in the care of patients at risk for cardiovascular events.

The recent developments incorporated into CAD-RADS 2.0 have already significantly enhanced the communication of test results between radiologists and referring physicians.

By providing standardized, clear, and actionable reports, CAD-RADS facilitates better patient management and outcomes. As these advancements continue to evolve, they promise to further improve the quality of care for patients with coronary artery disease.

To learn more about CAD-RADS and how to incorporate them into your practice, visit https://www.circlecvi.com/cardiac-ct#reporting

Despite the promising developments in CAD-RADS and AI-based post-processing systems , several challenges remain.

These include the need for robust validation of AI algorithms, ensuring interoperability and standardization between different systems, in addition to the ever-present concerns related to data privacy and security. Future research should focus on overcoming these obstacles while continuing to refine CAD-RADS and exploring the role of new AI applications in cardiac imaging.

As CCTA technology advances, so too will CAD-RADS. We can anticipate further refinement of the categories and modifiers, potentially incorporating artificial intelligence and machine learning to enhance risk prediction and personalized management.

For any healthcare professionals, familiarizing themselves with CAD-RADS, embracing its comprehensive framework and utilizing its modifiers thoughtfully, can unlock its full potential and help navigate the complexities of coronary imaging with greater confidence and precision.

A Brief History of Coronary Artery Disease Research and Diagnosis

Wed, 27 Aug 2025 19:08:37 GMT

Taking a tour of even some of the historical branches of coronary artery disease (CAD) research, should make any healthcare professional excited in anticipation of the synthesizing effect of emerging technologies, such as AI, in CAD diagnosis, treatment and prevention.

History of Coronary Artery Disease Research and Diagnosis seems to predict a great leap forward

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. While often thought of as a “modern disease”, Coronary Artery Disease is probably as old as humanity. In evolutionary terms, the complex effects of prolonged lack of oxygen to myocardial tissue - as a result of the reduced blood flow via the arteries that supply the heart itself - are likely as old as the structure and function of any hominid heart.

Long before the terms "atherosclerosis" or "ischemia" were coined, humanity had already begun encountering the symptoms of coronary artery disease. Ancient Egyptian mummies have shown evidence of arterial calcification, suggesting that atherosclerosis – the buildup of atheroma within blood vessels – has existed for millennia. These calcified plaques, visible through modern imaging like CT and MR contrast-enhanced scans, tell a story of a disease that spans human history.

The history of diagnosing and treatment of CAD is a fascinating journey reflecting advancements in medical understanding and technology. As is often the case, the various innovations serving as milestones on this journey say as much about the age in which they were introduced as they do about the disease they are attempting to diagnose or treat.

For most of humanity's evolution and more recent sentient, recorded history, just from symptoms observed, the morbidity related to the functional “design” of our heart’s own plumbing must have been a terrifying (and perceived mostly as mind-bogglingly random) way to go. “If only we could recognize the signs earlier, predict the “attack” from early occurring symptoms” ...maybe then, we could prevent the seemingly random, sudden deaths resulting.

This became the mantra, even the obsession of physicians and researchers focused on solving this puzzle. Starting from very caring, but only anecdotal observation, the inquisitive, but slow pattern-searching followed. Different branches of research began to take shape. Then, as in every other area of medical research, art gave way to science and through experimentation and innovation we started to make progress in researching the heart and the role of the coronary vessels as well. However, while each branch built on the conclusions of previous studies, the different areas of research have remained largely independent in approach and as a result, often stayed isolated in their progress as well.

From Early Clinical Observations to Linking Symptoms to the Heart - The age of enlightenment and the honing of the scientific process:

Historical medical texts, including those from ancient Greek and Chinese medicine, documented symptoms like chest pain, shortness of breath, and fainting – signs now often associated with CAD. While these early observations were often interpreted through mystical or humoral lenses, they laid the foundation for the clinical curiosity that would fuel centuries of cardiovascular research.

Before any specific diagnostic tools existed, CAD was primarily recognized through its symptoms, most notably as chest pain. During the renaissance, anatomical discoveries through autopsies started to uncover the links between the structure of the heart and blood supply but the cause of angina remained too complex for the models of the age.

William Heberden provided a detailed clinical description of angina pectoris in the late 18th century, linking it to exertion and emotional stress – further complicating the observed model. However, the underlying cause of narrowed coronary arteries wasn't fully understood.

The Dawn of Objective Diagnosis (Early 20th Century):

Early 1900s: Electrocardiogram (ECG):The excitement of the age about all things electric, predictably, was applied to cardiac research as well. The early 20th century introduced a transformative leap in cardiac diagnosis with the invention of the electrocardiogram by Willem Einthoven .

This groundbreaking device allowed doctors to record the heart’s electrical activity - a revolutionary method that marked the first truly objective diagnostic cardiac exam. ECG allowed physicians to record the electrical activity of the heart and identify patterns indicative of myocardial ischemia and infarction. It also signaled the shift from just understanding to actually trying to do something about cardiac diseases.

