Cardiovascular Business - October/November 2007 - (Page 6) Costs of Adoption Depending on the vendor and whether you purchase third-party software and workstations, cost for the equipment will run from $1 million to $2 million. Original equipment manufacturers include: → Toshiba America Medical Systems: The Aquilion 64 → Siemens Medical Solutions: The Somatom Sensation 64 and the Somatom Definition → Philips Medical Systems: The Brilliance 64 → GE Healthcare: GE LightSpeed VCT and the GE LightSpeed VCT XT Third-party workstations and software is available from: → TeraRecon: Aquarius Workstation → Vital Images: Vitrea 2 Software → Emageon: HeartSuite While the hardware is necessary, you might be able to save some up-front cash by using the hardware vendor’s workstations and software versus third-party workstations and software. There are pros and cons to both approaches. Rob Schwartz, MD, FAAC, FAHA, a cardiologist with the Minneapolis Heart Institute, believes the investment in third-party workstations and software is well worth the out-of-pocket costs. “The companies building hardware tend to try to be all things to all people, and the software side is so complex that those companies focused on the software have gained an advantage because they are more nimble. “The state-of-the-art [advanced visualization software] vendors make it much easier to navigate around a particular case so that you can interpret the study more quickly and more easily.” Schwarz uses a Siemens Somatom 64-slice CT scanner with Vital Images Vitrea 2 software. The Minneapolis Heart Institute is affiliated with the 128-bed Heart Hospital at Abbott Northwestern Hospital in Minneapolis. The Institute has 52 cardiologists. Many facilities will need to add on room to their existing building to house the new equipment, adding construction costs and lengthening out the time frame for when the technology actually comes on line. You’ll need to hire a technologist in a market that is fiercely competitive due to a shortage of trained cardiac CT technologists or train your own in house. Technology Applications The potential uses of the technology are running way ahead of current reimbursement levels, but provide a view of how the technology is revolutionizing cardiology, raising the number of applications that physicians may eventually receive reimbursement for. Experienced cardiologists and radiologists as well as recent studies are finding a number of applications for the technology, including: → Screening low and medium Framingham risk patients for coronary artery disease → Peripheral vascular disease assessment → Calcium scoring → Emergency department triage for patients with undifferentiated chest pain → Monitoring coronary artery disease progress over time → Pre-operative planning for repeat bypass and stent patients → Guidance of placement for biventricular pacemakers While more data are needed to provide evidence that all of these applications are appropriate, preliminary data are convincing. At the Cleveland Clinic, Scott Flamm, MD, FACR, a radiologist who is the head of the Department of Cardiovascular Imaging, reports that patients undergoing repeat coronary bypass for the second, third, fourth or even fifth time are experiencing dramatically lower complication rates when surgeons use cardiac CT to visualize previous bypass graphs prior to the surgery. “We are seeing complication rates from redos of bypass surgery approach the national rate for first-time bypass surgeries, which is just amazing,” he says. Flamm uses a Philips Brilliance 64-slice CT scanner. The Clinic’s Heart and Vascular Institute’s section of Clinical Cardiology has 24 cardiologists; the Clinic overall has 1,008 beds and completes 7,000 CT scans a year. Schwartz is running a study in the emergency department about the use of cardiac CT on patients with undifferentiated chest pain. Under the study protocols, half the patients are sent for cardiac CT and half are observed in the hospital for 36 to 48 hours and given EKGs; depending on the results, they are either sent for a cardiac catherization or sent home. “Our ER docs are seeing better results when the patients are sent right in for a cardiac CT and that it’s Cardiovascular Business october/November 2007
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