Cardiac PET CT Improves Heart Disease Care at Centra

A clearer heart scan can change more than an image, it can change a decision. We talk with Jared Vest, who oversees nuclear cardiology and PET CT at Centra, about the arrival of cardiac PET CT and why it’s a major leap forward for diagnosing heart disease closer to home. 

We walk through SPECT versus PET in plain language, then dig into what makes PET CT the new gold standard: higher-quality imaging and the CT mapping that helps correct for attenuation artifacts that can mask or mimic poor blood flow. That accuracy matters because it helps clinicians send the right patients to the right next step, including whether someone truly needs a heart cath or can avoid an unnecessary procedure.

We also get into what’s especially exciting about cardiac PET CT: the ability to quantify blood flow and coronary flow reserve, not just “look” at perfusion. That opens the door to detecting smaller defects and microvascular disease earlier, and it points toward future options like viability imaging to see whether heart muscle can benefit from intervention. If you care about preventive cardiology, advanced cardiac imaging, or patient-centered heart disease care, hit play, then subscribe, share with a friend, and leave us a review with your biggest takeaway.

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Transcript

Welcome And Why This Matters

Cami Smith 0:00

Hi, and welcome to And So Much More. My name is Cammie Smith. I'm your host, and I'm here with my friend Jared Vest, who's also a caregiver here at Centra. And we get to talk about some new equipment that we have, new machine that thanks to really generous donations from Centra Foundation as well as the Al Stroobants Foundation, we were able to purchase a PET CT, a cardiac PET CT machine that is new to Centra this year and very specialized and very cool thing for our community, for our Caregivers. And so you know so much more about this than I do, but I do want to go ahead and dig in and hear a little bit about you first.

What Jared Does Day To Day

Cami Smith 0:43

So tell me about your role at Centra. So you're over nuclear medicine, nuclear cardiology, or supervisor for PET CT, correct?

Speaker 0:49

That's correct.

Cami Smith 0:49

So tell me about that. What do you do on a daily basis?

Speaker 0:52

So you know I'm still somewhat clinical. We do quite a bit of um, you know, patient studies, but then also, you know, I have to kind of herd the cats, right? So um sort of day-to-day stuff. We do quite a bit of organizing. Um, we sort of coordinate patients for the day. Um, you know, if there's outages or we have issues with with medications, because all of our medications we rely on our pharmacies outside the center um to get us all of our medications, uh, sort of navigate those changes, staffing, schedules, vacations. Okay, well, yeah. That's a lot of you like make all the wheels turn.

SPECT Vs PET In Plain English

Cami Smith 1:23

So cardiac PET CT. Why? Well, first, what is it? Tell us what that is.

Speaker 1:29

Yeah, so uh so you know, traditionally, like I guess we kind of have to go here to go there. So traditionally, um, Centra has always done SPECT. Um, and SPECT is uh it's an acronym, kind of like SCUBA, right? So SPEC stands for single photon emission commutative tomography. There's no quiz at the end of this. Um but basically um you know we're doing that. It's a way to image something in three dimensions. Um a good uh way to think about it is like if you close one eye and you look at a pencil on its end, right, at the pointed side, don't run with it. Um but if you turn it, you can see that you know, if you only have one eye, it looks two-dimensional until you turn it, right? And then it looks three-dimensional. And so um, that's sort of what you're doing in Spect. So we're injecting the medicine. Uh we're then rotating the patients, the uh the scanner rotates around the patient, then grabs that heart in all in all the ways around it, right? Um the beautiful part is that PET, uh, so we're the goal of the exam is still the same, right? We're still looking at blood flow to the heart, being able to figure out how well the heart is performing under stress and rest conditions, make sure it's getting enough blood flow for both. Um so the main the main core of the exam is relatively the same. The difference though is that pet is able to acquire that um instead of turning, it actually is acquiring it in 3D all at once.

Cami Smith 2:37

Oh wow.

Speaker 2:38

So um, so that that's a very different end result. Very much a different end result. Yeah. Okay. Yeah. Wow.

Cami Smith 2:45

Okay, that's fascinating. So I'm gonna try to find a picture and insert here so you guys can kind of see what he's talking about.

Speaker 2:50

I can send it to the phone.

Cami Smith 2:51

Um yes, thank you. Um so when we're talking about preventative care, long-term management, and and really heart disease, like what does this mean for our community now having this technology?