Visualizing the Arteries - Catheterization and Coronary Angiography:

The magic of looking inside the human body without having to take it apart, through Wilhelm Roentgen’s X-rays, was obviously going to be aimed at the heart as well. The moment the technology moved from the hands of WWI military field-medics to routine practice in hospitals, the first cardiac fluoroscopy studies were also performed.

The bizarre, self-experimentation story of first the cardiac catheterization was practically inevitable and also reflected the weirdness of the age between the world-wars. But, as Forssmann walked the stairs from the OR to the x-ray room a floor below with a catheter he inserted into his own right ventricle via his antecubital vein in 1929, (just wow!!) the practice of cardiology changed forever– the stunt proved that internal cardiac access was possible.

The development of coronary angiography by Mason Sones by the late 1950s logically followed and, indeed, marked another significant leap in our understanding. The concept of injecting a contrast dye into the coronary arteries and taking X-ray images, allowed direct visualization of arterial blockages in real time and in-situ mapping of coronary arteries and their stenosis. Angiography quickly became the "gold standard" for definitively diagnosing the presence and extent of CAD, further improving our model of not only how a normal human heart tissue is structured and supplied with oxygen, but also showing how narrowing's and blockages in “this plumbing” result in the disease that can lead to potentially fatal clinical consequences. While our functional modeling and understanding of the disease took millennia, it took Dr. Sones less than a decade to move from the first coronary angiogram to the first coronary artery bypass graft (CABG) procedure.

Expanding Diagnostic Capabilities in the late 20th and early 21st Centuries:

Now that we had a clear model of CAD with a viable “fix”, the search was on to recognize it earlier, with decreasingly invasive procedures. The objective became to make the diagnosis more definitive and more predictive, while also reducing the risk from the diagnostic procedures themselves. At the same time, finding new patterns now visible from the combination of deploying the different diagnostic modalities that became available increased our understanding of the cause and the clinical risk from the extent and location of the stenosis.
Stress Testing: Exercise electrocardiography (stress testing) gained prominence as a non-invasive way to provoke symptoms and ECG changes suggestive of CAD during physical exertion, combining clear anatomical understanding of heart function with the patterns of electrical activity.

Prominence of Imaging:

One unexpectedly positive legacy of the “nuclear age” – the medical use of isotopes for functional imaging was predictably applied to CAD diagnosis as well. Nuclear Cardiology techniques like myocardial perfusion imaging using radioactive tracers emerged to assess blood flow to the heart muscle under rest and stress conditions.

The recognition of the negative effects of radiation necessitated the innovation of imaging while minimizing ionizing radiation. Ultrasound imaging of the heart became a valuable tool to assess heart function and sometimes visualize signs of ischemia. Combining ECG with ultrasound, stress echocardiography further enhanced CAD diagnostic capability.

Computed Tomography Angiography (CTA) : As the age of analog instrumentation gave way to the age of digital signal processing and computers, CT imaging was born. In Cardiology, non-invasive, Computed Tomography Angiography(CTA) logically followed . In more recent decades, even though it is using x-rays, non-invasive CT angiography has become increasingly sophisticated, providing detailed 3D images of the coronary arteries without the need for catheterization in many cases. The near-ubiquitous access to CT scanners made cardiac CT (CCT) studies very common. The acquisition protocols have also evolved to better visualize lipid and calcium deposits, while quantitative analysis and standardized reporting of CAD continues to hold further great potential.

Cardiac Magnetic Resonance Imaging (CMR ): Along with CCT, Cardiac MRI offers detailed information about heart structure and function and can be used to detect myocardial scar tissue and assess blood flow. Being a non-invasive, radiation-free imaging modality, CMR imaging is useful for the management of patients with CAD. Various MR acquisition techniques and protocols have been developed over the last three decades to evaluate cardiac function and detect defects in myocardial perfusion. Specifically, late gadolinium enhancement (LGE) imaging, a well-established technique that uses contrast to highlight scar tissue, can identify the presence and extent of scar tissue in the heart, which is a common finding in CAD. While CMR has a high degree of accuracy and reliability in detecting and characterizing CAD, the modality also allows accurate risk stratification of patients with established CAD.

Post-processing and Reporting : While the amount of imaging studies and the corresponding imaging data has increased exponentially, the need for post-processing has also sky-rocketed, making automation necessary. Machine-learning techniques make it increasingly possible to minimize the manual effort required to not only accurately map the cardiac structure, function and blood-flow but to also to quantitatively analyze cardiovascular diseases, including CAD. Structured reporting’s adoption in cardiology is significantly ahead of other disciplines. Yet, only in the last decade have we started routinely categorizing and stratifying CAD , based on the extent of stenosis and overall plaque burden. Needless to say, quantified analysis and standardized reporting represent both a great downstream clinical value and a gold-mine of data for population-level analysis.

