Scanning the horizon

Something isn’t right. You’re not sure what, and you’re not even sure where. The sensation is in your arm, which could actually mean the problem is in your heart or even your head. You know you should get it checked out but you’re not sure how to do that, and you’re not even sure where. If only you could find a doctor with X-ray vision, someone who could look inside and tell you what, if anything, is wrong.

Believe it or not …

… Community Hospital now has the technology to equip its doctors with virtual X-ray vision. There are open MRIs and closed MRIs, ultrasounds, CT scans, PET scans, CACS (coronary artery calcium scoring), nuclear stress tests, even virtual colonoscopies.

OK. So right about now, this technological wave probably feels like a tsunami that has left you drowning in a sea of medical science. Let us help.

“Open” MRI

Likely the best-known diagnostic procedure is magnetic resonance imaging, or MRI. The patient is placed into a tunnel-like structure where images are obtained via a circular magnetic field. While the majority of patients are not intimidated by the environment, some feel uncomfortably confined for the 20-to-60-minute procedure.

Enter the new open MRI at Community Hospital.

“The good thing about our new open MRI technology,” says Dr. Daniel Hightower, chairperson, diagnostic/interventional imaging division at Community Hospital, “is that the structure, which utilizes a super-conducting magnet, is open on the sides. The environment is less confining, which really is its most appealing feature. It does take longer to acquire data because the magnetic field is not as strong. It all has to do with physics. The images are not better in either case, just acquired differently.”

Because of its reduced strength, the open MRI is best suited for structural scans (of the spine, for example); it is not appropriate for scans of the heart, which require the higher magnetic field of the traditional MRI because of the heart’s constant motion.

CT

Community Hospital’s new LightSpeed™ Ultra CT Scanner System is the latest generation of computerized tomography, which provides additional coverage, improved image quality, and faster examination than previous versions of the CT.

“The multislice CT scanner,” says Hightower, “can scan eight times the area of the body in the same time it takes older scanners. If we think of the patient as a loaf of bread, it can view more slices at once. It’s a new generation of high-speed diagnostic technology that yields a faster exam using a lower dose of radiation. We’re actually able to get more information, more quickly, with less radiation.”

Virtual colonoscopy

Because of the invasive nature of a conventional colonoscopy, some people put off the procedure until a symptom becomes suspect and they must intervene. Now, the same innovative technology driving the CT scanner enables doctors to scan the colon for early disease detection without going inside.

Although not a replacement for a standard colonoscopy, this “virtual colonoscopy” is better, much better, than nothing. Especially for highrisk patients — those with a family history of colon cancer.

The benefit of a virtual colonoscopy is that it offers a level of comfort and efficiency that will encourage more people to undergo screening. Regular screenings help doctors detect precancerous symptoms or small cancers in asymptomatic patients, thus catching the disease in its embryonic stage, when the cure rate is highest. In the 10-to-15-minute procedure, a CT scanner takes a 3-D X-ray of the colon and displays the image on a computer screen viewed by the doctor.

“We have the technology to do this kind of diagnostic scanning,” says Hightower, “and all kinds of software programs are being developed to look at and interpret the data it yields. Sometimes, technology runs ahead of its practical application. With increasing experience, medical professionals will learn how accurate the data is.”

It’s important to note that, despite the advantages of a virtual colonoscopy, the procedure provides images only, not diagnosis and treatment. Anyone with a suspicious polyp will need to follow up with a traditional colonoscopy to remove the growth for biopsy.

PACS

The picture, archiving, and communication system, or PACS, is a computerized system that eliminates the need for X-ray film. Soon the days when a physician clips a dozen sheets of X-ray celluloid to a light box for review and interpretation will be long gone. Today’s multislice CT scanner has the capacity to generate more than 100 sheets of film, which, according to Daniel Ehnstrom, director of Cardiopulmonary and Radiology Services at Community Hospital, translates to 50 pounds of film for a single scan. The PACS yields the same information, without the film and unwieldy storage requirements.

The PACS generates no film,” says Ehnstrom. “It stores the data in a computer, which a physician can fly through with the click of a mouse. To move into these new technologies, to manage all this data, we had to have a system that allows us to manage it digitally. PACS is the backbone that allows us to move forward in this diagnostic technology, to be ready for what comes.”

