WellSpan Health steps into the future with spectral CT
Customer story ∙ By Philips Healthcare ∙ Featuring WellSpan Health ∙ Jul 06, 2021 ∙ 10 min read
When it was time to upgrade an aging fleet of CT imaging equipment, Dr. Edward Steiner, MD, FACR, Chairman of Imaging and Radiation Oncology of WellSpan Health integrated delivery network in central Pennsylvania, turned to Philips spectral-based CT systems to elevate their imaging quality and patient experience. In this customer story, you will learn how the transition resulted in improved workflow efficiency, image accuracy and cost savings.
WellSpan Health is an eight-hospital IDN made up of 2,600 physicians and advanced practice providers and includes the region’s only accredited Level One Trauma and Stroke Center. When Edward Steiner, MD, FACR, joined WellSpan four years ago as Chairman of Imaging and Radiation Oncology, he knew the imaging equipment could not support the health system’s mission to deliver exceptional care for all.
Over a two-year period Dr. Steiner and the WellSpan team worked with many vendors to chart the best path forward, and eventually decided to collaborate with Philips to install a fleet of 12 cutting-edge spectral detector CT scanners for its imaging and radiation oncology departments.
“I really believe in spectral technology. I think it is the way to go. And I think that in this day and age, if you don’t buy a spectral CT, you’re not thinking of the future."
Edward Steiner, MD, FACR Chairman of Imaging and Radiation Oncology, WellSpan York Hospital
A closer look at spectral CT
Spectral CT uses two separate x-ray photon energy spectra to visualize tissue composition to allow for the interrogation of materials that have different attenuation properties at different energies. “Spectral CT is the way to visualize tissue composition, not only attenuation, but actual tissue composition. If we can determine the amount of iodine in tissue that’s enhancing – if we can subtract the iodine – and if we can manipulate fatty tissues, we really are ahead of the game in diagnosis,” says Dr. Steiner.
Conventional CT
Spectral CT
With spectral CT, conventional CT images are paired with layers of spectral results in the same scan, allowing what was once invisible or not diagnosable to now being both visible and diagnostic. These spectral layers include:
Improved clinical confidence with Philips spectral CT
There are three ways to obtain spectral data and multiple ways to process it. According to Dr. Steiner, this means that choosing the right approach to fit your workflow and clinical needs is crucial. “My approach was very scientific,” he said. “I went to our physicists and we looked at all the vendors and at spectral separation. I looked at temporal cohesion, and then lined them up to see what each vendor had to offer in terms of hardcore physics data. Then, we looked at how the data is processed and how we were going to do it in York.”
Spectral CT can be accomplished utilizing three different methods. One is dual source DECT, where two X-ray tubes at different energy outputs with a dedicated detector and the computer overlays two images. The second method is kVp switching, in which the spectral tube is rapidly switching energy levels that are caught by a single detector. The third option is the Philips approach, where a single detector is simultaneously capturing and distinguishing high and low photon energy.
The WellSpan team chose to collaborate with Philips to standardize on spectral detector CT because the Philips spectral results are always on. There is no need to compromise or predetermine which patients would need spectral imaging for diagnosis. The team also appreciated how technician-friendly Philips spectral CT is and that it doesn’t require dedicated spectral protocols or add additional radiation doses, so there was no change to the team’s existing workflow. The detector technology allowed for true temporal cohesion and the data integrated into their radiologist workflow without causing data overload.
“With dual source CT and kVp switching, you have to pick which patients are going to be scanned in spectral mode initially. With the [Philips] system, which is a detector-based system, it’s always on. There is nothing to pick."
Edward Steiner, MD, FACR Chairman of Imaging and Radiation Oncology, WellSpan York Hospital
See what you've been missing
Computed tomography, or CT, is often the go-to imaging modality for a wide range of clinical indications. Conventional CT images are not always able to provide clinicians with the answers they need, and this can result in indeterminate findings, poor visualization of tissue, and the need for repeat scans or alternative modalities such as MR.
Spectral CT helps provide additional clinical enhancement when you need to drill deeper to diagnose a patient, or if you are dealing with exam types that are typically difficult to accomplish with traditional CT, such as renal cysts.
With spectral CT you can complete full studies with under 50 cc’s of contrast for patients with renal failure, helping protect the kidneys. Combined with Philips proprietary Magic Glass, spectral CT enables instantaneous and simultaneous viewing of up to five different spectral results by opening a mini browser within the radiologists’ own ACS system. This simplifies use and interpretation of spectral results, and integrates it into established workflow without data overload and improving time to confident diagnosis.
Improved contrast for better visualization in difficult cases
“Renal cysts are a problem if they contain malignancy. They may be 100% curable when they are small nodules,” says Dr. Steiner. “It is an example of a case where you ask what am I missing by not using spectral CT? When you integrate [a conventional study] with Magic Glass, you have a secondary window and can see virtual non-contrast. [You] pull the contrast up and see its hypo-dense, but it’s not calcified. When you further manipulate the image with a push of the button, the mono-E shows you a beautiful enhancing nodule.”
"Precision diagnostics’ is a great name for technology that answers the question the first time without re-scanning, without going to MRI, without having to redo the study."
Edward Steiner, MD, FACR Chairman of Imaging and Radiation Oncology, WellSpan York Hospital
With spectral CT you have the ability to not only bring virtual non-contrast (VNC) study to make sure there is no calcification, but also with iodine overlay or iodine density to quantify the degree of enhancement characterizing a lesion which would be highly suspect for carcinoma. Therefore there is no need for a costly MRI and delaying the diagnosis.
Spectral CT’s improved contrast provides better visualization in other difficult cases as well, including PE visualization in large BMI and hyperdynamic patients and detecting bowel ischemia and tumor vascularity. This enhanced visualization improves characterization of GI bleeds, helps facilitate better coronary studies and can eliminate the need for MR to define acute verses chronic fractures in patients with spinal trauma.
A lower cost of care
According to the Journal of the American College of Radiology (JACR), dual-energy CT may benefit patient care and decrease institutional cost by decreasing follow-up exams due to incomplete diagnosis and decreasing recommendations for follow-up MRI.1 The ability to get the right diagnosis the first time can also facilitate faster discharges and reduce potential damages from missed-diagnosis lawsuits.
Benefits achieved at WellSpan Health
Conclusion
WellSpan Health is paving the way in the future of spectral CT standardization and, as Dr. Steiner says, “It’s more than just pretty images, it’s true results.” This project has helped the WellSpan Hospital system by improving contrast and reducing iodine doses for patients. It has helped decrease utilization of follow-up studies, improved triage, discharges, and patient flow and has helped improve time to diagnosis.*
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Footnotes
Results from case studies are not predictive of results in other cases. Results in other cases may vary. [1] https://www.jacr.org/article/S1546-1440(20)30006-5/abstract
