The latest technology that can help detect heart disease is being tested at just a few places. One of them is in Pasco County.
By MELIA BOWIE
Published November 23, 2003
[Times photo: Brendan Fitterer]
Technologist Dan Aranda prepares a patient for a scan in a 16-slice CT scanner at the Florida Institute for Advanced Diagnostic Imaging in Port Richey.
PORT RICHEY - Cardiologist Robert Frankel flew down from New York to see the technology for himself:
A noninvasive heart test so advanced it eventually could eliminate the need for cardiac catheterizations as one of his staple screening procedures.
"About four years ago I started looking at noninvasive ways to image the heart," said Frankel, associate director of interventional cardiology at Maimonides Medical Center in Brooklyn.
The technology wasn't there yet, he said.
Today it is on the fast track, Frankel said as he examined Toshiba's new 16-slice CT scanner - the Aquilion 16 - on a recent afternoon at the Florida Institute for Advanced Diagnostic Imaging.
The facility, sandwiched between Thrifty Car Sales and Verizon along U.S. 19, is one of three U.S. sites picked by Toshiba to market its most advanced equipment. The scanner now is used on local patients.
The upgraded CT angiography equipment offers an alternative for doctors relying on invasive catheterization to screen for heart problems.
Promoters of the technology say it is accurate, faster, cheaper and in some case more comprehensive than conventional tests.
But there are roadblocks to its widespread use. Among them, the system's $1.2-million-and-up price tag.
Nor does CT - or computed tomography - generate the high profits for hospitals that come with catheterization. And because the imaging field is changing so rapidly, 16-slice CT could quickly become outdated, a point acknowledged by the manufacturer. The number of "slices" equals the amount of pictures taken per rotation.
"The question is what's going to be next? Is it 32 slices or 64 slices?" asked Jim Sardano, senior account executive with Toshiba America Medical Systems Inc.
Physician preference is another factor stalling its universal acceptance, say those in Pasco's medical community.
This year in Hudson, 7,500 cardiac catheterizations were performed through September at Regional Medical Center Bayonet Point's well-known Heart Institute, said hospital spokesman Kurt Conover.
During catheterization, a thin flexible tube, or catheter, is inserted into the groin, threaded through the body and into the heart, where X-ray images, or angiograms, are produced.
The procedure typically takes two to three hours and confirms an artery blockage, which can cause a heart attack. Doctors also use the diagnostic tool to help them decide the treatment to use.
But "as the CT scan and the MRI improves, the reliability of (those tests) will improve so people won't have a catheterization when they don't need to," said Dr. Rao Musunuru, directory of cardiology at the Heart Institute.
Including inpatient costs, the American Heart Association put the average price of a cardiac cath at nearly $17,000 in 2000. According to state reports, in 2001 Tampa Bay hospitals billed upward of $25,000 on average for the procedure.
At the Florida Institute for Advanced Imaging, the 16-slice CT scan - priced at less than $1,000 - is almost as accurate at caths in detecting coronary artery disease, said Dr. Steven Strobbe, CEO of the medical center.
"Down the road it's eventually going to replace diagnostic caths," he predicted, estimating the outpatient cost of a cath procedure averages between $5,000 and $10,000.
"It also gives a lot more data," he added, noting the 16-slice CT shows "soft" plaque - a predictor of heart disease - that cardiac caths do not typically pick up without a special ultrasound probe.
Unlike cardiac cath images, the Aquilion 16 and its counterparts made by companies such as GE, Philips and Siemens let physicians see precise pictures of the heart with such detail that even small arteries and minor abnormalities in organ tissue can be explored.
Toshiba's new 16-slice CT is an upgrade from 8-slice and even 4-slice CTs.
The increased number of slices cuts scan times and radiation exposure from as much as 30 minutes to less than 30 seconds.
Such advances prompted Frankel's visit from New York to Gulf Coast Medical. Selected a year ago by the company, the facility is a testing and marketing site for Toshiba's newest equipment. The other locations are Johns Hopkins University Hospital in Baltimore and Long Beach Memorial Medical Center in California.
"We have all the flagship products," Strobbe said, noting Port Richey offers more immediate access for visitors than busier hubs, where the machines are in constant use.
But what is the future of multislice CT?
In Japan, the technology for 256-slice CT already exists but "there is no computer that can (reconstruct) all that data," said Toshiba's Sardano, adding that advancement is possibly three years away.
A larger obstacle, said Frankel, is that other procedures such as cardiac caths might bring in more money for a hospital.
"There's a business to medicine," Frankel said, and a cardiac cath department typically is a large revenue source for hospitals.
"To take that business away . . . affects their bottom line," he said. In New York, "I've had resistance from several hospitals."
And those who are interested in the technology might not be ready to buy right now.
"The 16-slice is just starting to become popular in the community hospital arena," said Sandy Seibert, director of imaging services at Community Hospital of New Port Richey.
With 16-slice CT "there is a chance you won't have to do cardiac caths," she said, but that position is not yet universally accepted.
"The technology is still relatively new," Seibert said, noting that when Community Hospital spent $800,000 in February 2002 to buy a 4-slice CT system by GE, 16-slices were just coming out.
"A lot of people who jumped on the bandwagon to get multislice CT started with 4 or 8 (slice)," she said. And those machines just "aren't worn out yet."
- Melia Bowie covers business in Pasco County. She can be reached in west Pasco at 869-6229, or toll-free at 1-800-333-7505, ext. 6229. Her e-mail address is bowie@sptimes.com