Local Access And Community Impact

Speaker 3:02

I think like, you know, on you know, as unfortunately as it is, you know, I'm from I'm from rural, you know, rural West Virginia. Um, and you know, and and extending into this region, you know, our access for the demographic of patients that we serve here, um, you know, their their access to you know, thinking that they have to go to UVA or Duke or somewhere to have this adequate level of care, um, it's right here now, right? So um so so it really means a lot for our community that we can serve them at such a high level. Um, you know, uh we had a few members of our board come through and they asked me, they're like, well, how impactful is this, right? And I thought that was a really interesting question. And I I it took me, it was the one question that it kind of took me and I took me a minute to think about it, and I said my answer was is it was paradigm shifting. So the only way to put it. Like we're going from something that was probably extremely, you know, you know, definitely, definitely okay, but really, you know, really getting antiquated as we look or sort of look forward. Yeah. Um, we almost took like two giant leaps for it. We skipped the whole thing in order to get that, right? So so quite literally paradigm shifting.

Cami Smith 3:58

So it's a big deal for those of you who are coming in to um the I guess center HVI for any kind of like cardiac heart disease. This is huge. You don't have to go to UVA, you don't have to make that drive anymore. We have this functionality right here in Lynchburg at LGH?

Speaker 4:15

Yeah, our gut scanner is at is at the Stroobants uh CVI pavilion.

Why PET CT Is Gold Standard

Speaker 4:19

Okay.

Cami Smith 4:19

So I keep hearing this term gold standard. So what does that mean when we're saying like this is a gold standard?

Speaker 4:25

Yeah, I mean, so like in healthcare, you know, we a lot of times like we there, you know, if if anybody's ever been in the hospital, there's lots of redundancies built in built-in things. You know, we you know, if we can't do a CT, an X-ray, right, you know what I mean? Um if we can't do an MRI, maybe there's some sort of equivalent, right? Um, or hey, I'm not really sure if this is you know the right exam. Maybe there's some lab work we can pull to sort of make sure that we're getting the right picture. So, you know, I feel like in medicine we tend to be quite redundant in how much um you know we're able to look for things or or be able to sort of look at a patient and be able to assess them. Um and so with that being said, um, you know, yeah, like this is with that specs, it was sort of the used to be the gold standard. Um it used to be plain R until then, uh, but this is now the gold standard meaning that like this is the what all of the others sort of look up to, right? So they're so the one in the middle is spec CT. Um one of the huge benefits of PET and SPEC CT is the addition of the CT part. Um so when we hear about it, we see PET CT, and a lot of patients think that it's two different things. And truthfully it is, right? Because we hear that you know, if you have to have a CT scan, that's different than having a PET scan. But what the CT does is it actually maps the body. And so, you know, if you where each patient may carry their weight, whether they're big or small. Um, a lot of times in female populations with their breast tissue, you can get attenuated artifact. And a lot of times, like our physicians will see that on imaging and they'll say, Oh, well, you know, she's not really having a heart attack, that's just breast tissue attenuation. And what attenuation means is that basically is masking the radioactive the little bit of radioactive material we have in there, and our tissue is actually kind of shadowing it. So it looks like that heart muscle is not getting blood. Yes. But it is, but it is right. It's just because that breast tissue is there, or you know, somebody you know like me is a little chubby, right? And so those types of things will um affect how that imaging actually looks. And so uh so the CT is probably the best part of one of the best parts of this whole thing, is so it actually takes each person and will scan them and set and find out where their densities are and where they or where they are not, and it will adjust the image to make sure that it's accurate.

Cami Smith 6:27

That's crazy. So it's kind of leveling the playing field and making this accessible for everyone, not just technology that's created for your type A individual who you know is going to fit the normal category. Right. I love that. So what does this mean for diagnosis and treatment for heart disease?

Better Decisions For Next Steps

Speaker 6:47

Well, you know, one of the questions was, you know, is when we look at when we look at volumes and and care for our patients, we say, well, you know, how much of this is going to impact patients going to the cath lab or going to Echo or having other downstream things? Um but I think the best way to answer that is to say that we this gives us our our physicians the best information they need to make sure that the right patients are going there.

Cami Smith 7:09

Okay.

Speaker 7:10

Right? If you don't need a heart cath, don't have one, right? Like there's no need to have things you don't need, right? Like I think in this generation, as we as you know, it's almost like pop culture now, we don't take things we don't need, right? Um and that, you know, maybe a little older generation maybe wouldn't would maybe it's kind of just keep doing what their physician says or whatever. But now everybody is very questioning, and I think that's great to be a part of your own healthcare. Um and so I think this is another way for our physicians to make sure that we're informing our patients that they can also be a part of that decision to help them make the best decision. And so in cases like this, this gives us the top-notch information service and say, hey, you know what, I still think I see a little something. Let's maybe run to the cath lab, and if we see something, we can take care of it. Whereas before, it's like, you know, this is really indeterminate. Um, the next step would be this.

