The global social media response to the 14th annual Society ofCardiovascular Computed Tomography scientific sessionsAndrew D. Choia,∗, Purvi Parwanib, Erin D. Michosc, James Leed, Vasvi Singhe, Emilio Fentanesf,Juan Lopez-Matteig, Martha Gulatih, Khurram Nasiri,j, Koen Niemanl, Leslee J. Shawk,Ron Blanksteine
a Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USAb Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USAc Ciccarone Center for the Prevention of Cardiovascular Disease, The Johns Hopkins Medical Institute, Baltimore, MD, USAd Division of Cardiology, Department of Medicine, Center for Structural Heart Disease, Henry Ford Heart and Vascular Institute, Detroit, MI, USAe Division of Cardiovascular Medicine and Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USAf Department of Cardiology, Tripler Army Medical Center, Honolulu, HI, USAg Department of Cardiology and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USAh Division of Cardiology, University of Arizona, Phoenix, AZ, USAi Houston Methodist Debakey Heart and Vascular Center, Houston, TX, USAj Center for Outcomes Research, Houston Methodist, Houston, TX, USAk Weill Cornell Medical College, New York, New York, USAl Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
A R T I C L E I N F O
Keywords:Computed tomographyCoronary artery diseaseTAVRCardiologyRadiologySocial media
A B S T R A C T
The 2019 Society of Cardiovascular Computed Tomography (SCCT) Annual Scientific Meeting (ASM) was per-haps the most impactful meeting in recent memory for the field of cardiovascular CT. Beyond just being thehighest attended ASM meeting in the society's history, the virtual impact of the meeting extended farther thanever before due to coordinated social media coverage and participation. As a result, the ASM reinforced the factthat the educational paradigm and audience of scientific meetings has changed. Bound through the hashtag#SCCT2019, social media allowed the research, education, networking and trends from this year's ASM to ex-tend beyond the walls of the meeting with a record setting level of digital global reach. Using posts from Twitteras a prism of interests and response of the global cardiovascular CT community, this article presents the topicswith the highest social media engagement from the 14th ASM.
1. Table of contents summary
The 2019 Society of Cardiovascular Computed Tomography (SCCT)Annual Scientific Meeting (ASM) was perhaps the most impactfulmeeting in recent memory for the field of cardiovascular CT. Beyondjust being the highest attended ASM meeting in the society's history, thevirtual impact of the meeting extended farther than ever before due tocoordinated social media coverage and participation. Bound through
the hashtag #SCCT2019 from Twitter as a prism of interests and re-sponse of the global cardiovascular CT community, this article presentsthe topics with the highest social media engagement from the 14thASM.
“The paradigm of how we teach our colleagues and why we gomeetings has changed. How should meetings be different in2019? We will make this a unique #patientfirst meeting like noother, full of #interactivesessions, #cuttingedgetechnologies
https://doi.org/10.1016/j.jcct.2019.12.003Received 4 November 2019; Accepted 5 December 2019
abbreviations: SCCT, Society of Cardiovascular Computed Tomography; FiRST, Fellow and Resident Leaders of SCCT; ASM, Annual Scientific Meeting; CT,Computed Tomography; CAC, Coronary Artery Calcium; FFR, Fractional Flow Reserve; PET, Positron Emission Tomography; ACS, Acute Coronary Syndrome; IHD,Ischemic Heart Disease; CVD, Cardiovascular Disease; CAD, Coronary Artery Disease; MACE, Major Adverse Cardiovascular Events; TAVR, Transcatheter Aortic ValveReplacement; FIT, Fellows in Training; ECP, Early Career Professionals; CMS, Center for Medicare Services; AMA, American Medical Association
∗ Corresponding author. The George Washington University School of Medicine, Division of Cardiology, 2150 Pennsylvania Ave NW Suite 4-417, Washington, DC,20037, USA.
and perspectives from top CT leaders and beyond.”Dr. Ron Blankstein (@RonBlankstein) on Twitter
The 2019 Society of Cardiovascular Computed Tomography (SCCT)Annual Scientific Meeting (ASM) was perhaps the most impactfulmeeting in recent memory for the field of cardiovascular CT. Boundthrough the hashtag #SCCT2019, social media allowed the research,education, networking and trends (Fig. 1) from this year's ASM to ex-tend beyond the walls of the meeting with a record setting level ofdigital global reach.1 Using posts from Twitter as a prism of interests ofthe global cardiovascular CT community, this article presents the topicswith the highest social media engagement from the 14th ASM.
