Welcome to the February 2011 issue of the Cone Connection - your source for medical imaging news, product information and Cone promotions.

With the increased population of bariatric patients, many aspects of medical imaging are affected - from equipment and imaging techniques to overall safety and staff protocol. We briefly touch on some of the key issues your facility should address to serve this patient population.

Our promotion of the month is the new Protex Wipes - handy towelettes to keep on hand to fight many harmful pathogens. For a limited time, buy 10 packs and get 2 free! This month, we're also highlighting a new, portable blanket warmer - ideal for smaller facilities on a budget.

Thanks for being a valued Cone Instruments customer. We appreciate your business and look forward to being your source for medical imaging supplies, in 2011 and beyond.

Over the past decade, obesity has become recognized as a national health threat and a major public health challenge. According to the CDC, in 2007/2008, approximately 72.5 million adults in the United States were obese. The obese patient population faces an increased risk for many serious health conditions ranging from diabetes to heart disease. With this increased risk comes increased health care.

In recent years, the rising popularity of bariatric surgery has brought more patients to imaging centers as well, because imaging is frequently used to confirm the placement of gastric bands.

Changes to your facility’s equipment, imaging procedures, staff training and facility protocols can help you stay ahead of the curve of increasing demand, while assuring patients of all sizes are properly cared for.

Imaging facilities are finding that an increasing number of patients do not fit the imaging equipment suited for "average-sized" patients, and manufacturers have responded accordingly by offering equipment with increased size and weight limits.

GE Healthcare, Philips, Siemens, Toshiba and other major manufacturers all offer large bore CTs with a gantry aperture of 80 cm or more. This allows all patients to be optimally positioned, regardless of patient size or the use of positioning aids. And while the bore size has increased, the CT technology to accommodate the bariatric community has kept pace as well. The Siemens SOMATOM Sensation Open obtains up to 40 slices per rotation and allows visualization of the smallest anatomical structures with the industry’s highest routine isotropic resolution of below 0.4 mm. In a 1,000 patient study, the SOMATOM Sensation Open achieved up to a 68% dose reduction with the use of an automated dose management system

The same industry trends are happening in the MRI suite. Hitachi Medical Systems offers the Oasis Bore-less High-field MRI designed specifically to overcome bariatric imaging challenges. The system includes an 82 cm wide patient table, a large flexible body coil (190 cm) and a weight limit of 660 lbs.

The newest generation of x-ray systems offers the increased kVp and mAs needed to penetrate thicker tissue. Many newer x-ray systems also offer a higher heat capacity on the x-ray tube, because it may run at high levels for a long period of time.

Imaging table manufacturers also have increased the weight limits on their tables. Biodex offers ultrasound and echo specific imaging tables with weight loads of 500 lbs, with weight testing up to 4 times the patient load rating.

Assuming the equipment accomodates the obese patient, radiologists and technologists still face challenges when it comes to obtaining useful images. The attenuation property of human tissue typically becomes a factor in patients weighing 250 lbs. Thick layers of fat are barriers to beam penetration, resulting in poor image quality for diagnosis and treatment.

The newer equipment for CT, MRI and X-ray have addressed the problems faced when imaging bariatric patients, to include increased KVp and MAs (CT), larger bore size (MRI), etc.

However, ultrasound sonographers still face issues when performing an imaging procedure on a bariatric patient. Because of the amount of beam degredation, ultrasound is the modality most affected by the increase of obese patients. Since ultrasound energy is most attenuated by fat at high frequency, experts recommend reducing the transducer frequency to as low as 1 or 2 MHz. This allows the ultrasound beam to better penetrate tissues and target abnormalities. Pushing the probe deeper into the skin is another common technique for improving exam quality as this decreases the target depth.

Obese people often shy away from doctors and hospitals because they are afraid of being embarrassed by medical workers or their surroundings. To combat this, staff should be required to attend bariatric sensitivity training. Practicing different patient interaction scenarios will help ensure they recognize appropriate language and behavior.

Many facilities struggle with workflow issues due to technologist’s lack of knowledge regarding equipment limits. Because of this, every CT or MR room should have explicit instructions as to the maximum load for that scanner. You don’t want to risk scheduling a patient for an imaging procedure, only to turn them away due to equipment limitations.

Because of the difficulty in handling large patients, workplace injuries are another potential problem clinical personnel face. Five documented employee injuries resulted when one 500-lb man spent several weeks at a Kaiser Permanente Hospital in Fresno, CA in 2000. Ensure your facility sets guidelines as to the appropriate way to transfer a patient on/off a bed, in/out of imaging scanner, lift from a laying-on-the-floor position, etc.

This highlights just a few of the changes facilities and medical personnel need to make to keep up with the increasing demand from this patient population.

While you know that Cone is your ultimate supplier for imaging supplies, did you know we also offer bariatric accessories? We offer transport aids, wheelchairs, scales, hygiene equipment and more to outfit your department.

Don’t see something you need? We’re here to help. Contact us at 800-321-6964 and we’ll find what you need.

Sources:

Olsen-Stanko, K., Adjusting for Bariatric Patients: One medical center makes imaging accomodations; RT Image, September 2010

Schuster, S., Obesity forces radiology to supersize, enhance x-ray technology; auntminnie.com, March 2007

Waldowski, K., The Big Picture: Obesity and Radiology; Advance for Imaging & Radiation Oncology, April 2006

Rising Obesity Rate Creates Unique Imaging Challenges; www.rsna.com, February 2010

Vital Signs: State-Specific Obesity Prevalance Among Adults - United States, 2009; Centers for Disease Control and Prevention, August 2010

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