After brain surgery at the public Karl Heusner Memorial Hospital, medical personnel risked taking PC Lorray Arzu to the private Belize Medical Associates for a CT scan because KHMH did not have a CT scanner. (Photo from Amandala)
A year and a half ago, a barrage of bullets caught a rookie police officer outside her home in Dangriga, Belize. The off-duty constable was taken to the country’s only trauma center, the public Karl Heusner Memorial Hospital, 74 miles away, in Belize City. After brain surgery, she underwent a risky move from the public hospital to a private one for a CT scan. At the time, no public hospital in the nation had a CT scanner.
After four days on life support, Police Constable Lorray Arzu, 27, died of her injuries on October 16, 2022, reported Amandala (October 17, 2022).
On February 27, a CT scanner was delivered to Karl Heusner Memorial Hospital, according to Love FM (March 14). It was expected to be installed and in use in the following week or two.
Karl Heusner Memorial Hospital (KHMH) is the national referral facility in the country of 8,867 square miles, comparable to the size of Vermont or Wales, and 400,000 people. It is also the district hospital of Belize District, the most populous of six.
At the hospital, on the day that the CT scanner arrived, Minister of Health and Wellness, Kevin Bernard, said:
“You can imagine when patients had to leave KHMH, as a radiologist pointed out, every second that patient left that facility to go to a private facility to get a CT scan was time lost by which somebody could die.”
Minister Bernard said that now a CT scan can be performed quickly and timely and that doctors can make decisions, then and there, based on the results.
“This is a boost to the unit, to the department and to our radiologists, who are trained to carry out their functionality now on these scans.”
Kevin Bernard, Minister of Health and Wellness, talks with radiologists about the CT scanner. When getting a scan, you lie on a narrow, motorized table that slides through the opening into a tunnel. While the table moves, detectors and the X-ray tube rotate around you. Each rotation yields images of thin slices of your body. You may hear buzzing and whirring noises. In a separate room, a technologist can see and hear you. The technologist may ask you to hold your breath at certain points to avoid blurring the images.
A computerized tomography (CT) scanner combines a series of X-ray images taken from different angles around the body, according to the renowned Mayo Clinic, in Rochester, Minnesota. It uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues inside the body. CT scan images provide more detailed information than regular X-rays.
A CT scanner has many uses. However, it is particularly well-suited to examine quickly patients who may have internal injuries from car accidents or other types of trauma. A CT scanner can visualize nearly all parts of the body. It is used to diagnose or monitor disease or injury as well as to plan medical, surgical or radiation treatment.
Many Factors
There are many factors to be considered in choosing a CT scanner.
Karl Heusner Memorial Hospital received a state-of-the-art 128-slice Fuji CT scanner.
Dr. Marcelo Coyi, an obstetrician-gynecologist at Belize Medical Associates, questioned the Ministry of Health and Wellness’ choice of CT scanner, reported 7 News Belize (March 20). He likened it to buying a state-of-the-art iPhone.
Dr. Coyi argued that four older, less expensive 16-slice CT scanners could have been bought for the same money, instead, and distributed, for example, to the Belize City public hospital as well as the three regional public hospitals in the country. Patients who live out-district could have avoided the trip, sometimes of hundreds of miles, to Belize City for a CT scan. Such a purchase would have been more equitable, he said.
When asked about the difference between a 16-slice and 128-slice CT scanner, he said that because of the number of detectors in the console and the speed of the rotations, a 128-slice machine is very good for cardiac studies but that 90 percent of the workload in hospitals is for other reasons, such as abdominal pain and trauma.
Dr. Coyi said that Belize Medical Associates bought its 16-slice scanner many years ago. In 2002, the first multiple-slice CT scanners providing 16 slices were introduced to the market, according to Slice of CT Scanners (June 23, 2021), NeuroLogica, a subsidiary of Samsung Electronics, Co.
“In the current market, the commonly available CT slice counts include 16, 32, 40, 64 and 128 slices, with less common ones providing up to 256- and 320-slice CT scanners.
“The 4- to 8-slice scanners are slowly being withdrawn from the market.”
An article in the National Library of Medicine agreed with Dr. Coyi’s assessment of the 128-slice’s prowess with regard to the heart. According to Image Quality and Radiation Dose for Prospectively Triggered Coronary CT Angiography: 128-Slice Single-Source CT Versus First-Generation 64-Slice Dual-Source CT (October 18, 2016):
“Compared with 16-slice and 64-slice CT, 128-slice CT has more detectors, which means larger volume coverage and shorter scans. These advantages are useful for the application in CCTA (coronary computed tomography angiography).”
CT beam and patient in a CT scanner (Drawing by U.S. Food and Drug Administration, June 2019)
Besides a shorter scan time, the 128-slice CT scanner has superior image quality, leading to earlier diagnostic results, and it delivers a lower radiation dosage.
The shorter scan time of a 128-slice CT scanner could mean only a few seconds as compared with as much as 10 minutes. Shortening the scanning time is useful, especially, for the treatment of children or others who find it difficult to lie in one position for an extended period of time, according to Slice of CT Scanners.
When patients are slid into the CT scanner, the circular opening rotates to take a series of X-rays with each rotation taking about 1 second. The initial 4-slice CT scanner took four separate images through each rotation compared to the 128-slice CT scanner that takes 128 separate images in a singular rotation, meaning that it takes significantly less time to complete a CT scan.
At Karl Heusner Memorial Hospital’s Accident and Emergency (A&E) department, about 30,000 patients, two-thirds of whom are adults, are seen each year. In the A&E, there are two critical care rooms, 10 monitored beds and distinct observation and pediatric sections for a total of about 30 beds, according to Rosh Review.
Less than two years after the tragic death of Police Constable Lorray Arzu, Karl Heusner Memorial Hospital now has a CT scanner. The officer would not have had to be taken to the private hospital, Belize Medical Associates, for a scan. And Dr. Fernando Cuellar, an internist at Belize Medical Associates, would not have had to appeal to private citizens and public officials to help acquire a CT scanner for public use, reported News 5 (October 15, 2022).
When Dr. Cuellar saw PC Loray Arzu pushed on a gurney into his hospital, he said:
“I wanted to break down into tears last night when I saw them bring in this young lady.”
With the acquisition of a CT scanner at Karl Heusner Memorial Hospital, such a dire situation will not arise again.
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