Then and NowWhere Is Imaging Headed?

Today, we have expanded our imaging modalities to include 7 cardiac cath labs, 3 electrophysiology labs, 1 magnetic resonance (MR) machine, and a 64-slice CT scanner. What will the future hold? As managers and administrators, we need to spend a considerable amount of time looking to the future. New state-of-the-art imaging systems cost in excess of $1 million each. Can centers afford to have all the available modalities, and if so, will they be prepared to supplement their cardiac patient volume with noncardiac patient volume? At Beaumont Hospital, we made a conscious decision to stay in the forefront of imaging modalities. We were the first to receive the Siemens state-of-the-art Hicor system in 1990 (Siemens Medical Solutions, Malvern, Pennsylvania). Now, our labs are equipped with high-resolution, dynamic flat panel detectors that provide the highest spatial resolution and excellent contrast through digital acquisition. Further advancements in imaging resulted in the acquisition of a 1.5 tesla Siemens MR system (Siemens Medical Solutions). Located adjacent to our catheterization laboratories, this equipment allows us to perform necessary cardiac studies immediately pre- or postintervention. Multiple research studies are being performed as we continue to perfect MR cardiac imaging. Unfortunately, there is not sufficient cardiac work to demonstrate 100% utilization of the unit. Beaumont therefore elected to launch a collaboration with the hospital’s radiology department, whereby 50% of the MR system’s use would be for noncardiac clinical studies. Our current unit has a regular Monday through Friday daily volume, which includes cardiac, vascular MR angiography and orthopedic procedures. This has proved to be a successful collaborative maneuver for the hospital between cardiology and radiology. However, we didn’t stop there. Beaumont’s imaging adventure continues to be on the cutting edge, with the first acquisition in the United States of the Siemens 64-slice Sensation Cardiac 64 CT scanner (Siemens Medical Solutions). This 64-slice CT scanner is also located adjacent to our catheterization laboratories. The cardiac cath and EP department’s collaboration with radiology continued, as we not only perform cardiac computed tomography angiography (CTA) procedures, but noncardiac clinical exams as well. This 64-slice CT scanner provides superb images, as well as digital cath lab angiography-like images. Moreover, the images are rendered in three dimensions rather than two. Being on the cutting edge of any new imaging modality, however, means that your center may be the first to struggle with reimbursement issues. Though reimbursement issues cause much concern, they are far outweighed by the positive revenue generated by noncardiac clinical CT studies. As our department struggles with reimbursement for the CTA- coronary images, we continue to look forward to the next imaging modality: magnetic navigation imaging. The Niobe® Magnetic Navigation System (Stereotaxis, Inc., St. Louis, Missouri) uses two gradient magnets positioned on either side of the patient to create a 0.08 tesla magnetic field around the targeted organ. This field allows for specially designed guidewires and catheters to be manipulated with exceptional precision for cardiac resynchronized therapy (CRT), cardiac interventions and EP procedures. The Niobe system has the ability to integrate CT, MR, X-ray and other modalities to create a more efficient therapy delivery platform. With more than 2,000 procedures performed thus far, operators at Beaumont have experienced a reduction in procedure times, a reduction in the variability of procedure times and a reduction in radiation exposure. The integration of this technology may enable operators to perform procedures currently sent out of the department or to other hospitals thus increasing utilization of capital assets and expanding services. As centers look to continue advancing into different cardiac modalities, they must accept the fact it is necessary to inter-mix the types of cases handled in order to achieve efficient, optimal use of their equipment. This can be achieved by integrating services such as interventional radiology and cardiology. Strategically locating these services in the same hospital quadrant can result in optimal utilization of all imaging equipment. In addition, when purchasing new equipment, it becomes critical to select multiple modality equipment that will allow for crossover use by several disciplines. As we look to the future, the integration of services is the key to providing comprehensive care to patients. Providing the best level of care for our patients requires collaboration among hospital services. Beaumont Hospital is in the healthcare arena to provide the best comprehensive care for our patients isn’t that what you expect when you or your loved ones go to a hospital? At Beaumont Hospital, we have made the decision to physically integrate our interventional and neurological radiology labs next to the cardiac cath lab, MR and CT units. This integration will allow for improved utilization of staff, space, holding rooms and imaging equipment. Having a core set of rooms that can be used by multiple disciplines leads to less downtime, consolidation of inventory and improved collaboration between all areas of expertise, which ultimately leads to optimal continuity of care for the patient. This integration will result in the evaluation of imaging modalities that provide cardiac, vascular and neurological capabilities. Lastly, imaging equipment manufacturers need to develop products that will allow for the testing of large patients (> 450 lbs). We are unable to provide imaging services for these patients. Let me leave you with the following questions to ponder: Do we replace cath labs with CT scanners? Should standalone cardiac programs venture into acquiring high-priced imaging systems and other technology? Should the labs be able to offer cardiac, vascular and neurological capabilities? Which imaging modality will be the first to allow for imaging large patients? The future is upon us. What will you do for imaging?

NULL