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| Frederick L. Weiland, MD, FACNP, says it is a joy to go to work each day. |
When it comes to patient care, Frederick L. Weiland, MD, FACNP, has a simple credo: It will always be a top priority.
In the age of managed care, working with hospital administrators to find a happy marriage between patient care and patient cost is a continuing struggle. The cost of performing state-of-the-art imaging should be weighed against improved diagnostic accuracy.
What does all of this mean to the patients at Sutter Roseville Medical Center (Roseville, Calif), many of whom reside in surrounding communities with a collective population greater than 100,000? Quick and accurate diagnoses that can translate into quicker and more accurate patient care.
Departmental Upgrade
When Sutter Roseville Medical Center turned to GE Healthcare (Waukesha, Wis) more than 5 years ago to revamp its nuclear medicine capabilities, it believed that the only way to be among the best hospitals in the country was to have the best equipment to meet its growing needs. GE Healthcare has been an integral part of a planned growth for this 170-bed hospital, located just 19 miles from the state capital of Sacramento. The hospital is a designated trauma center, and it handles 250,000-plus outpatient visits annually.
Over a 6-year period, the nuclear medicine department had been allocated more than $2 million to upgrade its nuclear medicine camera capabilities. The camera purchases included the single-head DSXI; the dual-head MG; and the hybrid SPECT/CT cameras?first the Millennium VG Hawkeye and then the Infinia VC Hawkeye, both with 1-inch scored crystals with coincidence imaging. According to Weiland, this combination of imaging systems has created a facility that features “one of the most technologically advanced arrays of gamma cameras available in the United States. This arrangement allows us to perform quality imaging with all available radiotracers. In addition, we can accommodate patients of all sizes and those who could be challenging due to equipment or medical conditions,” such as intensive care or surgical/trauma patients.
When the group began planning for its upgrade, research indicated that the trend in nuclear medicine imaging would be in the area of fusion imaging. Sutter Roseville purchased the Millennium VG Hawkeye system in 2000 because, according to Weiland, “We thought that fusion imaging was the technology of the future, and GE was the only [manufacturer] that had it.
“We found the hybrid of SPECT imaging with CT invaluable because we realized that one could increase their specificity by merging metabolic and anatomic scans,” Weiland continues. Soon after, the physicians were working with co-registration software to fuse diagnostic CT scans with PET images from the mobile unit. The facility works with Northern California PET Imaging Center (Sacramento), which provides a mobile PET scanner. Staff members faced a bit of a learning curve in the beginning, but it has certainly been worthwhile.
“The important point is that hybrid SPECT/CT systems, like the Infinia VC Hawkeye, are single-slice and, thus, lower-resolution scans; you’re not getting a full diagnostic CT scan,” he relates. “And, of course, we know that for current PET/CT scanners, the number of CT slices varies from four slices to high-end 64-slice scanners.”
The new hybrid SPECT/CT system gave the department the advantage of not only performing fusion imaging, but also using the system for attenuation correction. Sutter Roseville has an active bariatric surgery program. Being able to correct for tissue attenuation can be critical to producing quality diagnostic images, particularly in this patient population.
Nuclear Family
“We’re very fortunate,” says Weiland, who, along with partner Penny Vande Streek, DO, FACNP, serves as co-director of the nuclear medicine department. “The administrators at Sutter Roseville have really supported our vision.”
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| The Sutter Roseville Medical Center has spent more than $2 million to upgrade its nuclear medicine department. |
Mutual cooperation has led to better overall patient care. Although Weiland and Vande Streek are independent contractors, they work closely as advisers on the planning and implementation of the department. Vande Streek helped the team focus on the importance of providing the nuclear medicine technologists with the flexibility to meet the demands of the department’s schedule. These technologists face the somewhat daunting task of integrating outpatients with an ever-changing caseload of inpatients and emergency-department referrals. The capabilities of the current camera systems allow the staff to efficiently address the patients’ needs without sacrificing image quality.
“Our hospital administrators believe in the direction we have taken to improve patient care. They made the commitment and see the wisdom of what we’re trying to accomplish,” says Weiland, who joined Sutter Roseville in 1991. In 1993, Vande Streek, having completed her US Air Force service, joined the group. “Our practice has been well-established for many years, and they respect our opinion,” Weiland notes. “We are fortunate enough to work well with our hospital administrators and imaging services directors.”
Training Is Key
“It is very important for us to get the best, most complete training possible,” explains Weiland, a graduate of the US Air Force Academy (Colorado Springs, Colo) and the Case Western Reserve University School of Medicine (Cleveland). “We try to build a lot of training into our equipment purchases, and GE Healthcare is very good at meeting this need. We have access to some outstanding people for applications assistance, both during installation and with continued service support. We feel it is worth building the training into the purchase contract, because we realize the value of this training to maximize the camera use and the understanding of the software applications.”
Therein lies the rub: What good is state-of-the art equipment if you don’t know how to use it? According to Weiland, who served as a consultant in nuclear medicine to the US Air Force Surgeon General’s office and has a great deal of experience in purchasing imaging equipment, the nuclear medicine technology is only half the equation.
“If a manufacturer installs the equipment and you elect not to receive any training, your staff might not be able to take full advantage of the system’s capabilities,” Weiland maintains. “The cameras are automated in so many ways, yet they are very complex pieces of equipment. You truly need to understand how to use them to realize the full potential of acquisition, processing, and display possibilities.”
As with any marriage, there will be some ups and downs, Weiland admits. But in the end, each side realizes that it is working toward a common goal: better patient care.
“We have worked consistently toward the vision we have for patient care at our hospital, and GE has been very supportive of that,” he notes. “There hasn’t been a reasonable request that the company has not honored. It has been an excellent working relationship. We understand that we must plan our purchases carefully with both the present and the future in mind. Our hospital is currently undergoing expansion, and we have a schedule that rivals any other level II trauma center in the country.”
Along with impressive Monday?Friday hours that stretch from 7:30 am to 10 pm, the staff remains on call during the weekend.
“We’re just as likely to have a full schedule on Saturday as we are on Monday,” he notes. “Ten years ago, weekend operations might be limited to a GI bleed or a ventilation-perfusion scan. Today, if you need a study performed on the weekend, it gets done. The emergency room uses us a great deal. If they can evaluate a patient and determine the best course of treatment in regard to admission, it helps them give efficient, excellent care. We’ve realized the importance of providing diagnostic nuclear imaging seven days a week,” adds Weiland, whose facility sees an average of 500?600 patients per month.
“With the camera systems we have put into place, we can provide excellent diagnostic nuclear imaging to assist our referring physicians,” he maintains. “Both our and the hospital’s commitment to patient care is of paramount importance. That translates to a staff dedicated to promoting the value of nuclear medicine by providing the best possible image quality and service. Then it’s a joy to come to work every day.”
Dave Cater is a contributing writer for Medical Imaging.
