In the last five years, the demand for advanced medical imaging and image-guided procedures has increased dramatically across the University of Michigan Health System, as doctors of all kinds harness the power of imaging to diagnose and treat a broad range of medical problems in adults and children.
Now, with today's approval by the U-M Board of Regents, UMHS will launch a $42.9 million expansion of its facilities for medical imaging and image-guided procedures.
By the time the projects are completed in late 2008 and early 2009, the expansion will give many more patients faster access to UMHS radiology services, including some services available at few other medical centers across the country. It will also allow U-M radiologists to continue developing new techniques as part of a nationally known research program.
Today, the Regents approved $32.7 million worth of radiology facilities, including CT and MRI, interventional radiology and breast imaging. The projects will be funded entirely from U-M Hospitals and Health Centers reserves, without direct funding from the state or the University's general fund. The additional scanners will also need approval from the State of Michigan's Certificate of Need committee.
The new projects join one that was approved by the Regents in July: a $10.2 million plan to move nuclear cardiology facilities from University Hospital to the new U-M Cardiovascular Center.
The projects approved today include a major expansion of facilities for interventional neuroradiology, a kind of brain surgery without surgery. This technique allows doctors to see and repair the tiniest blood vessels in the brain and spine, giving them the ability to treat strokes, aneurysms, blood-vessel malformations and more. Three new suites for such minimally invasive procedures are proposed, up from one dedicated and one part-time suite currently in use.
Also approved today are two new CT (computed tomography) scanners and one new MRI (magnetic resonance imaging) scanner in University Hospital, and a breast-imaging and stereotactic biopsy area in the Comprehensive Cancer Center.
"We're investing in capital equipment projects that will allow us to stay on the cutting edge of rapidly evolving medical technology, improve patient access, and advance our researchers' studies of new imaging techniques," says N. Reed Dunnick, M.D., the Fred Jenner Hodges Professor and chair of the Department of Radiology. "The expansions will help us respond to the growing demand for imaging and interventional procedures, and be ready for further growth in coming years."
In the last decade, imaging has replaced many exploratory operations that carry a much higher risk for patients. And interventional image-guided procedures have become viable alternatives to open surgeries for many patients, including those who have been told that their problem is inoperable.
The projects brought before the Regents are:
Interventional Neuroradiology and CT: This project, on level B1 of University Hospital, will renovate 6,600 square feet of space previously occupied by cardiology services. The total cost of $21.1 million includes renovations and the creation of three new treatment suites including two biplane neurointerventional rooms and a multipurpose room for spinal procedures. If approved, one of the interventional suites will include a hybrid system combining a CT scanner as well as biplane imaging - the first of its kind in the country and a major advance for treating some conditions.
Every year for the past four years, the number of interventional neuroradiology procedures has increased by 15 percent at UMHS. These procedures allow specially trained U-M radiologists and neurosurgeons to diagnose and treat a broad variety of problems related to the blood vessels and other structures of the brain and spine, both on elective and emergency basis.
By inserting a thin flexible tube called a catheter into the bloodstream via a small groin incision, specialists can use an X-ray technique called fluoroscopy to guide them as they thread their way up to the area of the brain or spine where a problem is suspected or known to exist. Then, they can open blockages, inject clot-busting drugs, fill up and close off aneurysms with platinum coils, and treat vascular malformations of the brain and the spinal cord.
Recent advances allow physicians to treat patients with previously inoperable AVMs (arterio-venous malformations), fistulas and many types of aneurysms that can result in catastrophic brain hemorrhages. New techniques have extended the time window for treatment of "blockage" (ischemic) strokes beyond the traditional three hours, by allowing doctors to inject clot-busting medicine directly into the area of the blockage or, in some cases, to pull the clot out of the vessels. U-M researchers are now working on a new approach that allows precise localization of tiniest vascular malformations and tumors deep in the brain, by combining the benefits of arterial catheter injections with very high resolution CT images to help guide surgeons and radiation oncologists.
Meanwhile, the two new 64-slice CT scanners will allow further expansion of U-M's extensive program in using these X-ray-based machines to image the heart, internal organs, muscles and bones in great detail. U-M researchers are currently conducting many CT-based studies, including one testing whether CT heart imaging might replace some catheter-based diagnostic procedures.
Nuclear Cardiology: This $10.2 million project, approved by the Regents in July, will allow heart patients to receive their treadmill stress tests and other nuclear-medicine exams in the new U-M Cardiovascular Center, closer to where their doctor's appointments and other tests are located. The new facility will be located on CVC level 1, in approximately 15,000 square feet of currently empty "shell" space.
U-M is a national leader in nuclear cardiology, which uses short-lived radioactive tracers such as technetium-99m Cardiolite and Myoview to create images that show how well blood is flowing to the heart muscle through the coronary arteries, whether there are blockages in those arteries that might need treatment, or how well the heart's chambers are functioning as they pump blood to the lungs and other vital body organs.
Often, this kind of imaging is done in patients who have experienced chest pain, heart attacks or a heart-rhythm irregularity, but at U-M it is also used to track the progress of patients who have received advance heart-assisting implanted devices. Nuclear cardiology stress imaging is usually performed after a patient exercises on a treadmill or receives an injection of a drug that substitutes for exercise in "stressing" the heart.
U-M had the world's first SPECT/CT machines that combined the SPECT (single photo emission computed tomography) camera that detects the movement and distribution of the radiotracers in the heart, together with a diagnostic-quality CT machine that lets doctors see exactly where in the heart the tracer is concentrating. This gives more precise information and may even allow patients to be spared a second scan while at rest. The new location will include SPECT/CT machines in three of the four nuclear cardiology imaging rooms, and other facilities. One SPECT/CT system will remain in University Hospital for non-cardiac use.
Magnetic resonance imaging: MRI has become important for imaging all parts of the body, to diagnose disease, plan operations, track the effect of treatment, and more. This project, on level B2 of University Hospital, will add one more MRI machine to the four currently located there. The new scanner will have a magnetic field strength of 1.5 to 3 Tesla, meaning that it may be able to be "ramped up" to stronger field strength in the future. The project also includes funds to complete an office suite for MRI staff, and to add one more reading room where physicians can interpret MRI images. The total cost is $8 million, including equipment and renovation of 6,000 square feet.
The new scanner will join University Hospital's two 1.5T scanners and one 3T scanner currently used for clinical care, and a 3T scanner entirely dedicated to disease-related research by doctors and scientists from all parts of U-M. UMHS also has a 1.5T scanner at C.S. Mott Children's Hospital, and two 1.5T scanners at the East Medical Campus.
U-M researchers have been leaders in developing a technique called diffusion tensor MRI, which can track the effects of cancer treatment by looking for changes in the cells of cancerous tumors. U-M studies have shown the technique to be effective in tracking brain tumor treatment-response, and it is now being tested in other forms of cancer and cancer metastases.
Breast Imaging: This $3.6 million project will renovate 2,400 square feet on level B2 of the Cancer Center, to expand the existing breast-imaging facilities there and to support the addition of stereotactic biopsy and breast ultrasound.
Written by Kara Gavin