Mary Helen Falender and her husband, Leroy, had been lugging 5-gallon buckets of rock as part of a landscaping project in their Owensboro yard when she noticed how easily she tired.
She didn’t think much of it. But she does have diabetes and high cholesterol—and her mother had died from cancer of the pancreas. So when Leroy suggested she have a body scan to check for problems in her pancreas, she reluctantly agreed.
The computerized tour of the inside of her body—all of which took place in about 15 minutes while she remained fully clothed—showed that her pancreas was fine, but her heart was not.
She had five blockages that ultimately required bypass surgery.
“You could have just knocked me over with a feather,” Mary Helen says of the test results. “I had no earthly idea. I feel like I was a walking time bomb, and that scan saved my life.”
Falender is one of thousands of Kentuckians who have benefited from advances in medical imaging technology.
The combination of highly detailed X-ray images and digital enhancements created by computers allows doctors to perform procedures resembling scenes from Star Trek.
Painless body scans reveal traces of calcium in arteries. Optical imaging tools create pictures of the inner workings of eyes and pinpoint early signs of glaucoma. And digital images guide doctors’ hands as they shrink fibroid tumors in the uterus and repair fractures in the backbone.
“I compare it to ground radar,” explains Dr. Mohammed Mohiuddin, chairman of the radiology department at the University of Kentucky. “You can now see, through the use of computers and enhanced technology, what is under the surface of the earth without ever using a shovel.
“That’s what we’re able to apply to the human body, as well. We don’t just have to see an organ or a bone, for example. We can tell exactly what is happening in different layers of it. We can see how each layer of tissue or each segment of tissue actually functions so we can say what is malfunctioning and what is functioning normally.”
Imaging advances have implications in almost every type of medicine—from cancer diagnosis to orthopedic surgery. We took a look at how some Kentucky physicians are using a variety of different body scanning technologies on patients.
The ultra-fast HealthScan machine that detected Falender’s heart problem is becoming the gold standard for early detection of coronary artery disease, says Cardiologist Kishor Vora of Owensboro Heart and Vascular.
“Basically, it picks up your disease at a much earlier stage than any other test,” Vora says. “There are times when we do the stress test (which uses electrodes to monitor blood pressure and heart rate during exercise) and we do not pick up blockages of 50 percent in the arteries. But the HealthScan can pick up even 5 percent.”
Vora sees this advantage as particularly valuable since 70 percent of people who have a heart attack never experience symptoms. Early detection gives patients much better odds of survival.
The machine works by using electron beams to take pictures of the body at a rate of 20 per second. Then it sends those pictures to a computer, which produces three-dimensional images of body organs.
In addition to the heart, the technology has potential for detecting problems such as cancer in the lungs, kidneys, pancreas, liver, ovaries, and colon, Vora says.
But use of the scan for widespread testing of healthy people remains controversial. Most insurance programs will not cover the cost, which generally ranges from $300 to $800. The American College of Radiology says there’s not enough evidence that the tests will prolong life to justify using it for people with no symptoms or family history of disease.
Mary Helen Falender, however, advises her friends to invest in a scan. “There are some things you do that are just a total waste,” she says. “But this was not a waste; it gave me the gift of my life.”
20-20 and Better
At the John-Kenyon Eye Center, with clinics in Louisville, Elizabethtown, and Jeffersonville, Indiana, new imaging tools are improving both the ability to detect eye disease and the precision of surgery to correct vision.
The diagnostic tool, known as the Optical Coherence Tomographer Model 3000 or OCT3, uses light rays and computer technology to generate high-resolution pictures of the retina and tissues beneath the surface of the eye.
“For really the first time ever in my 32 years of practice, I’m able to see what’s going on in a clinical, pathological level of the eye,” says Dr. Larry Alexander, a medical optometrist and practice administrator for John-Kenyon. “It is without a doubt the most exciting diagnostic instrument I’ve seen.”
In the past, optometrists based their diagnoses of eye disease on what patients told them they could or could not see. The OCT3, however, gives them an exact picture of damage to eye tissue and allows them to monitor progress.
