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Calcium Score radiation concerns.
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Calcium Score radiation concerns.

My cardiologist has ordered a Calcium Score scan to determine if my arteries have been damaged by high cholesterol.  No symptoms. My concern about the test is the amount of radiation I have already received this past year due to other conditions.

I have had 6 dental x-rays, 2 full head dental scans, a chest x-ray and a head/face CT scan.  These were all done in the past 6-7 months.  Is it too early to have another scan due to the amount of radiation I have received in less than a year.  I was told the 64 slice scan for the calcium score would add another one millisievert to the total I've already received.

I've tried to calculate the total radiation I've received from information I've located on the web and it appears I'm approaching the limit.  Would it be beneficial to wait for six months to have the calcium score scan?
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367994_tn?1304957193
QUOTE: "My cardiologist has ordered a Calcium Score scan to determine if my arteries have been damaged by high cholesterol.  No symptoms. My concern about the test is the amount of radiation I have already received this past year due to other conditions".

.....I had a CAT scan 64 slice a little more than a year ago. The scan evaluates the the amount of soft plaque betwen the layes of a vessel.  This soft plaque sometimes brings through the vessel inner layer and a clot forms that can be dislodged and cause a heart attack.  The score is a numerical value of the degree of soft plaque for each of the 4 coronary vessels and then a total score of all 4 vessel.  Then there is a prognosis of a possible coronary event within a year or more.  My total score was over 1000 and my risk for a major heart is a 20% probabillty within a year with each of the 5 years going forward.

Frankly, it provides no useful information regarding a prognosis because if one is in the high risk category with CAD there is no practical therapy to reduce the speculated risk ...exception for practical use may be with a young  individual with a family history of  heart disease and whether or not to begin some therapy,if there is evidence of coronary artery disease.

If your cholesteral is high, your doctor may want to reduce the level with therapy.  An educated guess by you doctor would be to acknowledge there is some soft plaque buildup and treat.

Hope this has provided some insight into the CT scan test, and whether or not you want to go forward.  The CT scan also includes the pulmonary system for any respiratory disorder as well as the abdominal arota and that may be a consideration but that hasn't anything to do regarding calcium score.

Take care and thanks for sharing your concern.  If you have any further questions or comments you are welcome to respond.  

  
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Avatar_m_tn
I have beat kenkeith's score by a mile, mine was over 1200. So I went to see a cardiologist with echocardiagram and nuclear stress test. It turned out my heart is fine with some leakage around the tricuspid valve (he called it age related} and some calcium deposits on the mitral valve. I had been on statins for at least 10 years prior and stopped taking them last year because of side effects. I also had a CT 10 years ago that showed no plaque. So, according to that scenario, statins cause plaque (only kidding). Therefore, based on my experience, heart CT-scans are for the birds especially since the insurance won't pay for them (I guess, they know already) and you probably can wait for a year or whatever -  but, I am not a doctor and don't even play one on TV.
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367994_tn?1304957193
My score is exactly RCA (872.2), LM (79.0), LAD (215) CX (40.6)  Total 1207.1...so it appears to be a tie :) I agree CT scan for soft plaque at a later age for someone known to have high lipid level is of little or no benefit. What is remarkable though is there has been such a change within 10 years!
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Avatar_f_tn
I am so happy you folks are out there and willing to share your experiences.  I had never heard of the calcium score and the cardiologist didn't tell me that it was a CT scan.  He walked me out of his office to the scheduler and told her to make me an appointment for a calcium score.  Of course, I had to go to the web to learn what the test consisted of since he had moved on to his next patient.

My total cholesterol is 289 and I was prescribed Simvastatin 20 mg, by my primary care physician.  I took 4 tablets and went down like a ton of bricks.  My muscles and joints were so painful that I was bedridden for three weeks.  Since I live alone, it was a nightmare.  I took the medication in February 2010 and have only begun to be able to exercise and move somewhat normally since late September 2010.  I feel as if there is some permanent damage to the muscles since I can no longer lift weights that I could previously due to muscle weakness.  I can no longer lift the 28 lb. cat litter box, I have to buy two 14 lbs.  I can't lift a case of water bottles and used to with little effort.

Lab results from October 2010 showed elevated cholesterol (289) and glucose (130).  I was referred to a lipid specialist that insisted I go back on statin medication. Thanks, but no thanks.  I didn't go back to her for a follow up, instead I made the appointment with a cardiologist to see if he had an alternative to the statins.  He looked at my vitamins, including fish oil, Co-Q10, folic acid, flaxseed oil and told me to add 500 mg. niacin per day.

