Ideas in Hospital-Based Imaging

Subspecialty Expertise for Small Hospitals
Multiple Uses for Aquilion ONE

Subspecialty Expertise for Small Hospitals

Small hospitals typically do not have radiologists come in at night, while other rural and suburban facilities still have no radiologists at all on-site. By waiting until the next morning for a radiologist to read images, issues may be missed and discrepancies may arise.

Foundation Radiology Group (FRG), Pittsburgh, looks to provide these non-university-affiliated health care institutions with subspecialty radiological expertise. Recently, the group signed 5-year contracts with Pineville Community Hospital and Knox County Hospital, both located in Kentucky, and became their exclusive provider of diagnostic imaging professional services.

“Many of the nighttime providers just try to get by until morning arrives,” said Brandon W. Chan, MD, FRG CEO. “Our philosophy is completely different. Care is delivered at the point of service with the best expertise we can muster.”

FRG places an emphasis on consolidating the fragmented small to medium hospital segment, and it targets multiyear exclusive daytime and around-the-clock radiology service bureau contracts. Since FRG has a 7x24x365 exclusive contract with the two community hospitals, the group has its own doctors in house who can read those x-rays that would have otherwise been held until the next day. This, according to the company, has a great impact on emergency departments. FRG’s contract includes providing final interpretations, 24 hours a day. Patients can come into the emergency department and have a final result, which the surgeon can act on immediately.

“This is the key differentiator for FRG as compared to other physician groups, in that we self-perform and offer our clients a 7×24 Service Level Agreement,” said Tim Pisula, CEO. “This is a win-win situation for our group and the clients we serve.”

Explaining further, Pisula said clients benefit from having a board-certified radiologist read emergency cases stat within the company’s Service Level Agreement Turnaround Time, or SLA/TAT. Meanwhile, FRG benefits by not needing to reread the overnight cases the next morning, thus allowing its physicians to focus on stat cases originating from client institutions as they occur, first thing in the morning and throughout the day.

“Patients in the past would have had to be transported to a high-level academic place,” said James W. Backstrom, MD, chief medical officer at FRG. “The hospital can market the fact that they can provide 24-hour services for radiology, thereby keeping the dollar in the community over the period of time.”

Pineville Community Hospital is a short-term, acute care 136-bed hospital that offers a variety of health care services, including emergency care, home health, laboratory services, respiratory, specialty clinics, inpatient surgery, and a radiology department with advanced diagnostic testing procedures.

Knox County Hospital, a critical access 41-bed hospital with a 16-bed skilled nursing unit, provides services in nuclear medicine, surgery, physical therapy, spiral CT, mammography, and a 24-hour, fully staffed emergency department.

FRG’s hybrid staffing model includes putting physicians on the ground to help manage interventional and patient-oriented procedures, supported by a subspecialty physician teleradiology network. As a result, the two hospitals are able to share physicians back and forth, “working more as a team and not competitors in the environment,” Chan said.

The group’s board-certified radiologists provide readings in musculoskeletal radiology, neuroradiology, mammography, cardiac CT, interventional radiology, pediatric radiology, brain perfusion, vascular ultrasound, OB/GYN ultrasound, and general radiology.

—Elaine Sanchez

Multiple Uses for Aquilion ONE

From heart imaging to lung imaging, a major hospital anticipates it will find far more than one use for its new Aquilion ONE CT. Beth Israel Deaconess Medical Center, Boston, a teaching hospital of Harvard Medical School, recently installed Toshiba’s dynamic volume CT system. Beth Israel Deaconess is one of the first teaching hospitals in the United States to implement this technology, which is the only dynamic volume CT system currently on the market.

The AquilionONE can image the entire heart in a single rotation, providing volumetric temporal resolution that is superior to multislice temporal resolution available today, resulting in clearer image quality.

The system uses 320 ultra-high-resolution detector rows of 0.5 mm to image an entire organ in a single rotation; the result is a 4D clinical video showing up to 16 cm of anatomical coverage, enough to visualize the entire brain or heart and show movement such as blood flow.

“Toshiba designed the Aquilion ONE for today’s health care environment,” said Doug Ryan, senior director of the CT business unit at Toshiba. “By replacing several tests with this single exam, the Aquilion ONE will allow physicians to treat at-risk patients immediately—saving resources and time for both health care facilities and patients.”

Vassilios D. Raptopoulos, MD, interim radiologist-in-chief in Beth Israel’s Department of Radiology and director of CT services, said the medical center is planning to use the system to detect and treat a variety of conditions, including cancer, heart disease, stroke, and other neurovascular conditions.

“We just started using the system a couple of days ago,” Raptopoulos said. “We’ve done some studies, but haven’t yet started pushing its capabilities. We have a grant to work on coronary angiography and heart imaging, and we’ll also use it on perfusion studies. Then we’ll expand into other areas.”

The Aquilion ONE system replaced an older CT scanner that had been in use at the medical center. “We need to teach with a state-of-the-art system,” Raptopoulos explained. “This system has the potential to provide a single, comprehensive exam that can replace a variety of duplicative and invasive procedures.”

Raptopoulos and team are also excited about the software capabilities of the Aquilion system. New applications include SureCardio Prospective gating software, which combines high-speed helical scanning with gated intermittent exposure to further reduce dose during cardiac examinations, and Variable Helical Pitch scanning to allow nonstop helical scanning while performing multiple exams.

“The cardiac tools are very exciting,” Raptopoulos said. “The system has a myocardial perfusion package, and the perfusion package is for both the heart and the tumors. Another area we want to use it is in sectional imaging. And we’ll use it to image emphysema and do presurgical planning for emphysema and other diseases of the lung.”

Raptopoulos also looks forward to the emergence of future enhancements to the technology. “I think it will be interesting in 6 months to see what we’ve found out with this,” he said. “I’ll be very excited to see how the clinical applications for this scanner will evolve.”

—Cat Vasko