Rick Duncan (Jul 12, 2007 6:59:15 PM)
Hi Everyone, Welcome.

Rick Duncan (Jul 12, 2007 7:00:32 PM)
Tonight we have Jon Tagliaferri from Siemens with us tonight. Jon will be speaking to us and IMT and how to use this in determining arterial health. Welcome, Jon.

Jon Tagliaferri (Jul 12, 2007 7:00:47 PM)
Thank you

Rick Duncan (Jul 12, 2007 7:00:53 PM)
Some housekeep before we start.

Rick Duncan (Jul 12, 2007 7:01:14 PM)
We invite everyone to join us every second and fourth Thursday for our scheduled chat sessions. Transcripts of past sessions are available from the chat page. Also, the Chat rooms are open every day. We encourage you to use them to chat with your colleagues.

Rick Duncan (Jul 12, 2007 7:01:34 PM)
A last comment - spelling goes out the door during these live events. We'll leave it to the spell-checkers to fix things before posting the transcripts of tonight's talk.

Rick Duncan (Jul 12, 2007 7:02:31 PM)
I'm happy to introduce Jon Tagliaferri. He attended the State University of New York at Oswego (SUNY Oswego), where he majored in English and Education.

Rick Duncan (Jul 12, 2007 7:02:44 PM)
After moving to Virginia in 1991, he attended Commonwealth Technical Institute school for Cardiovascular Technology in Virginia Beach, where he was first in his class.

Rick Duncan (Jul 12, 2007 7:02:59 PM)
He was a technologist and instructor for the CVT school at Norfolk General Hospital in Norfolk, Virginia for 3 years.

Rick Duncan (Jul 12, 2007 7:03:10 PM)
He has worked in the field as an Echocardiographer and/or manager for the last 14 years, and has worked for Siemens as the National Education Manager for Cardiovascular Ultrasound for the last year.

Rick Duncan (Jul 12, 2007 7:03:16 PM)
Welcome, Jon.

Jon Tagliaferri (Jul 12, 2007 7:03:25 PM)
Thank you for having me here tonight, and for taking time from your busy schedules to spend some time with us.

Jon Tagliaferri (Jul 12, 2007 7:03:47 PM)
First I would like to start off with Arterial Health Assessment Objectives.

Jon Tagliaferri (Jul 12, 2007 7:04:20 PM)
Hopefully I will inform you of the benefits of assessing cardiovascular risk and performing the CIMT study. Describe arterial anatomy, and the ultrasound appearance of that anatomy. Describe the imaging pitfalls and protocols necessary to perform a CIMT measurement and study. Describe automated measurements and how they can aid in the assessment of cardiovascular risk. Provide references for later study and follow up.

Jon Tagliaferri (Jul 12, 2007 7:04:47 PM)
Why is IMT so important?

Jon Tagliaferri (Jul 12, 2007 7:05:06 PM)
Coronary Heart Disease (CHD) is the single largest killer of Men and Women in the United States. ~14.6 million people have a history of MI and/or angina. The estimated direct and indirect costs of CHD are $133.2 Billion

Jon Tagliaferri (Jul 12, 2007 7:05:26 PM)
Incidentally, More US females die from cardiovascular disease, defined in this case as heart disease and cerebrovascular disease, than from the other four of the top six leading causes combined.

Jon Tagliaferri (Jul 12, 2007 7:05:49 PM)
Despite an overall reduction in the rate of death due to cardiovascular disease (CVD), CVD remains the No. 1 killer of both women and men. In 2001, CVD accounted for 38.5% of all deaths in the United States

Jon Tagliaferri (Jul 12, 2007 7:06:06 PM)
Between 1991 and 2001, death rates from CVD declined by 9.2%, but less for women than for men. However, in the same 10-year period, actual CVD deaths increased by 0.9%. Note that in every year since 1984, CVD deaths occurred in more females than males, and the gap is widening.