Cami Smith 7:54

I love that. Right.

Speaker 7:55

And so it's making sure that we're sending the right people to the right treatment and that they're getting the right care.

Cami Smith 8:00

Well, and it's eliminating probably redundant or unnecessary things that you know in the past you just do to make sure and to cross your T's and dye your I's right we can see more clearly on the front end to make better decisions on the back end. And I think that means so much to our community who I mean, we're nobody wants huge hospital bells, right? Like we just want the things that we need. Let's get straight to the point, let's find out what's going on. Um, and I think this is huge for that. So you mentioned an older population. Um, what is is there like a specific demographic or a specific population that this is gonna mean the most for?

Speaker 8:36

I mean, really, just I think it's just just the region, you know what I mean? Like um having just really, I mean, we we can scan anybody, right? Yes, um and and and you know, and as sad as it is, you know, heart disease sometimes doesn't really discriminate on age. I mean, there are, you know, you can pull literature and look at specific demographics and say, you know, um, you know, African American males from six, you know, fifty to sixty-five, maybe more likelihood of having um prostate cancer or heart disease um or you know, whatever, uh, or or white males at this age may be more likely more inclined to have um lung cancer. Um and so I think really at the end of the day, we can always pull stuff like that. But ultimately, um in my experience so far, even, um, our patient population's been pretty, pretty fair. It's just whoever really needs one and needs to make sure that their heart's working okay. Yeah. Um you know, it's yeah, so it is pretty cool. And the likelihood of them actually having a cardiac event with PEC CT after having one and it being clean is about one percent.

Cami Smith 9:30

Oh wow.

Speaker 9:31

So rest assured, you know? Absolutely. Yeah, statistically it's about one percent. Yeah. So that's it.

Cami Smith 9:38

So we have this machine for how long?

Speaker 9:40

Uh I think it was installed in maybe in February or March.

Cami Smith 9:43

Okay. So, I mean, you've experienced this, you've seen the before and the after for our patient population. What would you say um is just your biggest takeaway? Like, what is the I don't want to say the most exciting part of it, but but you know, like as a clinician, like what is that like to see something like this that can change so many people's lives?

Speaker 10:01

I you know, it's just it's really nice to know that you've caught something. Um, you know, you have there's patients that um, you know, maybe have something that they didn't know um and they get the right treatment. And they I think just knowing that they're how assured they are that they can place a little bit of that worry on us, right? And they can say, you know what, like I'm in good hands. I know that the people here know what they're doing, they have the right equipment to do the right job, they you know, they have cutting edge stuff. I think for me, you know, you know, it's always nice to have a positive a single uh one single you know, positive interaction with a patient. But for a patient to really feel confident that you gave them delivered the best quality care and and that and then like they're and are almost proud of the fact that like they walk out and they know that we, you know, that like Centra has something this this great and this new, to me, like that that to me is like and as a and as a you know, as a leader now, like that for me has always been more exciting. So, you know, to they can walk away knowing that.

Cami Smith 10:50

Well, it's very cool to think about the things that you know, Centra, at least from my perspective, in the five years that I've been here, you know, that they look at the community needs health assessments. They look at where are our most vulnerable populations? What do our patients need the most? And then we have these incredible partners like the Centra Foundation and the Alice True Bones Foundation as well, who help us provide things like this based on the needs that have been identified. And that's so intentional. That's not just hey, bright new, shiny machine, let's do it. That's saying, you know, what is going to further our patient outcomes in a way that is gonna change lives? And then something like this is brought in. So I think you're right. I think that it says something when you can brag about your local health system and say, hey, we have this thing because it's gonna help so many people, especially with heart disease, and we do see so much of that in our area. Well, is there anything that I haven't asked you that you feel like you just really want our our patient community to know?

Speaker 11:54

I mean,

What The Scan Feels Like

Speaker 11:55

you know, I guess, you know, I guess for one is you know, if you have something, if you feel like you've had something you pushed it off, right? Know that this test, you know, it only takes about 20 minutes. Total, total time in the hospital, maybe an hour, an hour and a half. That's nothing. And you know, the meanest thing we're gonna do to you is starting an IV, right? I mean, other than that, it's really not that bad. Um, but you know, and it and it really looks about like the size of like a CT scanner, maybe about two of them put together. So it's pretty open in there. Um, you know, and and the whole thing's done like 20 minutes. Um, you know, you you walk out, there's no anesthesia, like it's yeah, you're not even radioactive by the time you go there, you know. I mean, you know, so like you know, it it really, you know, and really before this, you know, you're talking like a three or four hour endeavor um to do this, and we're four hours to twenty about twenty minutes for the actual procedure.

