Description and Indications

Some doctors call the EBCT Scan procedure the "mammogram of the heart" because of its capability of detecting heart disease at an early stage. The EBCT Scan is a simple non-invasive test used for early detection of heart disease. With early detection and modifying your risk factors, the potential for advanced heart disease may be significantly reduced and in some cases reversed.

The EBCT Scan is a painless test that takes about 10 minutes. The process is similar to taking an x-ray of your body. An individual lies on the scanner table and multiple images of the heart are taken. A cardiologist from the Orange County Heart Institute then interprets these images to determine the amount of calcified plaque in the arteries.

Minimal Calcification
Moderate Calcification
Severe Calcification

When plaque develops in the coronary arteries, it starts as small streaks of fat on the inner lining of the arteries. As the plaque progresses, calcium is deposited, forming a composite plaque. The EBCT scan detects the calcium which correlates with the total amount of plaque in the arteries.

The best scanning technology to detect coronary calcium is the Electron Beam CT scan, also referred to as the EBCT or EBT scan. The EBCT scan is a unique type of CT scanner that was designed for speed to detect plaque in the coronary arteries. The electron beam sweeps from behind the heart at an extremely high speed, literally freezing the image of the moving heart. The advantage is that the detection of calcium deposits is very accurate, fast and extremely low radiation is delivered to the body.


Why do we use EBCT Scans instead of MultiSlice CT ?

Imaging the heart presents unique challenges compared to tests to image other organs of the body. The speed of the EBCT heart scan makes it a very specialized CT scan for screening heart disease.

Whenever attempts are made to screen people for any type of disease, especially a disease like heart disease (which is so deadly and the most wide-spread of any known disease), the tools used to screen for the disease  must meet these criteria:

  • Extremely safe ( meaning very low radiation) 
    • Relatively inexpensive (cost is less than most stress tests)
    • Very accurate ( coronary calcium means  coronary disease)
    • Large body of scientific evidence validating the benefits (thousands of scientific papers on EBCT scans)
    • Large body of scientific evidence of how to modify the disease process if disease is found

    EBCT scans are the only technology to meet these criteria when screening for coronary disease. EBCT scans are the gold standard. Basically, for now and long into the future, EBCT scans will be the preferred scan for coronary calcium screening because of speed, low radiation doses, and the vast number of studies performed using EBCT scans.

    However, technology is rapidly changing and newer varieties of CT scans will undoubtedly be developed that will compete with the EBCT scan for heart imaging. However, a modified EBCT scanner, referred to, for lack of a better name, as super EBCT is possibly in the near future, having the advantage of low radiation, and superior detail and may be the preferred tool for CT angiograms as well as for screening.

    Newer conventional CT scans called multislice CT scanners are becoming available. A “slice” essentially refers to how many tiny lenses are in the CT camera—the more lenses or slices, the greater the picture detail and the more surface area of the heart covered in a certain period of time. The more slices or lenses, the higher the radiation dose. Most people have now heard about  the 64-slice CT.

    There is a great deal of confusion with the public since recent public demonstrations of the 64-slice CT on national TV shows like The Opray Winfrey Show and The Today Show. These shows demonstrated CT angiograms, which required intravenous dye injection and large doses of radiation. CT angiograms are not screening tests and should only be performed on the advice of a physician and for particular reasons. This distinction is not made clear on any of the shows which demonstrated this technology. Due this confusion, people are now calling for 64-slice CT scans for screening on themselves, or CT angiograms for screening.

    The bottom line is this: 64-slice CT scans are not acceptable for screening due to the extremely high radiation dose, and less than optimal for calcium visualization. Other multislice CT scanners, commonly referred to as 16-slice CT scans have similar characteristics and are also not suitable for coronary screening.

    The 64-slice CT and EBCT scanners are  excellent scanners for CT angiograms. CT angiogram using EBCT scans expose the patient to the radiation of 10 chest xrays. CT angiograms using 64 slice CT expose the patient a minimum 100 to 300 chest xrays! A CT angiogram is when a dye is injected into a vein during the time the CT or EBCT scan is performed. A detailed picture of the coronary arteries and coronary bypass grafts is seen. These are called angiograms. Presently, only  EBCT coronary angiograms are approve for CT coronary angiography, but the 64-slice will shortly receive approval. However, neither has the detailed image of invasive coronary angiograms, but the CT angiogram is non-invasive, quick and relatively safer than invasive angiograms. CT angiograms on our EBCT scan provide unequaled detail images of the coronary artery. We have the very latest software enhancement and continuously modify the scan for the individual patient based on their heart rate, body size, lung capacity.

