Diagnostic imaging across Canada: The emperors still have no clothes

By Andy Shaw

In 1999 Canadian Healthcare Technology reported in these pages that Canada had fallen to near the bottom of the list of industrialized countries in its use of high-tech medical equipment such as MRI, CT, and PET scanners. Now, more than two years and $1 billion of federal government fix-up spending later, our situation is little improved, say prominent radiologists. Indeed, such is the continuing vacuum of modern imaging gear in Canada that, despite being potentially illegal, private diagnostic clinics are rushing in to fill the void right across the country.

In Ontario, where a private Toronto clinic will soon offer $2,500 a session PET scans, the head of the provincial radiologists association, Dr. Giuseppe Tarulli, says the provincial government invited such willy-nilly privatization of healthcare by playing sleight-of-hand.

“In September, the Ontario Health Minister announced $50 million in one-time federal funding for new radiology equipment. But then in effect he clawed it back by reducing the funds available to run the equipment,” says Dr. Tarulli.

What’s worse, adds Dr. Tarulli, the $50 million buys only about 300 pieces of radiology equipment in a province limping along with 2,400 outdated imaging machines.

Ontario is not the lone culprit.

In British Columbia, the provincial government was even more blatant in its misuse of federal dollars, according to Dr. John Mathieson, chief of radiology for the Capital Health Region in Victoria.

“The federal government transferred $280 million for high tech equipment to B.C., but the problem was, it didn’t get a written agreement on what the money was to be spent on,” says Dr. Mathieson. “Right away $190 million of that money was siphoned off to cover health budget overruns. Another $40 million of that high-tech money was put aside to settle a doctors’ wage dispute in Prince George. So only about $70 million out of the $280 million was available for new equipment.”

But this purposeful misspending did not end at the provincial level, adds Dr. Mathieson. “Of the remainder, Victoria got $6 million but $4 million of that got spent on buying new beds. Hardly what I’d call high tech.”

Similar tales of being short-changed are being told by other radiologists in other provinces including Nova Scotia and Quebec. Dr. Paul LeBrun, chief radiologist at the Queen Elizabeth II Health Sciences Centre in Halifax says some of his colleagues are working with 34-year-old X-ray machines and estimates that 45 percent of the province’s imaging equipment needs to be replaced.

That would cost $45 million dollars, estimates the provincial health department, which will receive only about $30 million of federal replacement funds. In Quebec, where about $120 million ticketed for medical equipment renewal has also vanished, Dr. Gaétan Barrette estimates that over one-third of the imaging equipment there remains very outdated. As a result, Quebec radiologists voted to charge $4 extra for each X-ray as an equipment improvement fee – despite being faced by a $2,000 fine for contravening the Canada Health Act by doing so. That got the Quebec government’s attention.

Country-wide, Normand Laberge, CEO of the Canadian Association of Radiologists (CAR), estimates that less than a third of the $1 billion dollars allotted has gone to buying and installing new diagnostic imaging tools.

“There is no doubt that some provinces have been playing games with the money and diverting it to other purposes,” says Laberge. “So we were encouraged when we heard (Health Minister) Allan Rock at the Canadian Medical Association annual meeting point the finger at Ontario and chastise it for paying old invoices with the new money. He has asked for detailed reports from provinces on how the money has been spent as a result.”

Laberge says, however, that such reports have been slow to trickle in and are not the solution to the problem at any rate. “In Ontario, for example, where half the radiology work in Canada is done, when you net out what it’s doing, the province is simply not adding new imaging equipment. So there’s no overall improvement. That’s what’s encouraging the private sector to come in.”

Such an invasion of the country’s socialized medicine would be preferable to the alternative of ever worsening degradation, says Dr. Mathieson. He reads from a recent letter of complaint from one of B.C.’s most experienced cardiologists, a specialist who attempted to insert a pacemaker in a patient using an ancient, fluoroscopic imaging machine to spot the pacemaker’s metal end.

“It was next to impossible to see anything...I have never worked with a worse piece of equipment in my career, including cases I have done in small towns in Brazil, Chile, and Uruguay. It is unsafe.”

