Advanced Visualization Adds New Practice Dimension

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Technology adoption increases referrals, bolsters bottom line

 Segmentation of left coronary circulation over a transparent heart with anomalous right coronary artery demonstrated in red. Image courtesy of Visage Imaging.

It’s been said that a picture is worth a thousand words; when it comes to the deployment of advanced visualization technology in cardiology, an image may be worth even more in referrals, according to practices that have adopted it.

“The whole world has been changed by the advent of ultrafast, multidetector cardiac CT,” says Robert S. Schwartz, MD, a cardiologist with the Minneapolis Heart Institute in Minneapolis. “It gives us extremely rapid three-dimensional images, which allows us to capture the entire beating heart.”

The downside to this achievement is that massive amounts of data are generated to deliver the 3D data sets from today’s multidetector CT systems, Schwartz notes. “One needs to be able to handle those massive amounts of data in a very efficient and facile way to make a diagnosis.”

The implementation of advanced visualization at the Minneapolis Heart Institute was driven by an uptick in coronary CT angiography (CCTA) studies. “Our coronary CT angiography service line really started to take off once we got high-speed multidetector CT systems,” Schwartz says. “We simply could not handle the huge amount of interpretative data being put out by these systems in an efficient manner. The workload would have been simply staggering if not for advanced visualization technology.”

Prior to the deployment of advanced visualization tools in the practice, the interpretation time for a CCTA procedure was anywhere between 20 and 30 minutes per exam. Now it is between three and four minutes for straightforward exams, and a little longer for exams that are more complex. An additional benefit of the technology has been the ability of the cardiologists to consult more efficiently and effectively with their referring clinician base. “Because of the efficiency of the software, we’re able to be doing something else, put it aside, and pull up a 3D image and review it with a clinical colleague in a very short space of time; we’re quickly able to demonstrate the exact results of an exam,” Schwartz says.

Referrals to the practice also have increased since the addition of advanced visualization tools. The practice can send the reconstructions over the network or burn a CD for the referrer. Patients also request CDs of their images and Schwartz is happy to oblige, noting that it generally has a positive impact on patients’ commitment to healthy behavior.

3D and collaboration

Michael Ridner, MD, a cardiologist at the Heart Center in Huntsville, Ala., and an associate professor of medicine at the University of Alabama School of Medicine, also has found the addition of advanced visualization technology to be a boon to his practice’s capabilities.

“What it has allowed us to provide is network-wide visualization of cardiac CT angiograms, at any site, in any location,” he says. “This permits the cardiologists in our practice to work on these exams anywhere, including at home. In addition, we’re able to share our 3D reconstructions in our consultations with our referring physicians, as well as with the patients.”

He also has noted a change in behavior as a result of sharing 3D images with patients. “The technology allows us to provide patients with a very compelling image of their diagnosis,” Ridner says. “By showing them an image of their arteries, we are able to convincingly demonstrate why they should follow the therapeutic regimen that we’ve laid out for them.”

The technology has paid unexpected dividends in the Heart Center’s affiliation with local hospitals. He noted that the cornerstone of the advanced visualization software is for diagnostic purposes in the practice, but it has expanded its capabilities well beyond that primary utilization. “In the ER, we’re able to perform a reconstruction in the department and make a decision as to whether a patient should be admitted or released, which vastly expedites the workflow in that department for patients presenting with chest pain,” Ridner says.

Other clinical departments in their hospital client base have also sought access to the technology, with very positive results. “It’s shown great benefit for our cardiothoracic surgeons,” he says. “The surgeon can call up the 3D image in real time and use it to determine anatomy in order to better guide their surgical intervention.”

Success in the operating room has led other interventional groups to utilize the advanced visualization images from the Heart Center. “We’ve also started using advanced visualization technology in our peripheral vascular lab,” Ridner notes. “This has allowed the clinicians to use the image to plan their intervention without having to take additional guiding images of the patient for their procedure.”

To demonstrate the capabilities of advanced visualization technology, Ridner and his partners at the Heart Center offered their entire referring clinician base the opportunity to have a no-cost CT heart scan conducted. They then performed 3D reconstructions and met with the physicians one-on-one to show them the images and discuss the results. “We had over 300 doctors take advantage of this opportunity,” he says. “When they saw the results, they were sold for life.”

Know post-processing

Elliot Fishman, MD, a professor of radiology and oncology at the Johns Hopkins University School of Medicine in Baltimore and a long-time proponent of advanced visualization technology, offered practical advice for a private practice looking to place the technology into their service line. He spoke at the 2008 meeting of the North American Society for Cardiovascular Imaging in Phoenix.

“The first thing, of course, is the ability to acquire the data sets; so, you need to know how to use the scanner well. You need to have it optimized, because when all is said and done unless you have a good data set, nothing else happens,” he says.

Achieving expertise on the advanced visualization application is the next step a practice must take for successful deployment of the technology, Fishman says. “The interpreting clinician must gain expertise on the advanced visualization software; it’s this post-processing that allows you to make an accurate diagnosis.”

Fishman says that cardiologists often will not venture into cardiac CT because of the perception that it’s difficult to acquire and post-process the data. But that was with yesterday’s technology, he says. “Today, the tools are easier, simpler, and more quantitative—but you still have to learn how to use them.”

He adds that as the interpreting physician, cardiologists should know how to do the post-processing. “You need to be interactive with the data set or you’re just not going to feel comfortable reading the studies.”