Once in the realm of science fiction, modern medicine has achieved advances beyond what people imagined only a few decades ago. If it’s true, as is often said, that there have been more technological advances in the last 100 years than in the previous millennium, a good portion of those advances have been in the identification and treatment of disease.
At northshore medical facilities, the enhancement of technology and staffing in recent years has given patients and their healthcare providers increasingly advanced options for non-invasive diagnostic tests.
“When you say ‘diagnostic imaging,’ it includes general X-ray, ultrasound, CT, MRI, mammography, PET/CT, and bone density studies,” said JoAnn Forsyth, director of M.D. Imaging in Slidell, where all of those procedures are performed.
“Our first order of business is diagnostics,” said Pat Maltese, head of the radiology department at St. Tammany Parish Hospital. “A patient presents with a complaint. The (diagnostic) exam allows us to take a view… to give the ordering physician a diagnostic interpretation so he or she can draw conclusions.”
Diagnostic imaging tests these days can range from X-rays to MRIs that show multiple views and perspectives on a patient’s viscera and other soft tissues with no more than a single needle-stick – a long way from the days of “exploratory surgery” to figure out what was ailing someone.
“Diagnostic imaging is all the tests used to evaluate the patient visually or to produce images of the patient,” said Dr. David Donaldson, diagnostic radiologist at Northshore Regional Medical Center. “Individual tests can be used by different specialties. Each specialty has one or two, or maybe three diagnostic imaging tests they are experts in,” Donaldson said.
Indeed, certain diagnostic imaging technologies are employed specifically by certain physicians, such as mammograms to screen breast tissue and ultrasounds to view a fetus, pretty much in the province of obstetricians and gynecologists. At NRMC, however, Donaldson, as a diagnostic radiologist, is trained to interpret the data from all types of D.I. tests.
While mammograms and X-rays may be the most commonly thought of procedures in diagnostic imaging, Donaldson said CT scans actually top the list. Once known as CAT Scans, for Computerized Actual Tomography, specialists dropped the “actual” when technology advanced even further. The “actual” referred to the number of computerized, visual “slices” the machine collected. And while those slices are still vital, “once the computer’s information got good enough, we could reconstruct images from CT scans.”
In other words, the computer’s ability to collect the data on what a patient’s insides look like no longer required such a lengthy time in the CT machine.
“It’s by far the most commonly used diagnostic imaging tool nowadays,” Donaldson said. “The utilization has jumped 100 percent in the last 11 years.”
“Computerized Tomography (CT) and PositronEmissionTomography/CT (PET/CT) continue to develop as the leading trends in diagnostic imaging,” said Cullen Meyers, assistant vice president for diagnostic services at North Oaks in Hammond. “Magnetic Resonance Imaging (MRI) technology also continues to advance and image faster. New magnets are designed to better accommodate patients—especially those who may be claustrophobic. And Digital Radiology (DR) is a rapidly growing technology that is enhancing the efficiency of image acquisition and distribution. “
OK, so what’s the purpose? Is this stuff just cool to have because it’s… well… cool to have? Not at all.
“The purpose of doing diagnostic imaging, especially using computer-aided diagnostics and CT scanners with finer slices, is that hopefully we find disease processes earlier,” Donaldson said. “In some cases, you can save lives and improve quality of life.”
“Diagnostic imaging enhances early detection efforts because it has the capabilities to catch health concerns quicker,” Meyers said. “For example, CT Coronary and Peripheral Angiography may be safer, quicker and more cost-effective to perform than conventional Diagnostic Angiography in a Cath Lab. MRI can be used as a non-invasive tool for evaluation of gall bladder stones in the biliary tree as opposed to endoscopic procedures.”
Even if you don’t know what “biliary” and “endoscopic” mean, you get the idea.
Forsyth said MR tests are increasingly ordered by examining physicians.
“A more common exam now would be an MR,” she said. “It offers a lot of information and it’s not radiation. Sometimes that’s used first. (X-ray) is still a good screening tool. It also offers a lot of information and leads the physician to the next step.”
The limitations of X-rays are that it shows only limited information about soft tissues. And it exposes the patient to radiation, making it contraindicated by the very common condition called “pregnancy.” And while the occasional X-rays most of us undergo don’t cause significant irradiation, patients with chronic illnesses who go through diagnostic imaging repeatedly to monitor the progress of disease or success of treatment could find themselves receiving dangerous levels of radiation with frequent X-rays. But here’s the upside:
“X-ray is also the least expensive,” Forsyth said.
“There are plenty of insurance companies that won’t pay for a 256-slice CTG of coronary arteries,” Donaldson said. “There is reluctance to pay for new technologies until we can prove the results are as good or better.”
Most diagnostic imaging has passed the “good or better” test to the satisfaction of insurance providers, but physicians still have to provide a reason for each test – a reason deemed “good enough” by insurers.
A standard CT costs between $1,200 and $2,000, Donaldson said. A CT with contrasts raises that cost by as much as $600. And MRIs can range from $600 to the ones done in a doctor’s office to about $3,000 in a high-quality MRI machine. Ultrasounds, by comparison, run about $300, but aren’t as thorough as the others and are used primarily in obstetrics because the tests are completely safe.
“The technologies are expensive to implement, so we must carefully consider what technologies to invest in based on the needs of the communities we serve,” Meyers said. “In many cases, the testing is more cost-effective because it is less invasive and can be performed on an outpatient basis.”
“Diagnostic imaging is driving the inflation of medical costs,” Donaldson said.
So is it worth it?
Ask a patient, perhaps.
At STPH, for example, physicians can see two views of the spine while making an injection, ensuring the needle is inserted to the right depth. And on a more advanced level, the technologies are allowing services once never even considered possible. “We can actually repair some fractures to the spine,” Maltese said.
They can also remove or de-bulk some spinal tumors, easing a patient’s discomfort.
“It’s not a cure, but it allows the patient some pain relief,” Maltese said. “That’s fairly new. There are not too many places doing that procedure.”
“We have some of the finest technology on the northshore,” Forsyth said. “We provide a higher level of service.”
“We are able to diagnose most conditions that physicians are not able to diagnose upon clinical exam,” Meyers said. “Less and less testing is becoming necessary to reach a diagnosis because of the progress and advances made with radiological equipment.”
“If you can (diagnose) colon cancer (for example) at the polyp stage, you can save that patient’s life,” Donaldson said. “We can do it with a CT scan, an air colonoscopy.”
“The thing I’m most excited about is that five years ago patients had to go to the southshore for advanced work,” Maltese said. “Now we’re able to do it here.”