Just to show our patients how far Molecular Imaging has come, we've hung this cerebral pefusion scan from 1973 in our testing waiting room. The image was acquired via rectilinear scanner in 1973.
During the processing portion of myocardial perfusion imaging, most begin by first placing a region of interest around the left ventricle. Next, the images are post-processed for quantitative analysis and reconstructed into short, horizontal, vertical sections. A question looms: How much time was really spent analyzing the SPECT data for normal/abnormal radiotracer biodistribution? Below is a Thallium-201 SPECT image acquired on a GE dual-headed Myosight. How much pathology can you find? *Answers below
Right Ventricular Uptake = Right ventricular overload from right-sided heart failure
Ascites = The liver isn't visualized. Should have hepatic/splencic radiotracer uptake. Findings may be from complications of right-sided heart failure
Increased Lung-To-Left Ventricle Ratio = Indicative of left ventricular dysfunction
Lack of Renal Uptake = Normal functioning kidneys should have radiotracer uptake, renal disease/failure is indicated if not visualized
Thin Walled, Dilated Left Ventricle = Indicative of dilated cardiomyopathy
Dr.'s Siegel, Stabin, and Marcus take an unconventional jab at the NRC pleading they stop ignoring their published work. Dr.Siegel specifically has been extremely vocal that current day medical radiation standards are based off unsubstantiated claims, guided by a 'radiophobic-centered,' not scientific, approach.
Is your Nuclear Cardiology Deparment documenting blunted heart rate responses? If not, this prognostic indicator, in addition to traditional MPI findings, adds
a 15% modest improvement to the net
As with Adenosine, when administering Regadenoson (Lexiscan) a normal increase in heart-rate will occur. A number of studies have shown that individuals whose heart-rates don't respond, specifically anything <28%, was significantly associated with poor outcomes. These findings were with patients who had normal and abnormal perfusion patterns.
Renowned Medical Physicist Jeffry A. Siegel dispels the 70 year old hypothesis that exposure to medical radiation could increase ones risk of cancer. In fact, he suggests it more likely helps prevent it.
He emphasizes, "This fear is unjustified by any scientific findings and is discredited by most experimental and epidemiological studies, which show that low-dose radiation, instead, stimulates protective responses provided by eons of evolution, resulting in beneficial effects."
Link to the JNM Issue can be found here.
Will A2A agonists be the next big weight loss drug?
Ordering Capital equipment, specifically Imaging, can be stressful, especially if you're working with a new vendor. Over the last 15 years in my position as an Imaging Supervisor I've built a rapport with a number of major OEM's. The thought of doing business with anyone else was very intimidating, not to mention ones credibility is on the line if anything goes awry. With reimbursements nose-diving, staggering costs to maintain compliancy and accreditation via governing bodies, dramatic loss in productivity when dealing with insurance companies, and the growing cost to maintain billing staff - just to get paid - one has to deal with this culminated force by trimming overhead expenses.
For those of you that don't keep a pulse on emerging trends, the refurbished medical equipment market here in the US is expected to reach 12 billion dollars by 2021, almost doubling this current years forecasts. One can strongly assume that within the next five years if you haven't purchased a piece of refurbished medical equipment, odds are you will by 2021.
The looming question remains - who can one trust?
Enter BC Technical.
Our practice just completed the installation of three major additions to our imaging portfolio; a 64 slice GE VCT, a dual-headed GE Ventri dedicated cardiac gamma camera, and an UltraSpect workstation. The initial deal just involved the CT scanner, but because of how much they exceeded my expectations, they were invited to bid on other projects, which they were successful in procuring. All in all, the entire process from the bidding, negotiating, financing options, and flexibility has quenched any previous reservations when doing business with a non-OEM entity.
Learn from my experience; don't be complacent. Commit now and start saving!
Never underestimate the power of prone imaging, otherwise known as the 'poor man's attenuation correction.' After its implementation, our false-positives were considerably lower.
