Health Imaging & IT - October 2007 - (Page 57) other locations and will continue to get studied. “That allowed us to purchase the equipment,” he says. “It’s a huge difference for us. As a cardiovascular disease group, we’re used to doing ultrasound and single photon nuclear medicine work in the office,” Port explains. The group does certain kinds of ECG recordings, Holter monitors and other work that does not require much in the way of patient monitoring. Before CT, they didn’t have to worry much about drugs or renal function. “Now you’re in a contrast business, and that’s a whole different ballgame.” Port says that adjusting the practice to giving patients contrast was a big change. Each patient requires a blood test for renal function and he or she is sent to a lab for kidney function evaluation. These and other steps significantly altered the group’s patient approach. In the hospital setting, “all of these mechanisms seem to happen for you. Skilled nurses take information from patients, check creatinine levels, and call if something is wrong. So much is getting done for you routinely [in a hospital setting] and it’s all happening in the background. Now it’s you and your people that have to make the whole thing flow properly. It’s a quantum leap to get used to that.” To get everyone on the same page, Port had training sessions for the staff. New requisition sheets were created. A CT technologist and CT nurse came on board a month before exams started on the system so they could develop clinical protocols. “You have to put processes in place,” he says. “It doesn’t become automatic right away.” Another change is taking on some level of financial conversations with patients. A lot of people in Wisconsin are still paying out of pocket, at least for coronary studies. The fee at Port’s practice is $600, an expensive study for any patient. When a doctor suggests this study to a patient, Port says, they have to have a real financial conversation to explain why the test is recommended and the benefits it brings. So far, Port says “we are thrilled with the equipment.” The SnapShot Pulse software offers a prospective gating technique. That allows the physicians to select small portions of the heart cycle to turn on the radiation. That reduces radiation by a factor of three to four. “It made me uncomfortable to deliver 13 to 15 milliseverts of radiation to the chest,” he says. “We start talking to women about their likelihood of breast cancer as part of whether to do this study at all. Now we can do a CT angiogram at the same or less radiation as catheterization. We still have to think about it HealthImaging.com “People are spending too much on technology when there’s effectively no difference. A high-quality 16-slice machine is more than adequate for everything but cardiac work.” Mark Winkler, MD, Steinberg Diagnostic Medical Imaging Centers, Las Vegas Health Imaging & IT | O C T O B E R 2 0 07 57 http://HealthImaging.com
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