DENNIS ODA / DODA@STARBULLETIN.COM
Looking to take a 3-D heart image of William Ahana is Kay Hada, a registered echo technologist at St. Francis Medical Center.
3-D technology
aids doctorsAmazed cardiologists find diagnosis
easier with new equipment
Cardiologist Neal Shikuma says it's the difference between looking at a painting of a bowl of fruit and actually holding the bowl in your hands.
He's describing new ultrasound imaging technology, which virtually puts a beating heart in a cardiologist's hands.
"You can open it up and literally look at the inside without anything invasive," said St. Francis Medical Center's chief of cardiology.
"It's a tremendous advantage. We're seeing things, quite frankly, that we've never seen before."
The technology making this possible is known as Philips' Live 3D Echo. St. Francis and Wilcox Memorial Hospital on Kauai were among the first 25 hospitals nationally to receive the equipment in March.
"It's a leap forward just using 3-D, as far as the visual information you can get," said Kathleen Nekomoto, manager of cardiac diagnostic services at St. Francis.
"The amazing thing is, it's a very simple test."
It allows cardiologists to see three-dimensional, real-time images of the heart, as well as two-dimensional views. They can rotate or crop images to focus on specific angles or functions, Nekomoto said.
"Two-D is excellent technology," she said, "but you don't see the walls (of the heart). ... 3D Echo is like taking the heart out of the chest cavity and looking at it, vs. a thin slice, like a slice of bologna."
The 2-D slices can all be put together for a more complete picture, she said.
But with 3-D "we get all information at one sitting. We can crop the image, take away things we don't want to look at and zero in on other things. We can go to the backside and look at valve motion, and look at the valve from different ends to see fine detail."
This results in a more complete examination to improve diagnosis of a heart problem and determine treatment, she said. It also allows doctors to follow patients noninvasively after surgery.
The 3D Echo is particularly helpful in examining children who cannot hold still for an echocardiogram, Nekomoto said.
"We can look at holes in the heart for kids. Pediatric cardiologists are getting phenomenal images. The same for adults."
Examining a heart on the screen to demonstrate how 3-D works, she said: "This is cool. I just flipped the heart over, and I can see all the valves, like an umbrella."
Looking over her shoulder, Kay Hada, a specialist in adult cardiac echo-sound, said, "It looks like a valve is not opening properly." She said it appeared to be a congenital defect, with only two valves instead of three.
"It is missing a leaflet," Hada said, explaining the patient will require close monitoring.
All facilities that received the first Live 3D Echo equipment are sharing information on cases to see how they can do things better since it is so new, Nekomoto said.
Shikuma, who commutes from the Big Island where he is also on the staff of North Hawaii Community Hospital, said physicians are learning how to read the 3-D images.
There is no published standard on what is normal in the new imaging, and the physicians are writing a research proposal to try to establish such a standard, he said.
"The definition of normal is critical. Once we clinically define normality, anything else is abnormal. ... We have to embark on a diagnostic road as to what's causing it and what to do about it."
Shikuma is proposing to use the new technology for other areas of study, such as using contrast materials to look at blood flow through the artery.
He hopes to coordinate studies at St. Francis with the North Hawaii Community Hospital, which he said recently installed the largest magnetic resonance imaging (MRI) scanner in the state.
"It seems like the planets are lining up now," he said. "We're at a new frontier. It is very, very exciting."
