Paul Langton

Rural/Remote Physician/Cardiology + Public & Refugee Health
Non-partisan Medical Science
Global Health to Mol Biology. #HRW. #Yamatji

[Paul Langton @WALangProf]

@drkeithsiau @AhmedAA88 Start with a child or teenager...
then give a trial of colchicine.

[Paul Langton @WALangProf]

@DocPriyamMD The sildenafil - nitrate interaction is an absolute myth that belongs in the dustbin of history. Any effect is theoretical and in practice it makes minimal difference on BP. To call it 'life-threatening' is showing your ignorance. Please stop repeating this nonsense.

[Paul Langton @WALangProf]

@FCademartiri @nicknorwitz Additional context on early coronary atheroma comes from the 30+ year experience of intravascular ultrasound, led by Steve Nissen, Murat Tuzcu, et al.
This has redefined our understanding of atherosclerosis as a disease starting in youth.
e.g. https://t.co/vX3WbcRjGH

[Paul Langton @WALangProf]

@taipan168 1.2% transmission rate amongst non-partner household contacts = not very infectious.

https://t.co/UWTmGAS2LG

[Paul Langton @WALangProf]

@FCademartiri 100% agree

[Paul Langton @WALangProf]

@FCademartiri We can agree to disagree.
WB-MRI is lagging behind PCCT, but the evidence is slowly accumulating.
I am not yet aware of any clinical outcome data for PCCT vs conventional current generation CTCA, but would be pleased to be updated if you know more.

[Paul Langton @WALangProf]

@jljcolorado @bmj_latest @WHO FYI
https://t.co/LBQxkIYCZD

[Paul Langton @WALangProf]

@FCademartiri Just look at the 'promise' of photon counting CT...

https://t.co/B81z0KtvvL

[Dr. Filippo Cademartiri @FCademartiri]

🫀⚡ Photon Counting CT is no longer “future technology.”
This multi-institutional guidance makes something very clear: PCCT is becoming a new framework for cardiac imaging itself.

For years, cardiac CT has been limited by:
👉 calcium blooming
👉 stent artifacts
👉 insufficient spatial resolution
👉 limited plaque characterization

PCCT directly addresses these problems at the detector level through:
⚡ direct photon counting
⚡ intrinsic spectral imaging
⚡ ultrahigh spatial resolution
⚡ improved dose efficiency

The paper highlights particularly important advances for coronary imaging:
✅ improved lumen visualization
✅ better stent assessment
✅ reduced calcium blooming
✅ enhanced plaque characterization
with in-plane spatial resolution approaching ~125–150 μm.

Perhaps the most important message is this:
PCCT is not simply improving stenosis grading.
It is progressively enabling:
👉 biological imaging of atherosclerosis

The review discusses improved visualization of:
👉 low-attenuation plaque
👉 lipid-rich components
👉 microcalcifications
👉 rupture-prone plaque features

Another key point: PCCT is NOT plug-and-play.
The paper provides practical guidance for:
👉 protocol selection
👉 UHR vs spectral acquisitions
👉 reconstruction strategies
👉 contrast optimization
Because advanced hardware without optimized acquisition remains suboptimal imaging.

My take
Photon Counting CT is not “better CT.”
It is increasingly behaving like:
👉 a fundamentally new cardiovascular imaging modality
integrating:
⚡ anatomy
⚡ plaque biology
⚡ spectral imaging
⚡ myocardial characterization
⚡ functional assessment
within a single ecosystem.

The shift from:
👉 stenosis imaging
to:
👉 multidimensional cardiovascular phenotyping
has already started.

#PCCT #PhotonCounting #CardiacCT #CCTA #PlaqueImaging #Atherosclerosis #Radiology #Cardiology #PrecisionMedicine

[Paul Langton @WALangProf]

@FCademartiri Whole Body MRI is a promise to longevity medicine similar to photon counting CT to cardiology.
Better detection, no current evidence of outcome benefit, ongoing research.
I'm open minded about both.

[Paul Langton @WALangProf]

@ScienceMagazine You can build an AI model that might be very good at picking up rare diagnoses - but if you deploy that into a normal population, all you will get is false positives.
Embarrassing article from Science.
#Stats101 #notrocketscience

[Paul Langton @WALangProf]

@DavidJuurlink #PPIs

[Paul Langton @WALangProf]

@Drakhil_cardio @DrRajeshG1 @iamritu @EscardioWeb @CadioArena @BrownCardiology @Cardiolgist1 @Cardiology @TrackYourHeart @CardiologyToday @MSMCardsFellows tight RV lead causing TR

[Paul Langton @WALangProf]

@taipan168 @AjaxXanthe Waiting for the Covidiots to get on board with Hantapanic

[Paul Langton @WALangProf]

@EricTopol @JAMA_current Coincidentally, this week...

[Paul Langton @WALangProf]

@EricTopol @JAMA_current 2/ meanwhile, Radiologists do nothing to discourage the massive overuse of ionising radiation +/- iodinated contrast in many low yield CT studies.
The issue of incidental actionable findings applies equally to all imaging, so any 'harms' are not unique to WB-MRI
#flatearthers

[Paul Langton @WALangProf]

@EricTopol @JAMA_current 1/ Alternatively, 2 radiologists show that they fail to understand the potential of evolving technology.
They limit the role of WB-MRI to early cancer detection, but ignore the potential for cardio-metabolic assessment and longevity focused therapy.

[Paul Langton @WALangProf]

@CDeBonrostro Gracias

[Paul Langton @WALangProf]

@CDeBonrostro Did she have a patent foramen ovale to explained haematogenous spread, bypassing the lungs?

[Paul Langton @WALangProf]

@taipan168 It's a great view from the top

[Paul Langton @WALangProf]

@taipan168 @TimeofAngel The independents such as IGA and Farmer Jacks chains are usually open 0700-2200 7/7.
Some are 24/7. 5km in Perth is a 5 min drive.