Dr. Mathieson adds that there are some modern imaging procedures commonplace around the world that either can’t or are rarely being done in Victoria because of dilapidated scanners or new equipment scarcity .

“When I was in my student days in San Diego in the early 1980s, we were routinely doing PET scans for pelvic cancer in women,” he says. “They’ve become the standard in most other places, but we still can’t do them here.”

Dr. Mathieson says he as stopped reviewing professional radiology journals because so much of what is reported by them deals with procedures done on imaging equipment unavailable to him.
While some new imaging technology is now operating in Victoria, its shortage creates a dangerous backlog that is all too common across the country.

“I had a young athlete here with an injured knee who badly needed an MRI,” relates Dr. Mathieson. “But he had to wait four months for the MRI, and by then the knee was inoperable. So he lost his full athletic scholarship.”

In a damning story carried by the Knight Ridder news service in 2000, James Frogue, a healthcare policy analyst for the Washington-based Heritage Foundation, wrote: “Waiting lists for emergency surgeries in Canada are sometimes so long that procedures never take place....The reason: (patients) had waited so long they were deemed medically unfit to undergo surgery without an unacceptable risk of dying. Similar examples, equally shocking, abound.”

Good that our shocking state was noted by a policy analyst. It is, after all, government healthcare policy that creates both the problem and at least hope for a solution.

“For five years, the NDP government here in B.C. stopped all funds earmarked to replace broken medical equipment and shifted them all into wages. So equipment that was already ready for replacement went at least another five years. In effect, government policy was based on the assumption that medical equipment would last forever,” says Dr. Mathieson. “And even now the provincial budget still looks dismal for the next two or three years. So the emperor still has no clothes.”

B.C. health policy makers remain vainly unseeing, says Dr. Mathieson, of a naked truth about healthcare technology: “The crux of the problem is that in the medicare model we have in Canada, there is no connection between supply and demand .”

On the supply side, explains Mathieson, there may be rapid and frequent advances in technology as there have been over the past 20 years in medical technology, but getting the government demand side to respond is a cumbersome and lengthy process. He cites the examples of old imaging procedures eligible for funding in B.C. that are so outdated he has never seen them used. At the same time, payments for CT scans are so out of whack with reality, it actually costs a hospital money to do them. So there’s no financial incentive to use better diagnostics.

Back east, there’s also growing recognition that imaging’s problems within publicly funded healthcare are similarly structural.

“ We haven’t managed diagnostic imaging as a whole sector,” says Dr. Henry Phillips, a former clinician and now medical consultant to the Provider Services Branch at the Ontario Ministry of Health and Long-term Care. “Traditionally, hospitals here get funding for radiology as part of their block operational grants to run the hospitals. Then there’s separate money for radiology in community clinics. So we end up with friction between them and competition for available funds. We need to fund all of radiology from a single envelope. That way we can also get into province-wide life cycle management of equipment.”

Without such centralized control, an estimated 16 million examinations done annually in the province cost taxpayers about a half a billion dollars a year . And that sum has been increasing at about 5 per cent a year – a growth rate, says Dr. Phillips, that all parties recognize as unacceptable.

“So after a single funding envelope, our next recommendation is that we need a co-governance structure, possibly a separate organization, to effectively manage this pool of funds. That would involve representation from the Ministry of Health, the Ontario Hospital Association, and the Ontario Medical Association,” says Dr. Phillips, who has filed a report to that effect with the Ministry.

“We’ve also recommended that we use cost-based accounting, so that we pay fees that cover the costs, that we place heavy emphasis on quality and standards, and that we institute evidence-based decision making to see if new technologies such as PET scanning should be introduced into clinical care in the province,” says Dr. Phillips.

He points with pride to a recent pilot project that assessed the readiness of PET scanning for insuring in Ontario. The report reportedly said, not yet.

Not the kind of approach to imaging’s calamitous state that Dr. Mathieson would applaud, however.