Social Media: “Social media importantly allows us to engage andeducate the broader global audience about cardiac CT advancesand optimal use to improve patient outcomes.” Dr. Andrew Choi(@AChoiHeart) on Twitter
Several unique innovations utilizing social media were incorporatedin this ASM. From October 2018, the SCCT appointed a social mediaworking group (Table 1) comprised of early career to advanced careerleaders at the intersection of cardiovascular CT, cardiovascular medi-cine and social media. Working group members served as social mediaambassadors utilizing the hashtag #SCCT2019 on Twitter with severalgoals: 1) To promote global dissemination of #SCCT2019 content; 2) Toallow for interconnected engagement; 3) To provide cardiac CT edu-cation; 4) To engage trainees, professionals, general clinicians and
scientists in the field of cardiac CT; and 5) Establish suggestions aroundbest practices for social media use. At present, SCCT has the broadestpresence among cardiac imaging societies on social media throughFacebook (> 4000 followers) and Twitter (> 10,300 followers).
Through these efforts, #SCCT2019 had the highest social mediaimpact ever for an ASM. From July 2018 through July 2019, posts as-sociated with the hashtag have generated an estimated 40 million di-gital impressions from > 9500 tweets, > 1300 articles and > 11,200visuals. Over 1200 users have directly “retweeted” or “liked” the con-tent from the meeting. This represents a 58% increase in digital im-pressions and 58% increase in the number of individuals with activeengagement with the tweets over the previous record setting#SCCT2018 meeting. In comparison, two major cardiovascular imagingmeetings within the past year have generated 1.8 million digital im-pressions with 227 engaged individuals and 4.8 million digital im-pressions from 555 engaged individuals respectively.
One of the means to provide education in this digital space over thecourse of #SCCT2019 planning was through the use of “tweetorials”, aseries of linked posts with slides, images, polls and video content thatallow for a novel means of interactive education with cardiac CT topics.Among the most impactful tweetorials were an introduction to plaqueimaging by Drs. Parham Esthehardi (@CoronaryDoc) and Choi.2,3
Coronary artery calcium: guideline endorsed: A few predictions:#CAC and imaging will increase with more lipid lowering therapies… and will allowed for better shared decision making” Dr. Ritu
Fig. 1. Social media trends from #SCCT2019.
Table 1SCCT 2019 social media ambassadors, influencers and program committee members.