Jon Tagliaferri (Jul 12, 2007 7:06:25 PM)
Since coronary heart disease (CHD) is the leading cause of death in the United States, prevention of cardiovascular events is a health care priority. Individuals who are candidates for intensive medical intervention need to be identified.

Jon Tagliaferri (Jul 12, 2007 7:06:42 PM)
How can we identify these people?

Jon Tagliaferri (Jul 12, 2007 7:06:54 PM)
By using Carotid Intima Media Thickness (CIMT)

Jon Tagliaferri (Jul 12, 2007 7:07:04 PM)
What is Carotid Intima Media Thickness?

Jon Tagliaferri (Jul 12, 2007 7:07:21 PM)
Carotid Intima Media Thickness (CIMT) is a sensitive, technically straightforward, and noninvasive marker of cardiovascular risk that can be used in the hospital or office setting as a valuable clinical tool.

Jon Tagliaferri (Jul 12, 2007 7:07:40 PM)
Measurement of carotid intima-media thickness (CIMT) ultrasound is a noninvasive and highly reproducible technique used to evaluate cardiovascular risk and for quantifying atherosclerotic burden.

Jon Tagliaferri (Jul 12, 2007 7:07:56 PM)
Increased carotid IMT has been directly associated with an increased risk for cardiovascular events (e.g., myocardial infarction and stroke) in adults without a history of cardiovascular disease. By examining the carotid artery wall rather than the lumen, risk prediction with carotid ultrasound identifies an earlier stage of atherosclerosis than standard Duplex carotid imaging.

Jon Tagliaferri (Jul 12, 2007 7:08:14 PM)
They say that the eyes are the windows to the soul. We like to say that the Carotids are the windows to the coronaries.

Jon Tagliaferri (Jul 12, 2007 7:08:30 PM)
What is Atherosclerotic Burden?

Jon Tagliaferri (Jul 12, 2007 7:08:41 PM)
A patient's age is a powerful indicator of absolute risk, because it reflects the total burden of atherosclerosis that has accumulated; the probability of suffering a major coronary event (unstable angina or myocardial infarction) is correlated with total plaque burden.

Jon Tagliaferri (Jul 12, 2007 7:09:04 PM)
The major risk factors -- cigarette smoking, elevated blood pressure, elevated serum total cholesterol (and low-density lipoprotein cholesterol levels in particular), low levels of high-density lipoprotein (HDL) cholesterol, and diabetes -- account for about 50% of the variability in risk in high-risk populations, and explain up to 90% of the excess population risk for CHD.

Jon Tagliaferri (Jul 12, 2007 7:09:24 PM)
Obesity and physical inactivity have such a strong relationship with the development of cardiovascular disease that they are designated major risk factors by the AHA as well

Jon Tagliaferri (Jul 12, 2007 7:09:41 PM)
One of the first things we should understand is the Anatomy of Vessel Walls.

Jon Tagliaferri (Jul 12, 2007 7:09:57 PM)
Vessel walls are made up of three layers:

Jon Tagliaferri (Jul 12, 2007 7:10:13 PM)
The Tunica Adventitia is the outermost layer and made of loose connective tissue. The Tunica Media is the middle layer, and gives the vessel stiffness, elasticity and strength. Last but not least is the Tunica Intima, which is the innermost layer or the epithelial lining of the vessel. These last two, the media and the intima, are the ones we are most concerned with for this.

Jon Tagliaferri (Jul 12, 2007 7:10:34 PM)
Ultrasound Appearance of the Arteries Intima and adventitia create echogenic parallel lines. There is an anechoic void (black area), which represents the media. Since it is a reflection, the actual thickness is smaller than the reflection.

