Fighting Over Heart CT Scans

Once again cardiologists are fighting - loudly and publicly - about whether heart CT scans ought to be performed routinely to look for coronary artery disease.

The fighting is serious, and not just a little because proponents of CT scans stand to earn big bucks by expanding the use of these tests, while detractors of CT scans are afraid they'll lose some of the big bucks they're earning today by doing heart catheterizations.

Longtime readers will know that it is a bad idea to try to stand between dogs fighting over a bone, or cardiologists fighting over procedures. So a normal person trying to decide whether perhaps they ought to have a heart CT scan needs to stand back a bit and look at the question somewhat more objectively than many of the battling cardiologists seem to be looking at it (at least the ones who have been "found" by many reporters.)

While it is exceedingly difficult to tell from reading the general media, there are actually two different kinds of heart CT scans, which have entirely different purposes, and which are useful (or not) in different kinds of patients. For many Americans at risk for heart disease, one of these CT scans - the so-called "calcium scan" - can often give some very useful information. The other variety of CT scan - the one that threatens to displace some of the catheterizing cardiologists - can also be useful but is much more controversial.

I have tried to sort out the controversy and confusion about heart CT scans in this article.