The control room looks like the cockpit of a jet, and Dr. Szilard Voros, a scientist at the Piedmont Heart Institute, is jumping excitedly from one large glass window to another big pane on the opposite wall.

Monitors beep and zigzag lines bounce up and down on several of the half-dozen computer screens.

Rich Addicks/raddicks@ajc.com (ENLARGE)

After a low-dose radiation CT scan, Jan McAlister is relieved to learn from Dr. Szilard Voros that she has no calcium in her arteries. McAlister is part of a demonstration project that started in April for blood relatives of people with heart disease.

Rich Addicks/raddicks@ajc.com (ENLARGE)

Cardiac technician John Burt cq helps a patient after receiving a CT scan at Piedmont Hospital's Heart Institute, where they are conducting a study to see if they can catch heart disease early in those who have a family history of the disease. For Bill Hendrick story on the study, and a new program called, iCare cq, which hopes to lower the rate of those hit by sudden cardiac arrests, similar to what happened to newsman Tim Russert. In the foreground is cardiac technician Kim Christian cq setting up post production so that the results can be viewed by a doctor. NOTE: The subject didn't mind having her picture taken, but didn't want her name used. She is not part of the study, but the process is still the same.

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On one side, Jan McAlister, 40, is lying on a gurney, being run through the purring doughnut hole of a low-dose radiation CT scanner that looks like a torpedo tube. On the other, a middle-aged man is sliding through a similar device that shows his heart in multiple views but exposes him to more radiation.

McAlister joins Voros in the control room and yelps in glee. She peers with him at a computer screen that shows a three-dimensional picture of her heart. She gets good news — no calcium in her arteries.

Calcium would be a warning sign of atherosclerosis, or hardening of the arteries, which Voros said could lead to the kind of sudden death that took NBC newsman Tim Russert in June. The diagnosis isn't as rosy for the man, who's being monitored simultaneously by Voros. He's going to need surgery.

McAlister is part of a demonstration project that started in April for blood relatives of people with heart disease. It's aimed at spotting early warnings that Piedmont's cardiologists will be looking for when it rolls out its patented iCare Clinic on Aug. 20.

It will offer all sorts of tests, some proven, some more controversial, such as high-radiation scans. Voros expects the clinic to get busy fast because the American Heart Association said Russert's death has led thousands of people to seek some assurance from doctors about their heart health.

Heart disease is the leading cause of death among Americans, killing about 700,000 people every year, including about 325,000 who die suddenly without symptoms.

About 150 people are being recruited to take part in the study, and 40 have signed up so far, including McAlister and her brother.

Their father had bypass surgery at age 62 after a blockage was found at 52.

Participants in the demonstration study undergo low-dose radiation CT scans, blood tests to detect genetic markers of heart disease and thorough analysis of both good (HDL) and bad (LDL) cholesterol.

People in iCare will have a choice of tests, but will have to pay out of pocket for many of them because most insurance plans don't cover blood analysis, nuclear scans or other exams.

They'll choose how far they want to go. The high-dose CTs expose people to 1,000 times the radiation of a chest X-ray, and radiation is a possible cause of cancer.

Scans that expose patients to high radiation are relatively new, Voros said, but provide more detailed pictures of the arteries and heart. Many scientists say such scans also find too many signs that a person has arterial problems that don't exist, or miss ones that do.

Hospitals for years have been doing low-dose CT scans, which show plaque or hard calcium. But there's no consensus on whether the high-dose scans are worth the long-term risk.

Value of tests in dispute

Dr. Gregg Fonarow, a spokesman for the American Heart Association and professor of medicine at UCLA, said research has been under way for years to determine the risk-reward ratio of high-radiation and genetic tests, and "there is no agreement" on their value.

But Voros said his research has shown that high-dose scans and genetic tests can detect blockages or inherited risk, and determine between hard and soft plaque — thought to be the kind that breaks off and rips through the arteries. In high-risk patients, he said, the high-dose scans could spot soft plaques and save lives.

In April, a Voros study published in the Journal of the American College of Cardiology Cardiovascular Interventions provided evidence that high-radiation scans were "quite reliable" in identifying hard and soft plaques. He said the soft plaque can't be identified with low-dose scans.

His latest research, published in late July in the journal Atherosclerosis, reported that 8.2 percent of patients with no hard plaque had significant amounts of the soft kind. He said he's also shown that specific genes can offer clues about the "stickiness" of arteries and the density of plaques.

But some experts, including Arthur Caplan, head of the Center for Bioethics at the University of Pennsylvania, are concerned that Piedmont might be overselling iCare. Caplan said he feels "there is more of a business opportunity here than a solid public health rationale."

Dr. Greg Simone, a cardiologist and chief executive of the WellStar Health System in Marietta, said "the question is how much is enough and how much is too much. We do testing. Emory has a whole section of predictive medicine. To think a genetic screen is going to be perfect is not right. We are not there yet."

'No magic bullet'

Dr. Steve Frohwein, medical director of advanced cardiology at St. Joseph's Hospital, said "there is no magic bullet, no magic answer" as the iCare program seems to be offering.

But Voros is adamant that iCare is a potential life-saver. He said he has developed "proprietary" analytical tests and that his lab has developed new ways to interpret calcium buildups, even from low-dose scans. He said he does not suggest high-dose tests to patients who have no symptoms.

In the iCare program, blood tests for genetic markers will cost $300, but won't be covered by insurance. Neither will high-dose scans, which cost $720.

To take a complete battery of tests, patients will have to pay large sums out of pocket. Low-dose CT scans cost $125, but Voros said they can't determine density of plaque.

But he said tests not included in standard screenings, despite their higher prices, could prove worthwhile because they'll be able to spot problems low-radiation scans can't, as well as genetic markers of heart disease.

"We're shopping iCare for funding," he said. "We want to show on a large base that the markers really signal heart disease. There are at least 30 of these genes."

The family project and the iCare program are linked. Voros said smokers can't participate in the demonstration study, but will be allowed to undergo all the iCare tests they want.

He said iCare will be individualized, based on his advice and the desires of patients, and that Piedmont plans "a heavy [marketing] campaign aimed at avoiding the Tim Russert thing."

But there's little doubt iCare will comfort folks like Alfred Hernandez, 66, of Stockbridge, a lifelong marathoner who was shocked to learn seven years ago he had a troubled ticker. He later underwent angioplasty and a triple bypass, and said he hopes iCare "will help my daughters," including one found to have plaque at age 37.