Electron Beam Tomography   added 10/14/01

One manufacturer http://www.imatron.com/

A service center http://www.hscan.com/full-body-scan.html

Article in local newspaper:

Scanner saves lives

As I held my breath and listened to the whirring of the Electron Beam Tomography (EBT) scan machine taking X-rays of my heart at 1/10th of a second between beats, I thought about my father.

He had no warning of the massive coronary he experienced six months ago, and the subsequent bypass operation to repair all the arteries in his heart. My father had been leading an exemplary life, losing weight, eating healthy and exercising. His cholesterol was within reasonable levels, and his diabetes under control.

Had he had an EBT scan, however, it could have shown him that calcified plaque had built up in his arteries to dangerous levels, nearly guaranteeing a heart attack.

Dr. Gary Oppenheim, an interventional cardiologist and medical director of the new EBT program at the Swedish Heart Institute, has managed to get Swedish Hospital to acquire the only EBT scanner in Washington state.

More than one million Americans will have a heart attack this year, and 50 percent of them will die. As the nation's leading cause of death, coronary artery disease can now be detected in its earliest stages with the EBT scan, and it can be treated or reversed with changes in diet and lifestyle.

In 50 percent of the men and 62 percent of the women who died of coronary heart disease, there were no previous symptoms of the disease.

``Patients have to have 90 to 95 percent blockage (of the coronary arteries) for it to show up on an electrocardiogram,'' Oppenheim said. ``They have to have 70 percent blockage for it to show up on a stress/treadmill test. By that time, it's too late; by then, they need angioplasty or bypass surgery.''

Though it looks like a CT scan machine, the EBT machine, invented in 1984, is five times faster than any other X-ray/scanner currently in use. There are three of these cutting edge machines in use at the Mayo Clinic in Minnesota and 10 in Chicago, where they were used recently to take a three-dimensional image of television talk show host Oprah Winfrey's entire body, inside and out.

``The detail you can see with an EBT scan is amazing,'' Oppenheim said. ``Soon we will be screening for lung cancer, because by the time you see something with a regular chest X-ray, there's only a 20 percent chance of cure; it has to be a big nodule just to show up.''

With the EBT scan, he noted, tiny tumors can be seen on lung tissue in three-dimensions and removed while the patient still has a chance of recovering.

Virtual colonoscopies are also possible with the EBT, allowing gastroenterologists a view into the colon and intestines in a pain-free and non-invasive way.

Another reason the EBT scan is important is because even cholesterol tests can't predict heart attacks.

``We all know people with cholesterol of 300 (normal range for cholesterol is under 200) who live to be 90,'' Oppenheim said. ``We also know people with cholesterol under 200 who have a heart attack at 40. How each body handles it tells the tale.''

For example, Oppenheim cited two physicians, both between 55 and 65 years old, who recently had heart scans performed. Both had high blood pressure and diabetes.

``Doctor A had a score of 2,300; severe plaque is 400 or greater. He had 100 percent narrowing of the right coronary artery and an 80 percent narrowing of his left main coronary artery and had bypass surgery. Doctor B had a zero score and was fine.

``There you have two people with the same risk factors, and while one has coronary disease, the other has none,'' Oppenheim continued. ``The secret is to focus on the disease itself, not on the risk of disease, as we have in the past. That's why the EBT scan is now the gold standard for coronary scanning.''

Oppenheim noted that with an EBT scan, he can get 40 clear images of a moving heart during one held breath, with the whole scan taking around five minutes, compared with the hours a patient would spend on angiograms, stress tests or other forms of screening.

An EBT works by generating a powerful electron beam that is focused on one of four tungsten target rings positioned beneath the patient. A technologist applies three electrocardiogram leads to the chest of the patient who is then passed through the scanner. Radiation exposure is minimal, and no intravenous injection of contrast dye is required as it is with other cardiac diagnostic tests.

The EBT scan detects the calcium that has built up around the soft plaque deposits in the walls of the arteries. Though most people develop some plaque in their lifetime, this calcification doesn't generally occur in the arteries until one is in their 40s or 50s.

It took three years and $1.7 million to acquire the EBT scanner and another $600,000 to acquire the special mobile van unit it's housed in.

``Eventually, we will find a permanent location (in Swedish) for an EBT machine and keep this one to move out to local hospitals and other areas like Olympia and Yakima,'' he said. ``But this will be in a fixture at the Swedish Heart Institute for the next six to 12 months.''

Oppenheim said that his work with the EBT is in addition to his work as a cardiologist based out of Minor and James Medical.

``This work is extremely important to me because I think it will save hundreds of thousands of lives a year,'' he said ``I've devoted a portion of my life to making sure it's successful.''

A New York City native, Oppenheim grew up in Brookline, Mass., and graduated from medical school at the University of Pennsylvania. After residency at the Harvard Hospitals and a fellowship at the University of Chicago, he landed a staff position at Stanford.

``I decided this (the West Coast) was a lot nicer place to live,'' he said. He and his wife have lived on the Island since 1990, and have two children, David, age 8, who attends Lakeridge Elementary School, and Brian, 4, who attends the Little Acorn Preschool.

``It's been wonderful living here,'' he said. ``There's a tremendous amount of organized activities for kids, plus you can drive 12 minutes from a big city and be in what looks like the country.''

Oppenheim confessed that because his father and grandfather had heart attacks at age 42, he himself had two EBT scans that changed his life.

He had an EBT at age 39, and had a zero score. But he also knew he could have soft plaque building up that just hadn't calcified yet and couldn't be seen.

``So I had an EBT again when I was 45, and I had a score of 29,'' he said. ``When I saw the early calcium deposits on my coronaries, I was motivated to lose weight, exercise, put myself on aspirin and cholesterol medication. I found it hard to control my diet and weight before, but once I knew I had the early stages of heart disease, it wasn't hard -- because I have two young kids at home.''

For more information on the Swedish Heart Scan, contact the Swedish Heart Institute at 1-800-Swedish. EBT Scans take place at Swedish Medical Center, Providence Campus and cost $550, which often isn't covered by insurance as it is a new procedure.