Noninvasive cardiovascular imaging is an essential part of successfully diagnosing many heart-related medical conditions, from coronary artery and heart valve diseases to arrhythmias, such as atrial fibrillation and heart attacks.
In Whatcom County, Bellingham’s PeaceHealth cardiologists and Mt. Baker Imaging have collaborated to create access to some of the newest noninvasive cardiac imaging technologies, not only in the state of Washington, but in the entire country.
“We really have something unique going on in Bellingham,” says PeaceHealth’s Director of Cardiac MRI, Dr. Kevin Steel, a retired Air Force colonel who is a Harvard-trained cardiologist. Dr. Steel has special interest in non-invasive cardiac procedures like magnetic resonance imaging (MRI) and computed tomography (CT) scans.
Dr. Steel works closely with Mt. Baker Imaging’s Dr. Jason Stoane, a board-certified neuroradiologist with particular interest in cardiac imaging. Together, the two physicians have worked to provide patients with the newest state-of-the-art cardiac imaging technologies, including using FDA-approved artificial intelligence software to enhance the relevancy, accuracy and efficiency of testing.
“At Mt. Baker Imaging, my partners and I have made a commitment to provide the best technology in order to perform these advanced imaging exams here in Whatcom County, so patients don’t need to leave their community to get state of the art care,” Dr. Stoane says.
Cardiac CTs (CCTA)
A cardiac CT scan is a CT scan with intravenous contrast (IV) used to show the inside of the coronary arteries for narrowing or blockages noninvasively.
Traditionally, in order to see these blockages in the coronary arteries, a patient would have to have undergone an invasive procedure (cardiac catheterization) which requires a catheter to be inserted into a patient’s arm or groin and threaded directly into the coronary arteries to inject dye into them and take X-ray cinematic images.
For the past 15 years, Mt. Baker Imaging has provided CCTA as an alternative diagnostic exam in the initial work-up of coronary disease. Last year, Mt. Baker Imaging incorporated a new FDA-approved artificial intelligence (AI) technology called Fractional Flow Reserve CT (FFRCT) where off-site computers not only analyze the CCTA exam for stenoses, but also evaluates the effect of the stenoses on the blood flow through those diseased vessels. This is all performed on the data that is acquired in only three heart beats from the CCTA exam.
As contrast dye travels through the arteries, its brightness can change when it slows at a blockage. FFRCT uses flow dynamics and mathematical algorithms to detect the change in blood flow. This can simulate pressure measurements only previously obtainable in the Cath lab with a catheter and a specialized pressure wire in the coronary arteries.
“It’s a really subtle change in contrast density that you really can’t see with the naked eye,” Dr. Steel says. “But what the AI is able to do is analyze the intensity as the contrast travels through the coronary artery, so it can tell us about blood flow. In addition, we have added an AI pre-read algorithm recently which can help identify areas of blockages for us to go back and further review.”
Using this technology is better, easier and can be accomplished in an outpatient setting, meaning patients have the exam performed and a few minutes later go home. This is a lot quicker and safer than if they’d had a catheter inserted. Mt. Baker Imaging, Dr. Stoane adds, was the first facility in the state to bring the FFRCT technology to an outpatient center.
Cardiac MRI and Stress Cardiac MRI
Cardiac MRIs are also being done at Mt. Baker and PeaceHealth St. Joseph Medical Centerl at a larger volume than almost anywhere else in the Pacific Northwest, according to Dr. Steel.
A typical university hospital might conduct up to 200 cardiac MRI scans per year, Dr. Steel says. But between PeaceHealth St. Joseph Medical Center and Mt. Baker Imaging, they are on track to administer over 1,500 by the end of this year alone. In fact, PeaceHealth recently performed the first cardiac MRI in the San Juan Islands, using a mobile MRI scanner to conduct imaging at PeaceHealth Peace Island Medical Center in Friday Harbor.
“It’s something I’m really proud of,” Dr. Steel says of the technology. “The cardiac MRI gives you a complete evaluation of the heart muscle, more than ultrasound and nuclear medicine exams. You get not just pictures of the heart, like a CAT scan, but you also get the motion of the heart and an evaluation of the heart muscle itself. You also get movies of the heart and the valves and how they work.”
Cardiac MRI provides doctors unique information about what is going on inside the heart muscle, Dr. Steel adds, allowing them to see scar tissue, fluid, and inflammation.
Mt. Baker Imaging is also among the first free-standing outpatient cardiac centers in the nation to provide MRI-based stress testing, says Dr. Stoane. Traditionally, these procedures are only done in hospital settings, and typically only at large academic-based medical centers. “We worked hard to create a safe, welcoming environment to be able to offer these highly specialized advanced exams in the outpatient setting,” says Dr. Stoane.
The entire process takes about an hour, including 30 minutes in the scanner using an IV and medication to simulate stress on the heart. The method is ideal for heart patients with mobility issues or heart limitations, Dr. Steel says, adding that Mt. Baker Imaging is conducting over 500 stress MRI tests per year.
“It’s the next generation technology for cardiac stress testing, and instead of following in someone else’s footsteps, working together, we paved our own way,” says Dr. Stoane.
From Far and Wide
These advanced cardiac imaging technologies are attracting patients not only from Whatcom and Skagit Counties, but from Canada and Seattle, as well.
Both Drs. Stoane and Steel say the support of their organizations — and the non-competitive way they have viewed each other — is a big part of why their collaboration has been so successful.
For patients, it means safer, faster, and more accurate testing that can lead to more nuanced and successful treatment of cardiac issues.
“We’ve been at the forefront in the state of Washington and the Pacific Northwest in bringing these new technologies to benefit the patients of Whatcom County,” Dr. Stoane says. “It’s a testament to the desire of our respective organizations to be able to provide this kind of cutting-edge technology for our patients.”
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