Computerized body scanning by demand is catching on fast

New technology lets doctors do a virtual "fly-through" of the colon, for example, or scope inside the coronary arteries without entering the body. And patients don't even have to undress.


	Technician George Pleitez of Health-Scan in Bellevue prepares a patient for a full-body scan by a $1.5 million ultrafast CT scanner. Paul Joseph Brown / Seattle Post-Intelligencer Click for larger photo

The scans have been heavily promoted elsewhere in the country, and some locations already have waiting lists up to six months long, although consumers have to shell out up to $900 -- usually with no help from insurance. In the Seattle area, body-scanning services are catching on.

But controversy remains over the best way to use the scan information and who should pay for it. Some doctors worry the scans will find harmless growths or other benign abnormalities that could lead to unnecessary invasive testing, driving up health care costs and subjecting patients to unnecessary risk.

Ultrafast computer tomography scanners are not completely new to the Seattle market. Several hospitals, including Virginia Mason Medical Center, have the machines, but use them only when ordered by a physician.

What is new is that now, anyone can walk in the door and order the tests for themselves -- if they want to pay for them.

Health-Scan, a Bellevue-based business started by Dr. Tom Giannulli, offers a complete body scan or a virtual colonoscopy using a $1.5 million ultrafast CT scanner. The X-ray scanner spins around the patient and a computer uses the data to generate finely detailed cross-sectional views of the anatomy.

Swedish Medical Center offers a heart scan using an even faster type of CT scanner -- the only electron beam tomography (EBT) scanner in the state -- and may expand the use of its new $2.5 million machine to scan for lung cancer and eventually colon cancer and osteoporosis.

University of Washington Medical Center, which already has three of the ultrafast CT scanners, has started offering coronary screening and is in the final stages of preparing a lung-screening program for consumers.

"You can look at any organ, or any part of the body without opening it up," said Michael Alotis, radiology administrator at the UW Medical Center.

"It's just like a game. You can spin (the organ) around, and travel through it," he said.

The goal for all the services is to detect disease early enough to prevent catastrophe.

Not all doctors are convinced they can do it. The American College of Radiology, for example, has said there isn't enough scientific evidence yet to recommend total body CT screening for patients with no symptoms or family history suggesting disease.

Nevertheless, patients are starting to line up for the exams, lured by their lifesaving potential.

Last week, a visibly relieved Seattle executive emerged from his CT scan pronouncing himself "clean as a whistle."

By contrast, an unsettled-looking patient discovered he had signs of fairly advanced coronary disease, despite having no family history and no symptoms. He was urged to see his doctor immediately to evaluate the next course of action.

One of the main uses for the CT scanners is detecting early heart disease.

The scans can measure calcium in plaques in artery walls, something normally measured only after death.

A higher calcium score indicates a greater degree of plaque, which is associated with a higher risk of heart attack, said Dr. Gary Oppenheim, director of EBT scanning for the Swedish Heart Institute. "It's like having an autopsy without having to die."

Patients who have no symptoms, and whose hearts test normally on conventional stress tests, may still have significant plaque buildup and be at risk of a fatal heart attack, he said.

"Nearly 50 percent of men and women will die from coronary artery disease, often without warning, and often without abnormal stress-test findings," he said.

If caught early, the disease can be slowed by a combination of medication, diet and exercise.

Alotis at UW had his heart scanned at age 52 because several members of his family had had heart attacks at that age. He was surprised to discover he has relatively little calcification in his arteries.

"It told me to keep with my lifestyle and medication," he said.

Oppenheim, 46, also got scanned. Both his father and grandfather had heart attacks at age 42. His calcium scores put him in a high risk bracket for his age, prompting him to lose 15 pounds, modify his diet, begin taking cholesterol-lowering drugs and running every day.

"It's a powerful incentive," he said. "I'm a cardiologist, and I couldn't do those things until I knew for sure I had (coronary artery disease)."

Some doctors and professional organizations remain skeptical that the preventive screens are a marketing gimmick to pay for expensive machinery.

The American Heart Association and the American College of Cardiology have stopped short of recommending such scans for people with no symptoms or risk factors.

"There are other tests that can predict heart disease risk, such as simple blood pressure and cholesterol measurements or an EKG," said Matthew Mitchell, senior research analyst for ECRI, a Philadelphia-based non-profit group that does medical technology assessment. "If the end result of a test is you eat better and exercise regularly, you don't need a test to tell you to do that."

Also, because it takes time for plaque to calcify, the tests typically won't detect plaque in women until after age 45 and men after age 40. A negative scan sooner than that doesn't necessarily mean there's no plaque present, only that it hasn't formed a calcium cap.

Similar debates continue around scanning for lung and colon cancer.

Early detection can make a huge difference in lung cancer, the leading cause of cancer-related deaths, Seattle pulmonologist Dr. Steven Springmeyer said.

By the time doctors catch lung cancer on conventional chest X-rays, tumors are typically already 10 to 20 millimeters in size. "It's about 90 percent fatal at that stage," Springmeyer said.

Ultrafast CT scanning, in contrast, can find lung nodules as small as 3 mm across. It could do for lung cancer what mammography did for breast cancer, Springmeyer said.

The availability of such scans has posed some dilemmas for physicians.

The scans can detect tiny lung nodules, but not all such nodules become cancerous, said Springmeyer.

Pulmonary doctors believe in screening, as long as a team of specialists deals with the resulting information, he said. "You don't just go straight to a surgeon."

One promising application of the technology is in detecting colon cancer.

American Cancer Society guidelines recommend colon cancer screening for people over age 50 at intervals that depend on the patient's history and risk factors. Such screening could be by conventional colonoscopy, by ultrafast CT scan, or by several other methods.

Because the other methods are invasive, however, the CT scans are most likely to be accepted by patients.

Despite heavy promotion, the scanners have fought an uphill battle for acceptance in the medical community since many doctors are still unfamiliar with how to use the information, and most insurance companies won't pay.

Swedish's heart scan costs $550. Health-Scan's whole body scan costs $900. A virtual colonoscopy costs $900 and a heart/lung scan $500. UW has not set its fees yet.

Those who offer the scans are optimistic that patients will demand them, and doctors will eventually follow.

Proponents of ultrafast CT agree the best way to use the scans is in combination with other information, including history, risk factors and other diagnostic tests. And they acknowledge that CT scans aren't a panacea.

"They won't replace mammograms," Giannulli said. And there are better tests for uterine, ovarian and prostate cancer. Brain imaging is better done by MRI (magnetic resonance imaging), a different type of scan.

Proponents of the scans are banking on consumers wanting information that their doctors may not order.

"It's a role reversal," Giannulli said. "It's a power shift from doctor to patient."

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com

Add P-I Local headlines to