Biomarkers for CAD : Another great branch of CAD research has been producing deeper understanding by identifying and utilizing various proteins, peptides and enzymes that are involved in CAD. Troponins, BNP, CRP, MPO, Lp(a) and IL-6– to name a few - each play a unique role in the diagnosis, risk assessment, and management of CAD. Troponins are considered the gold standard for diagnosing myocardial infarction (MI) and are highly sensitive and specific for cardiac injury. Elevated troponin levels can indicate ongoing ischemia and are used to assess the severity of CAD, often guiding decisions in emergency settings, triaging patients for further imaging or intervention. As research continues to evolve, these and other biomarkers may offer new insights into the pathophysiology of CAD. Labs now use highly sensitive assays to detect even minute changes, and AI-powered platforms hold the potential to synthesize this multifactor, often unstructured data into actionable clinical insights.

Genetics and epigenetics - Unlocking Hereditary Risk : Recent studies have identified numerous genetic variants associated with CAD . Genome-wide association studies (GWAS) have pinpointed specific genes linked to lipid metabolism, inflammation, and vascular function. Some of these notable genetic markers associated with CAD have been studied extensively, including:

PCSK9 : Variants in this gene can lead to elevated cholesterol levels, increasing CAD risk.
LDLR : Mutations in the LDL receptor gene are linked to familial hypercholesterolemia, a condition that significantly raises the risk of CAD.
APOE : The APOE gene is involved in lipid metabolism, and certain alleles are associated with increased CAD risk.

Ongoing studies aim to discover more genetic variants and their functional implications . Additionally, advancements in gene editing technologies, such as CRISPR, hold promise for developing novel therapies that target the genetic basis of CAD.

By leveraging genetic insights, healthcare providers will be empowered to routinely offer personalized care that addresses the unique risk factors of each patient.

Present-Day Landscape: Merging Traditional and Tech-Driven Tools

By now, in the early 21st century, we understand that Coronary Artery Disease occurs when the coronary arteries become narrowed or blocked, often due to atherosclerosis. Statistically, we have identified known risk factors, that include high cholesterol, hypertension, smoking, and diabetes.

Nevertheless, CAD is a complex disease that varies in presentation and its exact progression in an individual remains difficult to predict. The biological mechanisms that lead to lipid deposits and calcification leading to the progression of the disease are relatively well understood. The less deterministic impact of family history, genetics and epigenetics is much less understood.

Today, the diagnosis of CAD often involves a combination of the previously mentioned methods, tailored to the individual patient's symptoms, risk factors, and clinical presentation. Simple, diagnostic stress-ECG tests are most often used for initial evaluation followed often by modern, non-invasive imaging studies, such as an echo and cross-sectional imaging studies (CCTA or CMR), with coronary angiography reserved for cases requiring more definitive diagnosis or intervention. The field continues to evolve with ongoing research into new imaging and other diagnostic techniques, with each test carrying different advantages and disadvantages.

Progress needs AI: The Case for Integration

Overcoming Fragmentation in Research and Practice

Progress is never a linear progression. Just like in other areas of cardiac research, and indeed all of medicine, of course, promising work is being done continuously in independent, but often diverging, sometimes even isolated areas of research.

The practice of medicine organized into compartmentalized healthcare departments brings focus to sub-specialties, but, combined with the funding structure through grants, the deep and narrow areas of research often continue in silos without the benefit of broader perspectives. This fragmentation not only creates frustrating confusion for patients, it also limits healthcare’s ability to generate holistic, personalized care plans.

It is high time to bring our historical learnings together – converging them, breaching conventional boundaries to improve cardiac research and care. Just like in other areas of life, we need to work to figure out how to bring AI to play a key role in integrating huge volumes of data and synthesize the information within various adjacent but seemingly independent scientific domains.

AI doesn’t just process data- by analyzing diverse and large datasets, AI could potentially help predict coronary artery disease risk, develop personalized interventions for individual patients, effectively synthesizing knowledge from various biological, diagnostic and medical disciplines.

AI also holds the potential to assist researchers by generating novel research hypotheses, detailed overviews, and experimental protocols based on a specified research goal for CAD research. AI could and should be harnessed to improve clinical practice diagnosis and subsequent management.

Conclusion

From the earliest symptom observations to today’s cutting-edge diagnostics, each era has added layers to our understanding of CAD. Can't wait to see what yet unpredictable benefits the age of AI will bring to the deepening of our understanding, assessment ultimately to the treatment of this pervasive condition.

It is exciting to imagine what the ever-expanding pattern-search, pattern recognition, and modeling capabilities of even narrow-AI algorithms will bring to the table in terms of personalized risk assessment from multifactor quantified analysis, early screening, based on genetic and epigenetic risk factors, incidental findings from non-cardiac intended chest studies, and more.

Maybe, just maybe,…we are on the cusp of bringing many possible angles of research, population health and diagnostic techniques together to make them quantified enough to bring these new, learning, modeling, intelligent tools to bear early enough for tackling CAD prevention- not just for an individual patient but for an at-risk population segment.

