Southwest Virginia's two major hospital systems are competing to expand their imaging services by being able to offer patients the latest advances in medical technology.

Both Lewis-Gale Medical Center, which is part of the nation's hospital giant HCA, and Carilion Clinic, the region's largest hospital system, have filed applications seeking state approval to increase their positron emission tomography/computer tomography scan offerings.

The two are longtime competitors operating in neighboring communities, but this time the competition comes with a twist: Roanoke-based Carilion wants to operate its mobile PET/CT scanner unit less than a mile from HCA's flagship hospital in Salem. Meantime, the Salem hospital wants to build its own permanent facility at a greater cost.

Shortly after Carilion announced it was seeking permission, Lewis-Gale filed a similar proposal for a certificate of public need to add a fixed PET/CT scanner to its hospital.

"We were already in the process of submitting our application for a fixed PET/CT scan when Carilion filed its application," Nancy May, spokeswoman for Lewis-Gale, said Monday. "It was already part of our strategic plan."

In making the case for approval, the Lewis-Gale application makes several references to staying competitive with Carilion. At one point Lewis-Gale's application states approval is needed not only to meet increasing demand, but also to "ensure that choice and beneficial competition exist" in the region because of Carilion's "existing and increasing dominance" in the area.

Because of the similarity of the two applications, the Health Planning Agency of Southwest Virginia is considering both as competing bids, said Kevin Meyer, the agency's executive director.

Meyer said, in part, the state-mandated certificate of public need process is intended to regulate competition to ensure that public health needs are met and that the market isn't saturated.

Carilion's bid is by far the less expensive of the two, coming in at an estimated $90,000 compared with the $2.1 million Lewis-Gale's bid would cost.

Carilion filed an application to park its mobile PET/CT scanner unit at a Salem nuclear pharmacy one day a week. Carilion already has permission to operate the mobile unit at locations throughout Southwest Virginia, but not at that specific Salem site.

Carilion, which already has a fixed PET/CT scan at its Crystal Spring imaging facility in Roanoke, says approval is needed in order to perform a very specific test for coronary artery disease known as myocardial imaging with N13-ammonia.

The N13-ammonia has a very short shelf life, and happens to be produced at a nuclear pharmacy located about a quarter-mile from Lewis-Gale in Salem.

"Unfortunately, N13-ammonia only lasts 10 minutes, making it impractical to transport the material to Carilion's fixed PET/CT scanner in Roanoke for use," said Eric Earnhart, Carilion spokesman. "Carilion's goal is to make a valuable and potentially lifesaving test available to our patients."

Earnhart said Carilion is not trying to take patients away from Lewis-Gale by bringing its mobile unit to Salem and welcomed any Lewis-Gale service that would also meet patient needs of the region.

Several physicians, nurses and businesses who filed letters of support included in the Lewis-Gale application, however, said they believed Carilion was trying to divert patients from Lewis-Gale.

"We do question the need for Carilion's request for a one-day-a-week mobile scanner when it could be handled consistently at Lewis-Gale Medical Center," May said. "And we question is it necessary to spend additional health dollars and duplicate a service one day a week when it could be offered seven days a week at Lewis-Gale."

Lewis-Gale, which also operates a mobile PET/CT but does not currently have a fixed scanning facility, said it is seeking the PET/CT facility to offer the same cardiac testing N13-ammonia procedure as well as meet increasing demand involving cancer patients.

The mobile service at Lewis-Gale is available two days a week and every other Saturday, and use has more than doubled in the past four years from 290 scans in 2004 to 749 scans in 2007, according to the application. If the new fixed scan is approved, Lewis-Gale said it would likely provide 1,178 PET/CT scans in 2010 and would earn an estimated $298,887 in net income.

Carilion said it would serve about 12 patients a month in the Salem parking lot. Carilion did not include net income estimates in its application.