Jon Tagliaferri (Jul 12, 2007 7:10:59 PM)
CIMT vs. Carotid Duplex Carotid duplex ultrasound identifies occlusive carotid lesions by identifying high-velocity Doppler signals. By the time a patient has an occlusive lesion, either in coronary or carotid arteries, there is extensive atherosclerosis burden. By examining the carotid artery wall rather than the lumen, an earlier stage of atherosclerosis can be predicted. The combined thickness of the intimal and medial layers is what is identified, measured, and used to predict risk.

Jon Tagliaferri (Jul 12, 2007 7:11:29 PM)
What are the Imaging Pitfalls?

Jon Tagliaferri (Jul 12, 2007 7:11:56 PM)
Poor Image Quality: Poorly delineated intimal-medial boundaries The sonographer must demonstrate these boundaries on both near and far walls. This ensures images are at true vessel diameter. Image perpendicular to vessel walls. Off axis imaging may make wall appear thicker or thinner than anatomically correct You must image the vessel at true diameter to demonstrate best IMT.

Jon Tagliaferri (Jul 12, 2007 7:12:23 PM)
Difficult patient anatomy or body habitus: Difficult patient anatomy includes tortuous vessels and high bifurcations. Body habitus may include large patients with thick or short neck area. Please allow adequate exam time to enhance image quality.

Jon Tagliaferri (Jul 12, 2007 7:12:40 PM)
Drifting: Drifting superiorly or inferiorly, or off angle may result in inaccurate interpretations. Identifying an extra-vascular landmark and lining up with it on each image may help. Example: Use m-mode cursor to identify the tip of flow divider. This allows the reader to segment arterial anatomy so they know where to measure. For the sonographer, this helps prevent inferior and anterior drift.

Jon Tagliaferri (Jul 12, 2007 7:13:01 PM)
Improper machine settings: You should view image through eyes of the reader. Do everything possible to show up blood-intima and media-adventitia boundaries. Depth should be standardized, focal zone at vessel wall segment, gain settings, etc.

Jon Tagliaferri (Jul 12, 2007 7:13:15 PM)
What kind of protocols should you use? Protocol Development should be based on the extent of screening needed for clinical risk assessment

Jon Tagliaferri (Jul 12, 2007 7:13:38 PM)
Protocol Differences include:

Jon Tagliaferri (Jul 12, 2007 7:13:55 PM)
a. Number and location of carotid artery segments § Depends on purpose of exam- risk assessment vs. research purposes § How much time can be dedicated to exam § Segment refers to a 1 cm length of carotid artery- common, bulb, or internal § Advantage of imaging more segments § Provides better description of current atherosclerotic burden § Disadvantage of imaging more segments § More time consuming

Jon Tagliaferri (Jul 12, 2007 7:14:23 PM)
b. Imaging near, far, or near and far walls § Imaging of both walls provides a more comprehensive evaluation. § This technique takes more time. § If only one wall is imaged, far wall is preferred- deeper in image, better resolution.

Jon Tagliaferri (Jul 12, 2007 7:14:45 PM)
c. Number of imaging angles § Angle refers to where on the neck the vessel will be imaged § A Meijer Arc can be used to further describe the angle § More angles lessens chance of missing thickest CIMT § More angles increases exam time § When evaluating CIMT progression, critical to image same angles, segments, and walls on follow up § Detailed descriptions are necessary and documented on all images § How and where segments were imaged § Which landmarks were used

Jon Tagliaferri (Jul 12, 2007 7:15:14 PM)
Why use an Automated Measurement?

Jon Tagliaferri (Jul 12, 2007 7:15:31 PM)
As you can see by the protocol suggestions, there can be many measurements done to ensure accuracy. Hand tracing and measuring could be very time consuming, and with many different people performing the studies, there can be many different thoughts as to the actual areas to be measured.

Jon Tagliaferri (Jul 12, 2007 7:15:56 PM)
Automated Measurement Packages: Automates measuring the intima- media of the carotid artery reduces time and inter-operator variability

Jon Tagliaferri (Jul 12, 2007 7:16:17 PM)
The syngo® Arterial Health Package (AHP) is an advanced quantification application developed to support the need of the cardiovascular specialist in assessing arterial health including automated measurements.

