Advancement in imaging technologies such as MRIs and CAT scans save time, which can lead to saved lives.

In emergency and trauma medicine the "Golden Hour" is the critical 60-minute countdown from the moment of injury when prompt treatment is most likely to save a life. Some prefer a less literal interpretation and use the term to refer to rapid intervention in trauma cases.

Either way, there's no time to waste. Quicker is better. Modern imaging technologies, which seem to advance almost daily, are sucking fewer and fewer precious seconds and minutes from that important hour "” and providing detailed, accurate life-saving information to boot.

"Several years ago it might take 30 minutes or more to get images needed for trauma treatment," says Jack Malott, administrative director of radiology at UC Health University Hospital.

SECONDS MATTER

"Now we can do a CT scan from the top of the head to the bottom of the pelvic bone in 20 seconds" and send the patient on to the OR where the data will be waiting for the surgeon. Then the technologist and radiologist can check the chest, pelvis or other areasm, and reconstruct data as needed. "These new systems collect volume data in seconds, and you can go back and reconstruct anything you want."

Speed and digital accessibility of data from imaging technologies are making MRIs, CT scans, PET scans, mammograms and ultrasounds ever-important and ever-expanding diagnostic tools for today's doctors as they record specific data. "You can do so much more now to enhance the exact images you need," Malott says.

In the old days, an X-ray was taken, film was developed and "hung," says Jason Wessel, system director of radiology for St. Elizabeth Healthcare. The doctor would read them, dictate a report that would then be transcribed, and the film would be packed up and filed. Today, film is available digitally. "A doctor can see it in seconds; his report is being processed as he dictates; there's no transcription. He or she checks "¢send' after reviewing, and it's available to the reviewing physician."

"Ten years ago non-emergency results were probably available in 48 to 72 hours," Wessel says. "Two years ago the target was less than 24 hours. Today we strive for under four hours, and we meet that goal 85 percent of the time. And all this technology has really helped the environment. We're not using chemicals to develop film or storing film."

As concerns about exposure to radiation-based technologies (CT scans, mammography, PET scans) have focused on patient safety, key developments have taken place, most recently with dose modulation, especially in CT scans, that can reduce the dose up to 50 percent in certain individuals.

"Advancements have improved our efficiency, significantly improved quality, improved patient safety in reducing exposure to radiation and have helped the environment," Wessel says. "In the end, it gives us a better patient outcome. Ultimately, that's what we are striving for."

ADVANCES IN THE BIG FIVE

Mammography

Though the traditional mammogram, producing a two-dimensional image, is still the main tool for spotting breast problems, it can be problematic for women with dense breasts. The compression of the breast causes overlapping of the tissue that could hide irregularities or cause distortions sometimes leading to frightening callbacks.

Breast tomosynthesis is a 3D mammography technique that makes it possible to explore the interior of the breast without the superimposition of the other tissues. With digital tomosythesis you can look at the slice and tissue superimposition is eliminated for a clear look. Physicians can identify tumors that are easy to miss with the 2D approach.

"It gives the doctor the ability to get rid of confusing information and look at a specific area," Malott says. "It's mostly been used in research but it has great potential, and we are about to implement it in general screening and diagnostic use. It's a good second step if you have a question."

CT Scans

This diagnostic tool has really stepped up to a new level in the cardiac realm of advanced imaging, sparing some patients the necessity of getting a catheter-based arteriogram to see inside the arteries.

A few years ago, an examination could only be done by injecting contrast material through a catheter into an artery to see tissue in an X-ray hunting for blockages, internal bleeding or other problems. It can take several hours, can require a sedative and has some risks, like clots or bleeding. In a CT angiography, the doctor injects the contrast material in the arm and takes a CT scan. The arteries in the lungs, kidneys, brains and legs can be checked in about a half hour. It hasn't completely replaced the old technique, but it spares some patients getting a catheter-based arteriogram.