To learn more about how AI-based CCTA post-processing can be part of your practice, visit www.circlecvi.com/cardiac-ct .

As research continues to evolve, the integration of the many different “branches of research” into clinical practice supercharged by AI, will undoubtedly enhance our ability to prevent, diagnose and treat CAD, ultimately improving patient outcomes and reducing the burden of this prevalent disease.

Frequently Asked Questions (FAQs)

Q1. What are the most frequently used tests for diagnosing coronary artery disease?

A combination of stress testing, cardiac CT angiography (CCTA), cardiac MRI, and biomarkers like troponin offers the highest diagnostic accuracy. Each test has unique advantages depending on patient risk profile.

Q2. How can artificial intelligence improve CAD diagnosis?

AI has the potential to improve CAD diagnosis by analyzing imaging, ECG, and lab datasets faster and with higher accuracy and consistency. It can help detect patterns in multi-modality datasets in the longitudinal health record of an individual patient, or can be an invaluable tool for analyzing large, multi-factor datasets across many patient groups.

Q3. What role do genetics play in CAD?

Genetics significantly affect CAD risk. Variants in genes like PCSK9, LDLR, and APOE can influence cholesterol metabolism, inflammation, and vascular function. Epigenetics further modify gene expression in the risk of CAD for a given patient.

Q4. Can CAD be detected early without invasive procedures?

Yes. Non-invasive imaging techniques like CT angiography, cardiac MRI, and stress testing, combined with biomarker analysis, can detect early signs of CAD without invasive catheterization. Given the general pervasiveness of CT for many different type of trauma or other clinical reasons for abdominal/chest CT acute studies, including additional quantitative analysis of CAD risk might carry significant value in the long run.

Q5. What’s next for CAD diagnostics?

Future diagnostics will rely heavily on AI, predictive modeling, and integration of multi-modal data including genomics, imaging, and lifestyle tracking. These advancements aim to enable early detection and prevention.

Cardiac CT Scan Vs Angiogram: What's The Difference?

Tue, 17 Oct 2023 19:08:37 GMT

A cardiac computerized tomography (CT) scan – which can also be referred to as a coronary CT angiography or CT angiogram – is an imaging test to view the heart and blood vessels. It is a test that carries few risks and is less invasive than alternative procedures such as an angiogram.

In this article, we are going to compare an angiogram with a cardiac CT scan ; a more modern version of the traditional angiogram.

What is an angiogram?

An angiogram uses X-rays to produce images of the heart’s blood vessels. It is done to check for any restrictions of the blood flow to the heart. An angiogram is also able to diagnose and treat conditions relating to the heart and blood vessels.

An angiogram works by guiding a catheter into the artery near the wrist or groin so the contrast dye can be injected to highlight blood vessels within the targeted area. An incision must be made in order to insert the catheter, and this is performed under a local anaesthetic. As the contrast agent flows through the blood vessels, X-rays of the head and chest will be taken from various angles. This is to diagnose or detect any issues affecting a patient’s blood vessels, such as atherosclerosis .

What is a CT angiogram?

A cardiac CT angiogram is a less invasive version of the traditional angiogram. Utilising state of the art computer tomography scanners, it checks the arteries supplying blood to the heart, and can be used to diagnose conditions such as coronary artery disease (CAD). Using detailed images of the heart and blood vessels, a CT angiogram can accurately highlight any narrowed or congested blood vessels.

CT angiography vs angiogram

CT angiography is a less invasive version of the traditional angiogram. The main difference between the two procedures is that while a standard angiogram involves a catheter being inserted into the artery and to the area being studied, a CT angiogram does not require the insertion of a catheter.

A significant advantage of a CT angiogram over a traditional angiogram is that a CT angiogram is non-invasive. However, for cases of abnormal CT angiogram results - such as one or several blood vessels being blocked or narrowed - a standard angiogram may be required as a follow-up. This is typical when surgery to treat the blockage or narrowing is being considered. Therefore, in some cases, a traditional angiogram can be more beneficial than a CT angiogram, as the doctor can perform an angioplasty right away.

How accurate is a CT angiogram compared to a traditional angiogram?

Studies have assessed the accuracy of a CT angiogram in comparison to an invasive coronary angiography. A study of CT coronary angiography vs invasive coronary angiography in coronary heart disease (CHD) looked at data from 44 diagnostic studies using invasive coronary angiography as the reference standard and two diagnostic studies using intracoronary pressure measurement as the reference standard. It was found that compared to invasive coronary angiography, CT coronary angiography had a sensitivity of 80% versus 67%, and a specificity of 67% versus 75%.

It is advised that CT coronary angiography should be the method of choice for ruling out obstructive coronary stenoses (OCS) to avoid patients having to experience an invasive angiogram. However, this should only be advised for patients with a pretest probability for CHD of 50% or lower.