Jon Tagliaferri (Jul 12, 2007 7:16:29 PM)
It contains: § An automated intima-medial thickness or IMT measurement § Calculated Vascular Age § Framingham Risk Factors

Jon Tagliaferri (Jul 12, 2007 7:16:47 PM)
The syngo® Arterial Health Package uses:

Jon Tagliaferri (Jul 12, 2007 7:16:57 PM)
Atherosclerosis Risk in Communities (ARIC) study, which was a Prospective epidemiologic study conducted in four U.S. communities using a total of 15,792 participants received an extensive examination, including ultrasound, medical, social, and demographic data. The normal values for IMT thickness for AHP are based on the ARIC study and are validated for patients age 40-70.

Jon Tagliaferri (Jul 12, 2007 7:17:08 PM)
Framingham CHD risk prediction model, which uses recent data from the Framingham Heart Study to estimate 10-year risk for myocardial infarction and coronary death as well as age, gender, total cholesterol, HDL cholesterol, smoker, blood pressure and blood pressure medication for calculated risk.

Jon Tagliaferri (Jul 12, 2007 7:17:31 PM)
Dr James Stein’s protocol calculates the average CIMT measurements and correlates based on data from the ARIC to determine a “Vascular Age”, and substitutes the corrected “Vascular Age” based on the patient’s atherosclerotic burden into the Framingham CHD risk prediction model.

Jon Tagliaferri (Jul 12, 2007 7:17:53 PM)
It also color codes the IMT thickness to correspond with a data base of over 15,000 people a. Green – below average IMT thickness (normal) b. Yellow - medium increase in IMT thickness c. Red – high increase in IMT thickness (abnormal)

Jon Tagliaferri (Jul 12, 2007 7:18:13 PM)
The IMT report gives maximum IMT distance, mean IMT distance and the standard deviation of the mean IMT distance. For Vascular age you need a minimum of 5 different segments. For the Framingham risk score you need to enter BP, Cholesterol, and risk factors. Editing of the Risk Factors or Measurements is available.

Jon Tagliaferri (Jul 12, 2007 7:18:29 PM)
The best part about the AHP package is receiving the patient’s 10 year risk assessment and “Vascular Age”.

Jon Tagliaferri (Jul 12, 2007 7:18:39 PM)
We keep talking about “Vascular Age”. What is vascular age?

Jon Tagliaferri (Jul 12, 2007 7:18:51 PM)
The databases available from the many clinical and epidemiologic trials using CIMT have adjusted a patient’s chronological age for their atherosclerotic burden using a concept called “vascular age”.

Jon Tagliaferri (Jul 12, 2007 7:19:07 PM)
Vascular age reflects atherosclerotic burden, which varies between individuals with the same chronological age, despite similar CHD risk profiles.

Jon Tagliaferri (Jul 12, 2007 7:19:18 PM)
For example: One could tell the patient and referring physician that he has a CIMT of 0.8 mm, but clinical use of that number may be limited because it is difficult to understand for many patients and physicians.

Jon Tagliaferri (Jul 12, 2007 7:19:37 PM)
Instead, the patient could be told that although he is at the 90th percentile for a 45-year-old, he is actually at the 50th percentile for a 60-year-old. In other words, his vascular age is 60 years old; the age at which an individual’s CIMT represents the median CIMT value, on the basis of sex and race.

Jon Tagliaferri (Jul 12, 2007 7:20:15 PM)
syngo®Arterial Health Package strengths include: Automated measurements provide consistency of measurements for novice or expert readers. There is a time savings in data collection You can have an optimized protocol as well as individual measurements with a graphic display and a report page Your processing options can include image analysis at time of image acquisition/patient exam or post exam offline with syngo ® US Workplace. The best part is the syngo® AHP is available on the ACUSON Sequoia®, Antares™, CV70™, and X300™ systems. The ACUSON Cypress™ also has an IMT measurement package available.

