CT and the Community Hospital: Formula for Success
CT and the Community HospitalAlthough academic medical centers and large hospitals were the early adopters of 64-slice CT solutions, community hospitals are entering the 64-slice world in quickly increasing numbers.

“Small hospitals are in a difficult position,” asserts Marc Miller, MD, chief of radiology at New London Medical Center in New London, Wis., and founder of Advanced Medical Diagnostics in Mission Viejo, Calif. “Many are struggling to keep pace, maintain imaging volumes, and compete with larger sites.” State-of-the-art CT scanners offer a means to compete with larger institutions, improve the bottom line, and enhance patient care.

At the same time, a small community hospital is not a large academic medical center. It often lacks the same budget, staff, or IT infrastructure as its larger peers, which leads many to ask: Can 64-slice CT succeed in a small hospital? The answer is a resounding “yes.”

Small hospitals can implement advanced imaging technology such as 64-slice CT and grow imaging volumes in a medically appropriate and ethical fashion, says Miller. One option is to contract with a consultant such as Advanced Medical Diagnostics which buys or leases scanners and charges hospitals a fee per scan to eliminate upfront costs and enable the hospitals to tap into state-of-the-art technology at a lower cost.

The key to success, says Miller, is to adapt the current imaging program to the expanded potential available with 64-slice technology. “We never recommend that a hospital deploy a 64-slice system and continue with the status quo.” Instead, the company outlines several paths to 64-slice success. Toshiba America Medical Systems Aquilion 64 can be a strong source of outpatient referrals and increased imaging volume and follow-up programs, particularly when implemented as part of a comprehensive strategy.

One option that allows small and community hospitals to capitalize on the potential of 64-slice technology is to establish screening programs. Sixty-four-slice CT can be used for screening exams such as CT colonography or calcium scoring. Such programs represent a win-win situation. First, the bottom line benefits come not only from the initial CT study but also from follow-up care in positive cases. In addition, patients may benefit. For example, few patients comply with colon screening guidelines, but the noninvasive nature of CT colonography could encourage compliance and increase the number of patients screened and diagnosed.

Another option for the small hospital is to review emerging exams, says Miller. CT brain perfusion, for example, is a fast, reliable way to look for stroke. Early diagnosis allows the hospital to offer thrombolytic therapy, which, in turn, may lead to better patient outcomes and could increase referrals to the hospital’s stroke program.

Other examples are noninvasive alternatives to conventional scans. For example, CT leg angiography is faster, less expensive, and less risky than a conventional angiogram.

Advanced Medical Diagnostics combines technology acquisition with extensive training, marketing, and education programs. “Educating referring physicians is the most important piece of 64-slice CT programs. Clinicians may not utilize the technology if they don’t understand how it can impact patient care,” explains Miller. For example, family physicians may not realize that 64-slice CT can be used to diagnosis renal artery stenosis or carotid disease. “Referring physicians need to be taught how to order and use 64-slice technology,” sums Miller. (For related story, see page 12.)

The 64-slice blueprint

Community hospitals can successfully use 64-slice technology to improve the bottom line and patient care. Miller outlines the basic steps. Although state-of-the-art equipment is essential, don’t start the process by buying the featured equipment. Decide on the business model and appropriate services prior to shopping for a solution.

• Complete a market assessment to identify procedures that the hospital can provide that it is not currently offering. The criteria for inclusion? The procedure should have a positive impact on the bottom line and patient care. Good medicine is good business, but the reverse is not necessarily true, says Miller. That is, don’t market expensive whole-body screening scans to consumers.

• Obtain exceptional imaging equipment, which means 64-slice CT in the current environment.

• Minimize the hospital’s financial risk by bargaining for the lowest possible prices and implementing strategies to minimize the initial financial outlay and maximize cash flow.

• Implement a robust program to train technologists. Sixty-four-slice CT scanners are sophisticated systems; optimizing the technology requires more than pushing the button. Techs need to be able to drive the machine well and know how to use the workstation to postprocess exams. On the clinical level, techs need to understand what the radiologist requires to make a diagnosis.

Case Study: Metroplex Hospital, Killeen, Texas  |  Success on a Grand Scale
Metroplex Hospital in Killeen, Texas, is a typical community hospital. The 117-bed, acute-care facility offers a 24-hour emergency center, general and same-day surgery, advanced diagnostic imaging, a cardiac cath lab, an extensive onsite laboratory, cardiopulmonary care, cardiac rehabilitation programs, and monthly community health screenings.

“When the time came to upgrade [our] single-slice system, I was told a hospital of our size did not need a 64-slice CT scanner and was directed toward 16-slice systems,” recalls Frederick Barnett, MD, radiologist. But Barnett persisted. Fortunately, the community hospital was eyeing cardiac imaging and wanted to establish interventional cardiology and peripheral vascular programs, which made the leap to 64-slice scanning both feasible and necessary.

“I realized 64-slice CT was the way to go not just today but for the next three to five years. I knew Toshiba’s Aquilion 64 would allow the hospital to do more diagnostic workups noninvasively, efficiently, and effectively,” continues Barnett. Sixteen-slice scanners, on the other hand, are compromised by a longer breathhold; their 25 second breathhold accommodates far fewer patients than the eight- to 10-second breathhold of 64-slice systems.

Metroplex Hospital replaced its old single-slice system with the Aquilion 64-slice solution, “our CT workhorse” as Barnett calls it, and now uses the scanner to complete 40 to 50 cardiac CTs weekly. Barnett uses a different yardstick to measure success. “Physicians are altering the way they diagnose and manage cardiac disease and using 64-slice as an effective, noninvasive screening mechanism.”

Anatomy of a success story

In many ways, Metroplex Hospital was ripe for 64-slice CT. The hospital had deployed a robust PACS the year before the new CT scanner. The PACS installation provides a means of managing and distributing 64-slice images.

The other essential building block is the 3D workstation. Initially, Metroplex added a single 3D workstation in Barnett’s office. He served as champion, super-user, and trainer of both physicians and technologists on both the scanner and workstation.

Another measure of success is the need to deploy a second workstation. Now, more radiologists are vying for the single workstation to work up 64-slice cases. Consequently, the site will add a second 3D workstation in the CT room. The new addition will streamline workflow and provide techs with a solid home base for their work.

Barnett has devised a “wise division of labor” to enable efficient integration of 64-slice technology. Techs complete the scan and then transmit raw data to the workstation. The next steps on the tech’s side include interrogating data, taking snapshots, calculating calcium scores, completing cardiac function analysis, and processing images for coronary CT angiograms. Techs also complete a preliminary findings template. “Essentially, the tech prepares the data so they are ready to send to PACS,” sums Barnett.

“Having a well-trained support team enables the radiologist to effectively utilize his time,” continues Barnett. He also interrogates vessels, but does not need to spend time with fairly rote reconstruction procedures such as removing anatomy. Instead, his priority is diagnosis.