Another study into the accuracy of CT angiography looked at 291 patients with symptoms of coronary artery disease (CAD) who were examined using a 64-slice CT scanner. It was found that CT angiogram identified 85% of patients with significant stenoses and 90% of patients with CAD accurately. The authors concluded that while CT angiography was not ready to replace conventional angiograms entirely, the more modern procedure was nearly as accurate as the traditional angiogram.

Cardiac CT Angiograms possess a high amount of accuracy for detecting CHD in patients when compared to a traditional angiogram. Nevertheless, diagnostic accuracy is decreased in diagnosing coronary stents due and severe coronary artery calcification due to its subordinate spatial resolution when compared to invasive angiograms.

However, a recent discovery has found an ultrahigh-resolution CT scanner that could be capable of overcoming the limitation of conventional CTA in the environment of severe stents or coronary artery calcification , thus surpassing it’s invasive counterpart. The ultrahigh-resolution CT scanner (UHR-CT) is equipped with 0.25 mm detector rows, half the width than what’s currently on the market (0.5 mm), which will result in twice the spatial resolution.

Angiogram risks

As with any procedure that involves X-rays, an angiogram exposes you to radiation. Complications from an angiogram are rare. However, potential risks include:

Injury to the catheterized artery
An allergic reaction to the medication or contrast agent
Arrhythmias
Bleeding
Infection
Stroke
Heart attack

CT angiogram risks

Like an angiogram, the X-rays that are involved in a CT angiogram will expose you to radiation. The level of exposure will depend on the machine type that is used. There is some degree of risk related to radiation exposure - such as the potential to harm living tissue and cause cancer - although this risk is small. You are not suitable for a CT angiogram if you are pregnant, as there is the potential it might harm your unborn baby.

Other potential complications from a CT angiogram, which are rare, include an allergic reaction to the contrast agent, which could cause symptoms such as:

Redness
Itching
Hives
Breathing difficulty
Nausea

Conclusion

A CT angiogram and a traditional angiogram are both effective imaging tests in diagnosing conditions relating to the heart and blood vessels. However, many will favor the non-invasive option of a CT angiogram, which is fast, convenient and relatively painless. A CT angiogram is very accurate in detecting CHD in patients and almost as accurate as a traditional angiogram, allowing doctors to make decisions such as ruling out CAD in patients with a low-to-medium risk of disease.

CT scans are already the preferred method of choice for patients with a pretest probability for CHD of 50% or lower. And with the recent introduction of ultrahigh-resolution CT scanners, it could only be a matter of time until conventional invasive angiograms are slowly filtered out and replaced entirely by CT scanners; due to their accuracy, convenience and development in spatial resolution.

Try cvi42 for CT scanners

Our fully embedded AI medical imaging software tool cvi 42 , provides unique tools for the evaluations of CAD using cardiac CT . These include:

Calcium scoring
Coronary arteries
Plaque assessment
Simplified reporting

You can learn more about the capabilities of our leading CT imaging software by downloading a free 42 day trial of cvi 42 . Experience the difference in AI reporting today. For more information or to speak to our customer support team, please contact us.

Sources :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334923/

https://www.nejm.org/doi/full/10.1056/nejmoa0806576

https://www.docpanel.com/blog/post/significance-coronary-artery-calcification-ct-scan

https://www.nhs.uk/conditions/coronary-angioplasty/

https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569#:~:text=Atherosclerosis%20is%20the%20buildup%20of,leading%20to%20a%20blood%20clot .

https://www.nhsinform.scot/tests-and-treatments/scans-and-x-rays/angiography#:~:text=An%20angiogram%20is%20a%20type,as%20it%20moves%20through%20them .

Quantitative Assessment Of CAD Using CMR

Thu, 03 Feb 2022 19:53:41 GMT

Can quantitative assessment of coronary artery disease (CAD) open the door to greater reproducibility and diagnostic accuracy than qualitative methods?

I n a recent review , researchers from the Cardiovascular Imaging Department at the Monzino Cardiology Centre in Milan, Italy, set out to explore the conduction of quantitative assessment of CAD, and its advantages over traditional, qualitative methods. The drawbacks of qualitative techniques were highlighted as limited sensitivity, low reproducibility, and the use of a binary approach to ischemia.

The review provided an overview of how myocardial perfusion can be used to assess CAD, as well as indications, challenges, and opportunities to improve patient management.

Superior performance of CMR?

The review highlighted the three “robust techniques” used for myocardial perfusion in clinical practice as single-photon emission CT (SPECT), positron emission tomography (PET), and cardiovascular magnetic resonance (CMR) . Of the three techniques, CMR and PET had demonstrated superior diagnostic accuracy in most meta-analyses . A fourth method, CT perfusion, has emerged more recently, but the review pointed out that there is less literature containing evidence of this technique’s effectiveness than the first three methods.

