Reprinted from the Monday, July 31, 2000 edition of the Worcester Telegram and Gazette. |
continued from page one |
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| Maloney, medical director for the
Chadwick
HeartScan Center. But the ultrafast CT-scanner can actually "stop" the
motion of the heart, taking a picture in a millisecond. Those pictures can reveal whether
there is a white area - calcium - in the walls of the arteries. Typically, exercise stress
tests have been used to detect blockages in the cardiac arteries by increasing the
workload on the heart muscle. If the cardiac arteries can't deliver enough blood to the
heart muscle, the abnormal changes will show up on an EKG or in flow studies from stress
tests using nuclear scanning, said Dr. Maloney. But using present methods only about 15 percent of people who have heart attacks can be diagnosed as having coronary artery disease, according to Dr. Maloney. "The remainder have this silent disease which we don't even know is going on," said Dr. Maloney, unless there's a way of looking at it. Calcium and cholesterol, two of the main ingredients in the plaque that causes artery blockage - can lurk behind the walls of the artery, leaving the shape of the arteries undistorted. "Because it doesn't deform the vessel, you would get a reading of a normal coronary artery," said Dr. Maloney. However, the hidden plaque can cause irritation and inflammation - much as a pimple would, and eventually will rupture into the artery. A clot can form, and, if it should fill the artery, it will then block the flow of blood to the heart and cause a heart attack. Ultrafast CT-scanners can show calcium - just as X-rays can show bone - thereby measuring the plaque buildup in the walls of the arteries even in the people who do not have early symptoms of cardiovascular problems. "These can be found years before they are likely to be found by conventional means," said Dr. Maloney. And if the calcifications are detected, that can set off alarm bells. Depending on the extent of the calcifications, a change in lifestyle, such as diet and exercise, may be required, or high blood pressure or high levels of cholesterol may need to be lowered. Most HMOs and insurance companies will not cover the use of ultrafast CT-scan studies for cardiac imaging. So people who are interested will have to pay for it out of their own pockets. At Chadwick, the cost is about $400. Over at Worcester Medical Center, "some patient's families are giving them one for Father's Day presents," said Dr. Sabel. UMass Memorial Healthcare, Inc. isn't doing coronary artery screenings, but finds that its new version of the ultrafast CT-scanner, one manufactured by General Electric, is valuable in many ways. Because of its speed, it is useful in screening patients who are not able to hold still. Children now do not have to be sedated for tests, according to Dr. John Knorr, a radiologist. Patients with motion problems, such as Parkinson's disease, can be more easily imaged. And the ultrafast CT-scanner is particularly valuable when large areas of the body need to be looked at quickly, such as when a patient is brought into the emergency department with major trauma. "It can scan the pelvis, the abdomen and chest in 20 seconds, looking for injuries," said Dr. Knorr. Both the Picker and General Electric CT-scanners can detect cancerous cells in lungs at an earlier stage than chest X-rays can. Clinical trials are ongoing elsewhere to see if this early detection can result in more successful treatment of lung cancer. HMOs and insurers aren't paying yet for that type of lung screening because its experimental, but UMass Memorial does use the CT-scanner to look for more lesions when chest X-rays have already found lung cancer. A few medical experts, including one at Boston University, are experimenting with using the equipment to detect colon polyps, a forerunner of colon cancer. If that proves successful, an ultrafast CT-scan could be an option to invasive colonoscopy. Now, the ultrafast CT-scanner is not only the star in the radiology department at Worcester Medical Center, according to Dr. Sabel, who worked with the just-retired radiology department chief, Dr. Murray Janower, to plan how the new medical center was going to be equipped. "I don't know of any other hospital that has what we have in terms of the latest technology," said Dr. Sabel. Taking its place near the two ultrafast CT-scanners is the latest "top-of-the-line, spectacular" MRI, said Dr. Sabel. "We are able to, with an added-on program, detect strokes within the first hour of the stroke. If a patient comes in with a sudden onset of paralysis, we can scan them and tell if it's really an acute stroke. We can also tell whether there is blood there. If there is no blood, then the patient might be able to go on blood thinners right away and you might be able to salvage the brain. "That MRI can do almost any part of the body now," said Dr. Sabel with a laugh. "There is nothing that is sacred any more." State-of-the-art ultrasound can not only image a problem, but can do a great deal of interventionist work. "We have biopsy probes that go right through the ultrasound probe itself," Dr. Sabel said. "So the ultrasound tells you where to go." A new, digital angiographic suite reduces exposure to radiation as it images any vessel in the human body. It captures the image, saves it and sends it via a new picture-archiving communication system to the physician on the case. "The heart of the department is the computerized system that archives all the X-rays," said Dr. Sabel. "We don't have hard copies unless someone makes such a request. Any time you want an X-ray, you can come into the computer system, whether in the reading room or upstairs (hospital rooms) in your office or in your home," he said, which allows health care providers to access the information. Not only are new films on the computer system, which has built-in safety features to eliminate unauthorized access, but a hospital digitizer machine has converted old films for the computer. "So if I am looking at a patient's film and I wanted to know what the old one looked like, for comparison, I can hit a button and the old one comes up right next to it." Tied into this is a voice recognition system that allows radiologists to dictate the report on the film study, which is then entered automatically on the screen and sent to the clinician. Turnaround time between when the picture is taken and when the clinician has the report is less than 24 hours in probably 80 percent of all studies, said Dr. Sabel. So what's left? "PET-scanning," said Dr. Sabel, with a gleam in his eye. "It (Positron Emission Tomography) has shown itself to be quite exceptional for lung cancer patients and oncology patients in general." Because of the scanner's expense, $2 million to $3 million, said Dr. Sabel, "we will probably get a mobile unit first, then lobby the hospital for one on-site." PET-scanning, working with functional MRI, an experimental form of MRI, is also being used experimentally to do metabolic processes revealing new information about schizophrenia, Alzheimer's, Parkinson's disease and other brain dysfunctions that have long been mysteries to health care practitioners. "We are on the threshold of some big discoveries here," said Dr. Sabel. |
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