BLOG: Why Advanced Imaging Is Critical in Rural Health

People who live in rural America may deserve the same quality healthcare as anyone living in the U.S., but it is not always immediately available.

据《美国医学杂志》报道，至少有三分之一的美国急诊部门可能无法使用核磁共振成像(MRI)American College of Radiology. Emergencies atWest Feliciana Parish Hospital, however, do. This rural health center with 12 inpatient beds and an emergency room also has access to a 128-slice computed tomography (CT) scanner.

Combined the two scanners “provide imaging services that other rural hospitals aren’t typically able to do,” saidDakisha B. Robertson, the hospital’s imaging department manager. Among them is cardiac scanning, which is possible on both theEchelon Oval 1.5T MR systemand theScenaria CT. Cardiac scanning with these two modalities represents a growth area that the hospital is currently trying to capitalize on, Robertson said.

For the most part, the imaging department fills available slots with routine cases, averaging as many as seven patients daily on its MRI and up to 10 per day on its CT. Patient volume in each modality has increased, she said, since the two scanners began operating in 2017. (Prior to their acquisition, the hospital offered MRI one day per week as part of a mobile service; the Scenaria CT replaced an obsolete scanner, installed years earlier.)

Balancing Routine and Advanced Imaging

Versatility is critically important, saidJohn Waddell, the company’s senior vice president of sales and marketing atHitachi Healthcare Americas, which makes the Echelon Oval and Scenaria. Systems operating at rural facilities must be able to handle everyday cases, as well as complex ones, he noted. That’s why Hitachi struck a licensing deal with Agfa for itsDR 800, a combined digital radiography and fluoroscopy system.

Waddell说:“对于农村社区医院等设施来说，拥有一间可以在高正常运行时间下进行DR和fluoro的通用病房是一项真正的优势。”

Similarly, offering modalities such as MRI and CT makes sense for these facilities, Robertson said: “A lot of people like to stay within their community so we try to add the specialties and services to accommodate them so they won’t have to go far.”

OGH Imagingis located in Grand Coteau, Louisiana, population around 1000. The outpatient imaging center is 10 miles north of Lafayette in the rural area of St. Landry Parish. Despite its location, the center aspires to be a top-level provider of imaging.

“We are off the beaten path, but we really pride ourselves on having the latest technology and capabilities,” said center directorDavid Rushing他指出，OGH Imaging提供1.5T MRI扫描仪，其中一种是宽口径Echelon Oval扫描仪。该中心还提供CT、乳房x线摄影、数字放射摄影、透视和超声检查。他说:“在城市地区，我们可以与任何人竞争。”

With a wide bore measuring 75 cm in diameter, the center’s compactSupria CTproduces high-quality images at radiation doses below those recommended by the American College of Radiology (ACR), according to Rushing. The scanner installed four years ago at OGH Imaging generates 16 slices per subsecond rotation. Data are processed using a 3-D reconstruction algorithm that produces high image quality images with minimal artifact.

Scarcities In Rural America

Advanced imaging capabilities, such as those at West Feliciana Parish Hospital, are scarce in rural America. In an article published September 2014 in theACR journal, CT was found to be present in just slightly more than half (56%) of all critical access hospitals (CAHs) in each of the nation’s states.

The ACR estimates that about 60 million of the 320 million people living in the U.S. receive health care at critical access hospitals. Many are elderly, as is the majority who use Republic County Hospital. Most of these patients are drawn from the small town of Belleville, Kansas, and surrounding counties. Total residency is about 5,000, according to David-Paul Cavazos, CEO of Republic County Hospital, which is formally recognized as a CAH.

The voluntaryCAH status，这赋予了报销优势，很难实现。它要求医院的急症护理住院床位不超过25张;全天及全年提供紧急服务;并能提供病人停留时间等于或小于96小时。这些医院通常距离其他医院35英里或更远;几乎所有这些都在农村社区。

“We are a rural hospital but I would not consider us remote or frontier,” Cavazos said, refuting the myth that rural hospitals necessarily operate in the middle of nowhere. Republic County Hospital is one of a few hospitals in the surrounding area to offer advanced imaging capabilities. Itoperatesa high-end ultrasound scanner, digital radiography, mammography, nuclear medicine, CT and MRI. (Cavazos noted, however, that MRI is available through a mobile service provider, although the hospital is now looking into installing an MRI scanner on-site.)

“We have to be everything to everybody out here,” he said.

这很难做到。According to the 2014 study published in theACRjournal, in no states in the nation did all CAHs provide CTs with at least 64 slices per rotation, MRI, and nuclear medicine services provided through single photon emission CT (SPECT) and PET/CT. The authors concluded that an overall scarcity of access to imaging services exists at CAHs throughout the U.S. Hitachi, whose marketing focuses on rural providers, is trying to do something about this.

“日立视农村医疗保健为美国的面包和黄油，”该公司放射产品执行董事杰森·米勒(Jason Miller)说。他指出，医疗机构往往是农村地区最大的雇主。为了保持这种突出地位，“他们希望提供大型医疗中心所提供的先进技术，这样他们就不必把病人送到很远的地方，以获得高水平的护理。”

It is vital, therefore, that units installed at these rural medical centers be reliable, Miller said, because “These facilities are counting on them.” That means on-site staff training and service must keep equipment “running at peak performance at all times.”

Reliability and uptime were key considerations when Louisiana-based OGH Imaging purchased its Hitachi-made MRI and CT scanners, according to Rushing. Staff availability is critically important to their prime operation, he said. About a half dozen technologists at OGH Imaging are cross trained on both the Echelon Oval MRI and Supria CT.

Because technologists need to be skilled in the use of the equipment, Hitachi offers unlimited on-site training, according to Hitachi SVP Waddell.

在服务方面，日立利用远程诊断保持在安装设备的顶部。米勒说，这使得许多问题在“发生”之前就能被预测和解决。

Ones that can’t be fixed remotely are solved in person by engineers who understand the problem and bring with them any parts needed to do the repairs — all thanks to remote diagnostics, he said.

U.S. residents deserve high-quality health care, no matter where they live, said West Feliciana’s Robertson, a sentiment echoed by other rural providers and Hitachi executives alike.

Greg Freiherr is a contributing editor to Imaging Technology News. Over the past three decades, he has served as business and technology editor for publications in medical imaging, as well as consulted for vendors, professional organizations, academia, and financial institutions.

编者注:本博客是关于美国农村医疗的四部分系列中的最后一部分。The first blog,Rural Imaging Requires Affordable And Versatile Equipment, can be foundhere. The second blog,Clinical Demands in Rural America Call for Advanced Imaging, can be foundhere. The third blog,How Clinical Versatility Helps Small Town and Rural Patients, can be foundhere.

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Rural Imaging Requires Affordable And Versatile Equipment

Clinical Demands in Rural America Call for Advanced Imaging

About Rural Health in America

How Clinical Versatility Helps Small Town and Rural Patients