    In summary, an EBCT scan is the screening tool of choice for coronary calcium and full-body screening. If your doctor requests that you have a CT angiogram, request it on an EBCT scan or 64-slice CT. Also request that it be done at a center  under the direction of cardiologists with experience in CT angiography. OC Vitalimaging has performed more CT angiograms than most places in the country. Drs. Santora and Alimaddadian, both of whom have over 25 years each as invasive and interventional cardiologist, oversee our CT angiography program.

    What is a calcium score?

    The conventional type of CT scanner, referred to as multislice or multidetector sweeps around the body in a circle. The speed is much slower and the radiation dose 5 to 10 times higher than an EBCT scan. However, what is more important is that since the detector or lens on a conventional CT is moving slower, they are not as accurate in picking up small to moderate amount of plaque. The calcium that is detected in all the coronary arteries is reported as a “calcium score”. Calcium scores less than 200, are much more reliably detected with an EBCT scanner. It is important to detect calcium or plaque as early as possible so medical treatment can be started to prevent advanced disease that may lead to a heart attack or the need for coronary bypass surgery.

    The higher the calcium score, the higher your chance of having a heart attack or needing coronary bypass surgery, unless, you are treated appropriately with medications. The higher the calcium score, the more vigorously your cholesterol needs to be treated.

    The calcium score is more predictive of your chance of having a heart attack than all the traditional risk factors. Know you calcium score is more important than knowing you cholesterol! Only EBCT scanning can provide this information.

    How does a stress test compare to an EBCT scan? A coronary artery has to be narrowed about 60% to 70% before symptoms are noted and before a stress test will detect any abnormalities. However, half of all heart attacks occur without warning because the artery was not narrowed enough to restrict blood flow and cause symptoms. Suddenly, the minor plaque ruptures, forming a clot within the channel of the coronary artery, closing off the artery resulting in a heart attack. Only an EBCT heart scan can detect and quantify this plaque that is not yet restricting blood flow but puts you at risk for a heart attack. Stress testing can only pick up advanced narrowing that often requires surgery or intra coronary stents. Numerous scientific studies show that coronary calcium is the best predictor of a heart attack risk, and more predictive than all the traditional risk factors combined.

    Guidelines for EBCT Heart Scanning

    A man older than 35, or a woman older than 40, with at least one of the following risk factors:

    • High total cholesterol -- if no coronary calcium, the cholesterol medications can be avoided and diet and exercise can be tried.
    • Low HDL (low good cholesterol) and normal total cholesterol -- if there is coronary calcium, then niacin or a fibrate should be used to raise the low HDL, even if the total cholesterol is normal.
    • Family history of heart disease -- even if the cholesterol is normal, if there is coronary calcification, then cholesterol meds would be beneficial.
    • High blood pressure -- even if the cholesterol is normal, if there is coronary calcium, then cholesterol medications would be beneficial.
    • Tobacco use -- if coronary calcium is present, cholesterol medications would be beneficial. In addition, you should have a lung scan at the same time, since the EBCT scan of the lungs is the best test to detect lung cancer and will only take one minute more to scan the lungs.
    • Obesity - if coronary calcium is present, cholesterol medications would be beneficial even if the cholesterol is normal.
    • Diabetes.
    • Steroid use  (our recent study conducted at OC Vital Imaging and The Orange County Heart Institute showed a large quantity of coronary calcium in competitive bodybuilders who used anabolic steroids).

    Recommendations Based on the Results of the EBCT Scan

    The following recommendations are made:

    •  The need for stress testing: If there is a significant amount of calcium on the scan, a stress test should be done to see if the plaque is restricting blood flow. The more plaque present, the more likely there may be restriction of blood flow.

    •  The levels of cholesterol control: The higher the calcium score for your age and gender, the more vigorously your cholesterol needs to be treated. Should the LDL (bad cholesterol) be reduced to 160, or 130, or 100?

    •  The interval when the EBCT scan should be repeated: The EBCT scan should be repeated in 18 to 24 months if there is calcium, otherwise you will not know if the treatment course has been effective. Often, if the treatment is correct, the plaque may regress somewhat. If the plaque progresses, that is a sign that even more vigorous medication and diet changes are needed. If there is no calcium, usually the scan can be repeated in 5 years. It is usually not necessary to repeat the scan sooner than 18 months.

    • Diet and exercise recommendations should be given.

    As you can see from the above recommendations, the scan will help to decide if medical treatment needs to be administered. Depending on the amount of calcium, starting a cholesterol medication could be life saving. If no calcium is present, you can possibly avoid taking a cholesterol medication.


    Remember, if you choose to have your heart scan performed at another facility, make sure they use an EBCT scanner. The EBCT scan is the most accurate scanner for coronary calcium. It delivers five to ten times less radiation than conventional CT scanners, and is the only scanner approved for coronary calcium screening by the FDA.