“If you wait for outcome or impact studies to really prove the benefit of a new technology, you’ll wait years for anything to get introduced,” says Dr. Mathieson, “And besides, you can go to the RSNA (Radiological Society of North America) in Chicago every year and find out what 60,000 radiology users and researchers have found out about what works and what doesn’t. Some things just obviously work and you don’t need a study to prove it. From the time the X-ray machine, for example, was first introduced at a medical conference, it took only about three months before it spread around the world and everybody was using it.”

Nonetheless, Laberge of CAR believes the more systematic albeit plodding, co-operative approach favoured by governments will win the day and eventually breathe life into our moribund imaging technology.

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Task force calls for hospital supply-chain improvement

By Dianne Daniel

Ontario hospitals could save $120 million annually in costs related to supply management, just by implementing best practices at a business process level – and that’s a conservative estimate, say those involved in a recent Task Force Report on Supply Chain Management. jointly sponsored by the Ontario Hospital Association (OHA) and the Efficient Healthcare Consumer Response (EHCR).

“It currently costs the Ontario healthcare system more than $250 million each year to procure and manage supplies within hospitals,” says Irene Podolak, a partner at Toronto-based Deloitte & Touche and a member of the task force. “We really feel that there is a huge opportunity for avoiding a significant number of those costs, if in fact we could go ahead and redesign our supply chain.”

According to Podolak, roughly 15 per cent, or $40 million, could be saved by adopting supply chain best practices and an additional $80 million in savings would come from reducing the overall cost of supplies once those practices are in place.

Says Podolak: “When you look at that kind of value proposition, why wouldn’t we want to get more involved to be able to do this?”

Formed in May, 2001, under the direction of the OHA’s eHealth Council, the task force brought together a cross-section of participants from the healthcare community, including hospitals, suppliers, group purchasing organizations, government agencies and industry consultants. It aimed to establish a compelling business case as to why Ontario healthcare decision-makers should begin to invest in the supply chain.

“Supply chain management has been largely overlooked in healthcare, even though the potential for direct cost savings, as well as reduced risk and improved patient care is significant,” the report states. “The evidence of the cost reductions and the quality improvement has been clearly demonstrated in the private sector, including the retail, automotive, and aeronautics and space industries.”

In addition to the potential for huge cost savings, the report identified two other key benefits resulting from an improved healthcare supply chain:

• a significant reduction in medical errors through better use of technology and standards;

• and more time spent on patient care, since clinical staff would be relieved of administrative duties related to supplies, ultimately leading to shorter hospital stays.

“In terms of replenishing the inventory and tracking the use of that inventory within the hospital environment in an automated fashion,” adds Fausto Saponara, OHA vice-president of corporate management and business development, “the group estimated that, based mainly on U.S. findings, we could probably save another $200 million in the system Ontario-wide.” Overall, Ontario hospitals spend an estimated $1.65 billion on medical supplies, pharmaceuticals and the systems required to manage this level of procurement.

The findings are significant and the group is hoping both hospital decision-makers and suppliers will take note. In particular, the report identified 14 best practices that would help achieve these benefits; three of which call for systemic changes while the rest can be implemented at an institutional level.

“I think there’s always an opportunity to review what you’ve been doing; it’s always changing,” says Reuben Devlin, president and chief executive officer of Humber River Regional Hospital and chair of the OHA task force. “What we’d like to see is not for every hospital to be doing the same thing in parallel, but if they could do it together. We would certainly all benefit from that.”

While it will take a group effort to develop bar-code standards, for example, to assist in the automatic tracking of medical supplies throughout the system, there are steps individual hospitals can take in the meantime. They include standardizing on products internally, consolidating the number of vendors they deal with and making changes at an organizational level.

For example, rather than allowing dozens of different types of latex gloves to be purchased by separate areas within a hospital, says Podolak, “why wouldn’t you standardize the kinds of gloves you want to use for different purposes, then consolidate your vendors and get a much better price?” Centralized purchasing of commodities has also proven effective in some health centres, she adds, since it frees nursing staff from routine ordering, stocking and searching – activities which typically take 10 percent of their time.

