York's state-of-the-art

ON the screen in front of us, an X-ray image shows a patient's heart pumping steadily.

A thin needle appears, and there is a puff of dark dye. Rapidly it spreads, outlining the great arteries of the heart and their network of supporting blood vessels against the lighter background.

Superintendent radiographer Alan Magson points at the screen. "That's a lesion," he says.

I peer more closely. The tightening of one of the great blood vessels is obvious. Halfway along its length it is pinched and narrowed as if tied with a tiny piece of thread, and almost blocked. It may have been caused, Alan says, by hardening of the artery, or else fatty or calcium deposits on the inside of the blood vessel.

If left untreated, the patient would suffer from increasingly painful angina and ultimately be at risk of a heart attack.

We're in the control station at the centre of York Hospital's new £4.5 million vascular imaging unit: a state-of-the-art X-ray day unit used to diagnose patients suffering from blocked or narrowed arteries.

The images we're looking at are those of a patient who was diagnosed some time ago, and who for reasons of confidentiality we're not allowed to identify. But they are perfect for showing just how, by enabling the rapid diagnosis of potentially fatal or crippling heart and other circulatory problems, this unit is going to save lives.

The images on the screen in front of me were obtained by a procedure known as an angiogram. A catheter is inserted into a patient's thigh, and then threaded up through the blood vessels to wherever a problem is suspected.

Then a dark dye is injected so that the blood vessels show up under X-ray, and the images can be examined on monitor screens even as a doctor works.

They are startlingly clear. So clear that even to an untrained eye such as mine the narrowing of an artery in a patient's heart is obvious once Alan has pointed it out.

Although officially declared open yesterday by former York consultant cardiologist turned national heart 'tsar' Dr Roger Boyle, the unit has already been taking patients for two months.

Even before it opened, angiograms could be performed at York Hospital. The new unit, however, doubles the number that can be carried out.

Previously, there was only a single ageing X-ray machine dedicated for the purpose. Now there are two, each in its own purpose-built lab. One is for heart patients, the other for the diagnosis and treatment of patients with a range of conditions affecting blood vessels elsewhere in the body, including narrowing and blocking of arteries in the legs caused by diabetes.

There is also a 13-bed recovery bay, where patients are prepared for their procedure beforehand and where they recover afterwards.

The idea is to be able to whip patients needing an angiogram in and out of hospital quickly on the same day, without the need for them to stay overnight. Not only will that mean patients having to spend less time in hospital, it will also help drive down waiting times, health bosses say.

And from the patient's point of view, stresses Alan Magson, it is often less worrying if they know they will be able to go home straight afterwards.

Michael Thomson certainly agrees with that. The 62-year-old from Wistow came into the unit for an angiogram after suffering from undiagnosed chest pains. He arrived at 8am, was given a local anaesthetic, and taken straight into the X-ray lab. Lying on a narrow bed while the great bulk of the X-ray imaging machine looped up above him, he was, he says, conscious throughout the half-hour procedure. There was no pain at all.

"They were playing nice music, and it seemed so relaxing," he says. "I never felt a thing."

Even better, he was given the results of the procedure by the doctor while he was still actually lying on the bed inside the X-ray theatre. It was good news: there was no sign of any blocked coronary arteries, as he had feared.

"It was unbelievable," he says. "It had been worrying me and my family for some time. It was absolutely fabulous. The staff here are just brilliant, and the NHS is definitely on the up."

Janet Finney wasn't quite so lucky. The 57-year-old from Holgate had also been suffering chest pains and her angiogram confirmed she is suffering from blocked coronary arteries. "They said one of my arteries was quite bad, and two others were moderately bad," she says.

"It could be hereditary, because my mother had heart problems."

She will need a further procedure, known as an angioplasty, to clear the blockages. This involves inserting a kind of tiny balloon through a catheter into the blocked artery and then inflating it to open up the blockage.

At the moment, that still can't be done in York, so Janet will have to go to another hospital, probably in Leeds or Hull. But she is no less enthusiastic than Michael Thomson about the care she received during the four hours she was at the York unit.

"They were absolutely brilliant," she says. "Super-efficient, and so relaxed."

Coronary angiograms are only part of what goes on in this new unit, however.

Alan Magson shows me another X-ray image, this time of a woman patient's legs. As the dye spreads down through her legs, it is obvious there are serious problems. Two of the main arteries supplying blood to her legs are completely blocked. The smaller blood vessels can take up some of the strain, Alan says, but unless this patent is treated, the pain in her legs caused by the lack of a proper blood supply will grow steadily worse, and in the end she may need to have a leg amputated.

By opening up the blocked arteries, a simple angioplasty ought to be able to prevent that ever happening. While York isn't yet equipped to carry out angioplasties on heart patients, this unit can perform them for patients with blockages in other blood vessels such as those in the legs.

Hopefully, the woman whose leg X-rays we've just been studying will be able to be treated successfully right here very soon, Alan says.

Hospital bosses have no doubt about how important the new unit is. They insist it is not just about cutting angiogram waiting times, which now stand at about six months for heart patients and a couple of weeks for non-heart patients. The quality of care for patients will be better, too.

Before, patients needing an angiogram had to spend a night on a medical ward before going to radiology for the procedure. Now everything is done in the one place by a team of specialist nurses, radiographers and doctors. That means less moving around the hospital for patients.

And because it is a specialist unit, it also means the staff have time to get to know patients properly, and explain the procedures to them.

That makes a big difference, says the new unit's manager Abby Waters. "They are much happier, because they know what's going on."

Ultimately, the hope is that the new unit will pave the way for angioplasty procedures to be carried out on heart patients in York. It may be some way off.

"That is something we will be looking at," pledged consultant cardiologist Dr Maurice Pye, speaking yesterday at the opening of the unit.

Good news for patients such as Janet Finney in the future.

Updated: 10:42 Tuesday, December 07, 2004