The comment the doctor made, while walking away, was that he hoped my score was less than 100.  After much reading on the web, and based on the two of you, that doesn't seem likely.  Although he didn't say it, my impression is that he wants to do something invasive for results over 100.  I'm not willing to go that route until I've had an opportunity to resume something like normal exercise and make adjustments to my diet.

It never occurred to me that my insurance might not pay!

Your input is very much appreciated.

On a sandbar in the Gulf.



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Avatar_n_tn
My total score was 257. My Angiograph showed that I have 35% blockage in my LAD and moderately blocked OBTUSE MARGINAL. I was asked to change my lifestyle. My lipid levels were always normal. I am a DIABETIC.
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Avatar_n_tn
My total score was 257. My Angiograph showed that I have 35% blockage in my LAD and moderately blocked OBTUSE MARGINAL. I was asked to change my lifestyle. My lipid levels were always normal. I am a DIABETIC.
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367994_tn?1304957193
Hi Sandbar.

I don't know if your treating hospital has state-of-the-art technology that is available and it permits an actual look inside the coronary arteries to see if there’s any hard plaque  or any soft plaque that is causing blockage and if it is causing blockage with the ability to see exactly to what extent it’s causing blockage or obstruction of the coronary arteries. This would be helpful because the soft plaque buildup may not significantly reduce the diameter of the vessel (stenosis) and conventional angiography and stress tests fail to provide a complete picture of plaque accumulation.

A significant number of patients who suffer a heart attack never have any warning signs. For many of these individuals, the source of the problem is noncalcified plaque, a buildup of soft deposits embedded deep within the walls of the heart’s arteries, undetectable by angiography or cardiac stress tests – and prone to rupture without warning.  The hard plaque in the vessel channel (lumen) represents a small percentage of heart attacks...much greater percentage from a soft plaque rupture of the lining into the lumen.

Most private insurance companies cover the cost of this procedure. The cost is approx.: Calcium Score: $250.00
CT Angiogram: $1500.00

Thanks for your response and if you have any further questions or comments you are welcome to respond.  I wish you well going forward. Take care.
























































































































































































































































































































































































































































































  
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Avatar_f_tn
You are a wealth of information!

I learned, after the fact, that this cardiologist has offices in four different locations and is difficult to contact unless you are having a problem.  I don't, as of today.  I could call his office in the hospital where I saw him and ask for more clarification, but based on past experience I don't know if he would get the message or respond if he did.  Nurses tend to be very noncommittal.

The 64 slice scan is scheduled for next Monday. I only know the machine is seven years old and this doctor owns it.  My immediate concern was that with all the radiation I've received in the past year.  Do the advantages of the calcium score outweigh that?  He did an ECG, but didn't discuss the results with me.

The lipid specialist assigned a risk factor of 17% in 10 years.  I've read information, much of it conflicting, on the web and am not sure how concerned I should be.

Thank you for your information.  I can now compile a list of questions for clarification.  If I can slow this doctor down long enough to answer them...

sandbar in the Gulf

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367994_tn?1304957193
The calcium within the vessels and with a CT scan X slices the density is measured.  It is based and characterized by the density and given a weighted score.  Then the weighted score times the area (in pixels) of the coronary calcification. The calcium score of every calcification in each coronary artery for all of the tomographic slices is then summed up to give the total coronary artery calcium score (CAC score). And the report can also provide calcium score for each of the 4 coronary arteries.

So basically the test is sensitive to the density of the image and the associated area.

Hope this helps.  Hope your test goes well and no surprises.  Take care.

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Avatar_f_tn
Please forgive the "newbie".  I didn't know I should have stayed with the same thread.

I had the scan yesterday afternoon and the technician gave me a copy of the results as I left.  I waited all day for a call from the doctor's nurse who left a message saying she wanted to give me the test results.  She finally called at 4:00 PM CST and said the doctor wants me to schedule a heart cath. I've asked for a consultation this Friday afternoon, Feb. 4th, since I am in a panic state and don't know what that entails.

I live on an island alone, and if I called 911, I would get "Barney Fife" from the police department.  The ambulance leaves the island at 5:00 PM.

I am one of those people that have had zero symptoms.  I've just now begun to recoup from the statin side effects.  I have been walking and waking up with energy, dragging ladders around, etc. This has just floored me.  I guess many folks have that reaction.

I've come to rely on your input!  It sounds as if you could have scored my calcium - I didn't need that other guy...  And I topped your numbers, but not on purpose.

