Cardiologist specific clinical indications

Now, we’re getting into some more cardiologist specific clinical indications. Evaluating extent or significance of known coronary artery disease. Typically these patients have a stenosis between 50 and 70%. Remember, when we look at a coronary angiogram all you’re looking at is the lumen of that blood vessel and this is a completely subjective call by the cardiologist as to just how much of a stenosis there is there. Generally, coronary disease is defined as a greater than 50% stenosis. But a lot of cardiologists won’t do anything to something that’s less than 70% because they don’t think it is functionally significant. So our study will help you decide whether it’s functionally significant or not.
Patients who have had PTCAs are something we need to watch very carefully. The main reason is that 30% of them will restenose in the first year after PTCA. That is a high number and these patients need to be carefully monitored. If you have somebody that had PTCA three months ago and they start having their typical chest pain again, you’d better be pretty suspicious about restenosis of their graft. Again, this is a noninvasive way of double checking whether there is restenosis. Again, extent of severity would be relative in this condition as well because if there is only a mild restenosis nothing will be done about it. If there’s a large area of severe stenosis, they might consider bypass grafting or repeat PTCA or, these days, stent placement. Again, detection of myocardial viability is often a question and you can use either thallium or PET scanning.

Bone scans. Detection and followup of skeletal metastases is probably the number one indication that I see bone scans for. The cancers that are the most relevant, unfortunately, which are also very common are breast, lung and prostate cancer. Now, typically with breast cancer, anybody that’s Stage III or above on their initial diagnosis needs a bone scan, anybody at any stage who has bone pain and for the followup of anyone who develops bone pain. It’s always indicated in prostate cancer and the reason is that prostate cancer metastases are notorious for being painless. So use this for the initial staging in all patients and for routine asymptomatic followup.

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