SCCT2019 Social Media Ambassadors SCCT 2019 FiRST Social Media Ambassadors SCCT Annual Scientific Meeting Program Committee
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Thamman (@IAmRitu) covering Dr. Ron Blankstein's (@RonBlankstein) talk on Twitter
“[There remain] barriers to saving lives with CAC using 2018AHA/ACC cholesterol guidelines” Dr. Jeffrey Carr (@JohnJeffreyCarr) covering Dr. Michael Shapiro's talk on Twitter
A major trending topic on social media was the role of cardiac CTimaging for enhancements in cardiovascular prevention. The role ofcoronary artery calcium (CAC) imaging, which is now guideline en-dorsed in 2019, was front and center.4,5 The cardiovascular preventionsymposium, chaired by Dr. Blankstein assembled an array of widelyrecognized experts discussing topics such as PCSK-9 inhibition (Dr.Khuram Nasir, @khuramn1), sex specific ASCVD prevention (Dr.Martha Gulati, @DrMarthaGulati) and icosapent ethyl acid (Dr. DeepakBhatt, @DeepakBhatt). A broadly shared post was an update to the2019 American Diabetes Association guidelines incorporating use oficosapent ethyl for patients with hypertriglyceridemia already on statintherapy.6 Dr. Raul Santos (@rauldsf_santos) discussed the evolving roleof risk stratification in familial hyperlipidemia emphasizing the het-erogeneity in risk (low-density lipoprotein levels, other risk factors,previous cardiovascular disease) and opportunities through CT angio-graphy and CAC to identify subclinical atherosclerosis.7 A social mediahyped debate among Dr. Nasir, Dr. Pradeep Natarajan (@pnatar-ajanmd) and Dr. Erin Michos (@ErinMichos) on CAC vs. polygenic riskscores vs. lifetime risk score in the 45-year-old patient was highlyprovocative both at the meeting and online.4,8,9
Dr. Roger Blumenthal's recognition as the 2019 Agatson AwardWinner was one of the mostly widely shared #SCCT2019 posts cele-brating a lifetime of work leading clinicians and researchers devoted toprevention of coronary artery disease (CAD), heart failure, atrial fi-brillation and in minorities and women. His talk emphasized the 2019guideline approved “ABCDE” approach that incorporates the importantrole of CAC and for increased prevention guideline adherence.10 On theheels of the SCOT-Heart trial, arguably the most widely and discussedcardiac CT study ever on social media, Dr. David Newby announcedplans for the SCOT-Heart 2 trial which plans to randomized 6000 in-dividuals to a CT vs risk score strategy (NCT03920176).
Perhaps the most important barriers to overcome were best articu-lated by Dr. Michael Shapiro (@DrMichaelShapiro) at SCCT2019 andpublished recently by Berman and Blankstein11. Dr. Shapiro remindedthe audience that while CAC has now become the guideline standard,advancement in insurance coverage, equal access, clinician and patientawareness remain inadequate.11 He pointed out that the Center forMedicare and Medicaid Services (CMS) does not have an overarchingcoverage policy and that 11 of 12 Medicare Administrative Contractorsstate that CAC is not a covered service or have no written policy re-garding coverage.
Atherosclerosis: “Its not the existing degree of coronary stenosis,but rather plaque composition that predicts future acute coronarysyndromes. #YesCCT can answer these questions … Dr. OmarKhalique (@OKhaliqueMD) covering Dr. James Min's talk onTwitter
A trending topic globally was the role of atherosclerosis imaging inidentification of high risk plaques and enhanced understanding ofischemia. Dr. James Min, Immediate Past Editor-in-Chief of the Journalpresented his Top 8 papers for the year which encompassed advances inatherosclerosis imaging. Among these studies, a recent PACIFIC trialsubstudy showed that non-calcified plaque volume and positive re-modeling were strongly associated with impaired hyperemic blood flowby cardiac positron emission tomography (PET) and FFR (fractionalflow reserve) enabling an improved understanding of how athero-sclerosis defines ischemia.12,13 The ICONIC trial studied quantificationof high-risk plaque features of patients with and without acute coronarysyndromes (ACS) and found that only 35% of ACS patients had > 50%stenosis prior to their event and that 52% had high risk plaques
compared with 33% without ACS enabling an understanding of thepotential most effective way to pinpoint high-risk plaques.14 ThePARADIGM trial through a prospective, international cohort, demon-strated a slower rate of quantitatively calculated non-calcified plaquevolume and reduced high risk plaque in patients with statin therapy,while plaque calcification increased.15
Atherosclerosis and Women: “Plaque is a sex specific signature”Dr. Purvi Parwani (@purviparwani) covering Dr. Leslee Shaw's (@LesleeJShaw) talk on Twitter
The Friday afternoon (July 12th) #SCCT2019 session featured anall-women faculty panel devoted to the topic of ischemic heart disease(IHD) in women. Dr. Gulati opened the session with a keynote on sex-based differences in cardiovascular disease (CVD). She noted thatwomen with CVD receive less aggressive care and have worse out-comes.16 She lamented that the link between symptoms and obstructivestenosis is so ingrained that patients and tests are labeled as “atypical”or “false positive” if no obstructive CAD is found. Yet, women who haveischemia with non-obstructive coronary arteries are at increased risk ofmajor adverse cardiovascular events (MACE) compared to asympto-matic women.17 Dr. Quynh Truong (@cardioQT) noted in the PROMISEtrial that women were less likely to have a positive CT (≥70% stenosis)than a positive stress test; however women with positive CT were morelikely to have MACE that those with positive stress tests.18 Dr. Shawdiscussed the uniqueness of atherosclerosis in symptomatic women. Keypoints were that atherosclerotic plaque in women is prevalent andprognostically important.19 In patients with signs/symptoms of IHD,women are more likely than men to have non-obstructive plaque, whichis associated with increased risk for MACE(19). Unfortunately, IHDdiagnosis in women is often deferred or delayed. There needs to bebetter recognition of non-obstructive plaque in women and more ef-fective approaches to prevention, diagnosis, and treatment (Fig. 2).
