Cardiovascular Business - October/November 2007 - (Page 38) the 3d heart: seeiNg mOre, mOre QuiCkly highly competent coronary analysis by coronary CT. Until that happens, users offer advice on how to make advanced visualization work. Bush recommends joint cooperation between radiologists and cardiologists. “This is one of those places where cardiology and radiology intersect.” That intersection is adversarial in a lot of facilities, he says. Joint cooperation can result in greater acceptance of the technology. “It tends to grow better than when one or the other tries to do it to the exclusion of the other. We’ve had a fully cooperative interaction and the two groups have been able to teach each other.” Another factor to consider is good image acquisition on the front end, says Bush. “It’s technically demanding to produce good studies.” Technologists, radiologists and cardiologists need to be aware of the importance of good patient preparation, including slowing the heart rate and breath hold instructions. “If one tries to push these scans through too fast, you wind up with studies that are much more difficult to interpret. You spend more time wrestling with something that could have been acquired better on the front end.” Users also need to take the time to master the special functions of the 3D workstation required to perform post-processing. Time for training To help clinicians master 3D interpretation, John Rumberger, MD, professor of cardiology at Ohio State University and medical director for Healthwise Wellness Diagnostic Center in Cleveland, has conducted an intensive training program on post-processing tools for about two years. Having viewed the heart in three dimensions for 27 years, he has worked with TeraRecon to develop interfaces and uses their Aquarius workstations and software. Rumberger’s course is frequently sold out and he has increased the frequency to accommodate demand. The three-and-a-half day course with two Level III instructors in the room at all times runs $6,500 to $7,000. Cardiologists primarily attend the course to learn how to do cardiac CT and read and interpret the studies. “They come into the training program suspecting that it will take them half an hour to read a single study. I tell them that they should be able to have it done in 10 minutes. They are surprised at how easy it is.” Medicare is the only payor reimbursing for coronary CTA at a range of $800 to $1,100, depending on location and the addition of the information on heart function. Private payors are coming along, Rumberger says. “It’s important to have enough doctors that know how to read them for payors to pay attention.” Sixty-four slice CT technology has allowed for a more universal scanning platform. “We can use the same scanner for the heart that we use to image the brain, legs and lungs. Plus, there have been hundreds of papers coming out every year showing how this can be used to do heart work. As people use this, they realize it probably eclipses just about anything else we use in cardiology for imaging.” Ten years ago, electronic beam CT scanning was a fantastic way to do cardiac work, says Rumberger. “The problem was that the slices were too thick. You’d end up with difficulty doing 3D manipulations.” Clinicians now have the ability to have very, thin slices and 38 Cardiovascular Business October/November 2007
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