Jumping on Board: Multidetector CT Grows & Flows

Cardiac 3D volume rendering from a Toshiba America Medical Systems Aquilion 64 scanner.With devoted clinicians, post-processing image labs, thorough training and dedication to success, organizations are making multidetector CT hum. A few adjustments and the workflow is taking off too, so say end-users. So what’s a facility to do that needs to upgrade to 16- or 64-slice CT? Grab some advice from your peers and jump on board.

What can you expect?

When Hartsdale Imaging in Hartsdale, N.Y., installed a 16-slice Siemens Somatom Emotion scanner, staff had to make a mental adjustment, says Adam Davis, MD. “Some of it was people getting used to getting volumes of data in any dimension as opposed to always assuming axial.”

But once users become accustomed to the new data volumes, they can improve their diagnostic quality, according to Daniel Stricof, MD, a neuroradiologist at Radiology Ltd., a practice with 10 locations in the Tucson, Ariz., area. Stricof and his colleagues cover three hospitals in addition to their own office locations. They use everything from four to 64-slice scanners, owning Aquilion equipment from Toshiba America Medical Systems.

Ronald P. Karlsberg, MD, interventional cardiologist with Cardiovascular Medical Group of Southern California and director of the Advanced Imaging and the Cardiovascular Research Institute of Southern California, has been working with GE Healthcare to integrate coronary CTA into the office setting. He has been using the GE LightSpeed VCT 64-slice CT scanner since fall of 2005. “I think this represents a cardiac revolution,” he says. “The ability to perform essentially a form of cardiac catheterization in the office setting now allows one to see coronary arteries directly without entering the body. This is the only technology that has the ability to see the inside of a coronary artery non-invasively.”

Installing the scanner on the sixth floor was a major endeavor, Karlsberg says. The floor required extra support, a window was removed and the scanner needed integration into existing IT systems. He says it is easy to underestimate the challenges involved in bringing this technology into the office setting.

However, Karlsberg is “very excited about how this technology has changed the very face of cardiology.” Being able to provide his patients with a color-rendered image of their heart as well as evidence of the degree of their blockage has proven to be very motivating for changing bad habits and staying on proper medical treatment. “Treatment that has been proven to reduce cardiac events,” he says. “In many  situations there is no other non-invasive way to make the diagnosis of coronary artery disease.”

Summit Medical Center in Hermitage, Tenn., installed a Brilliance 64-channel CT from Philips Medical Systems in late 2005. It was “an opportunity to provide cutting-edge imaging for the specialists who needed the angiography product,” says Gregory Thon, director of medical imaging.

The hospital’s administrators had “no problem justifying a 64-slice,” he says. In fact, the facility’s CT angiography procedures increased by 74 percent from 2005 to 2006. The 188-bed community hospital planned for the scanner to help expand its oncology, radiology and growing cardiology product lines.

“It was very easy to use the capabilities of the 64-slice scanner to support the multiple specialties of the medical staff,” says Thon. He credits the physicians with the success of multidetector scanning. “They have taken ownership because they no longer have to send their patients to a bigger hospital for specialized studies. We have the technologists, equipment and radiologists who know how to read the studies as well. That’s a combination that’s pretty rare and sometimes difficult to get in a small hospital.”

Mastering efficiency

Most multidetector CT scanner users have found some common factors getting the most out of the equipment. Consider the following to find the same level of success:

Having a PACS is a prerequisite. Aside from assistance with the enormous jump in data, the connectivity offered via PACS is essential. “It’s extremely helpful to have a user-friendly PACS that can distribute images out to various radiologists interpreting the studies,” says Stricof.

Consider a centralized 3D lab. “The ability to obtain thinner slices rapidly can improve diagnostic quality largely by the ability to obtain outstanding 2D and 3D images,” Stricof says. “To really take the greatest advantage of multidetector technology in all areas, we have a centralized 3D lab.” Radiology Ltd. is big enough to make the lab practical and economically feasible. Although scanners come with software and workstations to aid in specialized studies, using them in-house can potentially tie up the scanner, he says. “It’s best to have the scanner being used to scan patients. Technologists should be scanning patients [rather than doing reconstruction]. If they’re not, it’s a waste of their talents and the machine.”

Provide the right equipment and access. Because his practice is a training center, Karlsberg and his colleagues have seven GE Healthcare AW workstations and a substantial IT network. Images also are available enterprise wide. That’s important because the images are “not just a diagnostic test that sits in a folder,” he says. “They are looked at frequently from any computer as we tailor medical therapy for each patient.”

Deliver training right to physicians. At Summit Medical Center, a workstation was put right in the doctors’ lounge for a full day of “show-and-tell” with applications staff from Philips helping physicians quickly get comfortable with the new technology, says Tohn. Everyone learned what they would see with this scanner, how to use it, what they could order, and how they would be able to facilitate that imagery in surgery. Once the scanner was installed, “there really was not a long learning curve,” he says. “The radiologists were there from the get-go as far as being able to read and the referring physicians had no problems. They were prepped and primed to order this type of procedure.”

Good support staff, whether in the facility or offsite, is vitally important. Just as technologists should be scanning patients, radiologists should be interpreting studies, Stricof says. Since efficiency is critical to the economics of any practice, he says, you need support and ancillary staff that anticipate the physicians’ needs.

Spend time with the advanced visualization tools. Davis found that it “really required time and effort to learn because it’s fairly complicated software.” He uses Siemens’ Leonardo multimodality workstation. Although he now has more standardized protocols, “to really mine the data for good imaging data requires more than the very cursory things they give you. The reading from the multimodality workstation really gives you a tremendous amount of information, clarity and confidence in diagnosing things you wouldn’t have with more standard protocols.”

PACS protocols might need tinkering. “We changed the protocols so we wouldn’t overwhelm the system,” says Deb Turton, Summit’s coordinator of MR and CT, regarding transferring images to PACS. Since multidetector CT offers up thousands of images in raw data, putting that data on the server would “bottleneck the system. CT would dominate and everything else in the building would slow down,” says Andy Altieri, Summit’s PACS administrator. The protocol tweaks mean that the system still works smoothly for other modalities and the doctors get what they want, says Turton.

Much more to come

Multidetector CT scanning will continue to impact cardiology, says Karlsberg. He predicts technological enhancements that will improve temporal resolution, make it easier to interpret and process images once acquired, and allow clinicians to perform a coronary CTA simultaneously to obtaining functional information. “I think we’ll also see improvements in reporting and dissemination of information as CT becomes integrated into other electronic medical records,” he says. Multidetector CT also has brought about a re-emergence of the significance of calcium scoring in cardiology workup, Karlsberg notes—helpful information that can be obtained without the need to inject contrast.

For these reasons, multidetector CT scanner installations and procedures — 64 slice in particular — continue to grow. Do your homework, put time into your preparations and you too can reap the benefits.