CT and Multimodality Imaging: “The right test for the right pa-tient”
Dr. Vasvi Singh (@SinghVasvi) on Twitter
Paralleling social media, a collaborative spirit permeated throughthe joint session with the American Society of Nuclear Cardiology, forwhich talks about appropriateness of stress echocardiography, PET andother functional testing modalities were discussed. Dr. John Lesserdiscussed “When is CT the best test” by highlighting scenarios andevidence behind CT from chest pain low to intermediate risk in theemergency department19,20; assessment of etiology of cardiomyopathy(ischemic vs. non-ischemic), CAD in left bundle branch block and sus-pected coronary anomalies.21 In the session “cardiomyopathy, thrombiand other masses” Dr. Benjamin Chow gave a talk about the use of CT inleft ventricular systolic dysfunction. He emphasized the role for CT as agatekeeper for invasive angiography, particularly to exclude ischemiccardiomyopathy for CAC = 0 or non-obstructive CAD in cardiomyo-pathy.22 In cardio-oncology Dr. Maros Ferencik (@CardiacCTGuy)shared potential applications for CT in this emerging field includingpreliminary data that shows how the CAC-Diagnostic and ReportingSystem (CAC-DRS) might be used as a potential risk stratification tool inpatients undergoing thoracic radiation therapy.23
CT and Structural: In the era of low risk #TAVR, will patientspecific risk by #YesCCT take front stage over surgical risk scores?Dr. James Lee (@jameschilee) covering Dr. Ron Waksman's (@Ron_Waksman) talk on Twitter.
The role of #YesCCT in structural heart disease has become afoundational part of the transcatheter planning process (Fig. 3) thatdrives innovation.24 Dr. Waksman reviewed the impressive data for lowrisk transcatheter aortic valve replacement (TAVR) and predicted thatpatient specific risk as determined by CT will take front and center stageover surgical risk scores. Drs. Jonathan Leipsic (@jonathonleipsic) andPhilipp Blanke discussed frontiers in TAVR including understanding
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TAVR leaflet thrombosis, planning of valve-in-valve implantationsusing novel measurements, and valve implantation for patients at highrisk of coronary obstruction through use of intentional laceration of theaortic valve leaflets to prevent coronary obstruction during TAVR(BASILICA procedure).25 SCCT2019 also had a dedicated session ontranscatheter mitral valve interventions (#TMVR), where concepts suchas predicting the risk of left ventricular outflow tract obstruction werediscussed.