“There are some hospitals that have done this and are really good examples of what can be done,” says Podolak, citing Sunnybrook and Women’s College Hospital and St. Michael’s Hospital of Toronto, the Ottawa Hospital in Ottawa, and London Health Sciences Centre in London. “But there are so many others that haven’t even begun the process. If they go ahead and implement some of the best practices that were identified in the report, there would be a huge, huge savings.”

While the task force is banking on capturing attention with the results of its initial report, the next step may prove the most difficult. The OHA and EHCR have agreed to continue to provide leadership and support as the group moves forward with its proposals, but the challenge will be making the supply chain a priority in the day-to-day pressures that already exist, says Saponara.

One recommendation is to promote awareness and build support for better supply chain management across all stakeholders by launching a broad communications initiative, supported by both the OHA and ECHR. The initiative includes keeping the core membership of the existing task force together while broadening membership to include physicians, drug manufacturers and food distributors. It also includes launching an educational program designed for hospital CEOs and senior management.

“Ultimately, the goal is to take cost out of the whole system, rather than looking for ways to shift costs,” says Saponara. “What we want is to make it productive and beneficial for all participants in the chain.”

A second recommendation emerging from the report is to develop a five-year strategy for implementing systemic supply chain changes. Part of this effort involves establishing a provincial supply chain Co-ordination Management Unit (CMU) that would co-ordinate various activities, helping to avoid duplication of effort and identify missing links as the new supply chain system evolves.

The basic goal for the group would be to research and disseminate information, and to assist hospitals and suppliers at an operational level as they attempt to implement some of the proposed systemic changes, says Saponara.

As he explains, “Ontario cannot develop unique standards – we’re part of suppliers who operate on a global basis. What we need to do is build on standards that are already out there, adapt them within our jurisdiction and then make it mandatory for anyone who wants to supply to the industry to adopt them.”

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Coding requires effort, but produces useful information

By Andy Shaw

Just as a fried egg cooks first at its outer limits, Canada began adopting the latest international medical coding standard at the country’s edges.

Last spring, Nova Scotia, Prince Edward Island, Newfoundland, British Columbia, the Yukon and Saskatchewan began to implement the Canadianized version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. In short, it’s known as ICD-10-CA.

Elsewhere across the country, ICD-10-CA is replacing the previous ICD-9 Canadian standard at an uneven rate. Alberta and recently Ontario have committed to making the switch this year. Concerns over cost and technology have New Brunswick dithering about its commitment. So is Manitoba. Quebec, interestingly enough, is leaning toward ICD-10 adoption, meaning it will likely be contributing its healthcare data to the Canadian Institute for Health Information (CIHI) for the very first time.

The CIHI – in co-operation with provincial and territorial governments – is facilitating the Canadian implementation of ICD-10-CA.

For its part, CIHI developed the Canadian Classification of Health Interventions (CCI). This new classification system contains a comprehensive list of diagnostic, therapeutic, support and surgical interventions, allowing for the collection of more detailed information, regardless of setting or service provider. On the surgical side, the classification will identify technological advances such as minimally invasive interventions using endoscopic approaches and lasers. Codes are constructed to identify groupings of interventions and to describe how they are performed.

“It’s been a tough battle for the CIHI because the implications of moving to a new system are huge,” says Gail Crook, the executive director of the Canadian Health Records Association (CHRA). “Just the training and education it takes are enormous tasks. But they’re worth the effort. We’ve been lobbying for ICD-10 now for quite a while because ICD-9 over the years has become, as I often say, bastardized. We have been trying to use it as a mechanism to support funding, but it was really just a clinical coding system. So ICD-10-CA will give everyone a clean start with a far more comprehensive system.”

Initially approved by the World Health Organization (WHO) in 1990, ICD-10 has been available for implementation since 1993. Australia was among the very earliest adopters. In May 1999, CIHI initiated the development of the Canadian version of ICD-10 to ensure the continued relevancy and utility of the standard in the country. The development process involved the efforts of an expert panel of physicians from various medical/surgical specialities, whose role was to provide advice on the ICD-10 Canadian enhancement process, select clinical reviewers and to assist CIHI in the review, analysis and final decisions for enhancements.

