With key Salem leaders in its corner, Lewis-Gale Medical Center sought Wednesday to persuade a regional state board to allow it to expand imaging services and deny a request by rival Carilion Clinic to bring a specific imaging test to Salem.

Southwest Virginia's two major hospital systems are competing to expand their imaging services to offer patients access to a cutting-edge cardiac diagnostic tool that uses a radioactive drug with a PET/CT scanner.

Both Lewis-Gale and Carilion currently offer positron emission tomography/computer tomography imaging. But as the technology has become more commonplace and as new ways for using it are developed, both hospitals filed certificate of public need applications for state approval to add new PET/CT services.

The Health Planning Agency of Southwest Virginia held a hearing Wednesday in Roanoke County to discuss both applications. Next its staff will make a recommendation on the applications. The board is expected to vote on them in January. The proposals then go to Richmond for another staff report and a final decision by the state health commissioner.

Roanoke-based Carilion wants to operate its mobile PET/CT scanner unit less than a mile from Lewis-Gale in Salem in order to perform a very specific test for coronary artery disease known as myocardial imaging with N13-ammonia. The N13-ammonia has a shelf life of about 10 minutes and is produced at a radiopharmacy called Blue Ridge Isotopes about a quarter-mile from Lewis-Gale in Salem.

Carilion has asked to operate its mobile scanner in the parking lot of Blue Ridge Isotopes because it doesn't have time to drive the N13-ammonia to its Roanoke hospital.

Blue Ridge Isotopes is an independent facility providing products and services to outpatient diagnostic imaging centers and hospitals with nuclear medicine imaging capabilities. While both hospitals said they plan to rely on services from Blue Ridge Isotopes, no one from that company spoke at the hearing.

Lewis-Gale officials contended that Carilion's proposal is to operate in Lewis-Gale's "back yard," an opinion shared by Salem government officials.

Mayor Randy Foley said it was in the best interest of Salem citizens and the community's health care needs that Lewis-Gale be allowed to operate a fixed PET/CT scanner.

Salem's city manager suggested Carilion's application may not be warranted.

"Carilion's COPN should be thoroughly investigated in terms of need in that location," Kevin Boggess said. "Our perspective is it's a service that can be provided through Lewis-Gale."

Lewis-Gale has said it would use the PET/CT to perform the same N13-ammonia test and argued that Carilion could refer its patients to them for the test. Currently Lewis-Gale offers PET/CT service through a mobile scanner at the hospital two days a week and every other Saturday. The hospital said patients would benefit from having access to a permanent scanner seven days a week.

Several Salem physicians, nurses and businesses filed letters of support included in the Lewis-Gale application, and many were on hand to speak at the meeting. Some Lewis-Gale affiliated physicians questioned the patient safety of Carilion's proposal, but Carilion's Dr. Wayne Gandee said, "The likelihood of a serious life-threatening event is nil or practically zero."

Gandee also said if Blue Ridge Isotopes, or another similar pharmacy, were located elsewhere, Carilion would have asked to locate its mobile scanner there.

"We do not seek dominance by this request, yet we merely ask for reasonable access," Gandee said during his prepared remarks.

The majority of those who spoke were affiliated with Lewis-Gale. However, two people without a direct affiliation to either hospital system but with strong interests in local health care did speak.

Marty Hellkamp, who recently sold Roanoke's only independent imagining center to Carilion, said he supported both applications because of the advancements in medical diagnostic technology. But he also said he didn't think Carilion was encroaching on Lewis-Gale's territory.

The Citizens Coalition for Responsible Healthcare, which has been a vocal critic of Carilion, was also represented at the hearing. Ken King, the coalition's president, said Carilion's application was a veiled strategy to gain market share.

Gandee said the Carilion unit would serve about 12 patients a month, but there is a possibility as the availability of new diagnostic agents like N13-ammonia come to market that Carilion could seek to expand its services at the Salem site if it had to operate under the same time constraints over use of a particular test.