Machine Learning: “Will machine learning completely auto-mate what we do as readers?” Dr. Choi (@AChoiHeart) coveringDr. Min's talk
Machine learning has received high attention on social media andfor the first time at SCCT ASM there was a dedicated session. Dr. Minled off by asking “Has the future arrived for cardiac CT?” with theprovocative statement above that machine learning may completelyautomate the interpretation of cardiac CT. With regard to athero-sclerosis, the application of machine learning may allow for automatedsegmentation of high risk plaque components, classification of stenosisgrades and association of these features coupled with clinical data tofully quantify and enhance areas of uncertainty in CAD.26 Dr. IvanaIsgum (@IvanaIsgum) discussed the use of convolutional networks to
allow for automated CAC quantification. She presented work from scansfrom the National Lung Screening Trial from 31 hospital and 13 dif-ferent CT scanners demonstrating near perfect agreement with expert,manual segmentation methods, but cautioned against false positivewith non-coronary calcium. Dr. Koen Nieman expanded on this bydiscussing work from CONFIRM demonstrating how the combination ofsegment based evaluation and risk modeling significantly improvedupon traditional risk models.27 He further cautioned against modeloverfitting as has been found in heart failure models. Perhaps the mostprovocative talk was that of Dr. Saurabh Jha (@RogueRad) asking thepacked room whether machine learning will take over all of our jobs.He argued that a field once infused with inference and judgement hasevolved into over measurement which has led to potential burnout.Drawing from lessons learned in the industrial revolution of the lastcentury, he predicted that machine learning will allow the cardiac CTimager to think more deeply about patients while leaving the mundaneto the machine.28
Trainees and Early-Career in CT: “All the top leaders in the fieldof #YesCCT [were] so accessible and available for early career[professionals]. I've never seen a meeting with that accessibility toour leaders” Dr. Juan Lopez-Mattei (@onco_cardiology) on Twitter
Fig. 2. Unique features of cardiovascular disease by CT in women.
Fig. 3. Emerging role of CT for structural heart disease.
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A notable initiative at #SCCT2019 was a renewed focus on resident,fellows in training (FIT) and early career professionals (ECP) develop-ment with a goal to continue to engage the future leaders in the field.SCCT President Dr. Blankstein advised ECP to become the local cham-pion of the modality through communication with the referring pro-vider and technologist training. Dr. Parwani spoke on carving a uniqueniche in cardiac CT in the era of tremendous multimodality advance-ment with cardiac CT. The world of imaging is exciting but complex toadvance due to extra training time, board certification in multipleimaging modalities, difficulties in finding a job with a satisfactory jobdescription and adequate compensation. For ECP, a lack of preexistingcollaborative structure requires the development of the program inaddition to strategic involvement of radiology cardiac imagers(#CardsRads on Twitter).29 Journal Interim Editor-in-Chief Dr. ToddVillines provided a unique perspective on submitting an excellent car-diac CT manuscript to include a novel, advancing the science of cardiacCT and impactful both on social media (Altmetric score) and by tradi-tional metrics (citation score).29 There were ample networking oppor-tunities through networking events, a tweet up and a baseball gameattended by many SCCT thought leaders (Fig. 4).
CT and Advocacy: “Its crucial for key stakeholders includinggovernment, payors, industry and the cardiac CT community tocollaborate to say #YesCCT to advance evidence based, high valuecare for patients” @Heart_SCCT
Collaboration efforts among SCCT, payors and industry partnerswere discussed by Dr. Richard Frank. This collaboration focuses onpatient outcomes that matter, investment in innovation, reducing thecost of administration, and equipping physicians with artificial in-telligence-enabled technologies. The unifying strategy across SCCT andphysician members involves addressing factors that affect reimburse-ment by ensuring ordered studies are appropriate and are of highquality. To boost CMS reimbursement for cardiac CT, Dr. DustinThomas (@DrDThomas30) explained the multiple factors that affectcardiac CT payment. Ambulatory Payment Classifications allocationsthat result in underreporting cost, inappropriately low charges onchargemasters and problematic billing practices impact reimburse-ment.30
Dr. Heather Brown shared insights into how to be a successful ad-vocate by becoming familiarized with top payors and their policies.Setting a meeting with clear objectives that present critical pieces of
peer-review evidence, quality of care, and patient experiences are es-sential, but a time-consuming investment and requires involvement inthe details such as tracking claims and denials and follow up aftermeetings. Dr. Matthew Budoff emphasized that all payors, even withnational coverage, make local decisions. The SCCT advocacy committeehas developed tools, model Local Coverage Determinations, and kits toassist members with their local advocacy efforts (Fig. 5).