The panel recommended over 4,000 new 6-digit ICD codes, 95 percent of which were approved by the WHO. The improvements over the 4-digit ICD-9 coding system are significant. The new classifications are much broader in scope than their predecessors, classifying not only diseases, injuries, poisonings, and causes of death as before. But they also categorize non-disease risks to health stemming from patients’ job, environmental, lifestyle, and psycho-social circumstances. In addition data collection is now possible in emergency, intensive care, operating theatre, bedside treatment, rehabilitation, homecare and visits to the physicians office.

“The benefits of implementing ICD-10-CA and CCI means we will have one single national set of standards. This will provide us with an opportunity to improve health information, plus improve national and international comparability,” says Barbara McLean, acting manager of classifications for the CIHI.

Ms. McLean points out that the CIHI’s development of a database-derived CD-ROM product, makes Canada the first country to introduce ICD-10-CA and CCI in an electronic format that will facilitate ongoing updates, keeping the classifications current for Canadian users.

“It’s a much more specific system and it will eventually enable us to compare much better the productivity of healthcare systems across the country and internationally,” says Jim Stewart, Canadian manager for 3M Health Information Systems. 3M provides expert-guided encoding software for ICD-10-CA that is integrated into hospital abstracting systems, speeding up the work of health records departments in reporting to the CIHI and their respective ministries of health. “Once those departments get through their encoding backlogs, ICD-10-CA will produce very clean data that will enable both hospitals and their funding agencies to make decisions that are much more evidenced-based.”

In Newfoundland, Evelyn Connors, the health records manager for clinical information at the Health Care Corp. of St. John’s, says they put their emphasis on communication and training. A province-wide tour by the head of the group, plus user surveys, preceded deployment of a CIHI workbook on the provincial network and a two-day CIHI workshop, followed up by further training in St. John’s on the new Windows-based 3M encoder.

“We’ve had a learning curve, because even though the abstract and the CIHI dictionary and tables were familiar, our coding people had to unlearn the old ICD-9 codes and their structures,” says Connors. “So we’re still working somewhat more slowly than we did with ICD-9.”

In British Columbia, Maaret Brandon, a project analyst and co-ordinator for the Vancouver General Hospital and other facilities embraced by the Vancouver-Richmond Health Board, says getting up to speed with the new ICD-10-CA/CCI codes wasn’t easy.

“Being a major hospital, we do a lot of very complex cases that often don’t follow standard procedures here. So becoming familiar with all the ICD-10-CA/CCI coding concepts was like learning to read Greek,” says Brandon. “But our coders were successful because they had a very strong fundamental knowledge of anatomy, physiology, and medical terminology.”

At the rural Kitimat General Hospital, the manager of medical records, Grace O’Connor, says adopting ICD-10-CA/CCI and making the it work was and is a “big, big deal.”

“It’s really intense and even at our size (24 acute beds) I can’t see anyone ever doing it manually,” says Grace. “There are far too many coding practices out there to be able to code with any consistency, without the help of a computerized code finder (the 3M encoder in Kitimat’s case).”

Even using the encoder, Kitimat’s two people who code – O’Connor plus a part-timer – will likely take until the July CIHI submission deadline to work through a backlog of over six months of records.

In Saskatchewan, Teresa Heinrichs, the supervisor of health records for the Mamawetan Health Region centred in La Ronge, says spotting such trends in ICD-10-CA/CCI data will be a major help in planning for her far-flung region’s future services.

“Going over to ICD-10-CA/CCI also meant we had to go electronic,” adds Heinrichs. “So that will probably allow us to start abstracting our out-patient visits as well. And I think that will mean, because we transfer so many patients to other facilities, that our levels of acuity will go up sharply.”

As elsewhere, such changes in care statistics will change how much money provincial health ministries dole out to whom.

In Alberta, the health ministry is handing out what’s likely the country’s largest single chunk of funding for ICD-10-CA/CCI implementation.