Jon Tagliaferri (Jul 12, 2007 7:20:39 PM)
What is the clinical justification for CIMT?

Jon Tagliaferri (Jul 12, 2007 7:20:55 PM)
Thickened CIMT is an indicator of atherosclerosis elsewhere in the arterial system. Increased CIMT is considered an early risk marker of atherosclerosis/ coronary artery disease.

Jon Tagliaferri (Jul 12, 2007 7:21:12 PM)
Thickened CIMT may predict risk of future myocardial infarction and stroke. Knowledge of CIMT can lead to improved preventative care tailored to the patient’s specific needs.

Jon Tagliaferri (Jul 12, 2007 7:21:27 PM)
The non-invasive nature of ultrasound allows repeated studies for increased understanding about etiology and progression of cardiovascular disease. Risk of first MI increases with CIMT ≥ .82 and risk of stroke increases with CIMT ≥ .75 mm.

Jon Tagliaferri (Jul 12, 2007 7:21:40 PM)
Why is knowing so important?

Jon Tagliaferri (Jul 12, 2007 7:21:58 PM)
Risk evaluation may lead to better individualized treatment. Knowing “vascular age” and 10 year risk assessment should lead to patient compliance with treatments. Most importantly, studies show that the effects can be reversed.

Jon Tagliaferri (Jul 12, 2007 7:22:15 PM)
One of the biggest questions we get is “can we bill for this?”. The answer technically is yes.

Jon Tagliaferri (Jul 12, 2007 7:22:42 PM)
The real question should be “will I get reimbursed?”. That answer is not quite as straightforward.

Jon Tagliaferri (Jul 12, 2007 7:23:00 PM)
CPT Code 0126T: Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment. Many private insurance companies do not recognize Category III codes (Services are Investigational/Not Medically Necessary). Providers are advised to discuss proper coding for this procedure with their payers prior to submitting any claims for an IMT study.

Jon Tagliaferri (Jul 12, 2007 7:23:56 PM)
Basically, this means that every insurance company is going to want information for reimbursement purposes.

Jon Tagliaferri (Jul 12, 2007 7:24:40 PM)
For more information on CIMT, please check out the following:

Jon Tagliaferri (Jul 12, 2007 7:25:00 PM)
Training available on site at Dr. James Stein’s Lab: http://www.cvrc.wisc.edu/airp/ The University of Wisconsin Atherosclerosis Imaging UW AIRP Home Framingham Risk assessment tool Risk Calculator.

Jon Tagliaferri (Jul 12, 2007 7:25:21 PM)
How bad is the problem in your state (USA)? Cardiovascular Health Statistics CVH Maps | Home

Jon Tagliaferri (Jul 12, 2007 7:25:53 PM)
For a demonstration, please contact your local Siemens ACUSON representative. Thank you for your time.

Rick Duncan (Jul 12, 2007 7:26:26 PM)
Thanks, Jon. Great information. Everyone please send in your questions for Jon.

Gail (Jul 12, 2007 7:27:44 PM)
Can we really determine if someone's arteries are really a certain age -- or are we saying... your arteries look like what we expect of an 80 yrs old?

Jon Tagliaferri (Jul 12, 2007 7:27:44 PM)
We would say that your arteries are what we expect of an 80 year old.

ranger (Jul 12, 2007 7:28:54 PM)
can we use other arteries instead of the carotids?

Jon Tagliaferri (Jul 12, 2007 7:28:54 PM)
Although other arteries can be used, the carotids are usually the most accessible and where most of the research to date has been.

Robbie (Jul 12, 2007 7:29:57 PM)
why does everyone use the common carotid, why not the proximal ica?

