Upgrading CT in the Emergency Department: Columbia Memorial Hospital Case Study

In August 2011, Columbia Memorial Hospital (Hudson, New York) began the process of selecting a new CT system to replace the four-slice system that the organization had been using in its emergency department. As Rhonda Makoske, director of medical imaging, explains, the 192-bed acute-care hospital is a local stroke center; two 64-slice CT systems are used for outpatient imaging, while the emergency-department system does double duty and is used for inpatient imaging as well. “We were replacing 10–year-old technology,” Makoske recalls. “We went through a lengthy selection process, looking at four different vendors—and through site visits, image evaluation by the radiologists, and speaking to users of the systems, we were able to create a spreadsheet with all of the attributes of the different vendors’ systems listed.” Makoske sat down with the emergency-department supervisor, two radiologists, and several CT technologists, and each of the stakeholders rated the various scanners’ features, according to importance. This weighting resulted in a winner: the SCENARIA 64-slice CT system from Hitachi Medical Systems America. “The tipping point for the technologists was the user friendliness of the scanner,” Makoske says. “The radiologists thought the images were great, and they liked having the latest dose-reduction capabilities. The system was also quite a value, compared with some of the other vendors’ systems.” Dual Needs The new system, which was installed in February 2012, is shared between the emergency department and inpatients—which means, Makoske notes, “We needed something that would work for both.” As a stroke center, Columbia Memorial Hospital often sees those patients in the emergency department, and it also performs many pulmonary-embolism studies in emergency patients, Makoske says. The hospital serves a large bariatric population, so the ability of the new CT system to accommodate overweight inpatients readily was key. “We are now able to accommodate people weighing up to 500 pounds on the scanner, and we have not had a patient yet who didn’t fit,” Makoske says. She adds that the gantry’s 75-cm (30-inch) aperture also helps with imaging the bariatric population. “We do face some limitations, with our larger patients, on some of our other imaging equipment, so a large CT gantry aperture was a real priority for us,” she says. “The image quality with the SCENARIA on the larger patients is still really great, compared with what we’d seen on some of the other scanners.” Inpatients and emergency-department patients tend to be those facing the most acute situations, Makoske notes, which also made the patient friendliness of the CT system an important consideration. “Some of the benefits are the same for inpatients as for the emergency department,” she says. “These are our sickest patients, who have the least mobility. The system helps with both of those aspects, with faster scans and by being able to move the table in three planes, rather than the patient.” Patient Focus In fact, the Scenaria system’s table movement was a key deciding factor for Columbia Memorial Hospital’s CT technologists, Makoske says. The table can also be moved laterally up to 80 mm, enabling the technologists to perform faster and easier positioning, especially of patients immobilized by stroke. “For the patient who can’t move around easily and the technologist working alone (and trying to work quickly), the table can be moved laterally to center the anatomy, instead of the patient,” she says. “It’s been a real plus for the technologists.” The Scenaria also offers rapid scan times, with the ability to acquire all 64 slices in a third of a second. “The imaging acquisition is much faster than what we were working with before,” Makoske says. “Breath holds are much shorter, and it’s easier to coach patients through exams—and get better images—as a result.” The system’s dose-reduction features, which include automatic exposure control and Intelli IP adaptive iterative reconstruction, mean that patients are imaged according to as low as reasonably achievable, or ALARA, standards. “Dose reduction is going to be a huge consideration, moving forward,” Makoske says. “The state is looking hard at what health-care organizations are putting in place to limit that, so it’s a big concern of ours. Patients are also a little more savvy about it—there’s information on the Internet that is creating a growing concern in patients. It’s good for them to know that they are getting a conservative dose on our new CT.” Clinician Support Makoske notes that the installation process for the new system went smoothly, and that the applications-support team from Hitachi was instrumental in getting the technologists up to speed on the new technology as quickly as possible. “They are some of the best that our technologists have ever worked with,” she says. “If they don’t have an answer to one of our questions that day, they work on the problem and call as soon as they can. They’re very accessible to our staff, and we’ve been very impressed with that.” Meanwhile, Columbia Memorial Hospital’s radiologists are thrilled with the image quality that the upgrade to the SCENARIA CT system has offered. “The images are tremendously better than what we were getting before,” Makoske says. “The radiologists can’t tell the difference between the images from our other 64-slice scanners and this one, and there is a dose reduction with the SCENARIA. They can read more quickly and have more confidence in their diagnoses.”Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.