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AHRA and Toshiba Announce 2009 Putting Patients First Grant Recipients

December 7, 2009

At this year’s RSNA, the AHRA: The Association for Medical Imaging Management and Toshiba announced the six recipients of the second annual Putting Patients First grant program.

This year’s Putting Patients First grant program was expanded to include imaging centers and three additional grants specifically for pediatric programs. The six recipients were selected by the AHRA selection committee to receive up to $7,500 grants to fund programs, trainings or seminars aimed at improving patient care and safety in diagnostic imaging.

In its second year, this program has expanded its scope to include improving the imaging of children.  Children have special imaging needs – exposure to radiation and contrast are concerns within the industry, as is ensuring that children are well prepared for the imaging experience.  Putting Patients First will help facilities address these very specific needs.

“Grant programs like Putting Patients First are critical given today’s health care environment and the pressures hospitals face due to limited resources and other financial challenges,” said Debra A. Lopez, AHRA president, CRA, FAHRA. “This year’s winning programs demonstrated quality and innovation in patient care. They will make significant improvements to patient care and better the imaging experience for physicians and patients, alike.”

The programs funded by the AHRA/Toshiba Patient First grants include:

Children’s Healthcare of Atlanta at Egleston – Use of Bismuth Shields in All CT Exams

• Several recent publications report radiation dose reduction benefits when using bismuth shielding for pediatric patients undergoing multidectector CT. Therefore, Children’s Healthcare of Atlanta at Egleston will implement the use of bismuth shields in all patients undergoing CT examinations. Implementation of this shielding program will entail staff training, purchase of bismuth breast and thyroid shields, ongoing review of images, development of resident and parental educational programs, and a cost analysis.

Community Health Network – Pediatric CT Imaging Simulation Program

• By enabling pediatric patients to better understand the CT imaging process, radiation dose will effectively be reduced, patient comfort will be improved and the overall imaging experience will be safer. Therefore, Community Health Network will create an Internet-based simulation program to educate pediatric patients and their caregivers about the diagnostic imaging process (focused on CT).  By incorporating audio, avatars and animation through a user-friendly computer program, patients will know what to expect of the imaging process and be more comfortable and compliant during the procedure.

Memorial Hermann Outpatient Imaging Division – Improved Process Program

• Memorial Hermann’s goal is to emphasize the importance of keeping radiation dose during CT procedures as low as reasonably achievable for pediatric patients, while still maintaining good image quality. It also recognizes the need for more education for the technologists and pediatricians on pediatric radiation safety. Therefore, Memorial Hermann will implement the Improvement Process Program to: 1) document the dose electronically PACs; 2) scan once – multiphase scanning is usually not necessary in children; 3) reduce or “child-size” the amount of radiation used; 4) audit and evaluate image quality monthly; and 5) provide physician and technologist continued education.

Highline Medical Center – Improvement Project for Scheduling Inpatients for Imaging Exams

• One of Highline Medical Center’s goals is to provide a patient-centered environment that personalizes, humanizes and demystifies patient care. Therefore, Highland Medical Center is undertaking an improvement project to develop, implement and spread a process for scheduling inpatients for imaging exams to accomplish safer patient care through: 1) better communication among the staff caring for the patient; 2) increasing involvement of the patient in his/her own care; 3) better coordination between services for tests and treatments leading to streamlined clinical pathway; 4) eliminating delayed/missed or incorrect imaging exams; 5) improving patient flow to potentially decrease overall length of stay; and 6) having imaging techs rounding on patients prior to high risk, invasive or advanced imaging procedures.

Shields Health Care – Understanding and Reducing Patient Anxiety

• Shields Health Care wants to engage the patient in a common language that educates and reduces patient anxiety. Therefore, Shields Health Care will develop multi-lingual web-based tools as well as professional staff training. Phase one of the program will be to research causes and develop solutions; phase two will be to implement and cross train professionals and technical staff; and phase three will be dedicated to reflection on lessons learned and measuring program effectiveness and outcomes.

St. Patrick Hospital – Interactive Utility to Improve the Imaging Process

• Inaccurate or inappropriate exam orders contribute to increased costs to patients, staff and facilities in terms of dose, money and time. Therefore, St. Patrick Hospital will create on its intranet Web site an interactive utility that is readily accessible to all staff to provide guidance regarding appropriate imaging studies and help facilitate clear exam orders to maximize the value of imaging studies. Once the program is developed for intranet users, St. Patrick Hospital will provide a condensed version of the utility on its hospital Web site with more links to helpful information in order to improve patient understanding of the process. This version also will be a tool used by clinicians and staff when discussing exam specifics with patients.

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Clinical Case of the Month: Congenital Heart, Double Aortic Arch

According to the March of Dimes, congenital heart defects affect more than 25,000 infants every year in the United States.

Imaging children has many challenges due to their unique imaging requirements compared to adults. The best benchmark for a pediatric CT scanner should include the ability to acquire images as fast as possible, with the best image quality, and at the lowest possible x-ray dose.

