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Discussing the value of ultrahigh-resolution CT scanning

by Gus Iversen, Editor in Chief | September 10, 2019
CT X-Ray
From the September 2019 issue of HealthCare Business News magazine


HCB News: Operationally, how has training and utilization of the system compared with other conventional CT scanners at UC Davis Health? Is there a learning curve?
JB: This scanner has a large repertoire of options, as you would imagine, and we are still very much on the learning curve in terms of protocol development. We have all become used to the complexity of modern CT scanners, with automatic exposure techniques (tube current modulation), and all the other factors involved in CT protocols. With this scanner, we add to the mix 7 different focal spot sizes, 4 different reconstruction modes, 4 different reconstruction algorithms (each with many flavors), and you can begin to realize how complex this system is. This scanner is a research scanner to some of us, but it is FDA approved and therefore, it is used at our institution for clinical imaging from 7 am to 5 pm. The standard of care imaging comprises the bulk of our clinical investigations comparing high-resolution to low-resolution CT. We really are still at the front end of the learning curve given the complexity of this CT scanner, and I hope over the next few months we will be able to focus on a number of specific clinical protocols and optimize them to achieve the best compromise between spatial resolution and noise. This new high-resolution scanner is certainly a game changer, but realistically it will take a couple of years for my radiologist colleagues to learn how to use this new technology in order to confidently and routinely use this tool to advance patient care.

HCB News: Can you discuss any research you are currently conducting with the use of the system?
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JB: As a medical physicist, there are many basic science studies we are planning to do, and these studies are ongoing. We have focused our early clinical investigations on areas of CT imaging where we feel that the spatial resolution capabilities of this new scanner will most impact patient care. Our current priorities are in lung imaging, and I can report that our chest radiologists give 2 thumbs up on high-resolution CT; we are also focusing on musculoskeletal imaging, and have imaged a number of cadaver limbs in various studies which show huge potential; we also feel that neuroradiology applications such as temporal bone imaging is clearly something that this scanner will provide new diagnostic accuracy for. We have a fleet of CT scanners at our medical center, and we are prioritizing the use of this new scanner for a subset of our ambulatory patients to focus on these specific areas.

HCB News: Has anything about the new system been a surprise?
JB: For me personally, there have been huge surprises relating simply to the installation of the scanner. Since this interview is for Healthcare Business News, I feel compelled to mention the following: I wear many hats, but as a clinical medical physicist for 35 years, I have always viewed the delays of equipment installation in the hospital setting as result of bureaucratic inefficiency and indecision. However, as principal investigator of this project, I was intimately involved with most of the steps that were required to install the CT scanner into our clinical CT area. I was so fully impressed at how a thousand people came together in a thousand meetings to expedite the installation of this CT system. I had no idea of the complexity of the process, and am dumbfounded, and grateful to all those who participated in making the siting of this CT scanner at UC Davis possible. From the vice chancellor and CEO of the hospital, to the many administrators, architects, engineers, IT staff, lawyers, X-ray technologists, and so many more that were involved in the necessary discussions and decisions required to install this CT scanner. I have a newfound respect for all those who have a hand in the siting of complex imaging equipment. As a longtime la-di-da full professor in the school of medicine, my advice to similarly gilded colleagues around the country is simple: hug your administrators today!

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