New CT Scanner should improve care at PAHCS

This article submitted by Michael Jacobson on 11/17/99.

CAT Scan drawing Cardiac scoring. Trachea malacia. Renal stenosis. Virtual colonoscopy. Virtual bronchoscopy. The Paynesville Area Health Care System (PAHCS) hopes eventually to be able to perform all these procedures with a new Toshiba Helical CT Scanner.

"This piece of equipment is right at the cutting edge of technology," said Mark Dingmann, director of radiology at PAHCS. "Basically, itÕs the top of the line CT Scanner."

The lease of a new scanner was included in the current budget, approved by the hospital systemÕs board of directors at their October meeting, and was ordered a couple weeks ago. It should arrive here next spring.

Better quality
The improved hardware and software of the new scanner will offer medical benefits to patients, agreed Dr. Randy Zimmerman, PAHCS chief of staff; Bev Mueller, patient care administrator for PAHCS; and Dingmann.

The new scanner makes a 360-degree rotation of x-ray images in a half second. "All of our images will be better," said Mueller, including scans of the lungs for cancer.

The new CT Scanner will also be able to view large arteries and veins. "In fact," said Zimmerman, "we can take a virtual journey through any vessel with a wall lining." That includes most organs, like the colon and stomach, as well as blood vessels.

The virtual journey is the result of the enhanced software. Combined by computer, the images can yield a picture of a patientÕs lungs or a sequential look through an organ or blood vessel.

"It will give a much better image than what weÕre doing today," said Mueller. "People will get better care out of this. ThatÕs good because our goal is quality care."

"ItÕs kind of neat," she added. "Time is decreased but performance is increased."

Dingmann said the new scanner will be able to scan an abdomen in 20 seconds, about half of what it takes now. Patients must hold their breath during the examination, a difficult feat now for some, when the scan lasts 40 seconds.

Additional procedures
The increased quality should enable the new CT Scanner to be used for a number of new uses. However, the scanner is so state-of-the-art that some of these procedures havenÕt been tested thoroughly enough.

For instance, a virtual colonoscopy could be used someday instead of a regular colonoscopy for screening purposes. In this case, only if a problem were detected would a regular colonoscopy be needed.

Zimmerman said he believes the medical acceptance of virtual procedures will continue to grow, and as it does more and more insurances will cover these procedures.

One new feature of the CT Scanner will be the ability to do cardiac scoring. Zimmerman said that in 30 percent of heart attacks the first symptom is sudden death. Patients can leave a medical exam and keel over because there is no test for early detection of coronary heart disease, until now. "Coronary heart disease is the only thing that deposits calcium in the heart arteries," Zimmerman said. "This will test the calcium in the heart artery."

Then based on the amount of calcium and the patientÕs age, a risk profile can be provided for them.

Mueller said some patients are fortunate to survive one heart attack and then can take steps to treat their coronary disease through surgery, lifestyle changes, or medicine. Cardiac scoring would give some patients an opportunity to treat their disease before a heart attack.

Diagnoses, not finances
The new CT Scanner will be leased for $900,000 over five years. The idea developed from a need to upgrade the generator on PAHCSÕs current CT Scanner.

The hospital board was presented with financial projections of upgrading to the Toshiba scanner, and, even in the best case scenario, the new scanner was not estimated to generate as much profit as the current scanner. Some, however, feel that the number of new procedures that the Toshiba scanner will do was underestimated. The hospital board was told about a state-of-the-art scanner in Colorado that started to do cardiac scoring and had hundreds of doctors show up to be their first patients.

"This is not a financial decision," Zimmerman said. The real benefit, he said, will be the ability to "make early diagnoses of things that are hard to diagnose."

"The doctors are very excited about it," he added. "We feel good to be in such a progressive institution."

The new CT Scanner will also make a better diagnosis for hypertension, known commonly as high blood pressure. People with elevated blood pressure could have a blockage in the renal artery, which the new scanner will be able to detect. Otherwise, the patient has hypertension.

The speed of the new CT Scanner should prove extremely useful in emergency situations. The images can be transmitted to the radiologists in St. Cloud electronically and consultations with the doctor will be able to be made concurrently. "If itÕs trauma," said Mueller, "seconds are lives."

At present, some patients are transferred to St. Cloud for additional tests. Better diagnoses with the new CT Scanner should enable PAHCS to transfer some patients immediately while treating others more promptly.

After the new scanner arrives and is installed next spring, all the radiology personnel will be trained in its use. That way, Mueller said, it will be available anytime, day or night.

Patient visits
A typical CT scan takes up to 30 minutes, according to Dingmann. That isnÕt expected to change much, as preparation time will still be the about the same. However, the actual scan should last half as long, meaning the patient will be exposed to x-rays half as long, Dingmann said.

In some instances, the new scanner could be used in place of more invasive procedures, including some that require minor surgery. For some of those tests, the recovery might require several hours.

The scanner would not completely replace these tests. But PAHCS predicts that the scanner will be used to screen patients. If a scan indicates a problem, then the full procedure would be needed.

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