The 64-slice CT scanner at HUP is now being used by the emergency department (ED) and could prove to be an effective tool in giving quick results to physicians – so they can identify the 15% of patients whose chest pain is being caused by heart disease (and, conversely, weed out the other 85% of presenting patients who visit hospital emergency rooms each year complaining of chest pains. Patients who are eventually found not to have heart and coronary diseases.) An estimated 3,000 patients a year come into the HUP ER with chest pains. Nationwide, that number is about 5 million.
The new multi-slice CT scan – which supplies experts with an exquisitely detailed 3-D image of the heart by utilizing unparalleled resolution and speed – was recently featured in a front-page article in Time Magazine (Sept. 5th issue). Multi-slice CT is a new application of computed tomography technology, which can look at the coronary arteries as well as actual heart function, helping doctors to identify problems without invasive diagnostic procedures. The 64-slice CT scanner at HUP is the fastest available in the world at this point.
HUP is gearing-up for a clinical study to see just how useful this technology in the ED would be… making HUP one of only a very few emergency departments in the entire country utilizing multi-slice CT in this manner. Only certain patients may benefit from or qualify for use of the multi-slice CT scan in the ED – namely, those determined to have a low risk of heart disease. Physicians caution further investigation of this application will be needed before it can be more widely applied.
"Normally, when a patient comes into the ED complaining of chest pain, an EKG is performed, blood tests are done, the pain is treated and then the patient is admitted to the hospital for further testing to make sure they are not having a heart attack," explains Harold Litt, MD, PhD, Chief of Cardiovascular Imaging in Radiology at HUP. "But now, after assessing the likelihood that it's actually coronary artery disease causing the chest pain -- based on family history and other factors -- low-risk patients can have this CT scan quickly, and within two to three hours of arriving in the ED, we can tell whether or not the patient has coronary disease and needs to stay in the hospital or if he can be sent home. The test itself takes only about five minutes, and can also show us many causes of chest pain not related to the heart."
"In the end, we hope to find patients that we can send home right away… because nearly 85 percent don't have ischemic coronary artery disease," said Judd Hollander, MD, the emergency medicine physician leading the study at HUP. "This is useful to Emergency Department physicians to find the 15 percent who actually do."
William Baxt, MD, Chair of the Department of Emergency Medicine at Penn, adds, "This utilization of multi-slice CT in the ED may help us catch the patients who we might have initially thought were safe to go home, but they're not. They need further treatment and observation for heart disease."
Dr. Baxt further explains, "On the other side, this potentially could save society vast amounts of money by foregoing unnecessary admission into hospitals for further testing. Also, more beds as well as emergency medicine personnel would be available to treat the really ill patients who need care."
Editor's Notes: The media is welcome to come photograph or videotape the 64-slice CT scanner, as well as reconstructed 3-D images, at HUP. Also, Drs. Harold Litt, Judd Hollander and William Baxt are available for interviews. Please arrange photos and interviews through Susanne Hartman at 215-349-5964 or susanne.hartman@uphs.upenn.edu.
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