June 10, 2009

Radiation For Heart Test Can Be Cut More Than Half

The radiation dose for a diagnostic scan of the heart and blood vessels was cut on average by more than half for almost 5,000 patients through a Michigan quality improvement project with no effect on image quality. Doctors and hospitals statewide have helped protect
patients from the potential risks of radiation exposure as a result.

Details of the project "“ a quality improvement initiative funded by Blue Cross Blue Shield of Michigan"“ are published in the June 10 issue
of JAMA.

The project not only involved 15 hospitals working together in the first multicenter trial of its kind, it also included heart specialists
and radiologists working side by side.

Known as heart CT angiography, or coronary computed tomography angiography, the procedure has a 90-percent success rate in diagnosing
heart disease. It is especially useful in identifying whether low-risk patients with symptoms do, in fact, have heart disease. It uses
contrast, or dye, in the arteries and high-resolution CT to get detailed images of blood vessels and the heart to identify possible blockages or
structural problems. But the exposure of patients to ionizing radiation during the test is a barrier to its widespread use.

The project participants were able to reduce the radiation dose by an average of 53.3 percent, to about the equivalent of three years'
"background radiation." This refers to radiation one would get from such sources as sunlight and radioactivity from the earth. They were
able to reduce the heart CT radiation dose through the use of seven risk-reduction protocols such as limiting the area scanned and by
adjusting the power of the scanner depending on the patient's weight.

"The public should be reassured that Blue Cross and the participating hospitals are monitoring radiation doses and looking for ways to reduce
them," says cardiologist Gilbert L. Raff, M.D., medical director of the Ministrelli Center for Advanced Cardiovascular Imaging at Beaumont
Hospitals (Royal Oak, Mich.), who leads the project. "By doing this in a voluntary and collaborative way, we've been successful in improving
health care overall, especially for those with medical conditions requiring frequent CT imaging."

Data for the radiation-reduction project were collected on 4,995 patients at hospitals in the Advanced Cardiovascular Imaging Consortium.
The consortium was organized in 2006 with ongoing financial support from Blue Cross Blue Shield of Michigan and Blue Care Network to provide administrative, logistical, statistical and analytical support for the quality improvement work.  

"The coronary CT angiography initiative is one of our organization's Value Partnerships - a collection of collaborative initiatives among
Blue Cross Blue Shield of Michigan and hospitals and physicians throughout the state," says David A. Share, M.D., M.P.H., senior
associate medical director, Blue Cross Blue Shield of Michigan. "Each initiative brings health professionals together to carefully examine
health care practice, generate new knowledge about which practices yield the best outcomes, and systematically apply that knowledge so that
quality of care improves, health care costs are lower and patients receive the best care possible."

Participating hospitals ranged in size from small community hospitals to large university and community hospitals with more than 1,000 beds.
The data were collected from July 1, 2007 to June 30, 2008.

The patient database assembled to support this quality improvement work represents the largest registry in the world of information about
coronary CT angiography.

The protocols developed for this project can be used by other hospitals and imaging facilities to reduce radiation exposure for their patients.
There is also potential to apply the same dose-reduction strategies when scanning other parts of the body.

In addition to Beaumont, the hospitals in the project during the time of this reported quality improvement were: Borgess Medical Center; Henry
Ford Hospital; Hillsdale Community Health Center; Lakeland Regional Health System; Marquette General Health System; Mercy Health
Partners-Hackley Campus; Mercy Memorial; Oakwood Hospital; Pontiac Osteopathic Hospital; St. John Hospital and Medical Center; St. John
Macomb; St. John Oakland; St. John Providence Hospital; and Sparrow Health System.

The project has since grown to include 35 participating hospitals and five physician practices.

Beaumontis a world leader in the use and study of cardiac CT imaging. Research at the hospital in 2007 showed that CT heart scans are
accurate, definitive, much faster and less costly than standard diagnostic testing for emergency room chest pain patients. That study
was published in the Journal of the American College of Cardiology.

Beaumont's cardiovascular imaging program is supported by philanthropists J. Peter and Florine Ministrelli of West Bloomfield,
Mich., including an endowed chair in cardiovascular research held by Dr.

Beaumont Hospitals

Beaumont is Michigan's, and one of the nation's, most experienced providers of heart care, ranking 14th on the U.S. News & World Report
2008 list of the "Top 50" hospitals for heart and heart surgery. The Beaumont Heart Center is a comprehensive, state-of-the-art facility
that's dedicated to the prevention, diagnosis and treatment of heart problems. Beaumont's Ministrelli Women's Heart Center is the first in
Michigan devoted exclusively to the prevention, diagnosis, and research of heart disease in women. Visit Beaumont on the Web at
www.beaumonthospitals.com ( http://www.beaumonthospitals.com/ ).

BCBSM Value Partnerships

The Advanced Cardiovascular Imaging Consortiumcoronary CT angiography initiative is part of the Blue Cross Blue Shield of Michigan Value
Partnerships initiative. Value Partnerships is a collection of clinically oriented initiatives among Michigan physicians, hospitals and
Blue Cross Blue Shield of Michigan that are significantly impacting the quality of patient care across Michigan by addressing common, costly and rapidly evolving areas of surgical and medical care. Through collaboration and data sharing, the initiatives are improving clinical
quality, decreasing complications, decreasing costs and improving health outcomes. 


Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.7 million members residing in
Michigan in addition to members of Michigan-headquartered groups who reside outside the state. The company offers a broad variety of plans
including: Traditional Blue Cross Blue Shield; Blue Preferred, Community Blue and Healthy Blue Incentives PPOs; Blue Care Network HMO; BCN

Healthy Blue Living; Flexible Blue plans compatible with health savings accounts; Medicare Advantage; Part D Prescription Drug plans, and
products in the under-age-65 individual market. BCBSM also offers dental, vision and hearing plans. Blue Cross Blue Shield of Michigan and
Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For more company
information, visit bcbsm.com.