A regional health planning board unanimously recommended approval Wednesday to add new imaging technology equipment at Lewis-Gale Medical Center but denied a similar proposal made by Carilion Clinic.

Southwest Virginia's two largest hospital systems are both seeking state approval to add PET/CT services in Salem. While the ultimate decision to approve or deny the projects rests with the state health commissioner, Wednesday's vote captured the community concern that has arisen during recent months over Carilion's market power.

Roanoke-based Carilion has asked for a certificate of public need to operate its existing mobile PET/CT scanner unit in the parking lot of a radiopharmacy located about a quarter-mile from Lewis-Gale. Carilion emphasized that it was not seeking to encroach on Lewis-Gale's turf but merely wants access to a very specific cardiac diagnostic drug that is used in conjunction with the PET/CT. The drug, N13-ammonia, has a shelf life of about 10 minutes.

"We do not seek dominance by this request," said Dr. Wayne Gandee, chairman of radiology at Carilion Clinic, calling any assertion otherwise "bogus and unwarranted."

Instead, Gandee said that approval was needed because the drug has such a short shelf life, making it impossible to drive it to Carilion Roanoke Memorial Hospital in time to use it.

Denying the application was denying Carilion patients access to the new diagnostic tool, Carilion officials argued.

"I think it was an unfortunate decision by the board and very shortsighted," said Page Pace, health services director at Carilion.

The vote by the board of the Health Planning Agency of Southwest Virginia also went against the recommendation made by the agency's staff report, which said both projects should be approved.

"Approval of both projects would appear to foster competition between the two providers," reads a portion of the 17-page report.

In the end, board member Dr. John Dreyzehner made the motion to deny Carilion's application because of safety concerns in doing the cardiac test on a mobile PET/CT unit and because there would be no barrier to patients accessing the service.

Before the vote, board members questioned Carilion for nearly an hour about the long-term intentions of broadening the scope of its operations at Blue Ridge Isotopes. Carilion representatives said they believed initially they would see about a dozen people a month at the site but that advances in radiopharmacology could produce another drug with a short shelf life.

By law a certificate of public need would grant permission to use the PET/CT for any purpose and would not restrict it to a specific procedure. Carilion assured the board it was only seeking to use the Salem location in cases where the drug had too short a shelf life to travel to Carilion Roanoke Memorial Hospital.

While Lewis-Gale also makes reference to performing the specialized N13-ammonia cardiac test, the main thrust of its proposal is to improve the services available to cancer patients by adding a permanent PET/CT scanner. Currently Lewis-Gale performs PET/CT tests using a mobile unit that isn't available every day. Lewis-Gale does not perform the N13-ammonia test because the doctors don't believe it is safe to do so in a mobile unit.

Carilion Roanoke Memorial Hospital added a permanent PET/CT scanner in 2008.

"The decision was positive for our district and our patients," said Victor Giovanetti, president of HCA Southwest Virginia, which includes Lewis-Gale.

Lewis-Gale asked that Carilion's application be denied.

The applications will now be sent to Richmond, where a state staff report will be prepared and the commissioner will make a final decision.

The regional board's recommendation and the agency's staff report are both part of the information given to the commissioner for review.

"We believe the agency's staff report, recommending approval for both projects, was correct," Carilion spokesman Eric Earnhart said in an e-mail. "This is important for our patients and we will make that case to the state."