Womens healthcare givers are seeing red these days. But rest assured, because its all good. Red has become the signature color for several campaigns to raise Americans awareness of heart disease, especially among women, for whom it is the leading cause of death. The National Heart, Lung, and Blood Institute and the American Heart Association co-sponsored National Wear Red Day this past February 6, as part of The Heart Truth campaign, and First Lady Laura Bush kicked off American Heart Month on February 4 in a White House ceremony.
The focus of the media blitzto educate about the symptoms and risks of heart disease and about heart-healthy habitsis no surprise to manufacturers in the imaging field who provide the technology and products that help reduce morbidity and mortality among patients. Companies have been working steadily on technological advancements that will make a difference in the detection and, thus, prognosis of heart disease in women.
Data Is Crucial
We know that women are nine times more likely to die of heart disease than of breast cancer, says Harry Chesnut of Agfa HealthCares (Ridgefield Park, NJ) product marketing division. Vendors now recognize that the algorithms that are appropriate for men are less accurate for women with regard to diagnosis of heart disease. Hence, along with the new concern about educating the public, manufacturers are thinking about the issue differently. The technology will not really change, but the protocols will, he believes.
The Impax cardiac information management system from Agfa Cardiology Products Group (Milwaukee) allows access to patients images and diagnostic results from various modalities as well as medical records information. Because the information can be acquired, manipulated, and shared easily, physicians can make diagnoses and initiate interventions faster.
Agfa enables the physician to collect information from different devices and assemble the data without having to make a correlation manually. Doctors need to find answers quickly, and our expertise is in connecting various systems, Chesnut explains. With the Agfa workstation, the physician can make searches with a variety of questions, such as how many patients in a particular population have had ejection fractions of a certain percentage. The systems templates can highlight problems that might not be readily evident, and the information is instantly accessible for identifying various subsets, study protocols, and outcomes.
In addition, cardiologists in particular have been pushing for more evidence-based medicine, he says, and now they have the tools. The Impax workstation incorporates a simple reporting system that allows discreet data to be entered without a lot of extra work, and can then be accessed later for follow-up and research. In the past, vendors didnt have workable solutions for data, and this hindered research. Only recently has the technology matured to the point that collecting, storing, sharing, and viewing images is no longer problematic.
The ultimate challenge, Chesnut says, is to make the workflow optimal for radiologists and cardiologists, all for the benefit of patients. Because the presentation of heart disease in women is subtler than in men, we wanted to make the technology better so that fewer [signs] would be missed, he says. With the higher level of accuracy and greater automation of todays technologyas well as better management of images and informationheart disease cases wont fall through the cracks, and appropriate treatment can be initiated in a more timely manner.
Faster Treatment Enabled by Technology
A recently introduced imaging system, the Innova 3100 from GE Healthcare (Waukesha, Wis), addresses the need to diagnose and treat the growing number of cardiovascular cases. GE Healthcare unveiled the system at the annual meeting of the American College of Cardiology last March.
The system produces images that are sufficiently clear and detailed for physicians to make accurate diagnoses as well as successfully maneuver catheters, stents, and guide wires. Flat-panel detector technology produces clear images of the heart, down to the finest vessels. Not only is the imaging minimally invasive, but it eliminates multiple procedures by enabling diagnosis and treatment to occur at the same visit.
Because cardiovascular disease affects the entire vascular system, cardiologists need to see beyond the heart, explains David Handler, general manager of cardiology marketing for GE Healthcare. In the past, analog-imaging technology was a stumbling block: You could get a larger field of view, but the image quality was compromised. Now, with digital technology and the Innova 3100 in particularimage quality is not compromised at all.
The new generation of Innova technology provides a 30-cm2 field of view, with flexibility for steep angles yet wide coverage and clear imagingan ideal combination for interventional and peripheral cardiology. This product can be used even on larger patients, up to 450 lbs. A doctor using Innova can place a stent in many cases if it is necessary, instead of having the patient undergo open-heart surgery, Handler notes. With better images and better data, we now have better management of heart disease.
Noninvasive, Efficient Imaging with CT
Robb Young sees the advances in CT technology as a huge benefit for women concerning diagnosis of heart disease. Because women have smaller hearts and, thus, smaller vessels, the thin scan slices acquired with CT, especially the multislice scanners, allow more efficient and accurate imaging of the organ, explains Young, who is cardiac CT product manager for Toshiba America Medical Systems (TAMS of Tustin, Calif).
TAMS recently introduced its Aquilion 32 CFX CT scanner, which delivers 32 simultaneous 0.5-mm slices in one gantry rotation. The thin slices not only show greater detail and improve the accuracy of measurement, but theyre also more useful for identification of plaque and determination of cardiac function. Furthermore, the systems speed allows data to be acquired twice as fast as with a 16-slice scanner.
CT angiography is a fast, noninvasive alternative to cardiac catheterization, Young says. The newest CT technology allows us to view the heart vessels quicklywithin a short breath holdand efficiently, he explains. It neednt involve hospitalization, so a larger population of patients can be reached. Research shows that with women in particular, diagnostic catheterization doesnt always clearly detect disease. In addition, cardiac catheterization has a 0.5% to 1% mortality rate. CT provides a safer alternativeinstead of insertion of a catheter in the heart for visualization of the vessels, CT [allows] a needle to be used to inject contrast material intravenously and less invasively.
Used as a plaque assessment tool, CT can be an independent predictor of heart disease: A scan as short as 5 to 10 seconds with a 16-slice CT system can determine whether plaque in the heart vessels is soft (a sign of early-stage disease) or hard.
We need to educate not only the public but also the primary-care physicians about the symptoms of heart disease in women and how they can differ from those of men, Young explains. With a better understanding of the disease and the better tools that are now available, clinicians can more safely look at the heart vessels and make better decisions about diagnosis and treatment. For almost half of people with heart disease, the first evidence of it is a heart attack. But CT, as a noninvasive technology, can be used to quickly assess pain and to detect disease earlier.
The Next Generation of Cardiac Imaging
With regard to the cardiac capabilities of CT, GE Healthcare believes it has made a breakthrough with its new generation of Light-Speed CT scanners. Recently cleared by the FDA, the LightSpeed VCT (Volume CT) enables wide-volume scanning as well as high-resolution images.
This product has significant potential because of the improved image quality, reliability, and repeatability, notes Scott Schubert, VCT global product manager at GE Health-care. The challenge with using CT for cardiac imaging is the movement of the heart and coronary arteries. Thus, two factors are critical in the CT examination: freezing the heart motion and ensuring high resolution. The LightSpeed VCT addresses these factors with high-speed imaging, fast temporal resolution, and high spatial resolution.
In addition to the reduction in scanning time from 20 to 5 seconds, another advantage of the new system is a reduction in the total amount of contrast medium injected: The typical dose of 100 cc is reduced by half. This is advantageous for patients who have kidney disorders or patients who need to immediately undergo interventional cardiac catheterization [and, hence, further injections], because overall, their contrast burden will be less, and there is no need to wait for it to diminish between the two procedures, Schubert explains.
With the variable-speed scanning offered by the LightSpeed technology, the rotation speed can be adjusted to better match the patients heart rate. In addition, electrocardiographic input detects the systolic phase and decreases the X-ray dose accordingly; likewise, the dose is increased during the end-diastolic phase in order to produce the best image. As a result, the LightSpeed VCT offers a 40% to 50% X-ray dose reduction over the previous generation of LightSpeed CT scanners.
Clinical testing of the LightSpeed VCT begins this spring, and GE Healthcare expects to begin delivery of the product later this year.
Aubrey C. Patrick is a contributing writer for Medical Imaging.