This report originally appeared in the January 2011 issue of DOTmed Business News

One of CT’s strong points has always been its speed, a factor that’s especially useful in a hospital’s emergency department. A study presented at RSNA and published in Radiology found that the prevalence of CT scans in the ED is on the rise, and if the trend continues, nearly 20 percent of all ED visits this year may involve a CT exam.

In the study, the researchers used data collected by the National Hospital Ambulatory Medical Care Survey from 1995 through 2007 to identify trends in the use of CT in ED. They found that the number of ED visits that included a CT scan increased from 2.7 million in 1995 to 16.2 million in 2007, an almost six-fold increase and an average annual growth of 16 percent.

Toshiba says it’s seeing a lot of activity around placing CT scanners into an ED, especially for evaluating chest pain cases in the ER, a point of care that’s considered by some “as the gatekeeper for the hospital,” says Cooper.

One small CT manufacturer based in Danvers, Mass. is acting on that information and is staking its ground in the ED, along with neuro intensive care units, stroke and trauma centers and operating rooms.

Since receiving FDA approval in 2005, more than 300 of NeuroLogica’s CereTom systems, a small bore, 8-slice portable CT scanner used for brain perfusion and brain angiography, have been installed worldwide. At RSNA 2010, the company introduced another addition to its product line: the BodyTom, a full-body 32-slice portable CT scanner.

The system, which is pending FDA approval, is a fully lead-shielded unit that can turn an emergency room into a scanning room and bring imaging to the patient in the OR, says David Webster, vice president of marketing and sales for NeuroLogica.

But convincing radiologists that they’re not sacrificing image quality with a portable CT scanner is not always easy. Many radiologists are also reluctant to embrace the concept of bringing imaging to the patient, rather than say, transporting a patient from the OR to the radiology department. Webster says it has taken the company “years and numerous clinical papers” to convince some radiologists that moving an OR patient for imaging is a cause for concern.

Portable or not, radiation dose is still a problem, but NeuroLogica addressed the issue years ago. “When we introduced CereTom, there was this overwhelming paranoia from the radiologists that if we didn’t put certain safety features in the CereTom, it was going to be used and abused by all kinds of different people because it’s portable,” says Webster.

The warning features that vendors are now adding to their scanners are already incorporated into the company’s devices.

NeuroLogica also offers RadRedux, an algorithm that enhances image quality and reduces noise using a post-reconstruction approach. “Most of the people that we’re scanning are in the neuro ICU and are getting daily scans for up to seven days,” says Webster. “Our clinicians challenged us to reduce the dose because we’re scanning the patients over and over and over again out of medical necessity.”

RadRedux, which can reduce dose by up to 50 percent from original settings, is incorporated into the new BodyTom scanner.

In addition to introducing the full-body CT scanner, NeuroLogica has been busy abroad. “We’ve been working with the German government to put a CereTom in the back of an ambulance, and in January we will unveil the world’s first, multi-slice stroke and brain trauma-specific ambulance in Germany,” says Webster.

The German authorities trained their emergency response operators to assess whether an incoming call necessitates the use of the stroke ambulance. Once a relevant incident is identified, the ambulance will be able to scan the patient at the scene of the accident and immediately send the information back to a physician at a hospital, who can then outline a course of treatment to be initiated on site. “The ambulance has been outfitted with everything necessary to treat almost all traumatic brain injuries or stroke,” says Webster.

In addition to initiating treatment on scene, the respondents can determine which hospital is best for the patient to be transported to, explains Webster. The ambulance will make its debut in Germany later this month.

EXTRA

A third-party view: CT refurbishers chime in
When Platinum Medical Imaging works on restoring a used GE CT back to life, the last part of the process is the most difficult. The final step is an eight-page image quality report, which “documents the overall performance of the unit to OEM specifications,” Robert Costa, the company’s COO, wrote in an e-mail to DOTmed News. “This is signed off by our in-house physicist, and then re-performed on installation to confirm compliance.”

By the time Platinum’s CTs are ready for end-users, they’ve gone through a 95-point checklist and even a paint job that ensures the systems are the correct OEM color and texture. As veterans in the refurbishment and service business, many ISOs offer a unique perspective on the industry.

Refurbishers cite 16-slice CT scanners as the high demand units of today. “[There] does not seem to be as much focus on really high-end gear,” Greg Kramer, president and CEO of C&G Technologies, Inc., wrote in an e-mail to DOTmed News. “16-slice is generally the bread and butter choice.”

ISOs report CT prices trending slightly downward for 2011, while trade-in values seem to be maintaining their strength. “Trade-in values have kept pretty consistent with what the market will bear on the third-third party acquisition side,” said Platinum’s Costa. “Some older equipment continues to lose market value on a trade-in.”

When it comes to purchasing a CT unit, ISOs recommend exploring all the available options for systems and service, as well as carefully analyzing a facility’s “need versus want” for any given scanner.

“I strongly advise customers during the planning or pre-purchase process to ask and answer the following question, ‘when do we plan on disposing this new piece of equipment?’” Charles Gauthier, general manager of Imaging Services, suggests. “Simply reverse the technology management principles of acquire, utilize, upgrade, re-deploy, dispose and begin with disposal and work the process backward.”