Cami Smith 12:43

Okay. I mean that alone, well you should have led with that.

Speaker 12:46

Yeah, I mean, you know, like yeah, yeah, you could like literally do that and then be like, all right, and like I'm gonna go hop on a Teams call or whatever.

Cami Smith 12:52

You know, like it's that's unreal.

Speaker 12:54

Yeah. Yeah, it's yeah, minus getting all the glue off of here for the KG leads. No, that's not anybody's favorite part.

Cami Smith 13:01

Well, thank you for sharing this with us and for um kind of giving us an insight. I know when we talk about with our community, like, hey, we have a new cardiac PET CT, like for the longest time, I I mean, I just had no idea what that was. And I think that our average patient, unless you live this and this is your like, you know, you're living in that cardiac world, um, having a better understanding of what's available here is going to be huge. So thank you.

Speaker 13:24

No, yeah, you're welcome. I definitely think, you

Measuring Flow And Finding Tiny Disease

Speaker 13:27

know, probably the only other thing I would say is, you know, advantages over traditional spec imaging. I mean, not only can we just image the heart, but you can actually we can actually watch the blood perfuse into the heart muscle or actually get absorbed in the heart muscle. Oh, yeah. And not only can we watch it, and then want to one up that not only can we watch it, we can actually quantitate it, which means like we can assign it a value, like in milliliters per second or milliliters per and what does that tell you? And basically, like so we it allows us to assess a patient's ability to actually have uh extra blood flow on demand in the event you need exercise, right? Because as we and I are sitting now, our heart hopefully our hearts are beating. Um but basically, you know, we have a certain amount of blood that needs to go to the heart, right? But then if we go and take off, and let's say we need to run across the room or go to the or run up a set of stairs, right? Our bodies need blood, our blood chemistry starts to change, and that says that tells our tells our heart that it's like, hey, we need more, we need more resources and we need to get you to get that blood to you. Well, the heart also needs its own resources. Yeah. So it has to feed itself blood so that it can feed, it can also meet the demand of the body. Okay. And so when stress happens, a lot of our arteries and veins will dilate to make up for that extra volume of blood that we need to do whatever exercise that we need to do. And so we can measure that now with this piece of equipment, that we can actually measure how much of that you have on hand is of what we call reserve. Okay. Um, and so and we can map that. Um and uh what that then allows us to do for imaging, we also so we can image it, we can quantitate how much of it is present, and then it also allows us to not even look at the ability for us to see smaller defects is way higher than it was prior. It had to be a relatively decent size um defect, meaning like an infarct or a blockage somewhere for us for for the scanner to see it. Um and it was it's sensitive. I mean, it it's not bad, right? But but this now is we're not e we're finding what we call microvascular disease, which is wow, tiny, like tiny blockages that you may not even know that you had.

Cami Smith 15:23

That over time could lead to big issues. Yeah. Wow. Okay.

Speaker 15:27

So yeah, so that that part of it's cool. They they do calcium scoring with it. Um and then I would say for the future, and we maybe talk about this a whole nother time, um, is like what else

What Comes Next And Wrap Up

Speaker 15:36

does this test lead to? Well, you know, obviously send patients to cath, but sometimes the next step after that, it's like, well, we can cath it, we don't know if that heart muscle is still alive. And then we're we're gonna introduce another another program, hopefully, uh, into this year, meaning of next year, where we then are gonna be able to do this, use that same scanner and actually be able to assess whether that heart muscle is still what we call viable. Wow. And um it involves a little bit of a little bit of funny blood chemistry. We mess with the patient's blood sugar a little bit. Um, and we can actually assess whether that heart muscle is still allowed to even know if the intervention is worth doing.

Cami Smith 16:06

Wow.

Speaker 16:06

And so again, getting the right patient to the right to the right study, the right intervention. Yeah.

Cami Smith 16:11

That's incredible.

Speaker 16:12

Yeah.

Cami Smith 16:12

Well, we'll have to talk about that. When you guys get that in place, you can come back and give us an update.

Speaker 16:17

Yeah.

Cami Smith 16:17

Well, thank you so much. Of course. I appreciate your time. Yeah. And thank you guys for joining us on the end so much more.