- The Washington Times - Tuesday, June 26, 2001

Some might recall Dennis Quaid as a miniaturized Navy test pilot traveling through nervous store clerk Martin Short's body in the late 1980s movie "Innerspace."
More than a dozen years after the movie's premiere, scientists still haven't figured out how to shrink people. The gap between science fiction and science continues to narrow, though, and with the help of the newest type of CT scanner, doctors can "navigate" through photographed images of a patient's organs that are projected in 3-D on a computer screen.
The technique can help doctors identify disease in patients who have no symptoms, such as early stages of lung cancer or abdominal aneurysms.
"It's almost like playing a computer game," says Joel Bowers, a radiologist with Millenniumscan Metropolitan Radiology Associates in Northwest. "It's exciting. You can fly through organs on the screen….A 7-year-old with good eye-hand coordination could navigate better than I can."
Dr. Bowers' medical group is the first in the area to use the new scanner, called the Millenniumscan, for screening purposes, meaning it offers scans to anyone interested in finding out whether he or she might have a disease that has gone undetected. The generic name for the scanner is a multislice scanner, which refers to the way the scanner takes pictures from different angles at the same time.
It's produced by at least four companies and is the most popular scanner at hospitals and radiology groups nationwide.
Some radiologists call it "preventive medicine of the 21st century," but the cost, $850 per screening, is not covered by insurance.
On a recent afternoon, J.B. Lawrence, 64, a resident of Silver Spring, came to the office to get a screening.
"My wife lost a sister to pancreatic cancer, so we decided to get the screening," Mr. Lawrence says. The sister had retired at 58 says. The sister retired at 58 and moved to Ocala, Fla., to continue an active life of golfing and cycling. Shortly after her move, she found out she had pancreatic cancer and died within six weeks.
"That's why we decided to do this. It's better to know if something's wrong," Mr. Lawrence says. His wife was scheduled for a screening too.
The actual screening takes a few minutes. The patient, dressed in a blue hospital gown, lies on a white cot that moves back and forth through what looks like a giant toilet seat turned on its side. Cameras located in the inner edge of the "seat" take pictures that create three-dimensional images that doctors later look at to determine whether there is any disease.
Patients, again in a style reminiscent of a science-fiction movie, are told by a computerized voice flowing from a speaker inside the scanner to "relax," "breathe in and hold" and "please don't move."
The computer can say this in seven languages, including Spanish, Korean and French.
"The entire body from head to pelvis can be scanned in less than three minutes with detail that's been impossible to achieve until now," Dr. Bowers says.
Images of areas of special interest can be isolated, measured, magnified, rotated and viewed in three dimensions.
One picture, which has been colored green and blue by the computer for a clearer image, shows a colon, which looks like intricate plumbing under a sink, covered in small bumps.
"All these bumps show there is an inflammation of the colon," says Kenric Higgins, chief radiology technologist, who runs the scanner and the software associated with it. The radiologists can detect abnormalities in different organs or arteries, but they will not diagnose the problem.
"Often, they would have to go in and biopsy to see what's wrong," Mr. Higgins says.
In the case of a colon abnormality, a gastroenterologist may both take pictures and biopsy to diagnose the problem.
Tumors (both benign and malignant), lesions of the brain, lung disease, urinary tract and gallbladder stones, thoracic and abdominal aneurysms, and coronary artery calcifications are among medical conditions that may be imaged in non-symptomatic individuals. The hope is that with early intervention will come decreased morbidity and mortality.
This scanner, produced by Marconi Medical Systems of Cleveland about two years ago, is about eight times faster than the previous generation of scanners. The new scanner's speed means doctors can see more while subjecting the patient to less radiation.
Though the patient can spend as little as half an hour for the whole visit, the doctors and radiology technician spend about 11/2 hours interpreting the images. Patients normally find out about the results of their scans within 48 hours.
The radiology group has been offering the screenings for about a month and sees up to 15 patients a day. In most patients, nothing major is wrong.
"Everybody tends to have something…But if it's not life-threatening, it may not be worth treating," Dr. Bowers says. "But we might find something that should be treated in 10 percent of the people who come in for a screening."
The most common finding is small lumps in the lungs that can be cancer.
Dr. Bowers says there is evidence that the survival rate for smokers with lung cancer diagnosed by the new scanner is much greater than for those diagnosed with the help of past generations of scanners.
Dr. Bowers says the noninvasive procedure should be part of people's preventive care plan, just like mammography and prostate-specific antigen (PSA) tests used to detect prostate cancer, but insurance companies are not paying for the screenings.
Walt Cherniak, spokesman for the health insurance company Aetna for the District, Virginia and Maryland region, says more studies are needed to establish the benefits of the scanner as a form of preventive medicine before Aetna can consider covering it. About 30 million Americans are covered by Aetna.
"The definitive value has not been established in peer-review publications …and that's what we rely on," Mr. Cherniak says.
He doesn't rule out that it could be part of future coverage, but only when the value has been clarified.
The technique for mammographies was well-established when insurance companies decided to cover it in the 1980s, and Dr. Bowers is hopeful the same will hold true for the scanner.
"In both cases, a key determining factor was the fact that these were the only tests available for detecting those cancers. We have begun to save lives. … I think insurance companies eventually will cover the screening," Dr. Bowers says.
Patients such as Bill Mihuc, 74, of Takoma Park, who came in for a screening on a recent morning, so far are paying out of their own pockets.
"I thought I'd get an overall assessment," Mr. Mihuc says. "The cost doesn't bother me as long as I can get a correct diagnosis."
Mr. Mihuc, who has had heart surgery (the stents from the previous surgery look like little white flies on the computer screen after Mr. Mihuc's body has been scanned) and recently diagnosed with Parkinson's disease, calls the scanner experience "non-threatening" and "fast."
"It's pretty neat; you're going through the gate, and the voice comes out and tells you to relax,"he says.
Though Dr. Bowers and other radiologists hope CT scanning will be used more often in detecting early stages of disease, they do not wish to replace patient's primary care doctors.
"The screenings are for people who might have a family history of cancer or vascular disease….The screening is not a substitute for seeing your doctor," Dr. Bowers says. "If you have symptoms, you need to see your doctor and get a much more focused study done."
One of the first patients, Julia Hopping, 52, who works next door as an office manager for her husband, plastic surgeon Steven B. Hopping, was the perfect candidate for a screening. She has a strong family history of vascular disease, and both her parents died of heart attacks.
"Most people in my generation do it to get a clean bill of health," she says. "In my case, they said, 'You are perfectly clean.' It was such a relief."


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