Viewing Cardiac Images: A Peek into the Future

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A 60-year-old male presented with severe chest pain. The gated chest pain protocol on the Siemens Somatom Definition Dual Source CT enabled the immediate visualization of the entire thorax as well the coronary arteries without motion artifacts. As shown, a Stanford type B aortic dissection was identified. The image was processed on the Siemens syngo MultiModality Workplace.Cardiac image viewing presents a conundrum for physicians and IT professionals. That is, cardiac and cardiovascular imaging consists of multiple types of images and datasets from a diverse array of systems including cardiac cath, echocardiography, nuclear medicine, CT and MRI. To further complicate the picture, a wide group of users need access to the cardiac datasets. Think cardiologists, radiologists, surgeons, referring physicians and more.

This month, Health Imaging & IT visits with two facilities to learn about the challenges of integrating cardiac image datasets and how cardiac image viewing platforms can be deployed to improve cardiovascular patient care.

Communication, consultation and excellence

Caritas Good Samaritan Medical Center in Brockton, Mass., is a cardiovascular center of excellence. Its objectives include state-of-the-art clinical care, standardized reporting and measurable outcomes. The hospital envisions developing a cardiovascular electronic patient record that facilitates the seamless transfer of images and clinical data across the enterprise to nurture online consultations among physicians, ease the referral process and increase workflow and efficiency.

The medical center plans to tap into Agfa HealthCare Heartlab Cardiovascular Solution as the cornerstone of its cardiovascular electronic patient record. “The primary challenge comes from the high number of cardiology sub-specialty areas. We need to deal with each area to create a complete patient record,” explains Richard Regnante, MD, FACC, cardiology consultant for cardiovascular program planning.

Heartlab Cardiovascular integrates an array of images and data, says Regnante. The center plans to use the system to address the complete cardiac care cycle. The patient care process begins with a history, physical and electrocardiogram. Standard next steps include an echocardiogram which helps the cardiologist look at the anatomy and function of the heart. “Traditional echo can help determine the presence of valvular stenosis and calculate the ejection fraction, but image quality is not always optimal. Physicians can use contrast echo or order 3D or transesophageal echo to potentially improve results.” Physicians often turn to a stress test or stress echo to detect ischemia or restricted blood flow. All of these basic assessments are critical to diagnosis, says Regnante, and should be available in the cardiac electronic patient record.

Other key diagnostic tests include nuclear stress testing to evaluate any ischemic changes. SPECT can detect perfusion abnormalities, and PET can help cardiologists determine the tissue viability and whether or not bypass surgery can improve the patient’s condition. MRI also may come into play if the physician requires an assessment of coronary and ventricular anatomy.  One of the most promising developments, says Regnante, is coronary CT angiography, which can provide a very pristine anatomical assessment of the coronary arteries. Other imaging data include cardiac cath x-rays and intravascular ultrasound (IVUS).

“Cardiologists need to pull together all of this imaging data to make a prognosis and determine treatment options,” explains Regnante. “Our vision centers on putting all of the imaging data into a single cardiology information system for analysis, storage, retrieval and multimodality comparisons. We’d like the electronic record to be available throughout the health system and at referring physician offices and home computers.” Caritas currently uses Heartlab Cardiovascular to handle cath and echo studies and just added ECG data to the system with non-invasive vascular, MRI, CT and nuclear medicine capabilities in development.

The project is expected to deliver improvements in both patient care and workflow. Physicians will have comprehensive access to patient data not only at the Caritas cardiovascular center of excellence but also at other sites across the six hospital system and at home. The ability to view and compare the complete patient dataset provides physicians with critical decision-making information and could accelerate care.

During the development process, however, Caritas needs to address multiple challenges. Proprietary data are an issue; the hospital needs to develop processes for converting and manipulating raw data. “The DICOM standard is helpful, but it doesn’t apply to non-imaging data like waveforms,” notes Regnante. Consequently, the center needs to address the issue with all of