In recent years, Yale-New Haven Hospital has invested substantially in technical improvements for the Department of Diagnostic Radiology.
The department has embraced electronic imaging and information systems as critical to our long term survival and success in a competitive marketplace. Beginning in the early 1990s, an IDXrad radiology information system was acquired permitting electronic report signature. By 1997, a Kodak PACS system for CT and MRI was installed, and web-based image distribution to referring physicians and radiologists alike was enabled via a web-based image server from Stentor. In 2003-2004, the department acquired a full scale PACS system from Fuji. Today, all imaging modalities are connected electronically to Fuji PACS and distributed both within and beyond the radiology department.
Automated voice recognition for radiology reporting is provided by Powerscribe, except in Breast Imaging where structured reporting is provided by PenRad. Automated critical results reporting is provided by Veriphy, and peer review capabilities are provided by PeerVue. Image data may be imported into our PACS system using LifeImages, which also allows remote distribution and viewing of outside images, as needed.
Angiography and Interventional Procedures
Five angiographic suites are devoted to noncardiac angiography and interventional procedures. In 2010, three of the five suites were replaced with state-of-the-art fluoroscopy equipment, including one bi-plane room. These machines produce very finely detailed images with low radiation doses. Also in 2010, an angiographic/MR-OR suite was installed in the operating room of the new North Pavilion. This suite combines a standard operating room with state-of-the-art angiographic biplane unit and a 3 Tesla MRI scanner, in three separate bays, providing significant flexibility in the types of procedures that can be performed in this facility.
The breast imaging service relies on full-field digital mammography equipment provided by Hologic for screening and diagnostic mammograms. Dedicated breast ultrasound units are used for diagnostic and interventional breast ultrasound examinations, as well as screening breast ultrasound exams in the setting of dense breast tissue at mammography. A dedicated 3T MRI scanner is housed in the Breast Center for use exclusively by the Breast Imaging service. The Breast Imaging Service interprets screening mammography studies performed at five locations including a mobile mammography trailer. Diagnostic and interventional breast imaging procedures are performed at two locations.
The department enjoys the use of seven CT scanners deployed within the hospital and at an outpatient facility. All scanners are manufactured by General Electric and include both 16 and 64 slice units. One inpatient scanner is dedicated for interventional and CT-guided procedures. A 64 slice scanner is housed in our Emergency Radiology Department, and a 16 slice scanner is housed in the outpatient facility. The department has a rich array of 3-D imaging workstations, including Vitrea 3D workstations (Vital Images, Inc.) and Advantage Windows workstations (General Electric Corp) for post-processing and 3D support for the CT service. Prospective EKG-gating hardware and software is available for cardiac CT applications.
MR imaging equipment is manufactured by Siemens Medical Systems, and consists of five 3 Tesla and three 1.5 Tesla MR. One 3 Tesla scanner is housed in the operating room and another 3 Tesla scanner is housed in the breast imaging (see above). One 3 Tesla and two 1.5 Tesla units are housed in an outpatient MRI facility that is attached to the hospital. Two 3 Tesla and one 1.5 Tesla units are housed in the radiology department in the new North Pavilion. The MR service is supported by a number of advanced imaging workstations. Functional MRI equipment is available on two of the 3 Tesla units.
There are nine dedicated research magnets on campus in the MR Research Center, including one 1.5 Tesla and two 3 Tesla units for anatomic and functional MR imaging. Two high field (4 Tesla and 7 Tesla) whole body units are available for human MR spectroscopy experiments. Three small bore magnets at 4.7 Tesla, 9.4 Tesla, and 11.7 Tesla are available for pre-clinical experiments. Two in vitro spectroscopy units round out the imaging armamentarium in the MR Research Center. The MR imaging equipment is supported by on-site chemistry and electronics laboratories.
The nuclear medicine service is housed exclusively in the new North Pavilion and enjoys the use of two PET CT scanners, including one with gated 64 slice CT capabilities for advanced cardiac imaging. Four gamma cameras, including one new SPECT/CT unit, are available for general nuclear medicine studies. One gamma camera is housed in an outpatient facility, and images are read remotely in the main nuclear medicine department.
There are two dedicated research PET cameras for human imaging, including an HRRT (high resolution, head only) and an HR+ (standard resolution whole body) PET cameras by Siemens/CTI. Animal imaging is also performed on these cameras; animal imaging is also possible using a Focus 220 camera, manufactured by Siemens/CTI. A new 64 PET CT scanner is planned for installation in 2011. The imaging equipment is complemented by a state-of-the-art radiochemistry laboratory that contains a medium energy cyclotron by General Electric and several hot cells with many automated synthesis modules.
The Ultrasound service is housed exclusively in the new North Pavilion. The service enjoyed complete replacement of its imaging equipment with its move to the North Pavilion in 2009. At present, a wide range of ultrasound units support the department of Diagnostic Radiology; two ultrasound machines are dedicated to the pediatric population. The ultrasound service provides dedicated, on-site service in a variety of clinical locations including the vascular and endocrine clinics. Dedicated ultrasound technologists are in-house 24 x 7 for inpatients and emergency room patients in need of sonographic services around the clock.
Dedicated pediatric radiology services are provided in both the main hospital and the outpatient facility at LongWharf, New Haven. Both sites provide comprehensive radiography, fluoroscopy and ultrasound services for the pediatric population. The hospital-based department performs pediatric CT and MR examinations using the equipment enumerated above, with the assistance of a dedicated pediatric sedation service. A dedicated pediatric MRI unit is planned for the Children’s Hospital in 2011.
North Tower Expansion
In 2009, Y-NHH opened a 14-story addition to the hospital complex. Located in the north corner of the quadrangle, the new tower houses the Smilow Cancer Center -- a comprehensive cancer center with both inpatient services and multidisciplinary oncology clinics for outpatient services. For Diagnostic Radiology, this building project represents the single largest expansion of the department in recent history with substantial increases in imaging resources as described above.