“It’s quantifiable; it’s not just a guess,” Alexander says. “Before, I’d look in the eye and say, ‘I think you’re getting better.’ But this just nails it.”
Another imaging device, known as the WaveScan, improves the precision of surgery to correct nearsightedness and astigmatism by creating a “fingerprint” of the eye.
“Most people would imagine an eye like a basketball, all spherical,” Alexander says. “But when you really break it down, the eye surface is more like a Pringles potato chip; there’s a whole bunch of different curves and directions, and your curves are different than my curves.”
The WaveScan sends digital data about an individual’s distinctive eye surface to the laser that the optometrist uses during corrective eye surgery—creating a customized procedure matched to the eye’s imperfections.
Another imaging device that improves the precision of LASIK surgery is the active/passive eye-tracking system of the Bausch & Lomb excimer laser used at the University of Kentucky Refractive Surgery Center at Kentucky Clinic South in Lexington.
An active eye-tracking system follows the tiny movements of the eye and adjusts the laser beam during surgery to be sure that it hits precisely on target. But the active-passive system at UK goes a step further. It has the capability to actually stop the laser pulse if the patient’s eye drifts even slightly out of the specified range.
“With it, you know you’re doing the best you can technologically to ensure accurate and precise placement of each laser pulse,” explains Dr. John Conklin, director of UK Refractive Surgery Service.
Conklin says he’s noticed a difference in patients who are achieving results of 20/20 vision or better with the use of the system. “But the key thing is it gives the patient more confidence. They know they have a safety check.”
Spell-Checker for Mammograms
A device that works much like your computer’s spell-check feature is improving the accuracy of mammogram readings at University of Kentucky Chandler Medical Center.
Just as spell-checker flags words that may be incorrect, the R-2 image checker, which UK installed in August and will begin using soon, marks potential problem areas on a mammogram reading.
“It doesn’t interpret the image; it just marks areas where you might want to take a second look,” says Dr. Angela Moore, director of mammography at UK’s Department of Diagnostic Radiology.
“It has picked up things that are very subtle to the human eye.” And some studies have shown that this device improves the accuracy of a reading by 15 to 20 percent.
“This is not meant to replace the human radiologist. It is just to aid them in interpreting the mammogram. A radiologist is good at reading mammograms and a computer is good at reading mammograms. Together, they’re even better. We believe it’s really a good step forward in the fight against breast cancer.”
During the 1970s, doctors began using X-rays, ultrasounds, and other imaging devices to guide small instruments during medical procedures. One of the first techniques in interventional radiology—a medical specialty in which radiologists have been specially trained in performing image-guided, minimally invasive procedures—was angioplasty, where a small balloon is inserted into a clogged blood vessel to restore blood flow.
The uses for this type of technology keep expanding.
In northern Kentucky at St. Elizabeth Medical Center, Edgewood, and St. Luke Hospital in Ft. Thomas and Florence, two procedures showing great promise are uterine artery embolization and vertebroplasty.
About 30 percent of women develop fibroids, which are benign growths in the uterine wall that can cause extreme pain and excessive bleeding. The traditional treatment for fibroids has been a hysterectomy.
But with the help of imaging equipment doctors are able to insert clotting agents directly into the arteries that supply blood to the uterus, causing the fibroids to shrink, explains Dr. Brian Lawler, an interventional radiologist.
The northern Kentucky hospitals are part of about 40 hospital systems in the nation participating in a study to track the long-term benefits of the procedure—and the results show a high success rate with minimal risks, Lawler says.
Most patients have been able to go home the day after the procedure and return to normal activity within a week, he says. By comparison, the recovery time for a hysterectomy is generally six to eight weeks.
Vertebroplasty is a treatment for fractures in the spinal vertebrae, which often occur when bones weakened by osteoporosis collapse under pressure, Lawler says.
The new technology uses X-ray images to guide a needle to the point of the fracture so doctors can inject bone cement that will strengthen the vertebrae, and secondarily decrease pain, which is the main goal.