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Avatar_m_tn
I hope I am not stepping on sandbars post, but hope that the answer will also be informative for him. I read your explanation of the Calcium Score. The way I interpreted that is that the density of the Calcium "coating" is measured, I assume based on how much a particular area lights up on the screen compared to the background. After multiplying this by a fudge factor and the affected area, you have a "Score". But, and this is where I am lost, you're talking area  and not volume i.e. if the whole artery is coated with a thin layer of Calcium, you could have a high Score and still not know what the percentage of blockage of a particular artery is. Is this correct?
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367994_tn?1304957193
Hi sandbar, absolutely no problem with having another post open, and not your fault and understandably it happens often :)

For some insight, it is recommended by the medical community that a CT calcium score does not have any useful service if the doctor has evidence or lack thereof for no soft plaque within the layers of a coronary vessel.  Also, the guidelines are to not do a CT scan if the probability is high for the likelihood of soft plaque. Soft plaque can rupture into the lumen and has the highest probability of a heart attack compared to hard plaque within the lumen and a score calculation attempts to predict a heart event based on the calcium score. So the guidelines suggest a CT score may be of service for the individulas with the possiblity of soft vulnerable soft plaque.  Within that category would be individuals that have a family history of CAD and heart attacks, etc. and that can provide a base line for any future evaluation.  

Vulnerable soft plaque can remodel the vessel as well.  Sometimes the increased wall size can stretch the outer vessel wall, and sometimes the soft plaque can reduce the
diameter of the lumen...If I remember correctly, it is medically referred to as a positive rmodeling when the outer wall shows the effect of the plaque buildup and negative remodeling if the inner wall is affected causing stenosis (narrow channel that can effect blood flow). So often a CT angiogram is also done at the time of the calcium score evaluation. You could ask the doctor why that wasn't done at the time of your CT scan?

Let us know the result of your doctor visit.  It seems the doctor would have expect some buildup of plaque within the walls of vessel, but if you don't have any symptoms that may the reason...some individuals have CAD and not symptoms. I hope it goes well for you!  Thanks for your response and sharing the information. Take care.


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367994_tn?1304957193
QUOTE: "I hope I am not stepping on sandbars post, but hope that the answer will also be informative for him. I read your explanation of the Calcium Score. The way I interpreted that is that the density of the Calcium "coating" is measured, I assume based on how much a particular area lights up on the screen compared to the background. After multiplying this by a fudge factor and the affected area, you have a "Score". But, and this is where I am lost, you're talking area  and not volume i.e. if the whole artery is coated with a thin layer of Calcium, you could have a high Score and still not know what the percentage of blockage of a particular artery is. Is this correct?"

You relate and your question is relevant, and if there are different points of view that is welcome as well....We realize that a calcium score  depends on differences of density and calcium has the most heavy denseness.  Volume would be longitudinal and cross sectional calculation for the area, and soft plaque may have composites of plaque at various density. And when the slices are stacked (reassembled)n and ct software analyzes the density representation.

There is a thin layer of fibrous matter that caps the soft plaque and prevents rupturing into the lumen.  It is my understanding that the state-of-art technology with CT scan has resolution capabilities of 1% differental of contrasting images. Reliability for a CT scan needs to consider motion artifacts (requires less than 60 bpm) and extensive calcification increases the uncertainity of any conclusions...That indicates a high calcium score may unreliable.  

Thanks for your comment, I'm not sure I answered your question? If you have any further quesitions or comments it would be interesting to hear.
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Avatar_f_tn
Ken, you and occupant provided much needed new information.  I'm trying to get my questions sorted out for the doctor visit (often at 3:00 AM), on Friday.

Any suggestions for questions regarding the heart cath?  His nurse said he "might" place stents and use medication to treat me.  This is assuming I don't need surgery, then I would be referred to a surgeon.

I have a Russian friend in Philadelphia that has a Doctorate in Biochemistry.  She is doing research for one of the universities.  She said she had tried five different statins with the same muscle problems that I've experienced.  I'm beginning to wonder if this side effect is under reported.

This is all a learning process for me.  I appreciate you guys "holding my hand"!
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367994_tn?1304957193
I was on a statin for a few months, and a blood indicated I had a high enzyme level (AST) indicating there may be some liver damage.  I stopped taking the medication as my cholesterol has always been under 200....usually around 150 and the doctor was wanting the level below 100...seems there is new evidence that lower than 100 is beneficial. For me, I don't believe the risk of liver damage vs. cholesterol below 100 is appropriate for me!
Proper diet and exercise is effective and I don't need something below 100...probably something started by the drug industry. This should not be a model for anyone to discontinue their medication, however.

Yes, there are known side effects including muscle disorder, and it may be under reported.  I have the highest respect for a PH.D in biochemistry or biology....I've listened to some of their lectures and they are very knowledgeable in their respective field of endeavor and the field certainly makes a major conribution to medical health.