Jon Tagliaferri (Jul 12, 2007 7:29:57 PM)
The common carotid is most used, usually because it is the easiest to find. The proximal ICA and other portions may and are used in many protocols

Robbie (Jul 12, 2007 7:30:41 PM)
what makes different races have thicker intimas

Jon Tagliaferri (Jul 12, 2007 7:30:41 PM)
That is a good question, and if I knew that answer, I would be a much richer man....

teacher (Jul 12, 2007 7:31:28 PM)
can you really see a regression of plaque with the use of statins?

Jon Tagliaferri (Jul 12, 2007 7:31:28 PM)
There are and have been studies with the use of statins, and the data suggests that CIMT is reduced.

Angel (Jul 12, 2007 7:32:39 PM)
Can we charge for the procedure?

Jon Tagliaferri (Jul 12, 2007 7:32:39 PM)
You can charge, but reimbursement is not always forthcoming by many of the payors. There is a code.

Dave (Jul 12, 2007 7:33:11 PM)
how do you write the report?

Jon Tagliaferri (Jul 12, 2007 7:33:12 PM)
The report is generated after all the information is completed.

Kay (Jul 12, 2007 7:34:05 PM)
Are people using this at screening along with i.e. R/O AAA?

Jon Tagliaferri (Jul 12, 2007 7:34:05 PM)
Not that I have heard of or seen as of yet, although I'm sure we may see this around soon.

Iva (Jul 12, 2007 7:35:12 PM)
What can we charge for an IMT evaluation?

Jon Tagliaferri (Jul 12, 2007 7:35:12 PM)
No straight answer for that. You may contact Dr. Stein at U of Wisconsin, or other s that are submitting. I have not heard of a standard charge though.

george wilson (Jul 12, 2007 7:36:24 PM)
Do your cardiac machines have this package?

Jon Tagliaferri (Jul 12, 2007 7:36:24 PM)
Our cardiac machines with vascular capabilities and linear probes certainly do. This is an easy upgrade with most of our current cardiac machines.

Mickie (Jul 12, 2007 7:37:18 PM)
how does the vulnerable plaque fit into this?

Jon Tagliaferri (Jul 12, 2007 7:37:18 PM)
Vulnerable plaque voids the CIMT, because we know that the patient already has disease. You should move on to a carotid duplex

chloe (Jul 12, 2007 7:37:46 PM)
Do we have to get a different probe? I might have missed that question.

Jon Tagliaferri (Jul 12, 2007 7:37:46 PM)
If you have a linear probe, you just need the software upgrade.

Barbara (Jul 12, 2007 7:38:38 PM)
should we do this with EKG leads -- to find maximum expansion.

Jon Tagliaferri (Jul 12, 2007 7:38:38 PM)
ecg leads will certainly help with this, and recommended with some protocols.

chloe (Jul 12, 2007 7:40:25 PM)
Where do we find these protocols? Our physicians want to start doing these?

Jon Tagliaferri (Jul 12, 2007 7:40:25 PM)
There are sample protocols. Check out Dr. Steins website for more info, or contact me later at jon.tagliaferri@siemens.com.

Barbara (Jul 12, 2007 7:41:52 PM)
are there articles you could recommend for measuring using m - mode and the accuracy/correlation.

Jon Tagliaferri (Jul 12, 2007 7:41:52 PM)
There are many articles in JACC etc.

soundwave (Jul 12, 2007 7:43:20 PM)
I heard that we have to be careful telling our patients about vascular age.

Jon Tagliaferri (Jul 12, 2007 7:43:20 PM)
You should always remember that all tests that we do have some degree of educated guesswork, but that it gives us somewhere to start a dialogue about their health.

george wilson (Jul 12, 2007 7:43:57 PM)
If there is significant plaque can we still get a good measurement?

Jon Tagliaferri (Jul 12, 2007 7:43:57 PM)
Any plaque means they have disease already...please go to a duplex scan.

Tony (Jul 12, 2007 7:46:05 PM)
Can we get accredited in IMT?