“It’s a $4.4 million project just for us out of about $10 million for the province as a whole,” says Kathleen Addison, the Calgary Health Region’s manager of coding services. But despite that healthy endorsement, selling the idea to physicians is proving challenging in the early going.

“The physicians all want to know: How does ICD-10-CA/CCI affect patient outcomes? or What is the cost-benefit analysis?” says Addison. “But the benefits are not really now, they’ll come down the road. Alberta Health will eventually move all funding including physician billing to the same reporting standard. It’s only then that all funding formulas will be comparable. And that will take a few years.”

Alberta and Ontario, however, only have a few months until April 1, 2002 to begin using the ICD-10-CA/CCI standard for submitting information to CIHI (information is provided to the Hospital Morbidity/Discharge Abstract Database and the National Ambulatory Care Reporting System). In Ontario, the decision to adopt ICD-10-CA/CCI was made only in mid-fall of 2001, breathtakingly close to the deadline. To meet it, Helen Whittome, a former health records specialist, will spearhead an educational and workshop drive for the Ontario Ministry of Health and Long-term Care. The workshops are aimed primarily at Ontario’s over 700 certified coders. The decision has also left the vendors of hospital information systems breathing a little easier. Their effort to make their software ICD-10-CA/CCI compliant makes better economic sense now that the country’s biggest healthcare consumer has opted for the new standard.

Meanwhile, at Ontario’s St. Joseph’s Hospital in Hamilton, Charmaine Shaw, the hospital’s head of health records, says she believes ICD-10-CA/CCI will help impart far greater understanding than ICD-9 ever did.

“Also the previous nine iterations of ICD really just built one upon the other. So the codes hadn’t really changed much in 30 years. Ten years ago, an intervention simply meant you cut someone open. But now we have more sophisticated techniques such as laparoscopic, ultrasonic, and radiological interventions too. With ICD-10-CA/CCI you can make those distinctions.”

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Made-in-Canada technology provides detection of hearing problems

By Neil Zeidenberg

TORONTO – A Canadian-designed technology is helping to detect and assess hearing deficiencies faster and more accurately than ever before. The non-invasive system is said to allow physicians and audiologists to test their patients quickly and easily. Each patient’s ear can be assessed in about 15 seconds.

“Hearing loss in newborns often goes undetected for several years, leading to serious impairment of brain development and language acquisition,” said Dr. Yuri Sokolov, president and CEO of technology developer Vivosonic Inc. (www.vivosonic.com), a University of Toronto spin-off company that was started in July 1999.

“For this reason, the screening of newborns and young children for hearing difficulties is crucial.” On the other hand, differential diagnosis of hearing losses is complicated without accurate diagnostic devices. It is estimated that up to 10 percent of Canada’s population, or approximately 2.8 million people, have some degree of hearing loss. The exact number is difficult to assess, since many people deny having a hearing problem.

Early hearing loss detection and intervention is critical in infants, but it is also very important in cases of noise-induced hearing loss – such as in musicians and people working in noisy environments, and hearing losses due to ototoxic drugs, such as those used in chemotherapy. In particular, if a hearing loss due to an acute acoustic trauma is detected early, it can often be successfully treated.

Vivosonic has spawned its own technology called Vivography, a digital signal processing methodology that extracts physiological signals from noise in real time and displays them as vivograms. It measures DPOAEs (Distortion Product Otoacoustic Emissions) in real time, using an elaborated Linear Minimum Mean-Square Error Filter, also known as the Kalman Filter. DPOAE is a faint tone that ranges between 0-20 dB, i.e. thousand times weaker than normal speech.

If a problem is detected in one or both of a patient’s ears, the word “refer” will flash on screen, meaning that the patient should be referred to an audiologist for further testing.Sometimes the problem turns out to be just a build-up of wax.

Vivosonic has integrated its software with a Fujitsu LifeBook B Series mini-notebook computer and a specially designed adapter that fits easily into a small briefcase, along with power supply and all needed accessories. This portability gives doctors the ability to test their patients anytime, anywhere. It can be easily used in a hospital maternity ward or ICU setting, since it takes up very little space and assessments can be performed quickly, or an Otolaryngology or Audiology clinic, or even at patient’s home.