What does that mean for the patient? Mostly, it means faster answers to questions. “A doctor can quickly retrieve and read the records with this system,” Hightower says. “Before, it was, ‘I’ll pull the films and call you back.’ With PACS, we can give immediate consultation.” So now that you’ve made your way through the latest scanning technology and all its possibilities, you’re probably thinking image is everything. Actually, it’s a bit more complicated than that at Community Hospital.

“We have a commitment to have the latest technology available to our patients,” Hightower says. “But it has to be the best technology with the least amount of risk. Until the medical community has evaluated thousands and thousands of patients — and not until then — do we embark on it. We want to offer only the latest, proven technology.”

Hedy Wainscoat

She had been there before. Even though she had closed her eyes, calmed her breathing, and eased her mind, the anxiety had persisted. She had felt restrained, boxed in. She hadn’t been able to get air. She couldn’t get free. And then it was over.

She had survived. But even after time had passed, she had to admit that, while it may have been OK for others, it really was that bad for her. And now, impossibly, she was back to do it again: a second MRI to evaluate possible aggravation of an old neck injury. She really didn’t think she could do it, return to what she had called “that tunnel, that tube, that coffin” again.

Fortunately, she didn’t have to.

What Hedy Wainscoat remembers most about Community Hospital’s new open MRI are the circulation of air and her ability to breathe deeply and calmly, to relax in an environment characteristically “unZen.”

“The closed MRI and the open MRI are worlds apart,” says Wainscoat, 43, who lives in Carmel Valley. “I’m slightly claustrophobic. In the closed MRI, it took a lot more mental work, more concentration for me to transfer myself out of the awareness of where I really was. The key in either experience was closing my eyes before I was rolled in; but in the open MRI it also helped to know that I wasn’t closed in, there wasn’t something right next to my face.”

Recently diagnosed with asthma, Wainscoat was concerned about her ability to breathe within the closed MRI, particularly when she was counting on her ability to lie still, put her mind on idle, and breathe normally to keep herself calm. In the open MRI, breathing wasn’t an issue.

“I would never recommend that someone do the closed MRI where they have the option of using the open format,” she says. “It’s a painless procedure. It’s a little loud, a bit like a construction zone, but I could still listen to a little classical music.”

And breathe deeply.

Fred Conte

Fred Conte had retired from a high-stress management position in the Silicon Valley and was putting his energy into his golf swing and a new career in real estate. With the move back to the Monterey Peninsula five years ago, he also began spending an hour on the treadmill every day and eating right, and he continued taking medication to mitigate a family history of high cholesterol.

But after suffering some discomfort in his upper chest that likely was the result of a shoulder injury, Conte’s family doctor recommended a treadmill stress test. The doctor wanted to be sure the pain was strictly related to the shoulder and not a symptom of potential heart disease. Conte completed the stress test quite easily. After all, he was fit. Yet the test printout indicated abnormalities while under physical stress. Dr. Soteria Karahalios, medical director of Cardiovascular Services at Community Hospital, interpreted the results and recommended a diagnostic follow-up with a nuclear stress test.

“I went back in,” says Conte, “and repeated the stress test with an injection of a nuclear isotope.” Again Conte experienced no symptoms, but the same problematic findings appeared on the electrocardiogram.

Conte climbed into a padded chair, raised both arms, and rested them above his shoulders while the scanner proceeded to take a picture of his heart every 40 seconds as the chair gradually rotated 180 degrees. These nuclear images showed an abnormality, but still didn’t prove that Conte was suffering from coronary artery disease. And with the lack of symptoms, it was unclear whether he should have an angiogram. To further assess his risk for a heart attack and the presence of disease, Dr. Karahalios recommended a cardiac CT scan, which measures calcium deposits lurking inside a patient’s coronary arteries.

“The hospital had just installed their new CT scanner (pictured at left), and I was one of the first patients to get tested,” says Conte. “In my case, the calcium scores were very high. I was floored. As a result of that, an angiogram was scheduled with (cardiologist) Dr. Richard Gerber. And, after consultation, it was followed by an angioplasty, where the doctor inserted two drug-eluting stents into my two main coronary arteries.”

Six days later, Conte played a round of golf.

“I feel very fortunate,” Conte says, “that the technology of today is so advanced and that Community Hospital has it. I’m feeling extremely well, and lucky that my problem was discovered before it could cause a massive and maybe fatal heart attack. This technology is a lifesaver.”