The limitations of a qualitative approach

A comparison of CMR and SPECT in women with suspected CAD from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) Trial found that qualitative assessment of ischemia with CMR had greater sensitivity than SPECT in both males and females. However, another study showed that adding semi-quantitative CMR to qualitative stress magnetic resonance myocardial perfusion could produce higher sensitivity, especially in left circumflex lesions detection.

There is more evidence to suggest that qualitative perfusion may be insufficient for future clinical practice. The Dan-NICAD study compared the diagnostic accuracy of myocardial perfusion (with visually-assessed SPECT and CMR) against invasive coronary angiography (ICA) with fractional flow reserve (FFR) in patients with suspected CAD by coronary computed tomography angiography (CCTA). It was found that the sensitivity of both CMR and SPECT, which were visually assessed, was low compared with FFR, questioning whether the diagnostic accuracy of qualitative perfusion is sufficient for future clinical needs.

Advantages of absolute quantification

The review identified the main advantages of the three quantification techniques – which are the dual-bolus protocol, pre-bolus technique, and single bolus with a dual sequence – as being “improved reproducibility and diagnostic accuracy”.

It highlighted the findings of a study by researchers from King’s College London which demonstrated that, compared with visual assessment, quantitative perfusion analysis techniques had a higher accuracy for correctly identifying the presence of coronary microvascular dysfunction. Research demonstrating that the capacity to detect functionally significant coronary stenosis is incrementally improved by the successive addition of coronary flow reserve, stress myocardial blood flow (MBF), and relative flow reserve to relative perfusion defect assessments was also presented, along with the CE-MARC trial’s establishment of CMR’s superior diagnostic accuracy over SPECT in CAD.

An insufficient level of training has been picked out as the main determinant of the diagnostic accuracy of visual assessment.

Using myocardial perfusion to assess CAD

The review’s authors stated that in their own experience, as a first-line test in symptomatic patients with a previous history of revascularisation, CMR offered higher cost-effectiveness compared to anatomical assessment with CCTA .

The Dan-NICAD study has identified a “huge need” for quantitative perfusion in the setting of obstructive CAD, as the sensitivity of qualitative perfusion alone is not sufficient. Based on this finding and to increase diagnostic accuracy, the authors of the review have begun clinical examinations with quantitative perfusion on top of anatomical assessment with CT and will start assessments using quantitative perfusion with CMR.

Improving CAD patient management with absolute quantification

Absolute quantification with CMR improves the management of patients with CAD, the review explained. It does this by delineating different levels of ischemia, rather than producing the binary result of qualitative techniques; i.e. a result that is either positive or negative for ischemia. This allows clinicians to differentiate between patients with a mild, moderate, or severe reduction of stress myocardial blood flow (MBF), and also to distinguish between patients with a lower or higher volume of myocardial mass. It is hoped that in the future, quantitative perfusion will be able to identify “an optimal threshold that can be used in clinical practice to distinguish between patients with CAD who require medical therapy and the minority of patients with CAD who require revascularisation”.

In terms of diagnosis, the review highlighted research that showed automatically generated, fully quantitative CMR MBF pixel maps to have high diagnostic performance for detecting significant CAD. A study of patients with known or suspected CAD revealed that a strong, independent predictor of adverse cardiovascular outcomes was provided by the automatic measurement of reduced MBF and myocardial perfusion reserve using artificial intelligence quantification of CMR perfusion mapping.

Indications for quantitative assessment

The authors believe that the first indication for quantitative assessment in patients with a positive CT , and the second indication in patients with complex coronary artery anatomy, “for whom CT is not a useful examination” - is recommended that functional testing with stress CMR is used for these patients. Quantitative assessment is also used by the authors for the prognostic stratification of patients with heart muscle diseases.

Challenges and conclusion

Among the challenges cited by the review were “a lack of reference values” with “many confounders that can influence MBF thresholds, such as cardiovascular risk factors”. The “cost and lack of availability of perfusion CMR in all centers” were also highlighted.

It is concluded that data suggests “quantitative perfusion could be a solution” to the “puzzle” of CAD diagnosis. The authors propose that now “quantitative perfusion has started to be used in a large number of patients, their data must be entered into large registries that track outcomes,” before artificial intelligence is used to establish “robust MBF thresholds that are related to patient outcomes”.

To learn more about quantitive perfusion and the many benefits it possesses, from high diagnostic accuracy to fast and automatic analysis, why not try it out for 42 days? Download a free cvi42 trial to discover the many capabilities and benefits of a powerful multi-modality imaging software.