Jon Tagliaferri (Jul 12, 2007 7:46:05 PM)
No accreditation that I am aware of.

Tony (Jul 12, 2007 7:46:46 PM)
Who should really be doing IMT, the cardiology or vascular?

Jon Tagliaferri (Jul 12, 2007 7:46:46 PM)
anyone who does vascular should be doing it.

Carrie (Jul 12, 2007 7:47:55 PM)
Are certain insurance companies NOT reimbursing it if it is not done in a vascular lab?

Jon Tagliaferri (Jul 12, 2007 7:47:55 PM)
No...insurance companies in general are only asking for medical necessity at this time.

Tony (Jul 12, 2007 7:49:39 PM)
Can there be significant error between testing or between different sonographers?

Jon Tagliaferri (Jul 12, 2007 7:49:39 PM)
Only if you are using a limited protocol, and using completely different segments of the arteries. remember that these protocols are asking that you use multiple sites, but the same sites for follow up to ensure better accuracy.

Louise (Jul 12, 2007 7:50:55 PM)
How long as IMT been recognized?

Jon Tagliaferri (Jul 12, 2007 7:50:55 PM)
IMT has been around for more than 6 years now. It has really become readily accepted over the last couple of years.

Lynn (Jul 12, 2007 7:52:02 PM)
Where can I get training?

Jon Tagliaferri (Jul 12, 2007 7:52:02 PM)
The best training is at Dr. James Stein's lab at the U of Wisconsin.

Barbara (Jul 12, 2007 7:52:11 PM)
should we do this with ecg leads -- to find maximum expansion?

Jon Tagliaferri (Jul 12, 2007 7:52:11 PM)
Although other arteries are being studied, the carotids are usually the most accessible and the only ones validated for IMT to date.

Dave (Jul 12, 2007 7:55:09 PM)
What happens if we have to be credentialed in our own specialties -- who gets the imt echo or vascular?

Jon Tagliaferri (Jul 12, 2007 7:55:09 PM)
Lot's of good questions tonight...The echo vs. vascular is a biggie. If you are a vascular tech (either straight vascular or echo-vascular) it will be an easy and useful test. It belongs in any lab doing vascular studies, even if it is an echo-vascular lab

rvtscanner (Jul 12, 2007 7:56:34 PM)
how often should we do imt scanning -- on a yearly basis. Is there any schedule like there is for carotid disease

Jon Tagliaferri (Jul 12, 2007 7:56:34 PM)
The recommended that I've heard is once every year or 2 without significant thickening, and 6 months to a year with...but that will depend on the physician

chloe (Jul 12, 2007 7:57:25 PM)
DoeS the upgrade cost us anything if we buy the probes?

Jon Tagliaferri (Jul 12, 2007 7:57:25 PM)
Contact your local rep for packaging. I'm not sure what is available at this time

denetra (Jul 12, 2007 7:58:20 PM)
Lawd, can WE get a raise if we know how to do this?

Jon Tagliaferri (Jul 12, 2007 7:58:20 PM)
You know we are all underpaid as it is...we should get a raise first, then learn it, and another raise...lol

Te Awamutu (Jul 12, 2007 7:59:12 PM)
New Zealand here, Christchurch. Who do we call to get training?

Jon Tagliaferri (Jul 12, 2007 7:59:13 PM)
I am not sure, but I can check. e-mail me at jon.tagliaferri@siemens.com, and I will see what I can find out for you.

Gail (Jul 12, 2007 7:59:59 PM)
Has anyone looked at post mortem studies

Jon Tagliaferri (Jul 12, 2007 7:59:59 PM)
Not that I am aware of, but I have heard that there is a retrospective study being done, and this may be part of it.

Gail (Jul 12, 2007 8:01:08 PM)
what about people who have CAD with normal carotid imt?

