UAB Synopsis, Vol. 24, No. 12, April 4, 2005

State-of-the art cardiac imaging will improve patient care, add new jobs to Alabama economy

A strong collaboration between UAB's Division of Cardiovascular Disease and Department of Radiology is advancing development of computed tomographic (CT) imaging techniques, says Robert C. Bourge, MD, professor and director of the Division of Cardiovascular Disease. A $1.5 million state economic development grant will soon accelerate that growth, bringing a 64-slice CT scanner and two new specialists — a cardiologist and a radiologist with expertise in high-resolution cardiovascular imaging — to UAB.

"Imaging plays an increasingly important role in evaluation and treatment of heart and blood vessel diseases," Dr. Bourge explains. "Current imaging modalities that are largely noninvasive, such as nuclear cardiology studies, echocardiography, MRI, and CT, all provide information about the heart's structure in both acquired cardiovascular disease and congenital heart disease. Imaging also guides many interventional procedures, showing physicians where to place stents, balloons, and cardiac resynchronization devices. UAB is a world leader in cardiac MRI and MRA, which gives physicians excellent high-resolution 3D images of the heart, but an increasing number of patients have implanted electronic devices that preclude magnetic-based imaging."

More Patients Will Benefit

CT imaging of the heart is currently limited by the speed at which images are obtained, Robert E. Koehler, MD, professor and Witten-Stanley Endowed Chair of Radiology, explains. "Many patients with high-normal to elevated heart rates cannot be adequately studied with current equipment. The 64-slice scanners, however, image chest volume quickly enough to obtain 'stop-action' pictures of a heart beating at 80, 90, or 100 beats a minute. The technology also includes newly developed software that creates 3-D reconstructions of acquired slices — images are displayed in anatomic form rather than as a series of slices.

"In some cases, advanced imaging will allow physicians to make clinical judgments more rapidly," he continues. "For example, a patient presenting in the Emergency Department with chest pain may be experiencing a coronary event, stomach reflux, or some other noncardiac cause of chest pain. Currently, patients may undergo cardiac catheterization if the level of concern is significant.

"When high-resolution cardiac CT is available, many patients with noncardiac chest pain may be able to avoid the risks and expense of cardiac catheterization."

Expanding Applications

High-resolution imaging could facilitate CT angiography, Dr. Bourge says. "The 64-slice scanner also will advance experimental studies. I'm interested in its utility in assessing coronary anatomy and developing technologies for true molecular imaging, combining cardiovascular CT with radiopharmaceutical tags that may allow for functional imaging."

Drs. Bourge and Koehler expect the 64-slice scanner to be installed this summer. It will be housed in the Department of Radiology next to the planned Heart and Vascular Center on the sixth floor of the new University Hospital.

UAB Chief Planning and Strategy Officer Martin Nowak, who organized pursuit of the grant, praises the collaboration that brought together the Department of Radiology, the Division of Cardiovascular Disease, and the State of Alabama. "By enabling cutting-edge research in cardiac imaging, enhancing patient care, and fueling statewide economic development, this concerted effort brings many benefits to UAB and the citizens of Alabama."

Recruitment efforts are under way for eminent clinician-scientists to help open new areas of research and patient care, but both Drs. Bourge and Koehler emphasize UAB's existing cardiology and radiology faculty have considerable expertise in cardiac imaging.

"Radiologists Satinder Singh and Hrudaya Nath and cardiologists Steve Lloyd, Himanshu Gupta, and Ami Iskandrian will be instrumental in jump-starting our efforts," Dr. Bourge says. "Advanced imaging technologies and additional specialists will improve clinical services and allow a concentrated effort in cardiovascular imaging, enhancing our ability to compete for federal and industry grants."

"UAB's robust partnership between cardiology and radiology is unusual in academic medical centers and helps power our efforts in cardiac imaging," Dr. Koehler says. "By developing this initiative together, we offer our patients comprehensive expertise. The State of Alabama Development grant will allow UAB to move to the forefront of this growing field of medicine, improving care and bringing a new line of employment to University Hospital and the Birmingham area. This will include not only the physician-specialists we hope to recruit, but also scientists, technologists, research technicians, and other support personnel, as well as extramural research funding."