Tuesday, February 02, 2010

Roanoke Valley hospitals gain new diagnostic tool

A rare test offered by only 3 percent of U.S. hospitals makes its Roanoke Valley debut.

After being admitted to Lewis-Gale Medical Center, Kenny Wingfield was one of the first patients to benefit from its new PET/CT unit.

Jared Soares | The Roanoke Times

After being admitted to Lewis-Gale Medical Center, Kenny Wingfield was one of the first patients to benefit from its new PET/CT unit.

Kenny Wingfield felt some tightness in his chest.

At 53, Wingfield knew with his medical history -- he had double-bypass heart surgery in 2007 -- he needed to head to the emergency room.

Doctors determined he wasn't having a heart attack on that Jan. 4 night, but admitted him. A stress test was scheduled for the following day.

The test, however, wasn't the same that he had previously had.

It was a brand-new procedure at Lewis-Gale Medical Center, and one that the hospital is hoping will change the way they diagnose cardiac patients.

Wingfield said he was told he was the second patient to have the exam.

The test involved injecting the radioactive isotope N13-ammonia and then using a positron emission tomography-computed tomography, or PET/CT, to take pictures of the arteries in his heart.

It takes about an hour, and the results are touted as allowing doctors to see a much more detailed picture of the heart. Just about 3 percent of hospitals nationwide provide the diagnostic test, said Derek Blaakman, the lead technologist who operates the scanner at Lewis-Gale.

That's because the half-life, or shelf life, of N13-ammonia is just 10 minutes, meaning the facility must have quick access to the cyclotron that produces the isotope. In this case the isotope is made by Precision Nuclear of Virginia less than a mile away from the hospital.

Although not common, the test is fully approved and covered by insurance companies, hospital officials said.

For Wingfield, the test revealed some blockages in his arteries.

"They saw something in there and went and did a cath a couple days later," he said referring to the cardiac catheterization procedure, where doctors use a narrow tube inserted into a blood vessel to see the heart.

An avid cyclist, Wingfield added, "They got it taken care of, changed my medications. Now I'm back at work, back on the bike and doing well."

The hospital has plans to offer the test even more quickly to patients like Wingfield. It plans to coordinate with its chest pain center.

"If we bring them straight from the ER, do this study here and exclude whether they have coronary artery disease, we could potentially prevent someone from having to spend the night in the hospital," said Dr. Bill Kiser, medical director of radiology at Lewis-Gale. "If you don't have a reason to be in the hospital, we don't want to keep you here."

Lewis-Gale began doing this test soon after the hospital had its PET/CT scanner installed. Prior to having the new equipment installed, the hospital had relied on a mobile unit, driven in twice a week, to conduct all PET/CT scans needed by the patients served by Lewis-Gale doctors.

The actual equipment is state of the art, complete with high-definition cameras and other bells and whistles that make people such as Blaakman very excited.

"This is the first one of its kind installed in the United States," Blaakman said while showing off the new scanner. "Therefore some of the things we're doing, no one else is doing."

When it comes to using the N13-ammonia, however, Lewis-Gale's chief competitor, Carilion Clinic, is also conducting the same diagnostic test.

On Thursday and Friday, Carilion did its first cardiac tests using the isotope.

Because Carilion Roanoke Memorial Hospital is located about eight miles from the cyclotron, the procedure cannot be done there. So the clinic petitioned the state to allow it to set up shop in the parking lot of Precision Nuclear.

Carilion's interest in operating less than a mile away from Lewis-Gale was the focus of an intense battle between the two health care providers last year. In the end, Lewis-Gale conceded to let Carilion operate the mobile unit for certain tests that require isotopes with very short shelf lives, such as N13-ammonia. And the state agreed to the compromise.

Carilion had said it would have the operation up and running by the fall of 2009, but delays in construction and in getting the necessary software installed put the project a few months behind schedule, said Sharon Bass, vice president for imaging.

While Lewis-Gale had to purchase the PET/CT scanner in order to offer the test, Carilion didn't. Carilion already operated a mobile scanner -- it is installed inside a tractor-trailer. But Carilion did have to construct a pad where the truck could park while tests were being preformed.

Once fully operational, Carilion plans to schedule about a dozen people a month for the test, which will be done only on Fridays.

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