This Article Free upon publication Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clouse, M. E. Articles by Krumholz, H. M. Search for Related Content PubMed PubMed Citation Articles by Clouse, M. E. Articles by Krumholz, H. M. Related Collections Health policy and outcome research Primary prevention CT and MRI Chronic ischemic heart disease

(Circulation. 2006;113:125-146.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

How useful is computed tomography for screening for coronary artery disease?

Noninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful

Melvin E. Clouse, MD

From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.E.C.); Section of Cardiology, Department of Medicine, Beth Israel-Deaconess Medical Center, Boston, Mass (J.C.); and the Sections of Cardiovascular Medicine, Department of Medicine; Health Policy and Administration, Department of Epidemiology and Public Health; and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, and Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Conn (H.M.K.).

Correspondence to Melvin E. Clouse, MD, Vice Chairman, Director of Research, Beth Israel Deaconess Medical Center, Deaconess Professor of Radiology, Harvard Medical School, 1 Deaconess Rd, Room 302, Boston, MA 02215 (e-mail mclouse@bidmc.harvard.edu); or Dr Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088 (e-mail harlan.krumholz@yale.edu).

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The introduction of new ideas and concepts that lead to change in practice has always caused some degree of controversy, especially in medicine. At first glance, the concept of noninvasive imaging for calcium as a screen to identify patients at high risk for future coronary events would seem the most intense; however, one must only reflect on past controversies to gain an appropriate perspective. The controversy over radical mastectomy versus segmental resection or lumpectomy with radiation therapy has raged for the past 50 years, and only recently have data from the 20-year follow-up of a randomized trial comparing these forms of treatment been put forward.^1,2 The process of establishing the chest roentgenogram as a standard diagnostic method in the diagnosis of respiratory disease spanned 30 years and was opposed by many of the leading physicians of the day, including Osler,³ who believed a good clinical examination was superior. In 1915, Crane⁴ stated that the chest roentgenogram that "claims a delicacy, rapidity and precision outranking the stethoscope and the percussion finger must expect to run a gauntlet of merciless criticism." The chest roentgenogram largely came into general use in the 1930s, when it was recognized that &15% of the deaths in the United States were due to tuberculosis, and a massive screening process was instituted after World War II.⁵ Establishment of the chest roentgenogram as a diagnostic tool was based largely on the belief in technology and innovation; to date, however, no prospective randomized studies have been conducted to determine whether . . . [Full Text of this Article]

Jersey Chen, MD, MPH; Harlan M. Krumholz, MD, SM

Melvin E. Clouse, MD

Jersey Chen, MD, MPH; Harlan M. Krumholz, MD, SM

This article has been cited by other articles:

				H. Chung, R. L. McClelland, R. Katz, J. J. Carr, and M. J. Budoff Repeatability Limits for Measurement of Coronary Artery Calcified Plaque with Cardiac CT in the Multi-Ethnic Study of Atherosclerosis Am. J. Roentgenol., February 1, 2008; 190(2): W87 - W92. [Abstract] [Full Text] [PDF]

				A. Simon, G. Chironi, and J. Levenson Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals Eur. Heart J., December 2, 2007; 28(24): 2967 - 2971. [Abstract] [Full Text] [PDF]

				T. W. Smith, B. N. Uchino, C. A. Berg, P. Florsheim, G. Pearce, M. Hawkins, P. N. Hopkins, and H.-C. Yoon Hostile Personality Traits and Coronary Artery Calcification in Middle-Aged and Older Married Couples: Different Effects for Self-Reports Versus Spouse Ratings Psychosom Med, June 1, 2007; 69(5): 441 - 448. [Abstract] [Full Text] [PDF]

				P. A. Cleary, T. J. Orchard, S. Genuth, N. D. Wong, R. Detrano, J.-Y. C. Backlund, B. Zinman, A. Jacobson, W. Sun, J. M. Lachin, et al. The Effect of Intensive Glycemic Treatment on Coronary Artery Calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Diabetes, December 1, 2006; 55(12): 3556 - 3565. [Abstract] [Full Text] [PDF]

				M. J. Budoff, S. Achenbach, R. S. Blumenthal, J. J. Carr, J. G. Goldin, P. Greenland, A. D. Guerci, J. A.C. Lima, D. J. Rader, G. D. Rubin, et al. Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology Circulation, October 17, 2006; 114(16): 1761 - 1791. [Full Text] [PDF]

				T. K Mittal, M. Barbir, and M. Rubens Role of computed tomography in risk assessment for coronary heart disease. Postgrad. Med. J., October 1, 2006; 82(972): 664 - 671. [Abstract] [Full Text] [PDF]