64-Slice Machine: Value Add or Expensive Toy?
Imaging Center Opens with 3T MRI

64-Slice Machine: Value Add or Expensive Toy?

The advent of the 64-slice CT has thrown both cardiology and imaging into a tailspin. The new generation of scanner, which operates at twice the speed of what, in 2003, was considered cutting-edge technology, provides definite benefits to the imaging field—most significantly, the ability to quickly image the human heart between beats. But the question remains: Can radiologists justify the cost of the new devices, especially in the face of competition from cardiologists and shifting reimbursement standards?

New investigational codes, which replaced the more generous practice of billing for both chest CT and 3D reconstruction, gradually are being formalized on a state-by-state basis and have thrown a wrench into early cost-justification models for the new technology. A code for primary CT angiography (CTA) means that whoever owns the technology will need to perform more procedures for a longer period before achieving a return on investment.

The 64-slice CT would enable radiologists to perform the same assessments as cardiologists, provided the referrals are forthcoming. “Right now, we are in control of more of the CT than we will be next year,” says Alan Kaye, MD, FACR, president of Advanced Radiology Consultants (ARC), Bridgeport, Conn. “And so to the extent that we can establish a foothold in this new application of an existing modality, we’ll be better served if we can do that sooner, while we have more control.” But years of watching heart scans return immediately to self-referring cardiologists have left radiologists with a lot of catching up to do. “It’s incumbent upon us to train ourselves or get trained,” Kaye says.

Furthermore, it is not evident to Kaye that any given 64-slice scanner is necessarily superior to a well-chosen 32-slice in any significant way—much less in a manner that might justify the tremendous expense associated with upgrading. “Not all 32s and 64s are created equal,” he says. “You’re dealing with the coverage size of the detector, and the other specifications of the detectors, as well as the rotation speed of the gantry. I think rather than get hung up on the number of slices, you want to really delve into the spatial and temporal resolution issues. From what I hear, most places use beta blockers to slow the heart rate down, even with the 64. That’s what we’re doing with the 32, and we’re getting good images.”

In 2003, Kaye’s practice purchased what was, at the time, a cutting-edge 32-slice scanner and began offering outpatient coronary CTA examinations. Owing to Connecticut’s stringent certificate-of-need policies, ARC expected to have a monopoly on coronary CTA for at least long enough to demonstrate to cardiologists that radiologists could work with them toward better diagnoses. Kaye believed they could establish the same kind of toehold in cardiac imaging that might be crucial now in order for radiologists to justify the cost of the 64-slice. At the time, Kaye told a writer for Axis Imaging News, “Perhaps this is idealistic, but I think it deserves a shot.”

But now, 3 years later, his enthusiasm has been tempered. “It’s not panning out as well as we anticipated because of the experimental nature of the codes and the nonreimbursability of it.”

The uncertain reimbursement environment also is reason to give cardiologists pause, according to Tracy Q. Callister, MD, FACC, director of the Tennessee Heart & Vascular Institute, Nashville, and a member of the board of the Society of Cardiovascular Computed Tomography, Damascus, Md. He advises physicians and group practices considering the addition of a new scanner to honestly evaluate their volume before buying.

“How many scans a day can you generate to pay for the scanner?” Callister asks, noting that at today’s reimbursement levels, a 64-slice scanner needs to perform about eight scans per day to pay for the scanner, the staff, the upkeep, and other costs. A 16-slice requires only four scans per day, and a 32-slice scanner breaks even at six.

“We have found that experience suggests a cardiologist tends to average about one scan per day, which means that a five-man group should average five scans a day,” Callister says. Knowing this information, a physician should ask himself what he really can afford.

Callister’s group opted for a 64-slice machine, but only after significant preparation. “We spent a year building the practice through the hospital and grew comfortable reading images,” he recalls. “When we first installed the machine, we had primary care doctors ordering the examinations already.

“If you’ve done your homework, prepared your community, trained your techs, and committed as partners, you should find the patients—they are out there,” he continues, adding, “If not, you just have an expensive toy.”

—C. Vasko and R. Diiulio

Imaging Center Opens with 3T MRI

Spokane Advanced Imaging Institute (SAII) recently opened a new facility at Deaconess Medical Center, Spokane, Wash, showcasing the latest in imaging technology. The 2,000-square-foot center is home to the only 3T MRI scanner within 300 miles. SAII wanted to make a splash with its new facility, says Steve Case, marketing manager.

Case says that SAII liked the capabilities of the Achieva scanner from Philips Medical Systems, Andover, Mass, and the flaired bore diameter of 110 cm. “Because it is a much larger bore, it can take up to 550 pounds, so larger patients can [be scanned with it],” he explains. “It also is less claustrophobic for [sensitive] patients.”

The Philips Medical 3T magnet is installed at the Spokane Advanced Imaging Institute.

Case says the average wait for a routine MRI in Spokane is about 7 days. With the addition of another scanner—and a higher-field one at that—SAII is hoping to drive down wait times. In addition, the 3T is in high demand with neurologists and orthopedists.

“The neurology world is very excited about it here,” Case says. “Many neurologists are showing a lot of interest, especially those who are dealing with patients [who have] MS [multiple sclerosis], because the 3T has been shown to be very effective in picking up plaque much sooner than any other magnet. The physician gets a definitive diagnosis of the MS much sooner, and he or she can at least start treating the symptoms better.”

SAII is a joint venture between Empire Health Systems—which owns Deaconess Medical Center, Spokane, and Valley Medical Center, Spokane Valley—Spokane Radiology Consultants and National Medical Development Inc, Bellevue, Wash.

—M. Saffari