The team was pleasantly surprised that their system found such success using these reports, most of which didn’t have labels explaining the exact severity level of the edema. Different radiologists write with varying tones and use a range of terminology, so the researchers had to develop a set of linguistic rules and substitutions to ensure that data could be analyzed consistently across reports.
It was enough of a jolt to prompt Bill Shetland to call his doctor, who recommended a basic test to rule out heart disease. When Shetland, 66, a retired salesman, continued to experience sharp but short-lived chest pains, his doctor referred him to a cardiologist, who performed a more advanced test for heart disease, called an echocardiogram.
Despite the dazzling array of body-scanning technologies and molecular diagnostic tests available to doctors, diagnosing the cause of chest pain remains one of medicine's most difficult -- and costly -- challenges. More than 6 million people a year seek emergency room care for sudden chest pain.
Blood tests have become extremely sensitive at measuring tell-tale proteins shed by dying heart muscle. “Patients get stuck in observation units, or a chest pain center, waiting to have more blood work done to see if a later sample will become positive,” Wei says.
But he said it's not very good for deciding whether a visible abnormality is actually the cause of chest pain or severe enough to warrant an invasive treatment such as angioplasty. It's not clear, for instance, whether the use of CT scanning would reduce unnecessary hospitalizations or merely add to the costs of caring for chest pain patients.
At OSU, cardiologists led by Dr. Kanji Paul are focusing on the use of an ultrasound technique called myocardial contrast echocardiography. It requires an intravenous injection of tiny bubbles the size of red blood cells that travel to the heart and sharpen the views made by ultrasound.
Compared to CT scanning, Wei said, contrast echocardiography costs less, involves no exposure to X -rays and can be performed at the patient's bedside. A study published last year by Paul, Wei and others provided some evidence that echocardiography could hasten the diagnosis of heart attacks and high-risk coronary artery disease -- and save money by avoiding tests and hospital admissions.
The researchers calculated that echocardiography could have saved about $900 per patient by avoiding unnecessary tests and hospitalizations. The OSU group is trying to get funding to compare the effectiveness of CT scanning and echocardiography in a randomized clinical trial with chest pain patients.
The threat of getting sued remains a powerful incentive for doctors to order unnecessary tests. The rare cases of missed heart attacks account for more than quarter all money paid in closed malpractice claims in emergency medicine.
In a study published in June, shared decision-making appeared to decrease hospital admissions and imaging tests without increasing the risk of missing serious heart problems. Researchers at Carolina's Medical Center in Charlotte, N.C., compared the outcomes of 400 emergency room patients who had chest pain.
Half of the patients received usual care while the other half also were given a personalized printout with a graphic display of the patient's risk of having severe coronary artery disease or heart attack, based on health history, physical exam and basic blood tests and electrocardiograms. After his echocardiogram came back inconclusive, Shetland says he and his cardiologist decided to go ahead with an angiography test, in which a doctor threads a catheter through an artery in the groin to the heart to examine blood vessels.
He underwent bypass surgery at Providence St. Vincent Medical Center to restore blood flow through four blocked arteries. However, 53 percent of Americans don't qualify as being “at risk” according to the Centers for Disease Control and Prevention (CDC).
A good predictor of heart disease risk is Washington Radiology's calcium scoring test. Early diagnosis is important, because it allows for lifestyle changes and pharmaceutical interventions that can help prevent further progression of the disease.
The Physician to the President, Dr. Ronny Jackson, revealed in January that the calcium scoring exam for Donald Trump was part of a series of heart wellness checkups including a stress test. How Calcium Scoring Works cardiac calcium scoring CT is a quick screening study recommended for middle-age and older adults who are asymptomatic but may have lifestyle factors or a family history that place them at higher risk for heart disease.
The CT scan is used by the radiologist to view inside a patient's coronary arteries for possible calcifications. This score gives the ordering physician an idea of the amount of calcification or plaque in the patient's arteries that has not yet caused symptoms.
Some health plans cover this study based on the patient's medical history and other risk factors. Washington Radiology recognizes the importance of maintaining heart health through regular screenings like calcium scoring and will file a patient's claim to their insurance plan.
A national leader in delivering exceptional care, Washington Radiology believes optimal health begins with regular wellness screenings. Washington Radiology is a part of the Solis Mammography network, headquartered in Addison, Texas.