“Patients often get complete or near complete pain relief,” Lawler says.
The advances and proliferation of uses for medical imaging technology amaze even the doctors who use the equipment every day.
“Basically imaging and computers are assisting everything that we do,” says Alexander, optometrist at John-Kenyon.
“It’s interesting because you have to work all day and go home and study all night just to keep up. But it’s a tremendous amount of fun as a doctor. Even after 32 years, it’s a total blast.”
Another imaging system that’s familiar to all of us—television—is also bringing better healthcare to Kentuckians.
More than 60 hospitals and clinics around the state are part of Kentucky TeleHealth, Department of TeleMedicine Service at University of Kentucky Chandler Medical Center in Lexington, a statewide network that distributes specialized medical care and educational programs to even the most rural parts of the state. Kentucky TeleCare, a member of the Kentucky TeleHealth network, provides videoconferencing systems that run on high-speed communication lines to achieve high-quality video and audio.
At St. Claire Regional Medical Center in Morehead, a frequent user of the system, about 1,000 patients a year see doctors by television, says Rick Phillips, program director for the hospital.
Primary users of the network are people who need specialty services that are not available in Morehead, such as dermatology, child psychiatry, and pediatric cardiology. For instance, an infant with a heart murmur might undergo a TeleHealth exam with a pediatric cardiologist in Lexington. Using electronic stethoscopes and the video equipment, the specialist can tell whether to rush the baby to a neonatal intensive care unit or send him back to his mother’s arms.
St. Claire also operates satellite clinics at schools and other facilities, Phillips says.
Dr. Kimberly Williams, vice president for medical affairs and physician services at St. Claire and former chairman of the state TeleHealth Board, has experienced every aspect of the network—including being a patient herself when she had a dermatology problem.
“I was able to get in to see the dermatologist at UK (virtually via TeleHealth) and I just had to walk down the hallway. He was able to look at my lesion over the system, make a diagnosis, and call in a prescription medicine for me. It worked really well.”
The system is also a valuable educational tool, says Rob Sprang, director of Kentucky TeleCare. The state health department used this capability to disseminate training on bioterrorism response and preparedness following the September 11 attacks.
“I’d dare say Kentucky is much more prepared than some states because we’ve been able to do the education that some states could not.”
For information on Kentucky’s TeleCare network, see the resource list below.
BODY SCANNING RESOURCES
If you would like more information about these latest medical technologies discussed in the story, contact your physician or the groups listed below:
HealthScan Body Scanner Information
Owensboro Heart and Vascular
1200 Breckenridge Street
Owensboro, KY 42303
Two Web sites that offer comprehensive information on this electron beam tomography scanning are:
www.geimatron.com is GE’s site about its HealthScan equipment.
www.scandirectory.com provides general information about scanning technology and a directory of facilities that offer scanning services.
Interventional Radiology Image-Guided Procedures
Vascular & Interventional Associates
170 Barnwood Drive
Edgewood, KY 41017
Web site: www.nkyxray.com
Society of Interventional Radiology
Use their search engine and find an interventional radiologist in your area.
Mammogram R-2 Image Checker
University of Kentucky Chandler Medical Center
Department of Diagnostic Radiology
800 Rose Street
Lexington, KY 40536
Medical Imaging Scanning General Information
Society of Interventional Radiology
Web site: www.sirweb.org
Optical/Eye Scanning Information
John-Kenyon Eye Center
Louisville, Elizabethtown, and
Web site: www.johnkenyon.com
Louisville (800) 223-8908
Jeffersonville (800) DIAL EYE
Elizabethtown (800) 483-3937
Web sites provide more info about
WaveScan: www.visx.com and
University of Kentucky Refractive Surgery Center
Kentucky Clinic South
2400 Greatstone Point
Lexington, KY 40504
University of Kentucky Chandler Medical Center
K117 Kentucky Clinic
740 S. Limestone
Lexington, KY 40536
St. Claire Regional Medical Center
222 Medical Circle
Morehead, KY 40351
Web site: www.st-claire.org/telecare