Part 4 of 6 in Circle CVI's Structural Heart series. Every Scan. One Plan. One Platform. Structural heart programs get measured on procedure volume. Case counts, room utilization, length of stay, the board slide with the line going up. None of that is where the queue forms. Every structural referral begins with a CT and a heart-team decision, and both of those happen in imaging. When referral volume rises, the cath lab feels it second.
Part 3 of 6 in Circle CVI's Structural Heart series. Every Scan. One Plan. One Platform. Ask who plans a structural heart case and you will usually hear the name of a physician. Ask what the plan is made of and you arrive somewhere else: a centralized 3D lab, a queue of studies covering three different procedures, and an analyst doing the measurement work that everyone downstream treats as fact. That work is the most standardized thing in the structural program and the least discussed.
Part 2 of 6 in Circle CVI's Structural Heart series. Every Scan. One Plan. One Platform. A diagnostic cardiac CT report ends in an impression. A structural planning report ends in a set of numbers that a heart team will use to select a device. That is a different product. The impression tolerates hedging, because the clinician reading it brings their own judgment to the question. The planning report does not, because a millimeter of annulus perimeter is not an opinion to be weighed. It is an input to a sizing chart. Imaging physicians have absorbed this shift largely without anyone naming it.
Part 1 of 6 in Circle CVI's Structural Heart series. Every Scan. One Plan. One Platform. The annulus measurement decides the case. Valve choice follows from it. So does sizing, so does the degree of oversizing, so does whether the root tolerates that oversizing, and so does whether you spend the end of an otherwise clean case managing a paravalvular leak. By the time the patient is on the table, that measurement was made days earlier, in a post-processing application the operator may never open, by a reader whose work arrives as a number on a report. For a procedure this dependent on millimeters, that is worth examining.
