by
Glenda Fauntleroy, DOTmed News | September 12, 2011
From the September 2011 issue of HealthCare Business News magazine
“Performing surgery on obese patients can be disastrous,” she says. “Technically, it can be very difficult because it takes surgeons longer to get to the particular organ we’re interested in and there can be increased blood loss and increased operative time.”
Telling obese patients that their weight requires a physician to treat them differently than they would a normal-weight patient is always a difficult conversation to have, says Cheskin.
“When physicians have to tell patients, ‘you are so heavy that we can’t do our usual tests,’ it’s discouraging for the patients to hear,” says Cheskin. “Even though we state it factually and scientifically, patients feel badly and we’re the ones delivering the news.”
Dr. James Brink, chair of the American College of Radiology’s Body Imaging Commission, says radiologists also face a dilemma when medical images—CT scans, MRI, or ultrasounds—are requested for severely obese patients.
Ultrasound, he explains, is probably the modality most degraded by obesity, especially as the patient nears 250 pounds. The ultrasound is not able to penetrate excessive fat well and typically yields poor image quality.
“Some of the challenges we face with obesity are based on simple laws of physics and there’s not a lot we can do about it,” says Brink.
In days gone by, the morbidly obese have also been excluded from having CT scans or MRI, says Brink, either because they exceeded the table’s weight capacity or were too wide to fit into the machine. Traditional MR scanners that can feel too confining for even a normal-weight person have a diameter of 60 centimeters (23.6 inches) and a table capacity of 350 pounds.
In an ACR report, “Radiology’s Big Challenge: Imaging the Morbidly Obese,” researchers from Harvard Medical School detailed cases from radiologists where even if obese patients “were able to squeeze through the CT gantries or MR bores, the resulting images were often subpar, sometimes strikingly so.”
Brink says, however, that recent design changes to imaging machines are offering a promising outlook for the future.
“It’s only through conversations between radiologists and manufacturers that I’m happy to report that manufacturers have produced larger machines that are now amenable to the obese,” he says.
Manufacturers have developed newer MR scanners with a diameter or bore of 70 centimeters (27.5 inches) and a weight capacity of 550 pounds, according to the team from Harvard. Newer CT scanners also have gantry diameters of up to 90 centimeters (35 inches) and table capacities up to 680 pounds. In their report, however, Dr. Raul Uppot, and fellow researchers found that in both newer and older models, up to 7 inches of a CT unit’s gantry diameter is taken up by the table itself, which results in a smaller capacity than advertised.
