Hospitals Incomplete Without CT

              4-E Sun,, Feb. 15,1981 SHRF.VKPORT-BOSMER The Times
Hospitals
incomplete
without CT
By SALLY REESE
Times Medical Writer
No acute-care, full-service hospital
today can be regarded as practicing
] state-of-the-art medicine without a CT
s scanner.
So asserted J. Michael Douthitt, ex-
| ej?utive director of Physicians & Sur-
• geons Hospital, before the board of the
i North Louisiana Health Systems Agen-
I ey. He was seeking the board's endorse-
' ment of his hospital's certificate of need
for a full-body CT (computed tomo-
\ graphy) scanner. The HSA board of
governors has since recommended ap-
• proval at the state level.
LSU Medical Center's Ohio Nuclear
| CT system became operational last
month. P&S expects its General Elec-i
trie CT/T to be operational by June.
: GE's Medical Systems Division will
install the scanner at a cost of $848,000.
Shreveport and Bossier City will then
I have CT scanners in five of their seven
| general hospitals.
Computed tomography has become
! the primary diagnostic mode for a
variety of medical problems, Douthitt
said. P&S transfers 400 to 500 patients a
year to another hospital for scans
"because every specialty on our staff
• has need of it."
Highland Hospital does not have a
scanner and, like P&S, must transfer its
patients to another hospital for scans. It
has used the Bossier-based scanner,
\ jointly owned by Doctors Hospital and
Bossier Medical Center. P&S uses
Schumpert's scanner, and before it got
its own, LSU Hospital sent its patients
to Willis-Knighton Medical Center.
CT combines X-ray imaging with
data processing. It is the visual re-construction
of a cross-sectional "slice"
of the anatomy through an X-ray scan-ning
device linked to a computer.
Its major feature is that it permits
visualization of different tissue types
without drastic interventions, like ex-amining
a slice of bread without open-ing
the loaf.
Because of its capabilities,
] Shreveport doctors are increasingly re-lying
on the CT scanner, said James K.
Elrod, president of Willis-Knighton. In
some cases, it is the tool of choice, said
; the hospital administrator.
In neurosurgery, it is the necessary
- tool, said Richard H. Ketcham, ad-
: ministrator of Highland. "In a head
; injury, for example, neurosurgeons
won't proceed without it."
- Actually, computed tomography has
; revolutionized medical science in the
past eight years, say members of the
". medical community.
(Times photo by Billv Upshaw)
Dr. Ronald Eisenberg and patient with LSU Medical Center's new scanner
Because of its ability to peer within
the body, many surgical procedures are
no longer necessary, said Dr. Ronald
Eisenberg, chief of LSU Medical
Center's radiology department.
Diagnostic studies and hospital stays
have been shortened and costs have
been reduced by the scanner's speed and
accuracy, he said.
The diagnostic procedure was in-troduced
in 1973 with the head scanner,
which created a sensation with its abili-ty
to visualize the brain. The whole-body
scanner appeared in 1975 to pro-vide
an image of the lungs, liver, pan-creas
and other organs of the body.
Douthitt said the fourth-generation
scanner that P&S has on order can
demonstrate very small variances in
tissue density. For example, tumors of
the brain, though basically the same as
surrounding normal tissue, do vary
slightly, he said.
"It makes it possible to see very
small body structures such as the optic
nerves, white and gray matter dif-ferences
in the brain, and tiny struc-tures
of the human spine."
The P&S manager said GE's "rotate-only"
scanner system solves a problem
of previous "generations" — image
blurring caused by body movements,
especially breathing. Since it can com-plete
an entire scan in less than five
seconds, a patient can usually hold his
breath during the entire study.
It can compute massive information
in less than one minute and then display
it on a screen for analysis, Douthitt
reported.
The HSA board recommended the
P&S scanner for approval on evidence
of need and cost efficiency.
LSUMC's Eisenberg said many in-dependent
studies have shown that com-puted
tomography is cost-effective,
even though the initial cost of a scanner
is high.
"The results of a CT scan may make
other radiographic examinations un-necessary,"
he explained. "In one study
of patients with suspected
hydrocephalus, there was an 80 percent
decrease in the number of pneumoen-cephalograms
once CT was available.
The average cost of the diagnostic
evaluation was 22 percent less."
A study at Johns Hopkins showed a
decreased cost of about $2,500 per pa-tient
after installation of the scanner,
Eisenberg said. Hospitalization was re-duced
by an average of seven days for
patients with subdural or epidural
hematomas (accumulation of fluid
within the skull but outside the brain).
"CT scanners may provide informa-tion
that is otherwise unavailable and
which may alter diagnosis, prognosis,
or therapy," he said. "In several studies,
about 20 percent of the patients for
whom an operation had been planned
were found not to need surgery."
In many instances, Eisenberg added,
a CT scanner can save the patient from
undergoing time-consuming, uncom-fortable
examinations.
"For example, if a patient who suf-fers
a head injury is suspected of having
a subdural or epidural hematoma, a CT
scan is the procedure of choice.
"This examination can be performed
without discomfort in less than an hour.
If a CT scanner is not available, an
arteriogram would be necessary, a pro-cedure
that may take several hours and
give intense pain," Eisenberg said.
"If a patient is suspected of having
hydrocephalus, the CT scan can de-termine
within a few minutes whether
the hydrocephalus is present. If a scan-ner
is not available, the patient may
have to undergo a pneumoencephalo-gram,
an extremely uncomfortable pro-cedure
that may take four or five hours
to perform."
(Hydrocephalus is enlargement of the
cranium due to abnormal accumulation
of cerebrospinal fluid.)
Eisenberg said CT is very effective
for evaluating patients with a possible
ruptured spleen or liver, who otherwise
would have to undergo arteriography or
exploratory surgery.
"CT of the abdomen is of great value
in identifying tumors of the liver, pan-creas
and kidneys, as well as in staging
of malignancies for radiation therapy
and surgery by determining the extent
of a tumor and possible metastic
spread."
CT has been called the most dramatic
breakthrough in diagnostic medicine
since discovery of the X-ray by the
German physicist Wilhelm C. Roentgen
in 1895. Doctors today can view actual
tissue inside the head or body without
invading either — can see man's inner
space without invading it.