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Faster than a speeding bullet

Hospital sets precedent with state-of-the-art CT scanner

As a rule, the latest and greatest medical technology first becomes available only at big-city medical centers. For patients who live elsewhere, that can mean long travel times, extra expense, and the discomfort of strange surroundings in order to have the best level of care.

Not at Community Hospital, which is breaking that mold once again with the Siemens dual-source CT scanner, one of the most impressive pieces of medical hardware available. This is scanning at its best, super-sized and super-fast.

An argument could be made that this CT is literally faster than a speeding bullet, taking three-dimensional X-ray images in a fraction of a second. More powerful than a locomotive?  For the first time ever, a scanner can now view any beating heart

without blurring the image and without a need to administer medication to slow the heart rate.  Some studies have even suggested that the dual-source CT can diagnose heart disease with 99-percent accuracy. And all in about 10 seconds.

This medical wonder is far faster and more powerful than previous scanners (4-slice, 16- slice, or 64-slice). The $2 million instrument, in operation at the hospital’s Ryan Ranch facility since March, was only the 25th installed in the nation. Community Hospital is the third hospital on the entire West Coast, after UCLA and Cedars-Sinai, to offer this technology. By early 2008, its twin will be up and running in the main hospital, facilitating faster diagnoses for hospital inpatients and emergency room patients — where seconds count most.

While the purchase of these scanners might seem extravagant for a local medical facility, their acquisition is actually a prudent nod to cost-effective medicine, says Eric LoMonaco, Community Hospital’s director of Radiology Services. “We want to provide the best possible care for our patients.  We believe in this technology because it will produce safer and faster diagnoses, and therefore faster access to the most appropriate treatment. And that’s more cost-effective for everyone, because it can reduce the need for other, often more expensive, tests and produce better outcomes for the patient.”

In keeping with that philosophy, both a radiologist and a cardiologist will be involved in interpreting each scan, at no additional cost to the patient. Not only will patients have the expertise of both specialties, they will have the most reliable readings on their scans, along with substantive clinical recommendations based on the specialists’ findings and the patient’s history.

“This is a terrific thing for patients,” says Dr. Stephen Brabeck, a Monterey cardiologist. “It’s so common in many other institutions that there is a battleground [between radiologists and cardiologists]. With this CT, it’s like a new frontier. It was the perfect time to say ‘Let’s collaborate.’ The radiologists have their [imaging] expertise and, alternatively, cardiologists have their physiological and clinical background, and now the patient will get the best of both of those.  Now, everyone wins.”

Like all CT scanners, the new machines will be capable of an impressive range of tasks, from gauging the extent of tumors to pinpointing a brain bleed after a stroke. But their forte, unparalleled by any other available technology, is imaging the beating heart.

Sharp images of the heart and its blood vessels are among the best methods doctors have to diagnose cardiac health. The tiniest constriction in the lattice of blood vessels feeding the heart can indicate a blockage — and warn of an imminent heart attack or suggest the need for action to reduce the risk of one.

To diagnose heart problems, it’s important to capture crisp images of the heart. This scanner is fast enough to get a three-dimensional image at a still point in the heart’s cycle — a snapshot in time as short as 83 thousandths of a second. A small but critical artery might be hidden as the heart contracts, but exposed again as it relaxes. “Even vessels one millimeter in diameter  are important to maintaining heart circulation,” says Dr. Robert Gardner, a  Community Hospital radiologist.

Yet the heart’s ceaseless motion defies attempts to freeze its image onscreen. With every beat, it shifts slightly within the chest — growing larger as it relaxes and its chambers fill, smaller as it clenches to pump blood through the body. Currently, with all other types of CT scanners, virtually all patients are given drugs to slow their hearts and ensure that their cardiac CT scans aren’t blurry.

The new dual-source scanners, however, can capture detailed images of even the most rapidly beating heart. With two X-ray sources and two 64-slice detector arrays, they complete scans twice as quickly and with twice the resolution as even the most advanced 64-slice CT scanners.  Because scans are so brief, the radiation dose to patients can be as little as half that of those same 64-slice scanners.

That extra resolution power means real improvements in diagnosing heart health. “It helps us tell the difference between hard calcifications, which are more stable, and fatty plaques, which are more prone to suddenly causing the blockage of a vessel,” says Gardner.

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In addition, fewer patients will need to undergo an invasive procedure called cardiac angiography to diagnose their heart disease, which involves threading a wire though a vessel (usually in the leg or groin) and into the heart to diagnose vessel blockages. “Right now, if you came into the emergency room with unexplained chest pain, you would probably stay in the hospital overnight and be periodically tested and evaluated to determine the cause,” LoMonaco says. “That approach is a lot more time-consuming and expensive than a five-minute CT scan.” With the new dual-source scanners, LoMonaco hopes to reduce the number of diagnostic catheterizations by as much as 50 percent while getting the necessary care to patients much faster.

Truly, the possibilities are endless for something that is arguably faster than a speeding bullet, more powerful than a locomotive, and able to create 3-D images of your heart in a single beat.


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