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Imaging Technology is Changing Diagnosis and Treatment of Disease

Posted on: Saturday, 24 June 2006, 09:00 CDT

By Nancy Young, The Virginian-Pilot, Norfolk, Va.

Jun. 24--Buried alive. That's what Deborah Morgan's friends said she'd feel like when she went into the MRI tube. Just the thought made her cry.

"I didn't think I could do it," said Morgan, who is claustrophobic. She called a diagnostic imaging center in Virginia Beach to see whether it had something new to more easily find the source of her lower back pain.

Soon she was in a recently installed upright MRI, which lets a patient sit while being scanned. Instead of staring up at a tunnel wall just inches from her nose, Morgan relaxed in front of a TV screen playing an episode of the '60s comedy hit "Green Acres."

Finding something new is not all that hard these days in the field of imaging, where a number of technologies are revolutionizing diagnosis and treatment of disease.

Without wielding a scalpel, doctors can increasingly see clearly down to the millimeter what's wrong. They can find tumors, tears and clots, tell whether that chemotherapy treatment you just started will work. They can do virtual colonoscopies and lung cancer screenings before a disease shows symptoms.

They can then share the findings almost instantaneously, across town, across country.

The technology improvements -- and perhaps a touch of over testing -- have helped make diagnostic imaging one of medicine's fastest-growing fields. Such procedures have increased by twice the rate of all other physician services combined so far this decade, a Medicare study found.

The trend has been playing out locally. Between 1999 and 2004 , the number of MRI, or magnetic resonance imaging, scans and CT scans done in South Hampton Roads jumped by 80 percent, according to a recent report by the Eastern Virginia Health Systems Agency. Earlier this month, the agency approved the installation of several new imaging machines at local health care facilities to keep up with demand.

Changes in CTs -- short for computed tomography -- are coming particularly fast. CT machines use special X-ray scans to capture "slices" of the body's insides, then computer-process that information to develop a cross-section of organs and tissues.

In the beginning, there were one-slice machines. Then two-slice. Four. Sixteen. Thirty-two. And now, 64 (with 128 and 256 on the way). The more slices, the better and faster the picture.

The 64-slice CT -- which went into use at Sentara Heart Hospital in Norfolk this year -- promises significant advances in diagnosing heart ailments, potentially replacing more invasive diagnostic techniques commonly used now. It also has wider applications for the emergency room, where Chesapeake General Hospital -- which is seeking state approval to acquire one -- would use it, said Dr. Scott Kellermeyer , the hospital's chief radiologist .

If a patient comes to an ER with chest pains, the 64-slice CT can do what's called a triple study to determine whether the symptoms are caused by one of three potentially life-threatening conditions: pulmonary embolism, aortic aneurysm and coronary artery disease, or heart attack.

"In 10 seconds or less, you have the answer," Kellermeyer said. That gets patients who need them the right life-saving treatments sooner, and, "if it's negative," as it is in a large percentage of cases, he said, "it has saved the patient all that work-up."

That's "a huge economic benefit to society," said Dr. James Thrall , a radiology professor at Harvard Medical School who is also chairman of the radiology department of Massachusetts General Hospital in Boston. With hospitals crowded or near capacity, he said, you don't want "all the coronary beds filled with people who don't need them."

One of the newest uses of CT technology has been to combine it with an imaging procedure called a PET, or positron emission tomography , scan.

PET involves the injection of specialized radioactive materials that are sucked up by diseased and healthy tissue at different rates.

Cancerous or inflamed tissue "will light up," said Dr. Richard Thomas , an assistant professor at Eastern Virginia Medical School and a staff radiologist for Medical Center Radiologists , which serves hospitals in the region.

On a CT, a cancerous tumor might not look any different from a benign mass -- "the blobs still look like blobs," Thomas said. Combining it with PET, however, will nail a diagnosis. "If it lights up on the other study, you know what it is."

Although it may soon be used for heart ailments, PET is primarily used for cancer patients. The immediate feedback it gives on how well a treatment is working "is extremely valuable because you can discontinue what is going to be ineffective much sooner" and switch to something else, Thrall said.

Often, doctors consult with other specialists before making such decisions. And, thanks to other advancements, that process is rapidly changing, too. Images that used to take hours or days to circulate can now get to all the key players in minutes.

It's "instant access anywhere," said Dr. John O'Neil , chair of the radiology department at Sentara Virginia Beach General Hospital . Medical professionals in the emergency room can look at a just-scanned CT, and "I can look at the same thing they're looking at at the same time. That was never possible before."

The difference is digital -- and another acronym, PACS , or Picture Archival and Communication Systems . Almost as soon as images are scanned, doctors have access online and can confer, looking at the same images even though they might be miles apart.

While he was being interviewed, O'Neil got a call from a surgeon asking about an image of an aneurysm in imminent danger of rupturing and in immediate need of surgery, "within 15 minutes of the completed scan."

No longer restricted by a static piece of film, computer technology also lets doctors do more with the images. They can highlight problem areas by clicking on them on a computer screen, which is what O'Neil did as he conferred with the doctor on the phone.

Not everything that is technically possible is widely available or affordable.

For example, virtual colonoscopies -- less invasive and quicker for the patient than the traditional -- can be done with a CT scan. While not yet generally quite as effective at finding the smallest polyps, they are effective for people whose colons have so many twists and turns that the traditional scope is blocked. But their usage has been limited, in part because they're not covered by insurance as often.

Likewise, CT-scan lung screenings for smokers could catch cancers when they're small enough that 85 percent of them would be curable, rather than the 15 percent cure rate now, said Dr. Charles Hecht-Leavitt , a neuroradiologist and medical director of MRI & CT Diagnostics , an independent center in Virginia Beach. "It will save lives."

Insurers balk at paying for such procedures, though, arguing that screenings, without any symptoms that cancer has taken hold, are too speculative to justify the cost.

More insurers have placed restrictions -- such as pre-authorization requirements -- on even common tests, which can be expensive. According to the health systems agency report, providers in South Hampton Roads expect to charge between $1,203 and $3,383 for MRI exams in 2007 , while the charge for CT scans is more than $1,000 .

Some health industry analysts have said the high profit margins possible from such charges invite over testing. Fear of malpractice lawsuits has also been cited as a possible reason.

While Thrall said unnecessary scans are performed, he blamed other factors for that problem.

"The development of knowledge is so rapid ... it's hard to understand when a scan should be done and when it shouldn't," he said of doctors. "If they're going to err, they're going to err on the side of doing everything possible for their patient."

With all the choices that technology brings come trade-offs, not just for health care professionals but for patients as well.

Deborah Morgan could have had her back exam done at MRI & CT Diagnostics in a machine that was five times more powerful and where she could probably have been done in half the 40 minutes it took in the upright MRI.

But the more powerful MRI machine has the traditional cylinder shape which surrounds the patient. It can be loud, and, from a claustrophobic's perspective, too close to the face.

When that was the only way to have an MRI, which uses powerful magnets and radio waves to create images, claustrophobics might need sedation or even anesthetic.

With the sit-down machine, there was no suffocating feeling -- and that's what mattered to Morgan.

"I could feel the air moving," she said.

At the end, Morgan hugged members of the staff.

"Piece of cake," she said. "Easy, easy."

-- Reach Nancy Young at (757) 446-2947 or nancy.young@pilot online.com.

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Copyright (c) 2006, The Virginian-Pilot, Norfolk, Va.

Distributed by Knight Ridder/Tribune Business News.

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Source: The Virginian-Pilot

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