Aquilion ONE can capture whole anatomical regions in a single rotation of the gantry. This ability can dramatically reduce the amount of contrast, radiation and possibly the need for sedation. Aquilion ONE also comes equipped with ^SUREExposure Pediatric which incorporates the unique imaging requirements of pediatric imaging and ensures the lowest possible dose while maintaining diagnostic image quality.

Case: CTA of the chest to evaluate congenital heart defect in a 9 month old infant with respiratory distress noted at birth.

Scan Parameters: 80kV, 25mAs, 0.35 second rotation.

3D volume rendered and MPR views clearly demonstrate this double aortic arch causing stenosis of the left main stem bronchus, most likely causing the infants continued respiratory distress. 3D images can give surgeons a roadmap for intervention, making it safer and saving time. No sedation was need for this scan due to the very short scan time of 0.35 seconds.

Toshiba Grants Bolster Creative Safety Initiatives

September 1, 2009

When St. Mary’s Regional Medical Center, Lewiston, Maine, decided to renew its focus on CT quality and safety, the first step was developing a set of best practices upon which future improvements to CT workflow could be based. “We thought we could tap into the validated knowledge that resource centers had put together and actually implement those findings in the field,” explains Donna Knightly, RT, radiology supervisor. “Our objectives were dual: promoting the use of ACR appropriateness criteria and improving patient safety in any way that we could.”

In January 2009, AHRA: The Association for Medical Imaging Management, in conjunction with Toshiba, awarded three $7,500 grants to help fund innovative patient-safety and quality initiatives. St. Mary’s was a recipient, along with Washington Hospital Center, Washington, DC, and Jennie Edmundson Hospital, Council Bluffs, Iowa. “We have changed the way we engage patients. We now are more focused on being patient-centered and family-centered,” Knightly says. “It’s little things that make a big difference, like having a blanket warmer in the room. We just converted a warmer box that was used for contrast media, and we located this right in the scanner room so it’s easy to access for the technologist and they can keep the patient warm during the scan.”

Gayle Thompson-Smiley, director of Radiology at Washington Hospital Center, used her facility’s grant to initiate a patient-handoff program designed to refine the processes involved in transferring 300-350 patients a day from the hospital floor to the radiology department. “Washington Hospital Center is a very large institution and quite complex. In this type of environment, we’re also focused on how we can better improve the patient experience and the patient outcome,” she says. “This was a very unique opportunity for us.”

Meanwhile, Jim Lipcamon, director of Imaging Services at Jennie Edmundson Hospital, sought to leverage his hospital’s information systems to alert radiologic technologists to potential complications associated with contrast media for imaging. “People who take metformin [for type II diabetes] are contraindicated to receive iodinated contrast,” he explains. “We wanted to hardwire that process. Prior to the grant, that process was strictly on paper, relying on the patients to remember to tell their physician or tell the nurse on the floor. With the increase in obesity nationwide, we felt that this was a critical issue that needed to be addressed in our institution.”

Tom Kaiser, informatics pharmacist at Jennie Edmundson, is grateful for the interdepartmental collaboration fostered by the grant. “We’ve been able to use a multidisciplinary approach to our patient-safety enhancements,” he says. “It allowed me an opportunity to work with IT professionals, radiology professionals, and the pharmacy itself to come up with a program that generated rules based on patients’ medications.”

Washington Hospital Center is developing a CME course to train staff on successful handoff communications programs. “The CME event will help prepare physicians in our staff to really think about how best to keep patients safe in day-to-day care and in whatever handoff communication processes that they are involved with,” says Kathleen Srsic-Stroehr, senior nursing director for Evidence-based Practice and Quality. “It’s really important to think about those particular processes and those sender and receiver communication messages that are so important in a handoff communication situation.”

Knightly concurs: “This is a great opportunity for other departments in CT to tap into this knowledge and apply it to what they do every day out in the field. These best practices are very simple, very usable and make a difference in patient care and patient safety. It’s very exciting to be able to share what we’ve found and also to encourage people to use what’s out there.”

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Validating Improved Outcomes for Diabetic Patients

June 1, 2009

According to the American Diabetes Association, more than 75 percent of today’s 23.6 million U.S. residents with diabetes will die of heart disease. Many of these diabetic individuals are asymptomatic for coronary heart disease (CHD) until their first heart attack, and there is no accepted method of detecting CHD, to date.

“Patients with diabetes have a risk of cardiovascular disease that is two to four times greater than that of nondiabetic patients,” Donald Lappe, MD, chief of cardiology at Intermountain Medical Center, Salt Lake City, explains. “The ability to detect CHD in at-risk, asymptomatic patients will have a significant impact on the ability to improve their cardiac conditions and will help save lives.”