Social Media, CT and the Clinician: “The world wide impact ofsocial media has changed the conversations and make cardiac CTdiscussions open for everyone: imagers, preventive cardiologistsand interventional cardiologists” Dr. Martha Gulati (@DrMarthaGulati)
The first ever #SCCT2019 social media symposium moderated byDrs. Choi and Shaw brought an overflow crowd to the Exhibit Hallencompassing range of trainees, clinicians and cardiac CT end-usersbound by a curiosity in how to leverage social media to enhance edu-cation in cardiac CT.1 Dr. Parwani presented a provocative look at therole of social media in elevating the cardiovascular trainee to create avirtual identity that enhances visibility, advocacy and mentorship. Dr.Michos discussed how social media importantly allows physicians toaddress and prevent burnout by creating what she coined as “a raft ofotters” that create a professional network of support that crosses geo-graphical boundaries while establishing new collaborations. As one ofthe highest followed cardiologists (> 20,000 Twitter followers) in theworld, Dr. Martha Gulati taught on important cautions about socialmedia such as avoiding angry rants and protecting patient privacy(HIPAA). The second half of the symposium moderated by Dr. MamasMamas (@MamasMamas) and Dr. Patrycja Galazka (@PatrycjaGalazka)gave users a brief overview of the basics of social media to advance thefield of cardiovascular CT with speakers Drs. Lee, Nidhi Madan (@Nidhi_Madan9), Lopez-Mattei and Ryan Daly (@DrRyanPDaly]
Future Vision: “At this critical junction as cardiac CT becomesintegral across the entire spectrum of prevention, risk assessmentand management decisions …” @khuramn1 covering Dr.Blankstein's Presidential Address.
During his presidential address, Dr. Blankstein shared with the au-dience why this is an exciting time for #YesCCT. His bright overviewincluded the fact that CTA has the highest level of evidence for im-proving cardiovascular outcomes, CAC is now endorsed by national
Fig. 4. Networking at SCCT 2019.
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guidelines, and that there is a pipeline of many exciting innovations inthe field of cardiovascular CT. The excitement in the field of cardiac CTcertainly resonated by those who attended #SCCT2019, as many at-tested that “Energy was palpable everywhere”.
Dr. Blankstein shared SCCT's new mission: “To improve healthoutcomes through effective use of cardiovascular CT” He then outlinedvarious steps that will be needed to achieve success, including: 1) Keepfocusing on the basics; 2) Continued emphasis on providing highquality coronary CTA; 3) Ensure appropriate use; 4) Focus on treatmentand prevention of cardiovascular disease; 5) Grow pipeline of CT im-agers – Training more radiologists and cardiologists; 6) Continued re-search; 7) Advocacy – improving coverage for CAC and CTA around theworld. Dr. Blankstein highlighted some of the key aspects of SCCT's pastand future success, including our diversity, collaboration with others,and investment in future leaders. He also discussed the importance ofengaging and educating a broader audience of care providers, includingprimary care physicians, cardiologists, emergency room physicians, andradiologists. “Educating our end-users will lead to improved utilizationof cardiac CT and ultimately better patient outcomes.” Dr. Blanksteinconcluded by thanking the annual scientific program planning com-mittee, the prevention symposium planning committee, the SCCT staff,and various SCCT leaders, including speical mentors, friends, and col-leagues who have been influential in many ways.
Funding
None.
Declaration of competing interest
None.
Acknowledgements
Social Media Ambassadors, FiRST Committee Members, SCCT 2019Program Planning Committee, SCCT 2019 Influencers. Dr. Nasir ac-knowledges support from the Jerold B. Katz Academy of TranslationalResearch.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jcct.2019.12.003.
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