Jon Tagliaferri (Jul 12, 2007 8:01:08 PM)
Chances are it happens...nothing is 100%. I would imagine that would be few and far between.

Jon Tagliaferri (Jul 12, 2007 8:04:04 PM)
At this point I don't have a good answer, but I am looking at some things we can do at Siemens that may be more cost effective, although not as good as Dr. Stein.

troy (Jul 12, 2007 8:04:30 PM)
Do cardiac medications affect IMT?

Jon Tagliaferri (Jul 12, 2007 8:04:30 PM)
Not that I am aware of other than cholesterol meds

troy (Jul 12, 2007 8:05:55 PM)
at what point do you call plaque intima media thickening versus plaque

Jon Tagliaferri (Jul 12, 2007 8:05:55 PM)
After about .82 ish, you have significant thickening and a full duplex should probably be done for plaque...

Louise (Jul 12, 2007 8:07:12 PM)
Should we be looking at the imt of teenagers who are obese etc?

Jon Tagliaferri (Jul 12, 2007 8:07:12 PM)
Our package is only validated for ages 40 to 70 for the vascular age component. This does not mean that IMT can't be done.

Robbie (Jul 12, 2007 8:07:33 PM)
Should I use color to see if what I think is true lumen is?

Jon Tagliaferri (Jul 12, 2007 8:07:34 PM)
It is not a bad idea if you are not sure.

echowoman (Jul 12, 2007 8:09:35 PM)
What is the code for billing - both CPT and ICD9

Jon Tagliaferri (Jul 12, 2007 8:09:35 PM)
§ CPT § 0126T Common carotid-intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment § ICD-9 Diagnosis § All diagnoses § Services may be Investigational/Not Medically Necessary: § If the procedure code used describes a procedure indicated in the Policy section as Investigational/Not Medically Necessary. § CPT § 93880 Duplex scan of extracranial arteries; complete bilateral study § 93882 Duplex scan of extracranial arteries; unilateral or limited study § ICD-9 Diagnosis § 401.0-401.9 Essential hypertension § 402.00-402.91 Hypertensive heart disease § 410.00-414.9 Acute myocardial infarction § 433.10-433.11 Carotid artery V81.0 Special screening for ischemic heart disease

ranger (Jul 12, 2007 8:10:51 PM)
At what age should we start screening patients

Jon Tagliaferri (Jul 12, 2007 8:10:51 PM)
You can start screening patients at any age, but those with risk factors should be considered first

Rick Duncan (Jul 12, 2007 8:14:00 PM)
Hi everyone, we're going to wear Jon out. We will end tonight's session. Jon has left his email address so if you have more specific questions you can contact he via email.

Jon Tagliaferri (Jul 12, 2007 8:14:03 PM)
Vascular age is the age of the arteries. We take the person's chronological age and figure out what percentile they are in. Then we move them from that percentile along the age chart to get them to the 50th percentile. Wherever they fall in the 50th percentile on the chronological age chart, that is their vascular age

Jon Tagliaferri (Jul 12, 2007 8:15:17 PM)
Please feel free to contact either myself or Amy Ratner who is my General imaging counterpart. She is at amy.ratner@siemens.com

Rick Duncan (Jul 12, 2007 8:15:23 PM)
Jon, it looks like we need a Part II on this topic.

Rick Duncan (Jul 12, 2007 8:16:10 PM)
Everyone, thank you for attending. Jon, thank you for being with us tonight. It was a great presentation.

Jon Tagliaferri (Jul 12, 2007 8:16:10 PM)
It seems so. We will be having this as a CME session soon to be given on line or from our applications personnel.

Jon Tagliaferri (Jul 12, 2007 8:16:21 PM)
Thank you all...

Rick Duncan (Jul 12, 2007 8:16:54 PM)
Everyone, the transcript should be up by Monday. Please check again soon.

Rick Duncan (Jul 12, 2007 8:17:09 PM)
Our thanks to Jon. Thank you all for being here.