The coronary artery calcium score (also known as CT calcium score) is a measurement of the amount of calcium in the walls of the arteries that supply your heart muscle, using Computed Tomography (CT) technology.

Calcium scoring does not measure how narrow the arteries are, rather it is a way of looking at the overall amount of cardiac plaque present, which can help predict your risk of a future cardiac event.

Your doctor will use the calcium score to decide whether you are at low, normal or high risk of a future heart attack and give you guidance on how to reduce your risk.

Your GP or specialist may refer you for this test to investigate if reflux could be the cause of, or contributing to, one or more of the following conditions:

• Cough
• Chest pain
• Throat clearing
• Difficulty swallowing
• Difficulty breathing
• Recurrent chest, throat and/or ear infections
• Sinusitis
• Pneumonia
• Bronchitis
• New or worsening asthma
• Disrupted sleep

The indications for the test are basically any chronic atypical symptoms, consistent with those of ‘silent reflux’, and for which an alternate explanation cannot be found. 

Silent reflux is quite common and affects approximately 40 to 50% of patients who have gastro-oesophageal reflux disease.  It is referred to as ‘silent reflux’ because it does not present with the classical symptoms of reflux, being heartburn, lump in the throat and regurgitation.  There is in fact nothing silent about the symptomatology which is often called atypical.  These symptoms range from chronic cough, recurrent sore throats, loss of voice, persistent throat clearing, chest pain, choking, wheezing and shortness of breath.  

This test is not advocated for diagnosing simple reflux which presents with classic and obvious symptoms, such as heartburn and regurgitation, as this can be managed clinically without testing.

You are required to fast for 4 hours prior to your examination. Please do not have anything to eat, drink, smoke or chew during the fasting period. All medications (including prescribed reflux medication) must be taken on the day of your examination prior to the 4 hour fasting period.

Part One

Upon arrival to clinic, the Nuclear Medicine technician will give you 20ml of an over the counter liquid anti-acid (GastroGel, Gaviscon, or equivilent) followed by approximately 50mL of water with a small dose of Technetium, and another 50mL of water to flush and clear the mouth of the tracer. 35 minutes of imaging will commence after consuming the water.

Dynamic images are taken from the mouth to the stomach in the upright and supine position. These images are then analysed with special software to indicate the frequency and amplitude of reflux contaminating the upper oesophagus and pharynx/laryngopharynx. 

Part Two

Following a 90-minute break, a further 25 minutes of imaging will commence. A study of the head, neck and chest will be performed to detect any aspiration of refluxate into the head and neck structures (including the laryngopharynx) and lungs.

You are required to fast for 4 hours prior to your examination. Please do not have anything to eat, drink, smoke or chew during the fasting period. All medications (including prescribed reflux medication) must be taken on the day of your examination prior to commencing the 4 hour fasting period.

Please allow up to 3 hours.

Historically, GORD has been diagnosed using pH monitoring, fluoroscopy or endoscopy.

pH monitoring is performed off therapy. Standard test preparation is to cease anti-reflux therapy for the 3 days prior to the test. This causes a rebound acid effect, and the stomach produces more acid. Although this test is 50-80% sensitive & 77–100% specific in the presence of heartburn & regurgitation, it is limited to oesophageal disease only, particularly the lower oesophagus. This test is expensive, invasive, and may be poorly tolerated by patients.

Endoscopy is effective as an anatomical diagnostic tool, but has a poor sensitivity for GORD (less than 30%) and is limited to detecting reflux disease that is severe enough to damage the oesophagus.

Fluoroscopy or Barium Swallow is insensitive and has a high radiation burden and only demonstrates oesophageal disease.

The Gastroesophageal Reflux Test provides an effective, bulk billed, non-invasive screening tool for oesophageal disease, LPR and lung aspiration, detecting contamination throughout the maxillary sinuses, throat, middle ears, laryngopharynx, airways and lungs. This test is 90% sensitive, detecting both acid and non-acid reflux and is well-tolerated by patients.  

The test does involve exposure to a small amount of radiation. The entire test, radioisotope and CT exposure is less than an interstate flight and a fraction of a chest x-ray.