As the population ages and studies prove CT is the right exam for more indications, volume is growing. While there are some factors to consider when launching CT in an outpatient imaging center, the modality lends itself well to the setting. Many industry watchers feel that CT scanning volume will only continue to move to outpatient centers.
CT is the ideal modality for the outpatient-based center, says Mark Winkler, MD, of Steinberg Diagnostic Medical Imaging Centers in Las Vegas. “You can do almost everything on an outpatient basis that you can do as inpatient.” For example, his group routinely performs CT-directed biopsies. “There is no reason to have someone go to the hospital to get a CT scan,” Winkler says.
No longer a hesitance
Since virtually every radiologist is trained to do and read CT, Winkler says, centers only need a CT technologist with a modest level of experience to start offering the procedure. The practice has four offices with a fifth under construction. They use scanners—one 64-slice, two 16-slice and four 4-slice—from Toshiba America Medical Systems. The planned fifth office is designed to manage the growing population in the Las Vegas Valley. Along with population growth, study volume is increasing. “I think that there are more and more indications for CT as prices [of systems and procedures] have dropped dramatically,” says Winkler. “So there’s no longer a hesitance to use the technology. A decade ago people were reluctant to refer a patient for a scan.”
It’s very easy to set up CT in an outpatient office, he says. Steinberg has a PACS and the CT scanner is plug-and-play right into that system. “It’s not that complicated. Everything is on standardized interfaces at this point, so it’s relatively easy to get into PACS.”
Patients too find the outpatient environment more pleasant, Winkler says. Outpatient centers are more likely to stay on schedule, while patients at a hospital are often bumped by emergency patients.
Along with a drop in equipment price, the cost of a CT scan has dropped by more than half, Winkler says. That makes physicians more willing to order CTs. “CT often provides a definitive answer that other modalities sometimes don’t.” If a scan can diagnose appendicitis, it’s better patient management than keeping the patient overnight in the hospital and running a battery of tests to determine the problem. Plus, CT can better evaluate the extent of sinus disease than x-ray can, cancer patients are routinely staged and restaged with CT, and 64-slice CT angiography for stenosis and peripheral artery disease is so good that CT is replacing much of conventional angiography.
A huge difference
Although the price of equipment is right, Comprehensive Cardiovascular Care Group in Milwaukee, Wis., has faced some struggles to get going with CT. The practice took delivery of the GE Healthcare LightSpeed VCT with SnapShot Pulse in May.
The practice merged with another and doubled in size. “We took on a cardiology group,” explains Port. “Because they had been ordering so many studies at the hospital, we knew that volume would translate over to the practice.” Plus, the practice has a significant number of patients who already are being studied at other locations and will continue to get studied. “That allowed us to purchase the equipment,” he says.
“It’s a huge difference for us. As a cardiovascular disease group, we’re used to doing ultrasound and single photon nuclear medicine work in the office,” Port explains. The group does certain kinds of ECG recordings, Holter monitors and other work that does not require much in the way of patient monitoring. Before CT, they didn’t have to worry much about drugs or renal function. “Now you’re in a contrast business, and that’s a whole different ballgame.”
Port says that adjusting the practice to giving patients contrast was a big change. Each patient requires a blood test for renal function and he or she is sent to a lab for kidney function evaluation. These and other steps significantly altered the group’s patient approach. In the hospital setting, “all of these mechanisms seem to happen for you. Skilled nurses take information from patients, check creatinine levels, and call if something is wrong. So much is getting done for you routinely [in a hospital setting] and it’s all happening in the background. Now it’s you and your people that have to make the whole thing flow properly.