The database software enables doctors to call up their patients’ assessments in different ways, including first names, last names, date of birth, and date of assessment, as well as compare multiple test results, for example before and after treatment or noise exposure.

The company has designed an ear probe containing two miniature microphones and two speakers that fit easily into a rubber disposable earplug, which is then inserted into a patient’s ear. The device, called the VivoScan, sends tones in the patient’s ear and then detects vibrations, which are coming back from the ear, and analyzes and displays them on the notebook computer.

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Canadian hospital world’s first to test capsule endoscopy with children

By Neil Zeidenberg

MONTREAL – Hôpital Sainte-Justine announced that it is the first institution worldwide to test a new, capsule-based camera technology for imaging the digestive tracts of children. The new technology – which can be swallowed like a gel cap – is a substitute for the discomfort and invasiveness of traditional endoscopy.

It’s possible the Israeli-developed technology will provide a more accurate diagnosis of bowel disorders affecting children, and physicians want to test the efficacy of the new system. The Hôpital Sainte-Justine doctors are particularly interested in how well the new technology helps identify intestinal bleeding, polyps and tumors, vascular malformations, malabsorption and Crohn’s Disease, a frequent cause of intestinal ulceration in children.

According to the hospital, only 5 percent of the small intestine could be viewed through traditional endoscopy. By contrast, the new capsule takes 50,000 colour video images as it travels through the child’s digestive system and provides information about the entire digestive tract.

A total of 30 patients between the ages of 10 and 19 are taking part in a six-month study at the hospital’s Mother and Child University Health Center. The test will compare the results of the patients’ previous GI examinations with those acquired by capsule endoscopy. The study will also compare the costs and benefits of the capsule technique with traditional endoscopy and colonoscopy.

Leading the investigation is Dr. Ernest Seidman and his team, which includes Dr. Josée Dubois and Dr. Marie-Claude Miron.

The project is funded in part by Given Imaging Ltd., of Yoqneam, Israel. The company is the developer of the technology and it has donated Cdn$40,000 worth of computer equipment and software. Each M2A capsule has a market value of $850.

The Given Imaging Diagnostic System consists of:

• The M2A Capsule: once swallowed by a patient, it captures thousands of color video images during normal peristalsis and is naturally eliminated by the body.

• The Given Data Recorder: a device resembling a “Walkman” is attached to a belt around the patient’s waist and records the data transmitted from the M2A capsule.

• The RAPID Workstation: software applications are used to analyze the recorded data and record a short video consisting of points of interest in the patient’s small intestine.

The M2A (Mouth to Anus) capsule measures 2.6mm by 1.1mm and is easy to swallow with a sip of water. It contains a tiny camera that captures and records thousands of colour images at a rate of two frames per second, while travelling naturally through the digestive system. It requires no sedation and causes no pain to the patient.

After swallowing the capsule, patients can leave hospital and resume with their daily routines. Approximately eight hours later, patient’s can remove the belt and data recorder and return the next day to the clinic. Researchers then download the recorded images to the RAPID Workstation where doctors can check for any anomalies.

According to Dr. Ana Maria Sant’Anna, a research assistant working in the study, preparation for the capsule endoscopy is very simple. “Patients must fast for at least eight hours the morning before their appointment, and refrain from eating breakfast. Two hours after swallowing the M2A capsule, patients may drink water and/or clear liquids. After four hours, they may eat a light meal. However, it is recommended that patients abstain from eating heavy meals.”

One of the key benefits to the M2A capsule is that, unlike traditional endoscopy, it allows doctors to see the entire upper intestinal tract.

During a traditional endoscopy, a flexible fibre-optic tube is inserted into the digestive tract. It requires the patient to be heavily sedated during the procedure. However, in some cases, despite the anesthesia, the process can be quite painful.

Illnesses of the small intestine can be very difficult to identify. Often, it’s only when the disease has reached an advanced stage that an accurate diagnosis is possible. However, wireless endoscopy makes it possible to detect these conditions earlier, allowing treatment before complications develop.

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