Emerging Technology Commingles Doctors’ Orders, Patients’ Needs

Most patients would cringe if their doctor compared his prized surgical device to a pocketknife, but that’s exactly the pitch Dr. Arnold Smith is making these days.

Smith is part of Highlands Oncology Group, which invested about a year ago in a linear accelerator radiation machine that’s providing new treatment options for patients in Northwest Arkansas.

“It’s a little bit of a Swiss Army Knife in that it can do both radiosurgery and the traditional IMRT treatments,” Smith said, referencing the intensity-modulated radiation therapy commonly used to treat certain forms of cancer.

HOG’s Trilogy system is manufactured by Varian Medical Systems, and while it provides multiple uses like a souped-up pocketknife, it comes with a much heftier price tag. The Trilogy equipment, in fact, cost about $3.5 million, or about $2 million more than a machine that doesn’t offer the stereotactic radiosurgery function.

Meanwhile, just around the corner at Fayetteville’s Washington Regional Medical Center, Dr. John Park spent part of a recent morning wondering when his newest piece of equipment will be up and running. The $1.2 million, Philips-manufactured interventional radiology system will allow Park to perform procedures like chemoembolization, a minimally invasive treatment for liver cancer.

About a month from now, Mercy Health System of Northwest Arkansas will unveil a $1.3 million robotic C-arm. It will be the centerpiece of the hospital’s newly expanded, $5.5 million Heart and Vascular Center and the first of its kind in the state.

Add all of these technological marvels together, and it’s clear Northwest Arkansas’ medical community is willing to spend millions in an effort to improve not just its profile, but its patients’ quality of life.

“I don’t always want to be the first,” said Charlotte Rankin, Mercy’s executive director of cardiovascular services and diagnostic imaging. “I just want to be the best.”

Doing the Homework

Technological advances in some industries – think: computers and electronics – have resulted in better performance at lower costs. That’s not necessarily the case in medical technology.

Advances like the aforementioned ones at local providers typically come at a high cost. That’s part of the reason doctors and other personnel log hours of research when exploring the possibility of adding such equipment.

Brands and models and functions are scrutinized. Park and Rankin said their selection processes took about six months.

Reading manuals and reviews, placing phone calls to industry contacts and attending seminars are the norm. In Mercy’s case, some staff members spent a week in North Carolina training on the new equipment, and a clinical specialist from manufacturer Siemens is expected to spend about two weeks in Rogers once the machine is operational.

“There’s always a new machine on the horizon,” Smith said. “The question is: When is it going to provide a benefit to our patients and our population? When is Northwest Arkansas ready to have this?”

Smith paused, then added more questions.

“How many patients are we sending away?” he said. “How many are we giving less quality of a treatment because we don’t have that equipment?”

The studying doesn’t stop when the equipment arrives. Scott Jones, a senior physicist at HOG, said part of his job is to monitor emerging technologies.

“The technology’s so fast-moving that two years from now, what’s cutting-edge will be common practice. It’s constant,” he said. “You have to be vigilant to stay up with training and stay up with the times in terms of what technology’s out there and then how to implement that safely and efficiently.”

Less is Better

Many of the technologies new to Northwest Arkansas result in less trauma for patients. Improved imaging, in particular, has allowed for more and more minimally invasive procedures.

Bulky monitors with grainy images have been replaced by flatscreen monitors that produce pictures similar to the ones beamed into living rooms.

“We’re image-guided people,” Park said. “It’s like going from black-and-white TV to color TV, or regular TV to high-def TV.”

In HOG’s case, the advancements have resulted in almost unimaginable treatments. Jones even recalled a time when contours of patients were made with paper and pencil.

“We’ve gone from that,” Jones said, “to modeling the patient in three dimensions, including their internal anatomy – their organs and the tumors – and highly sophisticated dose-calculation algorithms that allow us to design treatments that are so much above and beyond what I ever thought when I got into this field 20 years ago.

“The imaging is what makes all that possible.”

Because more can be seen on-screen, the means of accessing and attacking affected areas also has been reduced in many cases. Smith said HOG’s new machine allows for pinpoint dosing in higher quantities.

A lung cancer lesion, for example, can be treated in maybe three to five treatments as opposed to 35 treatments using traditional methods. The new treatments also deliver about 10 times as much radiation.

“The exciting thing is that data has been pointing to the fact this will give us significant improvement in disease control,” Smith said. “There are several papers out now suggesting we’ve gone from a cure rate of 60 to 70 percent with seven weeks of radiation and the addition of chemotherapy, to the 90 percent range with radiation only.”

Rankin put it in more blunt terms when talking about the benefits of Mercy’s new Artis Zeego device. It’s part of a new hybrid catheterization lab that will allow for more minimally invasive procedures.

Not only do such procedures let patients spend less time in the hospital, but they provide a more obvious advantage.

“They would rather have their leg stuck than their chest cut open,” Rankin said.

Extra Benefits

The Artis Zeego is just one of the additions to Mercy’s center. The expansion also will include five echocardiogram machines and an echo stress room, and two nuclear medicine cameras and two nuclear stress rooms – all at a cost of about $2.5 million.

Those types of technological upgrades help attract staff, like the three full-time cardiologists Mercy added in May. One of Mercy’s cardiologists, Dr. Amr El-Shafei, became the first in Northwest Arkansas to repair a hole in the heart using a procedure called an Amplatzer closure in November.

When new technologies and procedures like that are introduced in an area like Northwest Arkansas, its residents are the ultimate winners, Smith said.

That’s largely because those patients can be treated here rather than seeking help in places like Little Rock, Tulsa and Kansas City.

Sometimes, Smith added, providing such a service makes a tough business decision palatable. That was the case with HOG and its Trilogy system.

“At one point we said we knew the radiosurgery side wasn’t going to make us any money,” Smith said. “We were going to lose money … but having a machine such as this, we were willing to invest and bring this to Northwest Arkansas before it made financial sense.

“It’s a treatment that if I were being treated, I would seek.”

And whether it involves a linear accelerator radiation machine or a Swiss Army Knife, that’s what patients want to hear.