Consistently meeting or exceeding my expectations, these companies have all made my 2016 recommended vendor list:
Inventory Distributors - Henry Schein, Lynn Medical
Pharmaceutical Distributor – Henry Schein
GPO – Intalere, Vizient
Radiopharmacy Services - Cardinal Health
Dosimetry Badges – Radiation Detection Company
Imaging Equipment Providers – GE Healthcare, BC Technical
Field Service Engineers – GE Healthcare
Power Backups - Powercom
Financing – GE Capital
Flood Source Provider – Lynn Medical
Physicist Services – Alliance Medical Physics
Radiation Monitoring Equipment Distributor – Medi-Nuclear
Scaler/GM Counter Calibration Services – Technical Services Group
Biowaste Management – MedPro
Patient Snacks/Beverages – Capital Office Products
EMR Client – eClinicalWorks
HR Services – ADP
Treadmill Stress Systems – Jaken Medical
Commercial Cleaners – Coverall
Radiopharmaceutical Management System – Syntrac
Hardware Based Resolution Recovery – UltraSPECT
Biomedical Services – Medical Maintenance Consultants
Nuclear Reporting Software – NRP by Syntermed
Nuclear Cardiology Processing – Emory Cardiac Toolbox by Syntermed
PACS – Genesis OmniVue
Linen Service – Southern Medical Linen Service
Georgia CON/LNR Legal Counseling – Ray & Sherman, LLC
That time I asked Bracco for two vials of CardioTec.
Here are the ones relevant to Healthcare:
(6) Sales to any Hospital Authority created by Article 4 of Chapter 7 of Title 31 of the Georgia Code.
(7) Sales of tangible personal property and services used specifically in the treatment function when the sales are to a nonprofit (i.e., a tax exempt organization
under the Internal Revenue Code) nursing home, inpatient hospice, general hospital or mental hospital. Application process is through Form ST-NH1.
(7.05) From July 1, 2015 through June 30, 2018, sales of tangible personal property to a nonprofit health center in this state which has been established under the
authority of and is receiving funds pursuant to, the United States Public Health Service Act, 42 U. S. C. Section 254b if such health clinic obtains an exemption determination letter from the
commissioner. Application process is through Form ST-NHC. Annual application required. Application must be filed electronically through the Georgia Tax Center. Qualifying sales are exempt from the 4%
state sales tax. These sales are subject to all local sales taxes.
(7.3) From July 1, 2015 to June 30, 2018, sales of tangible property and services to a nonprofit volunteer health clinic primarily treating patients with incomes below 200% of the poverty level and which property and services are used exclusively in performing a general treatment function when such clinic is a tax exempt entity under the Internal Revenue Code and obtains an exemption determination letter from the Commissioner. Application is through Form ST-NVHC. Annual application required. Application must be filed electronically through the Georgia Tax Center.
(47) Sales or use of drugs that are lawfully dispensable only by prescription for the treatment of natural persons; Insulin regardless of whether the insulin is dispensable only by prescription; prescription eyeglasses and contact lenses; drugs dispensable by prescription for the treatment of natural persons without charge to physicians, hospitals, etc. by pharmaceutical manufacturers or distributors; drugs and durable medical equipment dispensed or distributed without charge solely for the purposes of a clinical trial approved by the FDA or an institutional review board. Note: This exemption does not include over-the-counter drugs, drugs sold for animal use, or nonprescription eyeglasses.
(50) Sales of insulin syringes and blood glucose level measuring strips dispensed without a prescription.
(51) Sales of oxygen when prescribed by a licensed physician
(52) Sale or use of hearing aids.
(54) Sale to or use by a patient of any prescribed durable medical equipment or prescribed prosthetic device.
(72) The sale to or use by a patient of all mobility enhancing equipment prescribed by a physician.
One of the most frustrating, and equally confounding, challenges for Healthcare providers in Georgia (historically has been a red state, yet this law completely defies laissez faire), is the CON filing process through the Georgie Department of Community Health. The supposed purpose behind the law is to 'ensure the availability of adequate health care services to meet the needs of all Georgians, while safeguarding against the unnecessary duplication of services that perpetuate the costs of health care services.' Below are a list of all projects that require a CON:
Thresholds as of July 2016:
Capital Expenditures, O.C.G.A. § 31-6-40(a)(2) $ 2,903,530
Single-Specialty Physician-Owned Ambulatory Surgery Facilities, O.C.G.A. § 31-6-47(a)(18) $ 2,903,530
Joint Venture Ambulatory Surgery Centers, O.C.G.A. § 31-6-47(a)(19) $ 5,807,061
Equipment, O.C.G.A. § 31-6-40(a)(3) $ 1,246,165
During the filing process, what's commonly not mentioned is the legal counseling that specializes in CON/LNR law is highly recommended. Most projects fail to take into account these costs which can easily breach five figures, even with the simplest of projects.
Recent reports have questioned this laws efficacy, now enforced in 35 states, with the latest stating it diminishes quality of care and in some cases even raises death rates. The Fiscal Times has a great article shedding some light on this failed policy.
Highly recommend paying Becker's website a visit. Very few have the pulse on Healthcare like they do.
Questioning your processing techniques? Both Cedars and Ectoolbox do a great job of supporting their users by posting tutorials and operating manuals.
Here are Cedars Tutorials
Here is Ectoolbox's operating instructions