What is the best use of the 64-slice CT imaging technology? Which patients would benefit most from this noninvasive coronary imaging modality? Will Medicare and third-party insurers reimburse for it as a screening tool? The ease of use it offers and the high-resolution images it provides are very helpful when screening patients with risk factors for coronary artery disease (CAD) and/or structural cardiac abnormalities.
—Gail Koelker, MSN, APRN-BC, FNP, Jefferson, Tex. 

Uses for the 64-slice CT are many. There is a high negative predictive value (93%) with CT angiography. This is most useful for evaluating persons at low risk of CAD and allowing avoidance of invasive coronary angiography. One aim is to eliminate negative angiograms. Angiography should be focused on obstructive disease and not overused for diagnostic reasons. Medicare and third-party insurers will reimburse only if the patient is symptomatic or has equivocal cardiac stress data. The term “screening” may have various interpretations. Aetna offers a list of accepted medically necessary uses of CT angiography (available online). For additional information, see N Engl J Med. 2008;358:1336-1344.
—Debra Kleinschmidt, PhD, PA (121-5)