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article imageNew fronts in heart disease: Innovation in computed tomography Special

By Michael Krebs     Apr 23, 2013 in Science
Innovations in computed tomography are driving forward progress in heart disease detection and treatment, and Murat Gungor, VP of computed tomography and radiation oncology at Siemens, shared his perspectives on these advances.
Computed tomography, more commonly referred to as CT scanning, has gone through some considerable innovations over the past few years - and these innovations have driven major advancements in the detection and treatment of heart disease. As hospital networks continue to compete in specialty treatment arenas - heart disease and oncology being foundations in these arenas - and against the backdrop of the Affordable Care Act, innovative technologies and treatments that drive the highest quality care at the most efficient investment levels will foster society-wide benefits for the American population.
In the computed tomography space, Siemens is arguably delivering the most innovative technology to its medical imaging customer base. The company stands by its position of providing the highest quality imaging at the lowest radiation dosage, and Siemens is confident enough in this position to openly invite CT imaging specialists to participate in an international imaging contest.
But what are the innovations that are piloting the successes in cardiac CT, and where are these advances taking the medical imaging community and the patients that community serves?
Murat Gungor, VP of computed tomography and radiation oncology, shared his perspectives on these questions.
"We started at a point where we were only able to scan the heart or perform CTA studies for only some patients in some occasions, and now all of a sudden we can do it for virtually every patient - from very small pediatric to very large geriatric patients, in fact, at all heart rates," Gungor said. "Usually we have to slow down the heart and now we don't have to do that. If there's an emergency situation, we can do it without slowing down the heart."
According to Gungor, the technology used to be additionally limited by time of day - and that nighttime technologies were not compatible with daytime scenarios.
"It used to be a problem in the sense that the night technologies weren't able to perform it versus the day technologies," Gungor said. "Now, of course, our users got more educated about the two, but also the software and the entire work-flow became very intelligent in providing that ultimate work-flow - that you can do it day or night."
One of the most notable technological advances that Gungor and his colleagues have seen is in the ability to deliver considerably lower doses of both x-ray and iodine contrast while also delivering the highest quality imaging needed to understand what is happening within a given patient's chest cavity.
"Now we can do it at really much lower doses of x-ray. And not just x-ray but even also the contrast that we use, the iodine that we inject into the vessels, that is also reduced significantly. We have seen roughly a 34-dose reduction in routine cardiac imaging," Gungor explained. "If you look at the dose levels that we are using in 2006 and 2005 and compare it to what is being used right now, there's really a 34-dose reduction. Significant."
Siemens' cardiac computed tomography offers a menu of scanning modes. The process of collecting images are known also as acquisitions. Different patients with different cardiac issues require different acquisition techniques, and the technological prowess offered by Siemens allows for the machinery to detect the specific acquisition mode needed in a given situation and to personalize the scan based on the readings received from the patient.
A flash spiral mode offers the fastest acquisition and is used in select patient settings. Its speed affords the flash spiral mode to offer a very low dose of radiation.
"You can complete that acquisition in about 250 milliseconds," Gungor said. "The quicker you fly the lower dose you apply."
But it is the intuition incorporated into the intelligent technology that drives such impressive innovation.
"If you were having this conversation four years ago, this question would probably have a very long answer," Gungor said. "But now all of this is embedded into the system as an automation. So, the minute you swipe the patient details and connect the electrodes you get right away from the system that this is the type of scan that you should be applying to this patient."
However, with any high-end technological innovation the matter of training the end user - in this case, the medical imaging community - on the day-to-day operations of such a sophisticated technology.
"What we realize is this innovation is cool, and we have all these options," Gungor said. "And the system is smart enough to recognize which one to use. But onto that point - I mean, five years ago we didn't think that automation or training was such a big deal, but I think the times told us that we have to be different in our go-to-market strategy. Yes, innovating something is cool but if you don't make it meaningful and digestible to the end user it means nothing."
The computed tomography business is a relatively competitive one, and Siemens bids globally against GE, Philips, and other manufacturers, Siemens appears to be pushing the more innovative frontiers.
"To my knowledge, there are no other scanners out there that are able to recommend a certain scan protocol to the user depending on the patient that is on the table at that moment," Gungor said. "I mean, that's by itself working towards this personalized medicine idea. Being able to recognize what kind of patient you are dealing with - and then the scanner to work hand in hand with you, and not just rely on user manuals of 600 pages floating somewhere."
Innovation of this nature in the present tense is expected to drive further advances in the future. However, the Affordable Care Act is causing ripple effects throughout the American healthcare establishment, and legislation as far reaching as the Affordable Care Act may yet have an adverse affect on innovation.
But Gungor is an optimist with an alternative perspective. He notes that the key advances on the horizon are centered on patient satisfaction.
"Patient satisfaction is something that everyone is focusing on," he said. "What matters is, for us and also for the market right now, is to be able to offer tools that make employees satisfied and employees happy. I mean, we don't want the CT users to be frustrated because they're using a cumbersome unit. We want it to be easy for them. We want them to spend more time with the patient and less time with the scanner. So, let's call that patient-centric productivity."
As Gungor sees it, efficiency yields a better patient experience. And patient-centric productivity is in alignment with the tenets of the Affordable Care Act and is considered a cornerstone of future innovation.
The faster speed and low-dose equation that Gungor has described has obvious benefits in terms of reduced exposure to radiation. However, the reduction in the dosage of iodine contrast also leads to a corresponding reduction in hospital re-admissions - as some patients have allergic reactions to the contrast, and others have kidney reactions as a result of too much contrast exposure and require additional treatment at the hospital. As the Affordable Care Act has specific guidelines on reducing hospital re-admissions, Siemens' CT solutions are additionally well aligned.
"This faster speed and low dose has a huge value," Gungor said.
Perhaps the most exciting near and intermediate future application in computed tomography is found in advancements in dual energy scans, according to Gungor. Dual energy CT offers unique visuals at the tissue level, as Google Images showcases here.
Computed tomography offers a considerable technological front in the comprehension of heart disease, and it achieves this in a cost-effective and personal manner. The innovations being brought forward offer an exciting promise in the mapping of our individual bodies and in our collective understanding of the inner workings of biology itself.
More about Siemens, Ct scan, Radiation, Heart disease, Heart attack
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