Sources:

https://www.emjreviews.com/cardiology/article/clinical-efficiency-of-absolute-quantitative-cardiovascular-magnetic-resonance-myocardial-perfusion-for-coronary-artery-disease-s020321/

https://www.researchgate.net/publication/339462630_Clinical_quantitative_cardiac_imaging_for_the_assessment_of_myocardial_ischaemia

https://pubmed.ncbi.nlm.nih.gov/24357404/

https://pubmed.ncbi.nlm.nih.gov/26642757/

https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-018-0493-4#:~:text=Our%20study%20demonstrates%20that%20the,in%20the%20identification%20of%20CAD.&text=Rest%20images%20did%20not%20significantly,similarly%20to%20level%2D3%20operators

https://pubmed.ncbi.nlm.nih.gov/27894070

https://pubmed.ncbi.nlm.nih.gov/29454767/

https://www.researchgate.net/publication/339273369_The_Prognostic_Significance_of_Quantitative_Myocardial_Perfusion_An_Artificial_Intelligence_Based_Approach_Using_Perfusion_Mapping

How Accurate Is Cardiac Calcium Scoring?

Mon, 01 Nov 2021 20:05:34 GMT

A CT cardiac calcium scoring test, also known as a calcium scan, can be suitable for people between the ages of 40 and 70 who have an increased heart disease risk but are not showing any symptoms.

At the end of a calcium scan, patients are given a calcium score. But what is cardiac calcium scoring? How accurate is it? And what calcium scoring software is available? Those are just some of the questions which we will answer in this article.

What is cardiac calcium scoring?

Cardiac calcium scoring tests can be used to determine the risk of cardiovascular disease and heart disease. The tests use a multi-slice CT scanner for the detection of small amounts of calcium or plaque in the coronary arteries. Images can show whether the coronary arteries are narrowed or blocked by any calcium or plaque build-up, which can be an indicator of heart disease.

What is involved in cardiac CT scoring?

Cardiac CT scoring is a non-invasive procedure that involves a CT scanner and works similarly to many other imaging tests. X-ray beams and x-ray detectors will rotate around the patient, measuring radiation absorbed by the body.

The scanner takes a set of images before the table moves and more images are taken. State-of-the-art cardiovascular imaging software is then used to process the data and create cross-sectional images of the body that are displayed on a monitor. The procedure only takes a few seconds and can offer a detailed, multidimensional view.

Who needs a CT cardiac calcium scoring test?

If you are at a higher risk of having heart disease, you might need a calcium scan. Heart disease risk can be increased by factors such as:

Smoking
Heart disease running the family
Being overweight
Being inactive
Having a history of diabetes, high cholesterol, or high blood pressure

How accurate is cardiac calcium scoring?

With the information obtained from the test, the amount of calcification can be determined, and this is represented by the calcium score. The calcium score can be used to predict the chance of a heart attack ( myocardial infarction ) in the future, helping doctors and cardiologists decide on the best treatment.

Calcium scores have a high level of accuracy, due to the clarity of the results produced by the calcium procedure. The multi-slice CT scanner takes pictures of the heart in thin sections. When these images are combined, calcium deposits can be revealed, showing up as white specks. Imaging software can then calculate the score based on the calcification measured. An advantage of the CT cardiac calcium scoring test is that false positive or false negative calcium scores are very unlikely.

Cardiac calcium scoring chart

The scoring chart measures the amount of calcification found, which is used as an indicator for the presence of heart disease. Before the result of your cardiac calcium scoring test is sent to your doctor by the cardiologist, it could be converted into a percentile rank that is based on your gender and age.

The lower your cardiac calcium score and percentile rank, the lower your chance of having a cardiac event in comparison to people of your age:

A calcium score of 0 means there is no evidence of heart disease
1-10 is for minimal evidence of heart disease
11-100 is for mild evidence of heart disease
101-400 is for moderate evidence of heart disease
Over 300 is for extensive evidence

Cardiac calcium scoring results

Now we’ve covered the basic structure of the cardiac calcium scoring chart, let’s look in more detail at what the various scoring brackets represent:

0 – a score of zero indicates that no calcium has been found in the heart and that your chance of developing a heart attack is low
1-10 - a score from one to ten means that your chance of having heart disease is under 10% and that you have a low risk of a heart attack
11-100 – a score in this bracket means that you have mild heart disease and that your chance of a heart attack is moderate. In this case, you may be recommended treatment and lifestyle changes
101-400 – this score bracket represents a moderate amount of plaque, which could be blocking an artery, and that your chance of a heart attack is moderate or high. A score in this range can mean you will need treatment and that further tests are required
400+ - this score means that a large amount of plaque has been identified by the cardiac calcium scoring test and that the chance it is blocking an artery is over 90%. Your chance of a heart attack is high and your doctor will need to start treatment, as well as carry out further tests

Cardiac stress test vs calcium scoring

A cardiac stress test is an examination that involves a patient exercising on a treadmill or exercise bike, while breathing, heart rhythm, and blood pressure are monitored.

Cardiac stress testing was formerly the standard non-invasive test for people with non-acute chest pain. However, as multi-detector CT technology has emerged, cardiac calcium scoring tests have become a more effective alternative for assessing if heart disease is present in patients, as well as its location and severity.

