If someone is suffering from sudden, unexplained chest pain, doctors may order a stress test to try to find the cause. As part of that test, doctors either use a treadmill or a chemical to "rev" up the heart. Now, a new cardiac imaging system makes the test faster and easier on patients.
Richard Bruce is a retired Pittsburgh building inspector and founder of the "Paint Your Heart Out" program, rehabbing homes for senior citizens.
Bruce told Ivanhoe, "I started getting these symptoms that I couldn‘t go up the steps."
Richard had heart failure and had a transplant in 2002. Doctors now check his heart function regularly with a nuclear stress test.
"You had to lie down, and then they pump the fluid into you and they pump your heart up like you were doing a four-minute mile," Bruce explained.
With traditional imaging machines, the nuclear stress test requires a patient to lie still on his back for about 10 minutes.
Prem Soman, MD, PhD, FACC, Cardiologist and Director of Nuclear Cardiology at the University of Pittsburgh Medical Center explained, "During the test they also have to hold their arms above their head, and this is often difficult for elderly patients and patients with orthopedic problems."
For those patients, this system may be the solution. The D-SPECT takes images of a patient sitting up with arms down. Nine detectors inside take 120 images instead of 64.
"In most patients we can finish imaging in three to five minutes," Dr. Soman said.
"Being more comfortable and relaxed than the other test," Bruce explained.
For Richard, who also struggles with his back, it means a cardiac check-up is no longer something to dread. Dr. Soman says because the new cameras are very efficient, patients need a smaller dose of the radioactive dye to take images.
Contributors to this news report include: Cyndy McGrath, Supervising/Field Producer; Cortni Spearman, Assistant Producer; Jamison Koczan, Editor and Kirk Manson, Videographer.
BACKGROUND: Heart failure is a serious condition where the heart can no longer supply the body's cells with enough blood. Heart failure doesn't necessarily mean that the heart is no longer working; it means that the heart is no longer pumping as well as it should. You depend on your heart to pump oxygen and nutrient rich blood to the body's cells. If the cells are not nourished properly then your body will no longer be able to function properly. If you have heart failure, you may suffer from fatigue, shortness of breath and coughing. Some everyday activities like walking and climbing stairs can become difficult to perform.
TREATMENT: Heart failure develops over time and is caused by damage to the heart that cannot be cured but can be treated. Heart failure treatments can include:
- Lifestyle changes- maintaining weight, diet changes, avoiding alcohol and smoking, managing stress.
- Medications
- Surgery
- Ongoing careHeaHhhhdhdhd
NEW TECHNOLOGY: In order for doctors to check a patient's heart, they often use a nuclear stress test. With traditional machines, patients have to lie flat, often for up to 15 minutes, with their arms above their head. Prem Soman, MD, PhD, Associate Professor of Medicine at UPMC Heart and Vascular Institute in Pittsburgh, PA says that this can often be difficult for elderly patients and patients with orthopedic problems. With the new solid-state detector technology, patients are able to be imaged while sitting up. They also do not have to hold their hands over their heads, making the process a lot more comfortable. In addition, patients can finish imaging in three to five minutes, and Dr. Soman says, "Because the cameras on the new machine are very efficient, we can also use smaller amounts of radioactive dye, therefore it's associated with a smaller radiation dose to patients."
(Source: Prem Soman, MD, PhD)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Rick Pietzak
412-523-6922
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com
Prem Soman, M.D., Ph.D., FACC, Cardiologist and Director of Nuclear Cardiology at UPMC Heart and Vascular Institute, explains a more comfortable imaging process with less radiation.
Interview conducted by Ivanhoe Broadcast News in April 2015
What conditions are you looking for when patients come in for imaging?
Dr. Soman: Usually, they fall into two categories from the perspective of stress testing. They're either patients with symptoms that suggest coronary artery disease and therefore we are doing diagnostic testing to see if they have blockages. That also gives us the opportunity to see how severe the disease is and to look at the function of their heart. Sometimes, we test patients who have known disease and that could be to see whether therapy and management have improved their disease, and also to understand the extent and severity of the disease.
Tell me about the traditional way of imaging these patients.
Dr. Soman: Nuclear stress testing is one of the most commonly performed diagnostic tests in cardiology. It is done primarily to diagnose blockages in the coronary arteries and to assess the severity of the disease. One can also assess the function of the heart with the nuclear cardiology test. The test consists of two parts. One is the actual stress testing, and in patients who can exercise, we put them on a treadmill and test their functional capacity. In patients who cannot exercise, we have chemical means of doing the stress test. The second part of the test is actually getting the pictures and that's where we use a gamma camera.
Tell me about the gamma cameras.
Dr. Soman: The traditional camera is a big camera. Patients have to lie flat and still , often for 10 or 15 minutes, to complete the test. During the test they also have to hold their arms above their head. This is often difficult for elderly patients and patients with orthopedic problems. The design of the camera sometimes induces claustrophobia in some patients..
How does the gamma camera compare to the newer cameras you are using?
Dr. Soman: There have been a new class of cameras introduced in the market and these are based on what we call solid state detector technology. We have one type of camera from this class called a D-SPECT camera. What's unique about this camera is that it has a very small footprint and actually allows the patient to be imaged sitting up. Being imaged Sitting up is much more comfortable than having to lie flat and still for 10 or 15 minutes. During imaging with this camera, they also don't have to hold their hands above their heads. These cameras are very quick and in most patients, we can finish imaging in 3 to 5 minutes in comparison to the traditional cameras where imaging takes between 10 and 15 minutes. We can also use smaller amounts of the radioactive dye and therefore is associated with a smaller radiation dose to patients.
Can you give me an example of how much less dye the patients get?
Dr. Soman: Traditional imaging can be associated with 10 or 12 millisievert, that's the units in which we measure radioactivity to the patients. With the new cameras, we can either make imaging very quick and keep the radiation dose the same, or we can reduce the radiation dose and keep the time of imaging the same. We can reduce radiation dose to less than 2 millisievert.
Who's the best candidate for this kind of imaging as opposed to the traditional?
Dr. Soman: Patients who find it difficult to lie flat for a long period of time or lie still for a long period of time. Also, patients who find it difficult to hold their hands above their head for long periods of time and definitely patients with claustrophobia. We've had several patients who we had been unable to image until we acquired one of these new cameras.
Is this is a better diagnostic tool?
Dr. Soman: The traditional camera still produces very good pictures and we get a lot of information, but the new camera is much more comfortable, quicker, and can be associated with a lower radiation dose.
Is this covered by insurance?
Dr. Soman: Yes. Insurance does not differentiate between the traditional way of performing the test and the new cameras.
In terms of the radioactive dye that you were talking about, is this still a safe technology?
Dr. Soman: Yes, it's very safe. As you know, there's radiation everywhere. We get background radiation from the earth, just for the privilege of living on this planet. You take a transatlantic flight, you get radiation. Astronauts who live for prolonged periods of time in space, get radiation. Smoking produces far more radiation to the lungs and the airways then you will get from any type of diagnostic medical imaging. But, that's not to say that we shouldn't be careful. The best way to be careful is to make sure that patients are appropriately chosen for testing and that we test them only when they need to be tested, using the best possible methods
For most patients, is it still to their benefit to use the traditional method of imaging as opposed to the D-SPECT?
Dr. Soman: The traditional camera still produces very good images and that is what is done in most of the country and most parts of the world. If a new camera is available, then that makes the test more comfortable and easier for the patient.
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.