Health Imaging & IT - March 2008 - (Page 22)

i n s i d e c a R d i ac i M ag i n g tHe it angle There is no denying the IT impact of cardiovascular CT. It is an IT behemoth, producing datasets in the 3,000-image range in some cases. Consider Fairfax radiological Consultants. The 16office practice completes all cardiac scans at one site, and images are read remotely at a second office. The practice invested in a beefy IT infrastructure to support its cardiac CT program. It boasts a one gigabyte (GB) network with a sonnet ring connecting all offices, which suffices for the practice’s CT workload. The other elements in the IT equation are the workstation and archive. Fairfax radiological uses Ge Advantage Workstation to review CT images and sends all images to its Philips Healthcare iSite PACS. The practice saves all reformats, processed images and selected images of each coronary artery for a total of approximately 1,000 images per patient. The rationale for its conservative approach is economics. “We have a generous contract with the PACS vendor and don’t pay extra to store larger files. We find it’s easier to have the images in the PACS to review at a later date if needed,” says earls. Abbott Northwestern Hospital also saves approximately 1,000 images from each cardiac CT study, sending one or two datasets per cycle to PACS, which meets the requirements of accrediting bodies. Lenox Hill Heart and Vascular Institute saves reconstructions used to make the diagnosis and three to four phases, including those that show ejection fraction and wall motion. “A cardiac CT scan is superior to a traditional stress test for determining the appropriate therapy: angiography, stenting or bypass surgery.” Harvey Hecht, MD, director of cardiovascular CT, Lenox Hill Heart and Vascular Institute in New York City Lenox Hill Heart and Vascular Institute sends cardiac CT techs to Philips Healthcare training programs, supplementing tech training as needed internally. For example, an internal workshop might address specific protocols or patient populations. Meeting tHe dOse ReductiOn cHallenge one of the critical advantages associated with the newest cardiac CT systems is lowered radiation dose. Like many other cardiac CT providers, Abbott Northwestern Hospital has taken a very proactive approach to dose reduction. “The Definition dual-source offers several options,” notes Lesser. The hospital does use beta blockers prior to scanning, which provides a very predictable time window for scan acquisition. Siemens MinDose algorithm allows the scanner to create an image in 82 milliseconds and can be used in studies that don’t require cardiac function data. Finally, Siemens post-acquisition software can add signal back to an image if a technologist undershoots a study in an attempt to reduce dose. The three-pronged approach yields impressive dose reduction results; Abbott Northwestern typically achieves doses of 3 to 7 millisieverts (mSv)—with dose stretching as low as 0.7 mSv for pediatric cardiovascular CT scans. The other element of dose reduction, says Lesser, is to carefully select patients by weighing the risks and benefits of cardiac CT. The ideal candidate reports chest pain but is at low to intermediate risk for severe coronary artery disease. Another trick to decrease dose is to adjust the upper and lower edges of the acquisition as tightly as possible, says Hecht. other systems take different, but also effective, approaches to dose reduction. For example, the Ge VCT XT decreases the average dose by 83 percent via prospective triggering. How does it work? With prospective triggering, x-rays are not continuously shot as they spiral around the patient. Instead, the scanner acquires one set of 64 images and then moves before acquiring the next set HealthImaging.com tRaining tHe Masses IT infrastructure is only one of the prerequisites necessary for a successful cardiac CT program. radiologists, cardiologists, technologists and referring physicians all require targeted education. Physician training must be targeted to the specific needs and background experience of the audience. radiologists and cardiologists require different types of training, says Lesser. each needs to learn how to use post-processing workstations and interpret cardiac CT data. radiologist training should emphasize cardiac disease, which provides them with a framework to present and discuss findings with clinicians. Cardiologists, on the other hand, may require education focused on workstation management and cross-sectional image review. In addition, practices aiming to initiate or expand cardiac CT programs should educate referring physicians, particularly cardiologists and internists, about the value of CT angiography to grow their referral base. Technologist training is more straightforward. 22 Health Imaging & IT | March 2008 http://HealthImaging.com

Table of Contents Feed for the Digital Edition of Health Imaging & IT - March 2008

Health Imaging & IT - March 2008 Table of Contents On the Web The Enterprise: Communicating Better News Update Critical Test Results Management: The Human Touch The Changing Face of the Cath Lab Cardiovascular CT: A Clinical Boon Cardiology PACS: Solutions to Fit Your Needs ACC 08: Building Quality & Value Together Picking the Perfect PACS Displays PET/CT: A Game-Changer in Cancer Patient Management DR: You Gotta Have IT – Delivering Speed, Efficiency, Savings Laser Imagers: Answering the Call for Hard Copy Reader's Resources Stat Sheet

Health Imaging & IT - March 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.