Imaging Studies: Stress Testing to Chest CT Scanning

From chest CT scans to cardiac stress testing, some of the more common imaging studies performed by the Cardiac and Pulmonary Imaging Radiologists at UCSF include:

CT-Guided Biopsy - UCSF Medical

Chest CT or Thoracic CT

Chest CT or Thoracic CT is an imaging method that uses x-rays to create cross-sectional pictures of the chest. The chest or thoracic CT is typically used in patients with pulmonary symptoms such as shortness of breath, cough or chest pain. Compared to chest radiographs, it provides a much more detailed and in-depth evaluation of the lungs and other structures within the chest. Chest CT may also be used to evaluate the vessels of the thorax, including the pulmonary arteries and aorta. It can assess for abnormalities of these vessels, including pulmonary embolism, aneurysms and aortic dissection, amongst others.

Chest CT - UCSF Medical
Coronal reformat from a CT scan in a patient with idiopathic pulmonary fibrosis
showing the typical basilar and peripheral distribution of honeycombing.

High-Resolution CT of Lungs

High-resolution chest CT provides highly detailed images of the lungs in patients with known or suspected diffuse lung diseases while using a low radiation dose.  Diffuse lung diseases may cause long-standing, episodic or progressive difficulty with breathing or cough. The high resolution of chest CT imaging is important in evaluating diseases such as sarcoidosis, idiopathic pulmonary fibrosis, collagen vascular, occupational lung diseases and hypersensitivity pneumonitis, amongst others. Radiologists at UCSF have a very close relationship with pulmonary medicine and pulmonary pathology, enabling the most efficient care of patients seen at UCSF for diffuse lung disease

Lung Cancer Screening Program

The Lung Cancer Screening Program at UCSF offers the latest CT technology to detect lung cancer as early as possible in current or former smokers. Lung cancer screening can prolong life by detecting disease early, when the disease is potentially more treatable. A research project called the National Lung Screening Trial showed a 20 percent reduction in lung cancer-related deaths in smokers screened annually with low-dose chest CT scan, compared to screening only with standard chest x-rays. In the UCSF screening program, the patient’s chest CT scans are analyzed by a thoracic radiologist specializing in lung cancer diagnosis and treatment. Thoracic surgery, pulmonary medicine, oncology and radiology experts work together to develop optimized treatment plans. Is screening for lung cancer valuable to you?

Cardiac MRI and Cardiac Stress Testing

  • MRI of the heart, a well-recognized method for imaging cardiac structures and function and as an alternative to nuclear cardiac stress testing, was developed at UCSF and other leading cardiac imaging centers 30 years ago. UCSF Professor Charles Higgins, MD, was a pioneer in this field.
  • MRI, which requires no radiation or injection of contrast media, can provide very precise images for assessing cardiac function as  well as testing for cardiac stress. Cardiac MRI is considered one of the “gold standards” for myocardial viability.
  • MRI also allows radiologists to obtain detailed perfusion images for patients undergoing chemical stimulation to generate cardiac stress.

Higgins - Cardiac Imaging Expert - UCSF Medical
Charles Higgins, MD, is widely considered to be the foremost international expert on noninvasive cardiac imaging for both children and adults.

Thoracic MR Angiography

Thoracic MR angiography provides images of the aorta and great vessels, in addition to the central pulmonary arteries and veins. This technique imparts no radiation to patients.  Thoracic MRA is most useful in patients who are young or who are expected to undergo multiple imaging examinations over time.

Coronary CT Angiography

  • Coronary computed tomography (CT) angiography is a scanning technology that, when used on the chest area, obtains 3D images of the entire heart and coronary arteries in a few seconds. Coronary CT Angiography can be used to “rule out” narrowing in arteries or to explain chest pain unrelated to physical exertion.

Coronary CTA - UCSF Medical
Coronary CTA

  • CT Angiography provides detailed images of the coronary arteries and accurate detail of the beating heart. Radiologists use the innovative displays from this technique to improve detection of the build-up of plaque in the walls of the coronary arteries.
  • Coronary CT Angiography is less invasive and costs less than standard coronary angiography. UCSF has invested in and offers the most advanced, low dose radiation exposure techniques. With CT, UCSF is able to use one-third of the radiation generally necessary for conventional angiography. Is a coronary CTA appropriate for you?

Coronary Calcium Screening

A coronary calcium screening exam is a non-invasive study that evaluates the presence of coronary calcium plaque buildup within the coronary arteries and is a good technique for identifying those who will benefit from aggressive programs to lower their risks of heart attack.

Combined CT and PET

  • This technology combines the structural, anatomical information provided by a CT along with functional imaging (the metabolic and biochemical activity) collected by the PET. It provides the benefit of integrating function with anatomy. The imaging shows the presence or absence of disease, how active it is, whether or not it has spread, and precisely where and how large an abnormality is present.
  • UCSF is one of very few locations in the country that offers this “one stop shop” approach to evaluating coronary artery disease.

CT-Guided Thoracic Biopsies

CT guidance may be used to perform biopsies of the lung and other structures of the chest in patients with suspected cancer. Using chest CT, radiologists are able to accurately place a small needle into specific areas of the lung or chest wall and remove a small amount of tissue for diagnosis. Compared to surgery, CT-guided biopsies are a relatively non-invasive way to make a diagnosis of various thoracic tumors.

Virtual Bronchoscopy

Virtual Bronchoscopy evaluates bronchial narrowing and obstruction potentially caused by tumors, mucus, foreign bodies, anatomical abnormalities or lymph nodes. The test can be helpful in the preoperative planning of stent placement and can be used to evaluate surgical sutures after lung transplantations, lobectomy or pneumectomy. At UCSF, virtual bronchoscopy contributes to a better understanding of tracheo-bronchial diseases.

Chest X-rays

A chest radiograph is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm. Chest x-rays are often used as a first step to identify causes of a persistent cough, coughing blood, chest pain, difficulty breathing or signs of tuberculosis, lung cancer or other chest or lung diseases such as pneumonia, or asthma. A chest X-ray can aid in diagnosing infection, collapsed lung, hyperinflation or tumors and, if needed, can be followed by a chest CT scan.