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Imaging Advances Improve Veterans Health Care


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Health technician watches patient preparing to enter a CT scanner at the Malcom Randall VA Medical Center in Gainesville Florida.

The 320-slice CT scanner at the Malcom Randall VA Medical Center in Gainesville, Fla. can do a 3D scan of the pulsing heart in less time than a heartbeat. Imaging advances like this have dramatically reduced the need for exploratory surgery. Photo by Greg Westlye

By Susan Wentzell
Thursday, August 30, 2012

Neika Garrison describes the pain she had been walking around with for more than a month: “It felt like an elephant was sitting on my chest.”  But the 57-year-old Air Force Veteran says she continued to ignore the pressure in her chest. “I thought maybe it was my asthma medicine.”

When the pain got steadily worse, Ms. Garrison called her VA primary care provider, Dr. Saji Packal, MD, at the Malcom Randall VA Medical Center in Gainesville, Fla.  “Dr. Packal and her nurse David Clegg told me to come to the Chest Pain clinic in the hospital’s Emergency Room as soon as possible. I’m sure glad I did—I believe they saved my life.”

Ms. Garrison, an Orange Park, Fla. resident, spent a fitful night in the Malcom Randall ER undergoing diagnostic tests ordered by her doctor.  The following day, she had an additional, high tech test--a Cardiac CT (computed tomography) scan, a quick, painless test that doctors use to look for heart and other problems. 

During a cardiology CT scan, an x-ray machine—which looks like a giant donut—rotates around the body taking clear, detailed pictures of each part of a patient’s heart at ultra fast speeds.  A computer puts the images together to make a three dimensional (3D) picture of the entire heart.         

A  Painless, Stress Free Experience

“I had a bad night in the ER the day before and my nerves were jangled.  But the test was quick and noninvasive.  From start to finish, it took only about 10 minutes and the CT technician, James (Mash), allayed all my fears. He was so reassuring, so kind, and so professional--he went above and beyond to make my experience stress free,” she says.

Thankfully, the CT scan, along with the other battery of tests, ruled out any damage to her heart, and with an accurate diagnosis, the problem was successfully treated and her symptoms subsided.  “She had what appeared to be chest pain related to her medication,” which was subsequently adjusted, according to Dr. Packal.    

Today, advances in diagnostic imaging, like CT scans, MRIs (magnetic resonance imaging), PET (Positron Emission Tomography) scans and other fused techniques are having a major impact on how disease is diagnosed and treated.  And a smarter way to manage these images means earlier diagnosis and treatment—especially for Veterans who receive their health care at VA hospitals and clinics in Florida, South Georgia and the Caribbean, the network of hospitals known as VISN 8.

The Malcom Randall VAMC obtained a 320-Slice CT scanner in November 2011.   At a cost of about $1.5 million, it can do a high-quality, 3D scan of the pulsing heart or other organ in less time than a heartbeat, according to Dr. David Wymer, Chief of Diagnostic Imaging.  He says there are less than 90 such scanners installed at hospitals across the country, including the VA. 
“The ability to image an entire organ and show how it’s working means faster, more accurate diagnosis, better patient outcomes and ultimately, lower health care costs.”

In fact, advanced imaging has, in many cases, replaced exploratory surgery.  Dr. Wymer compares the CT diagnostic technique with a more conventional procedure to evaluate the heart. 

“A cardiac catheterization procedure takes two hours—plus time off from work, sedation, and surgical risk. The cardiac CT is noninvasive and takes two minutes.”  

A CT scan is quick and noninvasive, but is it safe?  “We keep the radiation exposure of our patients at the lowest possible level. We are fortunate to have highly advanced imaging equipment that allows us to use low exposure imaging and software on our machines that lowers the dosage by another 20 to 30 percent,” Dr. Wymer says. 

Being able to do the test doesn’t equate to being able to read the test, according to Dr. Wymer.  Typically, radiologists evaluate the film from an X-ray, CT, PET or any other health care image and report the findings to the patient’s physician(s). 

“Having the ability to perform the study with the advanced technology equipment is of little use if physicians trained in interpreting the procedures are not available. Fortunately, at the North Florida/South Georgia Veterans Health System, we have subspecialty, fellowship-trained cardiologists and radiologists to analyze our cardiac and body images.” 

PACS: A Smarter Way to Manage Imaging

Today, VISN 8 is one of only two VA networks and one of only a few private hospital systems in the country to have a system-wide, multi-hospital PACS—Picture Archiving and Communication System.  PACS is a filmless information system that enables radiologists in different locations to analyze and discuss images from any hospital in the System without ever having to leave their local workstation.  PACS is directly tied to VA’s Vista system, which manages the many documents and images in a patient’s electronic health record. 

PACS was initially acquired as an independent system at each VA medical center in VISN 8.  Now, PACS functions as a single system for the entire network with the capability for radiologists to read images for multiple facilities. The benefits include quicker turn-around-times, enhanced patient safety, and lower costs, according to Dr. Wymer. 

 “We can now analyze images from anywhere at any time. If a test was done in Orlando and Miami has the best GI radiologist, we can reach out to that specialist immediately. It’s also useful for our patients who travel and get their care at different VA facilities. They won’t have to repeat the test,” he says.

Another benefit is the ability to remotely read emergency CTs which is helpful if a radiologist is ill or when one hospital has too many studies to handle.  “The capability to share images and expertise makes VA absolutely unique,” Dr. Wymer notes.

Improved patient care at the hospital level is another plus to PACS as radiologists from different imaging modalities consult with specialists and a patient’s primary care physician to develop a treatment plan for a patient.     

Such is the case at Malcom Randall which merged Radiology and Nuclear Medicine into a combined clinical service.  Staff there recently developed combined interpretation sessions where Cardiology, Radiology and Nuclear Medicine physicians all come together to discuss each cardiac case and ideally, provide the very best analysis.   

Of the synergy achieved by the merger, Dr. Wymer says, “By doing this, we can come up with the very best clinical decisions for our Veterans, and that’s what we’re all about.”