COVER STORY: High-Tech Diagnostics

FARGO, N.D. — Instead of a stethoscope, Dr. Neville Alberto, Sanford Health hospitalist in Fargo, N.D., has a portable ultrasound draped around his neck, something he has been using for more than a year to diagnose patient’s medical illnesses.

Alberto’s portable ultrasound is made smaller for him to carry around and has a probe that can check various parts of the body including kidneys, gall bladder, liver, heart muscles and valves in the chest, lungs, swollen knees and vessels in the neck.

In the past, if a person had abdominal pain you put your hand on the area and suspect what is wrong, he says. “With a portable ultrasound, in less than a minute you can pick up the ailment,” he says. “This technology is about bringing care to the bedside, providing care much faster, defining thoughts much faster and then going to the next step quicker.”

The portable ultrasound is one new piece of technology that is being used to help diagnose medical illnesses.

Dr. Dick Marsden, senior executive vice president for Sanford Health clinics in Fargo, who is in charge of day-to-day operations, says the goal of new technology is to better diagnose medical issues using noninvasive techniques.

“It is about a noninvasive approach to making a diagnosis work and allowing subsequent treatment to be tailored directly to the process,” he says. “From the patient’s perspective it eliminates significant guesswork. Over the long haul it prevents unnecessary surgeries and really gets you to the right spot at the right time.”

Dr. Tim Mahoney, clinical chief, general and vascular surgery at Essentia Health in Fargo, says medicine is continually moving forward in diagnostic evaluations. Patients with pain or discomfort require a diagnosis including what type of treatment is needed. Therapeutically, pain can be treated by an operation, radiation therapy or chemotherapy. “Most of the time patients’ desire treatment with the least amount of pain, the least amount of bother and what feels [mentally] comfortable to them,” he says. “We have seen huge gains in the diagnostic field with better equipment.”

A clearer picture

Essentia Health continues to add new diagnostic equipment to better diagnose medical problems, including a highly efficient magnetic resonance imaging (MRI) machine. This MRI provides more detail through crisp, clearer pictures that, for example, show in-depth ligament tears to knees or shoulders, and can be used for breast biopsies and breast imaging for younger patients with a history of breast cancer in the family.

Essentia Health has two GE logiqE9 ultrasounds. At one time ultrasounds were done only in 2-D. With the E9, all images can be seen in either 3-D or 4-D. This provides superior image quality and detailed information for all exams. Equipment is efficient, user friendly and ergonomically correct. Detection of problems is clearer and more accurate.

Five years ago, Essentia added a 64-slice cat scan (CS). A 4-slice cat scan can take 30 to 45 minutes for a diagnosis. It takes five minutes with the 64-slice CS. This machine provides a faster diagnosis and is a noninvasive exam. Scans show all the vessels in the heart, neck, head and lower legs, which assists in the diagnosis of cardiac, vascular and lung disease and cancer.

Digital diagnostics (once called x-ray) is much faster, provides clearer images, has a lower radiation dosage and provides better detail. Patients are in and out in a short period of time. “Diagnosis is much easier and more accurate than before,” Mahoney says. “We can get so much more information.”

Dr. Colleen Swank, the medical director of primary care for Altru Health System in Grand Forks, N.D., who has been a pediatrician for 12 years, says there are now easier ways to detect childhood illnesses and diseases. For example, when babies are born doctors evaluate for genetic or congenital diseases that if diagnosed and treated early can improve the health of the infant. Detecting congenital hypothyroidism is one example — if missed for several months a cognitive disability would occur.

Health care systems also have more resources, says Altru Health System chief operating officer Brad Wehe. “The team is larger. The team is more specialized,” he says. “From a patient’s perspective, they can come in and have a much broader team of specialists and tools available for them. We are very integrated; all under one roof working together.”

Altru Health System has acquired four buildings on the south end of Grand Forks to complement its Columbia Road Medical Park. In addition, the health system has a medical residency practice on the University of North Dakota campus and the health care system is leasing 12,000 square feet in a new wellness center, which is currently under construction.

Analog to digital

In June 2011, Rapid City (S.D.) Regional Hospital installed a digital mammography unit to detect breast issues. It allowed the hospital to move from an analog concept to a digital concept, as well as display more images on a computer.

“It allows us to provide better detection for our patients,” says Tami Andersh, mammography technologist at the hospital. “We can transmit the images across the network, print the images or provide access to our local providers.”

“Digital technology is the best technology out there offered for mammograms,” says Jayne DeCastro, supervisor in medical imaging for Rapid City Regional Hospital.

Digital mammography units do a better job of imaging dense breast matter, as well as allowing radiologists to enlarge the image on the computer to get a better look, Andersh notes. “We’re able to get faster images and accurate findings that may not be picked up as easily,” she says. “A computer image is a different way of looking at things.”

The technology, which can provide an overall view of the entire breast, as well as the chest walls, is mainly used for routine screens.

“It makes our job easier when you can look at the images and get a better idea of what is happening,” Andersh says.

Dr. Richard Keim, who works in internal medicine at Queen City Regional Medical Clinic in Spearfish, S.D., says the facilities’ bone density test (DXA) is a radiological test that uses low radiation to evaluate the bone density in the spine, hips or forearm. It is a high technology component that allows physicians to calculate how much calcium is in the bone at a specific spot.

The majority of patients that benefit from use of the bone density test are females 65 or older, but the test is also used for those who take steroids or seizure medication, smoke or consume a high amount of alcohol.

“The whole goal is to identify patients at risk for a fracture and provide appropriate help before the bone fractures to avoid all the complications that go with the fracture,” Keim says.

Keim says statistics show that 25 percent of people who have a hip fracture die within a year and 50 percent have permanent immobility.

Larry Schulz, president and CEO of Lake Region Healthcare in Fergus Falls, Minn., says new technology is important because the sooner we catch the disease or find out what the disease is, the sooner we can get better control of it.

“New advances are taking place and being introduced all the time,” he says. “It is hard to envision what all the changes will be coming in the future.”

Continuing education is crucial as new technologies are developed and studies are conducted. At Lake Region Healthcare, groups of physicians meet regularly to review medical journal articles and talk about what’s new in the medical field. “We also have medical grand rounds where physicians discuss the latest in a particular disease or modality to treat a disease,” Schulz explains.

One challenge is the ongoing debate about the efficacy of different tests, Schulz notes. “We may have something that can help diagnose disease sooner, but the insurers and the government may be looking to see if it is worth the cost based on the number of people it would benefit,” he says.

For smaller health care systems such as Lakewood Health System in Staples, Minn., it boils down to quality and finances. “If something comes available we will identify if we can or should offer it,” says Tim Rice, president and CEO of Lakewood Healthcare System, which serves people in a 20-mile radius around the Staples community in north central Minnesota. “We really rely on our departments to be aware of new technologies. Once they are identified, it is important to analyze if you can provide it effectively and financially if it makes sense.”

Like Lake Region Healthcare, education is a key component for Lakewood Health System. “Benchmarking with each other and attending conferences is how you learn about these things,” Rice says.

Prioritizing is also a key for smaller health care facilities. “Our focus is on quality and service,” Rice says. “Our physicians are very conscious about not asking for things just because they want them. If they ask for a new technology, it is because it will make a difference to the patient.” PB

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