To assess the viability of using 64-detector row CT to diagnose CHD in asymptomatic patients, Toshiba America Medical Systems, Inc. in Tustin, Calif., funded faCTor64, a 1,100-patient prospective study conducted by researchers at Intermountain Healthcare, Salt Lake City. Investigators will identify asymptomatic diabetic patients using Intermountain’s diabetes database; then, they will compare two patient groups. Half will be evaluated for CHD using cardiac CT angiography (CTA) using the Toshiba Aquilion® CT system, while the other half will undergo traditional diabetes management. Researchers will follow both groups for five years to assess which group experiences better outcomes.

So far, 261 patients have been enrolled in the study, with 93 patients scanned; Intermountain hopes to complete enrollment by 2010. Using the Aquilion’s Volume Imaging protocol, Intermountain researchers have been able to create up to five different reconstructions using data from a single acquisition, allowing them to review more aspects of the patients’ cardiac function. Intermountain physicians also are able to develop their own CT protocols based on specific patient needs, and they can customize Toshiba’s proprietary SURECardio software to reduce the amount of contrast, and the radiation dose, that patients receive.

Researchers say the study’s initial results are promising. CHD has been diagnosed in approximately 75 percent of the scanned asymptomatic diabetic patients, and many of them also have high-grade, severe stenosis warranting revascularization. Several of the patients also have a defective anginal warning system, possibly providing a clue as to why they are asymptomatic, in spite of the severity of their CHD. The team at Intermountain also notes the results of the CTA scans have helped with patients’ health management; many patients who need to lose weight or make other lifestyle changes have been more compliant after seeing their CT results.

CORE 320 Set to Validate Dynamic Volume CT

January 1, 2009

As the next phase in validating advanced computed tomography technology in a clinical setting, Toshiba Medical Systems Corporation (TMSC) is supporting CORE 320, the largest worldwide multi-center trial comparing the effectiveness of 320-detector row dynamic volume CT to SPECT technology. The trial is examining whether the combination of CT angiography and myocardial perfusion can identify coronary stenoses that are less than or equal to 50 percent by Quantitative Coronary Analysis (QCA) and correspond to a SPECT perfusion defect.

“One of Toshiba’s core missions is to validate its technology through clinical trials by leaders in the medical field,” explained Yusuke Toki, general manager, Clinical Application Research Center, TMSC. “As the first and largest multi-center trial using dynamic volume CT, CORE 320 will result in the most statistically reliable data available on this advanced technology. This will be attributed in part to the trial’s design, which calls for an international, multi-center approach, bypassing the limitations associated with focusing on one geographic area and/or small patient populations.”

CORE 320′s multi-center trial will be lead by primary investigator Dr. João A. C. Lima of Johns Hopkins University School of Medicine, in Baltimore, Md. Johns Hopkins University will also serve as the core site for CT. Dr. Marcelo Di Carli of Brigham and Women’s Hospital, a Harvard teaching hospital, in Boston, Mass. will serve as core site for SPECT. Additional investigation sites will be announced in the coming months.

“We expect CORE 320 findings to impact the way the medical community views the role of dynamic volume CT in the diagnosis and treatment of life-threatening diseases,” explained Toki. “These results eventually could impact they way patients are diagnosed and treated.”

Fast Definitive Diagnosis From Toshiba’s Aquilion ONE Allows St. Elizabeth Medical Center Physicians To Prevent Stroke In ER Patient

December 1, 2008

Patient Pamela Louderback had been experiencing dizzy spells for months and arrived at St. Elizabeth Medical Center’s emergency room (ER) after blacking out one morning at work. Unbeknownst to her and her doctors, she was on the verge of suffering a stroke.

Fortunately for Louderback, St. Elizabeth used the world’s first dynamic volume CT system, the Aquilion® ONE, to diagnose her condition within an hour and prevent a stroke from occurring at all. Using one X-ray rotation to capture 16 cm of anatomy — an entire organ — and show organ function over time, the Aquilion ONE is ideally suited for detecting neurovascular conditions quickly.

St. Elizabeth physicians used the Aquilion ONE to detect that Louderback’s right carotid artery was 90 percent occluded, which significantly reduced blood flow to the brain. By diagnosing this condition within the hour, physicians immediately planned stent treatment to open the artery passage, preventing a stroke.

“Toshiba’s Aquilion ONE allowed us to accurately diagnose the patient quickly, dramatically improving her quality of life,” explained Dr. Jeff Dardinger, director of Imaging, Vascular Institute, St. Elizabeth Medical Center, who interpreted Louderback’s images. “Without dynamic volume CT, the patient would have undergone a series of tests for two-to-four days, at a minimum, to uncover the occlusion. Being able to diagnose the patient within an hour allowed us to plan treatment immediately and prevent a stroke.”

“I truly believe this system saved my life,” explained Louderback. “I had several exams over the past few months, none of which could detect why I was having dizzy spells. It wasn’t until I was imaged in the ER using the Aquilion ONE that a definitive answer was found.”