Medicine takes a look inside - September 8, 2013

Courtesy of The Times

The Region’s hospitals and healthcare centers are tapping into new imaging technology that aids diagnostic procedures for the health and comfort of the patient.

3-D Mammography

A leap in mammography technology is making diagnostic breast examinations easier and much less painful at Methodist Hospital. Dr. Anastasia Siatras, radiologist and fellowship breast imager, uses 3-D mammography, a procedure that detects cancers earlier and can eliminate the need for further testing and biopsies.

The technology, called tomosynthesis, provides three-dimensional images of the breast taken by an imaging machine that moves around the breast in an arc and takes multiple X-rays that a computer shows as a 3-D image. The imaging technology was approved by the U.S. FDA in 2011 and used at Methodist ever since. Methodist was the first healthcare system in the area to use 3-D technology for mammography.

“3-D mammography has revolutionized mammography the way CT (Computed Tomography) has revolutionized plain X-rays,” Siatras says. “It uses computer software that allows us to scan through the breast in one millimeter segments. We’re able to see significantly better and essentially pick apart breast tissue to reveal hidden abnormalities.”

A Pennsylvania-based university hospital currently is testing the next step in 3-D mammography. “They’re doing breast biopsies using 3-D imaging while doing the biopsy,” Siatras says. “It’s that type of thing we’ll see coming down with 3-D imaging in the next couple of years.”

Oasis MRI

In early summer, St. Catherine Hospital, a part of the Community Healthcare System, began using an Oasis MRI, which has the largest opening – called gantry — in the industry.

“Our goal of providing our patients with advanced technology and the most up-to-date treatment techniques is achieved through the investment in equipment like the Oasis MR system,” says Craig Bolda, St. Catherine’s chief operating officer. “Patients are able to choose St. Catherine Hospital with the confidence that they are receiving testing and treatments in a comfortable environment that provides high quality results.”

Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to visualize internal structures of the body in detail. MRI makes use of the property of nuclear magnetic resonance to image nuclei of atoms inside the body. MRI can create more detailed images of the human body than are possible with X-rays.

An MRI scanner is a device in which the patient lies within a large, powerful magnet where the magnetic field is used to align the magnetization of some atomic nuclei in the body, and radio frequency magnetic fields are applied to systematically alter the alignment of this magnetization.

An MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart and cancers compared with other medical imaging techniques such as computed tomography (CT) or X-rays.

Unlike CT scans or traditional X-rays, MRI does not use ionizing radiation.

The Oasis MRI scanner is a revolutionary advancement in MRI technology, combining the high resolution, extended capabilities and fast scan times of a high-field, closed magnet with the comfort of the open MRI magnet. Because of the open design, the magnet speed and the video system, patients rarely require sedation. The high-field open design allows high quality images to be obtained on all patients – large and small.

Open MRI machines are far less constricting, as they are open on the sides, and the machine does not enclose the patient’s entire body.

St. Catherine’s new MRI, which is a 1.5 tesla, is the latest addition to the hospital’s other state-of-the-art imaging equipment, including a new ultra-fast CT scanner, according to a hospital spokeswoman.

In February, Ingalls Healthcare System Family Care Center in Flossmoor began using its new 3 tesla (3T) MRI. The tesla number denotes the strength of its MRI magnet.

The Ingalls 3T is the first located in the south suburban Chicago and Northwest Indiana. Currently, the vast majority of the 3T MRI scanners are used at the large university hospitals.

The Ocelot

In May, Dr. Samer Abbas began using an advance in optical coherence tomography at St. Catherine Hospital to treat patients with Peripheral Artery Disease. The disease can cause a heart attack, amputation and other serious conditions.

During the procedure, Abbas uses a device, called the Ocelot, which allows him to visually navigate inside blocked leg arteries.

The Ocelot, manufactured by Avenger Corporation in Redwood City, California, is the first Chronic Total Occlusion catheter with a camera inside.

“With Ocelot’s first-ever advanced imaging technology, I can see, in real-time, the intricacies of what I’m doing inside blocked arteries of my patients,” Abbas says. “This new technology provides us a more scientific and controlled way to treat Peripheral Arterial Disease.”

St. Catherine’s Cath lab is one of only three centers in the bi-state Indiana and Illinois area currently using Ocelot in the treatment that removes blockages in the leg. Ocelot is only used in cases that are so severe and difficult that traditional catheters can’t be used.

In the past, surgeons would have had to rely solely on X-rays as well as touch and/or feel to guide catheters through complicated blockages. With Ocelot, physicians can more accurately navigate through chronic total occlusions (CTOs) by seeing images from inside the artery.

Dr. Grace Lee, vice chairman of radiology for the Ingalls system, says she is “absolutely delighted” to have the 3T MRI, which she said is faster and provides greater detail than scanner with fewer teslas.

“It can image vessels in greater detail without dye, which is good for those who can’t have dye because of kidney function, and we couldn’t do it with high quality and in detail without dye,” Lee says. “It’s much more comfortable for the patients, and the exams are faster. We’re seeing smaller abnormalities sooner. It’s easier for the radiologist to pick up abnormalities.”

High-field strength MRI delineates structures that have not been seen before, such as blood vessels as small as 200 to 300 microns, drilling down to the ultra–structural level, she says.

Experts contend the 3–tesla MRI is more than just a glorified, high–tech microscope. According to radiologists who have been testing high field strength MRI in clinical settings, 3–tesla machines can do anything a workhorse 1.5–tesla scanner can, and do it faster and better.

“It’s especially good for imaging of the brain,” Lee says. “We can see abnormalities of the brain easier and sooner and with greater detail. We can see smaller plaques in the brain core.”

Using the 3T MRI, radiologists also can see ligaments in hand or fingers, small fragments of cartilage in the knee, tears in the cartilage of the shoulder without dye, all problems they may not have been able to see using a traditional MRI scanner, she says.

“Overall, it makes it easier to make a diagnosis without doing an invasive procedure,” Lee says.

The Ingalls 3T also was a wide bore (opening) that accommodates the largest patient and eliminates claustrophobic reactions seen with closed or smaller bore MRI scanners.

Dr. Matthew Evon, director at radiology at the Franciscan Alliance Imaging Center in Valparaiso, says his facility’s has a traditional1.5 MRI scanner with a wider than normal bore and it is shorter than many other scanners.

“In a lot of exams, the patient’s head is out of the magnet, but it doesn’t sacrifice any of the images,” he says. “That’s a real advantage to the patient’s comfort.”

Although the Alliance doesn’t have any 3T MRI scanners in its area network, Evon says this technology is the wave of the future.

“When I was an intern at University of California San Diego, they (3T MRIs) were just coming in as I was leaving,” he says. “They produce a better image quality for some exams. It’s clearer and thinner. But they have certain drawbacks.”

Among the drawbacks are their costs, the amount of artifact—in medical terms this means unrelated images—seen with the stronger magnet and the skills and experience of the radiologist learning the new technology, Evon says.

And MRI scanners with even greater magnetic strength are coming,” he said. “The inherent positives will probably outweigh the negatives,” Evon said.