Inside Duke Medicine

CT: Teamwork and technology in action

The CT Radiologic Technologists Team is pictured, left to right, in front of a new 64-slice CT scanner. 1st row: Lori Davis, Heidi Everitt, Keith Payton, Linda Rubeor, Ray Bowman, David Whitney and Al Moore. 2nd row: Kevin Brogan, Irving Arnold, Shakeel Ahmad and Brian McDonald. Not pictured: Brian Cook, Tina Cozart, Amanda Fisher, Abie Jeffries, James Korol, Erin Trella and Kristin Womble.

Mr. Jones enters the Emergency Department (ED) in the early morning because his right foot has turned blue. To determine why this has happened, the ED sends Mr. Jones to the Radiology Department for a CT scan. This is when two certified radiologic technologists in Computed Tomography (CT) become involved.

They prepare the room and discuss the procedure with Mr. Jones so he is aware of what to expect. Using only a normal peripheral antecubital IV (which reduces the risk of complications related to intravenous), the team performs a CT scan of the abdominal aorta with femoral artery run-off.

The CT scan takes approximately 20 minutes to complete, and the result is a crisp digital 3-D image of the aorta and the blood vessels in Mr. Jones’ legs to his ankles.

A CT radiologist interprets the CT scan in the Picture Archiving and Communication System (PACS). The scan reveals a stenosis (narrowing of the blood vessel) in the right leg. The CT radiologist immediately consults with the interventional vascular radiologist and determines that Mr. Jones needs a femoral stent to open up the blood flow to his foot.

Mr. Jones is quickly transferred to the new digital Interventional Vascular Lab (also in the Radiology Department). The team of specialized radiologic technologists and the interventional radiologist who staff the lab place the femoral stent. Once the stent
is placed, the patient has immediate blood flow in the femoral artery. Within the hour, Mr. Jones’ foot returns to normal.

“Our patient was held overnight in the hospital for observation and released to go home the next morning. His foot was saved all within the Radiology Department without needing to be transferred for surgery,” says Greg Thon, Radiology director.

Mr. Jones had a great outcome, and his story is one of hundreds that occur in Durham Regional Hospital Radiology Department each week. For every one of these outcomes, precision, accuracy and speed are critical to the team’s success.

Radiologic technologists work around-the-clock throughout Radiology to meet the needs of both outpatients, inpatients and patients presenting to the ED. The CT team consists of 18 full and part time radiologic technologists who perform approximately  24,000 studies a year. The CT team is available 365 days a year, 24 hours a day.

Like many divisions in Radiology, CT has recently completed major renovations and new equipment installations in the past year. The two new (CT) scanners allow radiologists to image the heart, brain or lungs in only a few seconds. One of the capabilities of the 64-slice CT scanners is CT angiography. Requiring an injection of X-ray contrast through an IV placed in the arm, the 64-slice CT angiography’s speed and resolution allow physicians to view even the smallest arteries in the brain, heart and peripheral vascular system.

This advanced technology offers patients benefits over traditional angiography.

Benefits of the new CT Scanners are:

• The exam takes only 15 to 30 minutes.
• There is no recovery time. Patients can leave as soon as their exam is complete.
• There are fewer risks. Since an arterial puncture isn’t required, patients have a reduced risk for complications.

With the 64-slice CT scan, physicians also can perform CT brain perfusion studies to evaluate blood flow to the brain in potential stroke patients. The 64-slice CT scan also is used in conjunction with the Vascular Lab to image vessels in the legs to look for deep vein thrombosis or blood clots.

David Whitney, CT scan supervisor, says the quality of the images for routine scans is also greatly improved, there is a lower radiation dose than most other equivalent 64 slice scanners and a new table is equipped to support patients weighing up to 660 pounds.

Whitney believes that even more important than the new technology, is the team of radiology technologists who staff CT. “We have an excellent team of highly-trained experienced technologists who are able to provide a level of care in a community hospital setting that is difficult to achieve elsewhere. The compassionate care is beyond anything I’ve experienced in my career,” he says

Radiology at a Glance

The Radiology team provides a full range of diagnostic services, including general X-ray, Bone Mineral Density Testing, Mammograms, Ultrasounds, Radiation Oncology, CT Scans, MRIs, Nuclear Medicine and Interventional Vascular Radiology. This team includes radiologists, certified registered radiologic technologists, Radiology nursing staff, support staff and administration.

In addition to CT, several additional Radiology divisions were recently upgraded. These include:

• The Interventional Vascular suite was renovated earlier this year to include an all-digital system for improving the image resolution, efficiencies, capabilities and cost effectiveness of the department. The suite can handle the full spectrum of interventional radiology procedures.
• Full scale digital mammography opened in Fall 2009. This mammography technique uses digital images instead of film x-rays to screen for breast cancer. Digital mammography allows improvement in image resolution and specificity, storage and transmission because images can be stored and sent electronically.

Most procedures are now faster with more capabilities and expanded times of operation. Patients can usually schedule a same-day appointment for most Radiology procedures. Scheduling an appointment is convenient by simply calling 470-5251