Metamorphosis in Medical Imaging

By Blair LaVake, Director, Cardiology, UPMC Presbyterian

Medical imaging had no choice but to face changes in waves throughout the pandemic and ride their resonance as the storm calmed. These changes came in many ways. Firstly, there was a total change with replacements for the latest and greatest equipment to help diagnose. Secondly, there were quality assurance re-evaluations for how we can offer outstanding care with a smaller workforce. And then came the metamorphosis in medical imaging for mixing these ideas in order to offer the best possible patient experience.

These metamorphic changes came to all areas of healthcare. Efficiency under depletion became a daily conversation, with the only answer being “All hands-on deck.” Adversity led to our opportunity for change. The “Black Bags” that doctors once took on house calls have now been replaced with webcams to diagnose their patients face-to-face from miles away. Bulky machines for many modalities have allowed technology to catch up to handheld models. In the new world in which we live, patient care will always get the gold medal, but patient convenience keeps racking up the silvers.

At UPMC Presbyterian, we wanted to offer Cardiac PET to a lacking market in Western Pennsylvania. One of the drawbacks to this was having available doses to our patients as needed. With the proper infrastructure and supplier in place, hiccups on this are minimal.  However, unless anyone on your nuclear team is a soothsayer that can prevent shortages, STATs, Discharges, or no-shows, this is still a real problem in imaging.

UPMC countered back with the investment in POCUS (Point of Care Ultrasound) tablets and probes that are handheld for our teams, easy to get in and out, and easy to disinfect once the exam is completed.

We wanted to flip the script on this to allow for these occurrences, as well as be able to offer what most can’t… Last minute add-on patients. We partnered with an outside vendor and allowed their team to place a cyclotron ON SITE so our patients could get the doses needed for their exams. The results of this undertaking became a beautiful partnership to get 9 MCI (Millicurie) doses of N-13 Ammonia to our patients within 10-20 minutes, which includes any immediate radioactive decay. The metamorphosis to imaging wasn’t just the shiny new Cardiac PET machine, but the combination of “On Demand” doses for our patients as well. 

The days of initial cardiac screening with portable X-Rays have also seen a decline in lieu of Echocardiograms. Our UPMC Echocardiography laboratories offer real-time imaging that has become even more in-depth with the use of both 3D and Strain imaging, which leads to enhanced imaging quality and better diagnostics for our patients. According to Dr. William Katz, Medical Director of Echocardiography at Presbyterian, “These modalities have been essential in guiding less invasive interventions for patients with structural heart disease allowing for repairing heart valves without surgery.”

In Echo, another metamorphosis happened during the adversity of the pandemic. We broke our team into two weekly halves to prevent the spread of COVID-19, which obviously led to less sonographers being on at a time. It was rough getting our full-sized ultrasound systems in and out of COVID rooms. Going around the tubes, plugs, wires, and doing so while in full PPE, with more time wiping everything from top to bottom once the exam was completed. All of these speed bumps contributed to the same melancholy that everyone in healthcare felt during those dark days. UPMC countered back with the investment in POCUS (Point of Care Ultrasound) tablets and probes that are handheld for our teams, easy to get in and out, and easy to disinfect once the exam is completed.

As we continued to use these POCUS tablets to our advantage, we wanted to get the most of them for the diagnoses of our patients with the least amount of exposure to our teams. We used a well thought out limited protocol to continue providing the echocardiographic information necessary for these challenging patients, while simultaneously limiting staff exposure to COVID-19. As an additional benefit of using POCUS, we have found expanded use for other indications which makes the sonographer workflow more efficient while navigating staffing shortages.

Thanks to “The Great Resignation”, these shortages also brought a significant change to operations throughout our entire system. Highly skilled technologists fled for promises of unlimited riches as a traveler. It became a game of musical chairs on a national level to staff departments. No matter the technologist’s skill set, these contracts usually gave just enough time for the traveler to get acclimated into our system before leaving. UPMC’s answer to this was to start our own internal travel program, which allows us to keep our people, in our organization, to staff our areas in the most need. We all still felt the pressure of day care closures, schools going to remote learning, and family routines upended by a positive COVID-19 test. We learned to lean on each other, work together with give and take, and became a stronger family than we could have ever hoped.

As we can all see, an organization can get tied up on a replacement for the wheel, when many times they just needed to focus on a different model of wheel. Looking at using the same wheel and adding ball bearings to give it some glide can be the most beneficial and cost-effective way to improvement. As technology continues to pave the road for a change, medical imaging should always remember that a caterpillar must start somewhere. Look toward metamorphosis in your modalities to build a better butterfly.