"We're using it more as a screening tool," Wessel says. "A patient can have a screening test if there's a family history of heart disease. If it's negative, fine; if it's positive then they might need an angiogram or another diagnostic test."

"CT scans are replacing a lot of conventional radiology exams we used to do," Malott says. "It's considered non-invasive and it's a study that a cardiologist, for example, might use to decide whether you need a stent or another therapeutic procedure. It can be used when giving a patient a clot-busting drug to evaluate its effectiveness."

MRIs

Historically, MRIs have been used for brain and spine work because it examines very minute differences such as the differences in gray and white brain matter. "But (MRIs) uses are expanding and about every six months something new comes out as technology progresses," Malott says.

"It allows you to look at functions. You can scan someone's head and see what parts of the brain are working," he says. "It helps neurosurgeons map out brain function."

The MRI scanner is often used in the operating room in brain surgery. "Previously, the neurosurgeon would go in and remove some tissue then send the patient to radiology before doing more work, going back and forth in this delicate operation," Malott says. "Now there's a MRI scanner right there so they can see exactly what's going on, mapping out and imaging the whole procedure. The concept of imaging while doing the procedure is so helpful."

Breast imaging using MRIs has also risen in the last five years, especially when dealing with high-risk patients or those with "dense" breasts who are more difficult to image with mammogram technology. "You are looking at a breast that has fatty and connective tissues that are close in density," Malott says. Because MRIs use chemical differences instead of density the differences can be seen more clearly.

Those with a strong family history of breast cancer or gene mutation can get periodic testing with MRIs to detect early lesions.

One of the big drawbacks to MRIs was the inability to accommodate heavy patients and the feeling of claustrophobia many get from the tube-like enclosure. With newer short-bore and better open scanners patients are not as completely enclosed, and hospitals are making accommodations. St Elizabeth's invested in video goggles so a patient can watch a video to distract them, and patients at The Christ Hospital can choose a scene projected on a wall and listen to music.

Ultrasound

"Ultrasound has been overshadowed in the past by some of the other diagnostic imaging tools," says Malott, but because of increased concern about radiation exposure, the use of ultrasound is climbing again.

Today's machines have improved resolution and can capture volumes of information by dragging the wand-like transducer across the surface, giving doctors 3D and 4D pictures with remarkable clarity. And because the equipment is smaller, sometimes a laptop size, "it allows up to take the test to the patient's bedside or out in the community," says Wessel.

Considered one of the safest imaging methods, it's especially good for pre-natal and abdominal imaging and "in recent years they have digitized the data allowing them to look at motion like blood flow," says Malott. "There's a flexibility for the doctor to construct what information he or she needs to interpret with ultrasounds."

It's also very useful in vascular studies. If you have a compromised blood flow in the in the neck, you are at risk for a stroke, same with the leg. "Making a quick diagnosis with some degree of accuracy . . . those are important to a surgeon, to know whether he needs to operate or not . . . and also to localize where the blood flow has stopped," says Malott. "In emergency situations it gives a crash view of the abdomen and is a powerful imaging tool."

Whole breast ultrasounds can also be helpful in patients with dense breasts when regular mammograms fall short because it gives a 3D type of evaluation.

PET scans

Used primarily in cardiology, neurology and oncology, PET scans track information about the body's chemistry and function not available through other imaging procedures. Use of the procedure by itself is not so common, but combined with a CT scan, for example, you get an exact location in the body overlayed with function. For example, a scan of a suspected bone tumor will show its exact location and track the activity of the tissue itself. "It helps an oncologist determine where something is and whether there's an indication of some disease process going on," says Malott.

The procedure used to take three to four hours, then it was down to two, says Wessel. "Now it's down to about 45 minutes, with better accuracy, better sensitivity and shorter turnaround times. You get anatomical and physiological information at the same time, fused together." 
 
Computerized Tomography Scan or Computerized Axial Tomography
Magnetic resonance imaging
positron emission tomography