News Column

Pictures of pathology: 3-D medical images improve local health care

May 25, 2014

By Courtenay Edelhart, The Bakersfield Californian

May 25--Shortly after a very pregnant Joanne McCain bared her swollen belly for Baby Sightings sonographer Cherry Hernandez, the image of a fetus emerged on a large, flat-screen monitor.

It wasn't the grainy, black and white ultrasound most mothers-to-be are used to. The gold, three-dimensional image on the screen offered so clear a picture that, at 30 weeks along, the baby's hair and facial features were visible.

"Poor little guy's got my chin," lamented McCain's fiance, Frank Amestoy. "He's going to have to have braces for, like, five years."

McCain dabbed her eye. "He's got your nose, too," she said.

And most important, her future son --boy bits also were clear -- had fingers and toes. No small thing for McCain, whose now 16-year-old daughter was born minus her left foot and most of her fingers due to amniotic band syndrome.

Medical imaging has advanced exponentially in recent years, improving diagnosis and treatment in every discipline from prenatal care to geriatrics. As a result, Bakersfield is enjoying a flood of new technologies allowing doctors to see inside the body like never before.

On the prenatal front, several places have sprouted offering elective ultrasounds of fetuses in either 3-D (still pictures) or 4-D (videos), including Baby Sightings, Baby Glimpses and Baby's First Photos.

Bakersfield Memorial Hospital earlier this year hired the county's first neuro-interventionalist, and he's begun using 3-D images to diagnose and plan treatment for brain aneurysms, abnormal connections between arteries and veins, and other anomalies.

Bakersfield Heart Hospital just got new equipment allowing it to do two different types of 3-D echocardiograms, which obtain images using ultrasound waves. Central Cardiology Medical Clinic uses cardiac computed tomography, or CT, technology to obtain detailed X-ray pictures in 3-D.

And in January, Quest Imaging began offering 3-D mammography for breast cancer screening.

All this technology means Kern County patients don't have to leave town for many procedures previously unavailable locally.


Advances in imaging have revolutionized the way illnesses are treated.

In years past, investigating doctors had to rely on two-dimensional images that were hard to read. Or, worse, they conducted exploratory surgery to figure out what was going on.

Better 3-D and 4-D imaging tools mean many of those exploratory surgeries are no longer necessary, or if surgery can't be avoided, it can be done more strategically.

"With a more comprehensive imaging study using 3-D and 4-D, when surgical intervention is necessary, it can be done much more precisely to spare healthy surrounding tissue," said Brenda Izzi, chief administrative officer and head of radiology at UCLA Health System.

That's especially important when a physician is looking at something tiny.

"The blood vessels in the head are much smaller and more delicate than blood vessels elsewhere in the body, so there's little room for error if you're navigating through those vessels with a catheter," said Dr. Kiron Thomas, Bakersfield Memorial's new neuro-interventionalist.

Cutting edge imaging technologies have been around for a while at research institutions and big city hospitals and clinics, but the most sophisticated of them are only now filtering down to smaller health care markets such as Bakersfield.

Bakersfield Heart Hospital interventional cardiologist Dr. Sarabjeet Singh said he lobbied hard for updated imaging equipment after arriving here from Los Angeles and finding most of the hospitals in town were years behind in their technology.

"There was a lot of resistance to it at facilities here because it's expensive and insurers and Medicare don't pay you anything extra for it, but it's so much better for the patients," Singh said.

He's banking on an increase in patients generating enough revenue to justify the investment. Depending on the type of device, the purchase price of 3-D imaging equipment can be upward of $1 million.

Quest Imaging isn't charging mammography patients any more for 3-D images for now, but that may change at some point.

Quest radiologist Dr. James Cusator said it only takes two or three minutes longer to obtain a 3-D image of the breast, but the resulting picture is vastly superior.

"The detail is just fantastic," he said.

Three-dimensional pictures generate fewer false positives and stressful call backs for patients, Cusator said. Conversely, they catch tumors and other pathology sooner.

Since two new machines went online at Quest this year, they have detected six cases of breast cancer that Cusator is sure would not have been picked up with a conventional mammogram.

"Obviously, the earlier we can find cancer, the better our chances of curing it," he said.

That could help hold down health care costs.

On the other hand, as each piece of expensive new equipment has entered the market, it has put pressure on competitors to acquire something comparable or better, contributing to an arms race of sorts.

The heart hospital's Singh said that's a good thing.

"It upgrades health care for the whole city," he said. "These are the new standard of care, these top-of-the-line devices."

It's certainly been good for mom-to-be McCain, who said she's much more at ease with her pregnancy than she would have been without 3-D ultrasound.

"We would have loved this baby, anyway," she said. "But it's nice to know."


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Source: Bakersfield Californian, The (CA)