The answers to so many medical questions begin with a picture. How severe is the stab wound? What is the source of the back pain? Has the cancer spread? Why does her head ache? Previously invisible, the diagnosis is revealed with an image, which is analyzed through the careful eyes of a radiologist. Once doctors can see the problem, they can begin to solve it.
At Penn Medicine’s new Pavilion, a range of high-tech imaging equipment will allow for more accurate diagnoses and will pave the way for a new era of medical research.
“We have brand new technology that is going to change the future of imaging in a brand new hospital that is going to change the future of patient care,” says Harold Litt, MD, PhD, chief of Cardiothoracic Imaging in the Perelman School of Medicine at the University of Pennsylvania.
The Pavilion is one of only a handful of sites in the world to house a Siemens Healthineers photon-counting-detector computer tomography (CT) scanner, which offers an “entirely new way to image patients,” according to Litt. Typical CT scans — which image nearly any part of the body, including the blood vessels and tissues — are limited in the level of detail and picture quality they can provide. The photon-counting detectors in the new CT scanner will allow clinicians and researchers to image the “underlying characteristics of a material,” Litt explains — for example, distinguishing bone from calcium from an iodine contrast agent.
“When you’re talking about imaging a cancer patient, measuring iodine in a tumor is a way of monitoring blood flow, which can tell us if a therapy is working,” Litt says. “And being able to characterize something like how much fat is in the liver is a measure of liver disease progression.”
Beyond clearer images, the new scanner also delivers a much lower dose of radiation to patients than a typical CT, says Peter B. Noël, PhD, an assistant professor of Radiology and director of CT Research at Penn, who studies the development and translation of photon-counting detectors. He believes the new equipment will allow Penn researchers to pose and answer new questions.
“CT is the most utilized imaging modality across the board, which makes my research very wonderful, because I’m not bound to one organ or one disease group,” Noel says.
Another state-of-the-art piece of imaging equipment in the new Pavilion will give real-time pictures of the brain.
“The problem with the brain, unlike a lot of other organs, is, how do you monitor what it is doing? We can monitor things like whether blood is flowing through it and its gross electrical activity. But unlike the heart or kidneys, it’s pretty tough to see how it’s actually functioning,” says Mitchell Schnall, MD, PhD, the Eugene P. Pendergrass Professor of and chair of Radiology.
That’s exactly why Laurie Loevner, MD, chief of Neuroradiology, and Frances Jensen, MD, chair of Neurology, advocated for the inclusion of an MRI scanner — which will be dedicated solely to neuroscience research — to be embedded into the neurosciences intensive care unit (ICU) on the 10th floor of the Pavilion.
“There are only a few places in the country that have an MRI scanner built in the middle of an intensive care unit, and it will allow for us to study disease on a minute-by-minute basis in a hyper-acute setting,” Loevner says.
Rather than waiting to monitor a patient 24 hours after he has experienced a stroke, for example, the embedded MRI scanner will allow research clinicians to see into the brain five, ten, and then 15 minutes later.
“We’re going to have a lot more information on functional status and outcomes, and we’ll have better timelines for which interventions work best at which point during the timeline,” Loevner says. “Additionally, we’ll be able to involve nurses and other clinical staff into patient research to get evidence-based information about outcomes, efficiency, and patient care best practices.”
Schnall says that having this kind of abundant, real-time data on the brain will give teams of researchers the opportunity to develop brand new interventions for complex psychiatric disorders, such as schizophrenia.
“Instead of taking a sledgehammer to the problem, we’ll be able to more precisely nail specific pathways to treat neurological and psychiatric diseases,” he says.
While the research MRI will give clinicians a real-time look into the brain outside of the operating room, an interoperative MRI scanner in the Pavilion will help to guide neurosurgeons during surgery.
“Let’s say a surgeon is removing a tumor. Well, the healthy brain doesn’t look too different from a tumor with the naked eye,” Loevner says. “So, instead of seeing that you missed part of the tumor a day, or a week later, you can image during surgery and find out immediately.”
This scanner will also have uses for treating disorders such as Parkinson’s disease and epilepsy, Loevner says.
With the Pavilion’s range of imaging equipment — along with the interdisciplinary teams using them to their fullest potential — Loevner says her ultimate goal would be for Penn Medicine to be at the forefront of advancing care and research in the neurosciences.
“Treating mental illness should be no different than treating cancer,” Loevner says. “I’m hoping that increased research in this field will open the avenues to create more knowledge, funding, and insurance options for patients with mental health disorders.”