November 16, 2001
The setting is humble—a trailer on the corner of Tulane Avenue and LaSalle Street, parked just outside Tulane Hospital’s emergency room. But what’s inside could save your life. It’s an electron beam tomography (EBT) scanner, which can take a picture of your heart between heartbeats and clearly show whether or not arteriosclerosis, a thickening and hardening of the arterial walls, is present.
It can detect the presence of calcium in the arteries before it would show up on a stress test and before there are symptoms. And the only difficult or uncomfortable part of the test is that you have to hold your breath for 30 seconds.
“The majority of people who have a sudden heart attack never had any previous symptoms. We’re trying to find disease and attack it before it strikes,” said Paolo Raggi, associate professor of medicine and director of preventive cardiology and non-invasive imaging.
Raggi has been an innovator in the use of the EBT and is the founder of the Society of Arteriosclerosis Imaging. Tulane’s purchase of the technology was spurred by his arrival at the medical school last year. Electron beam tomography has been around since the mid-’80s, but it suffered from a bad reputation, said Raggi.
“It was used as an instrument to make money,” Raggi said. The test was marketed to consumers who paid hundreds of dollars to get scanned. Then the results landed on the desks of physicians who knew nothing about how to read the report. At the same time, there was doubt in the medical community that a small amount of calcium in blood vessels was really a problem. But that has changed.
“Properly conducted studies were completed and more are ongoing,” said Raggi. “There’s growing evidence that the message is valid. Having calcium in the arteries means having arteriosclerosis, and that’s a bad thing. This equipment can be used to the patient’s advantage. It’s just been abused.”
Paul Whelton, senior vice president of health sciences, also believes in the value of the EBT and strongly supported its acquisition. “Its capacity as a screening and diagnostic tool is well-proven,” he said. “I’m delighted that Tulane is making this valuable asset available to our community.”
Tulane’s EBT is the first and only one in the three-state area of Louisiana, Mississippi and Alabama. Unfortunately, because the technology is new to the area, most local insurance plans don’t cover the test, even though it is widely covered in areas where it is better established. Even so, the cost of an EBT scan is comparable to a stress test, which is less effective at detecting the early stages of arteriosclerosis. It’s also cheaper than having a heart attack, Raggi notes.
“Let’s say you have a heart attack and go to the emergency room. Then you spend three weeks in the critical care unit, end up having a bypass, and then go home on rehab,” he said. “You will not believe how expensive it is.”
On the other hand, Raggi believes that those who have tried to sell the test to the general public have only caused confusion and fear. Instead he’s working to educate physicians about the EBT.
“We can’t just scan everybody. But the majority of heart attacks happen to people with normal cholesterol and normal blood pressure,” he said. “Physicians need to know who to scan, who not to scan, and how to handle the information they get back.”
Early detection of arteriosclerosis can save lives if patients are willing to make changes in their lifestyle. “You have to be willing to work at the results,” he said. “Start exercising, quit smoking, take care of yourself.” In order to facilitate those kinds of major lifestyle changes, the EBT will eventually be part of a prevention and rehabilitation center that will be installed in the hospital.
Tulane University, New Orleans, LA 70118 504-865-5000 firstname.lastname@example.org