The fourth dimension

In early February, Feather River Hospital added a new dimension—two, actually—to imaging scans of the heart. The technology is called 4-D cardiac ultrasonography, and Feather River is the first hospital in Butte County to employ it.

What is the fourth dimension? Essentially it’s time, translated into motion. Using the two new General Electric E9 scanners, cardiac ultrasound technicians at the Ridge hospital record beats of the heart—recordings that cardiologists review three-dimensionally with movement to see how the patient’s heart is functioning.

“What we have been using is two-dimensional [scanning],” explained Julie Meyer, supervisor of cardiology services at Feather River Hospital. “You only see two dimensions in those pictures; that gives us a lot of information—good information—but now we can see how the heart has strength over its different areas, such as the radial and longitudinal dimensions of the heart.

“When we talk about how the heart is actually beating, it moves in more than one dimension. We can evaluate it better looking at it this way.”

Four-dimensional ultrasounds have been used in obstetrics to show the fetus to expectant mothers and their doctors. Through cardiac scanners, the technology has made a logical leap into cardiology. Feather River still uses its 2-D scanners, but cardiologists now have the option to order 4-D scans when needed.

“We’re really excited to have this equipment up here on the Ridge,” said Benjamin Mullin, the hospital’s director of cardiopulmonary services. “The image quality that these machines generate is superb, and physicians may be able to see things that they couldn’t before, to help them with their diagnosis. The more information they can get, the better it’s going to be for the patient.”

Heart scanners have been in use for many years, to detect a variety of conditions. The new scanners are particularly helpful in detecting weaknesses in the heart walls. This may apply to patients undergoing certain cancer treatments known to affect the health of cardiac muscle tissue.

In these cases, a significant application of 4-D is AFI, or automated function imaging, which GE describes as a software tool that animates scans to show “in real time” strain on the heart wall.

“When using the automated function imaging, we can see if there’s a segment stiffening,” Meyer said—potentially an earlier sign of trouble that may not be detected on a two-dimensional image without the benefit of AFI.

“Many patients can benefit from that, even those you wouldn’t expect,” Meyer continued. “It’s a way to be able to make sure the heart muscle is strong and healthy in all the segments.”

The 4-D scans require only five to 10 minutes more than the 2-D scans, running the total time for the test to 45 minutes to an hour.

“It’s just like [getting a 2-D] an echocardiogram,” Meyer said. “They lay down in a darkened room like you would [for] a sonogram. The technician scans the heart and activates the protocol to initiate the automatic function imaging, and the machine pretty much takes care of that.”

The information gathered in the scan gets downloaded as the scanning takes place, and the physician reviews the scans later.

Business is booming on the 4-D cardiac ultrasound scanners: “We’re using both of them every day,” Meyer said, “to capacity.”

Physicians and technicians received special training on the equipment. So far, Meyer said, the reviews are positive, with different physicians appreciating different aspects of the technology.

“One of our doctors is just thrilled with the AFI,” Meyer said. “Another is more conservative and said he’d wait to say what his favorite tool is.”

As for how patients will benefit, Meyer said, “I feel we’ll be giving them quicker insight into the health of their heart muscle, and that may in the long term help their outcome.”