Before you have an angiogram, you may want to the read about the therapy available for occluded vessels. You may want to discuss interventional therapy, and what that has to offer with medical treatment.  I do well on medication with vessel occlusions greater than 70% and 70% or greater is the guidelline for a stent if there ae symptoms unresolved with medication.  Take care, and thanks for your response.

Ken

http://blogs.wsj.com/health/2007/03/26/to-stent-or-not-to-stent/
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Avatar_m_tn
No, you have not really answered my question, but the Internet may have done it for me, at least in part. I found a website for a company that does CT-Scans and their disclaimer (right on the website) says: "Calcium Scores do not indicate degree of arterial blockage".
@sandbara addressing the "under reported" issue: My Total Cholesterol was always (for at least 8 years @~200 with Statins and @~160 for 3 years on Vytorin) within recommended guide lines yet I developed a high Calcium Score (>1200) within the last 10 years. A year and a half ago I developed severe kidney pain. It got so bad I had to check myself into the E.R. The administering nurse said it looked like kidney stones. After all the tests were done, it was: "You have just muscle pains, nothing wrong with you" and sent me home. Next night, the same thing. I knew then, going back to the hospital wouldn't resolve anything. It then it dawned on me, I was taking the Vytorin at night and as soon as I quit taking it, the pain went away. I should also point out that as long as I was taking the Statins, my ankles started swelling because of retained fluids. I mentioned this to at least 2 doctors who said: "Congestive heart failure" and left it at that. When I told the cardiologist, that I saw last week, about this he just snickered and didn't say much else because he knew by then that there was nothing wrong with my heart.
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367994_tn?1304957193
Q:  "Calcium Scores do not indicate degree of arterial blockage".

>>>>>I don't disagree with that...  Calcium score relates to soft plaque within the layers of a vessel and from that calculation there is some prognostic value?!. That condition with little or some soft plaque does not cause any occlusion in the lumen.  The CT score does not evaluate the lumen's occlusion or lack thereof.

CT angiogram provides more detailed images than either ultrasound or MRI. It is fast becoming the radiological test of choice to look at disease of blood vessels. There is an injection for contrasting with CTA but not CT scoring.  Yes, plaque will be lighter than the contrast medium and from that input the software with the CT scan does the calculations of degree of blockage as I understand it.  

Q: I mentioned this to at least 2 doctors who said: "Congestive heart failure" and left it at that. When I told the cardiologist, that I saw last week, about this he just snickered and didn't say much else because he knew by then that there was nothing wrong with my heart.

>>>>I had CHF and that condition by definition is edema of the lungs.  Peripheral edema can also be a factor if the heart does not effectively pump. Reading between the lines you have had an adverse reaction to the statin....no heart failure, but a high calcium score?  Is that correct?
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Avatar_f_tn
There have been some interesting developments with me.  

The cardiologist rescheduled my heart cath consultation appointment for next week, instead of tomorrow.  My primary care physician has just moved to a new location so I drove there to get a refill for a prescription.  The doctor agreed to see me on short notice and I brought him up-to-date concerning the lipid specialist, Cardiologist and the Calcium Score CT, and impending heart cath.  He went ballistic about the CT scan saying it was not helpful and he is going to do even more investigation.  He did sketches of possible outcomes based on this scan showing how it is inconclusive.  He opined the scan is used to justify the heart cath.  

Based on the state of my health today, he doesn't agree with the urgency and has referred me to another Cardiologist he trusts for an evaluation.  He gave me a two week supply of Niaspan 500 mg. to see if I tolerate it.

My final word on statin medication:  What value are "good numbers" on a piece of paper if you're bed-ridden with muscle and joint pain?

I'm beginning to feel like a ping-pong ball bouncing between doctors with differing opinions. I know many of you have been through this already and it's a learning experience.  Thank God, you are there and willing to share your experiences and knowledge!

Ken, I read your link and will print it for future reference.  Thanks.
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367994_tn?1304957193
It does appear the doctor inappropriately gave you a CT scan.  From my information the selectivity and reliabilty is very good for no false positives (95%).  On the other spectrum  there is not much confidence regarding reliability to a high score and its calculations.
There is some validity to rely on a CT score for the individuals in the medium range.  So if an indivdual has a family history of early CAD, heart failure, etc. some doctors may want to do a CT scan to see if there is any early signs on CAD and treat accordingly.  

Q: My final word on statin medication:  What value are "good numbers" on a piece of paper if you're bed-ridden with muscle and joint pain?

>>>>I agree, sometimes the benefit of feeling well outweighs speculation there is a risk that may never happen.

Take care, and thanks for your response.

Ken  


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