A research paper that reviewed the two tests found that “indirect and direct comparisons between CCTA [cardiac computed tomography angiography] and stress testing consistently revealed superior diagnostic performance by CCTA for the diagnosis of CAD [coronary artery disease] as defined by standard definitions.”

Cardiac calcium scoring software

Circle CVI provides state-of-the-art cardiac CT imaging software tools for the assessment of coronary artery disease. cvi42 is considered to be the leading option for cardiac calcium scoring as it offers more clinically cleared diagnosis tools using semiautomatic calcium quantification, risk classification, and percentile ranking.

cvi42 is an advanced reading and simplified reporting solution that covers:

Calcium scoring
Coronary arteries
Plaque assessment

The fully embedded AI is quick to use and easy to understand. The smart software package also provides cardiac MRI, quantitative perfusion, 4D flow, myocardial strain, interventional planning, and electrophysiology.

Due to advanced imaging capabilities, cvi42 offers a high level of diagnostic accuracy and fast, automatic analysis. Its accurate calcium scoring and automated quantification of calcified, non-calcified, and low-density plaque make it a very powerful tool for both clinical and research purposes.

Find out for yourself why clinicians value accurate and user-friendly cvi42 as an essential tool for cardiac CT scans and calcium scoring. Try cvi42 for 42 days and realize the many benefits of a seamless AI software solution. Download a trial of cvi42 today.

For more information or to talk to a sales representative, contact the Circle CVI team today.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613789/

circlecvi

One Cardiac Platform. Triple the Impact - Part 3

Clinical Wins and Daily Practice

Introduction

What clinicians gain from one platform

Better consistency and confidence

Stronger positioning for advanced and reimbursed work

Less burnout, more sustainable practice

Circle Cardiovascular Imaging Expands cvi42 Platform with Advanced Vascular CT Capabilities

Advancing Quantitative Cardiovascular Imaging

ABOUT CIRCLE CARDIOVASCULAR IMAGING

About Astute Imaging

Beyond the Calcium Score: How AI-Enabled Coronary Plaque Analysis is Redefining Heart Health

What is AI-Enabled Coronary Plaque Analysis?

The Science: Why "Soft" Plaque Matters

What are the Benefits for the Patient?

What Does the Procedure Entail?

Precision Medicine for Your Heart

Taking Action: How to Ask Your Doctor for a "Circle Report"

The Unified Cardiac Workflow: Bridging the Gap Between Anatomy, Function, and Inflammation

The Clinical Challenge & the cvi42 Solution

The Physician Perspective: Precision and Autonomy

The Patient Impact & Strategic Outlook

Strategic Value for the Healthcare System

Strategic Financial Analysis: The Imaging Department & CFO Perspective

One Cardiac Platform. Triple the Impact - Part 2

Clinical and Financial Wins that Scale

From Single Platform to Strategic Advantage

Why Circle’s platform stands apart

A foundation for growth

AI Coronary Plaque Analysis: Reimbursement, Risk Stratification, and What You Need to Know

One Cardiac Platform. Triple the Impact

Why a Unified Cardiovascular Imaging Platform Wins

Why a single platform beats best-of-breed

Technical and operational gains

The effort and risk of going single platform

Why wait?

Expanded Insurance Coverage Validates Circle’s AI Approach to Coronary Plaque Evaluation

Unlock Practice Growth: Experience cvi42 at RSNA 2025

Highlights

﻿

Circle CVI Announces FDA Clearance for cvi42 | Plaque for Coronary Artery Disease Evaluation

CAD-RADS: A Guide to the Evolving Framework

Decoding the Coronaries

Why CAD-RADS?

Beyond Stenosis: Understanding the CAD-RADS Categories

Plaque Amount Assessment

P1 Descriptor

P2 Descriptor

P3 Descriptor

P4 Descriptor

The Power of Modifiers: Adding Clinical Context

Importance of CAD-RADS in

Clinical Practice

Looking Ahead:

A Brief History of Coronary Artery Disease Research and Diagnosis

History of Coronary Artery Disease Research and Diagnosis seems to predict a great leap forward

﻿

From Early Clinical Observations to Linking Symptoms to the Heart - The age of enlightenment and the honing of the scientific process:

The Dawn of Objective Diagnosis (Early 20th Century):

Visualizing the Arteries - Catheterization and Coronary Angiography:

Expanding Diagnostic Capabilities in the late 20th and early 21st Centuries:

Prominence of Imaging:

Present-Day Landscape: Merging Traditional and Tech-Driven Tools

Progress needs AI: The Case for Integration

Conclusion

Frequently Asked Questions (FAQs)

Cardiac CT Scan Vs Angiogram: What's The Difference?

What is an angiogram?

What is a CT angiogram?

CT angiography vs angiogram

How accurate is a CT angiogram compared to a traditional angiogram?

Angiogram risks

CT angiogram risks

Conclusion

Try cvi42 for CT scanners

Quantitative Assessment Of CAD Using CMR

Superior performance of CMR?

The limitations of a qualitative approach

Advantages of absolute quantification