Cath Lab Digest - March 2008 - (Page 17)

MARCH 2008 CARDIAC IMAGING 17 Advantages of a New Digital Lab at Baystate Medical Center Cath Lab Digest talks with Marc J. Schweiger, MD, FACC, Director, Cardiac Catheterization Laboratory and Gregory R. Giugliano, MD, SM, FACC, FSCAI, Associate Director, Cardiac Catheterization Laboratory and Cardiology Research, Springfield, Massachusetts. What kind of technology does the Artis zee offer in terms of reducing radiation exposure and documenting patient dosages? Dr. Schweiger: In Massachusetts, we are now required to obtain radiation dosage on every patient. The radiation exposure per patient is easily obtained off the monitor. As far as radiation dosing, because the image is sharper and easier to see, by definition you wind up taking fewer pictures. The other thing the Artis zee does have is the ability to fluoro-record, so, for example, we used to document our balloon inflation by cine, but now we can document it by fluoro-record. Do you maintain dosage cumulatively, over all a patient’s procedures? Dr. Schweiger: We do not. That is a very important point, and when you consider the big picture, it becomes a public health concern. The challenge is that patients tend to go to multiple healthcare facilities. While I think one can and should figure out a way to monitor radiation across parameters, ultimately, it means you also have to figure out a way to monitor radiation across different hospitals. If a patient goes to three different emergency rooms and gets a 64-slice CT in all of them, ultimately, we need to have a way to be able to track their radiation exposure. It’s something that in the future we will be appropriately forced to do. Are there any additional capabilities of the Artis zee which aid in diagnosis and treatment? Dr. Giugliano: The Artis zee allows us to move the camera into a lateral position, which enables visualization of the groin area. This means we can visualize the femoral head in all patients, regardless of their height, which is a limitation in other labs. We do this routinely to ensure that our entry site into the femoral artery is over the femoral head, which minimizes inappropriately high or low sticks associated with bleeding complications. In other labs it is a limitation that you cannot move the camera in that fashion, especially for patients taller than 6 feet. Dr. Schweiger: It also moves quickly and easily. We have a number of labs where you can in fact move the equipment laterally, but it’s much more involved. Ergonomically, the Artis zee is easy and quick. Dr. Giugliano: Yes, it’s a single joystick maneuver. The ability at the tableside to adjust your fluoroscopy rates for your digital capture rates, frames per second, is also a nice feature. In other rooms, we have to yell out to the back, “Change it from 15 to 30 frames a second.” You have that control at your fingertips in this lab. With the abilities you have with this lab, do you see any trends or techniques emerging that you feel should be standardized across the community? Dr. Schweiger: What we have started doing on all our patients is visualizing the sheath before we go ahead and do our procedure. We see where the entry site is, and on some occasions, it helps us with our anti-coagulation strategy. You do two things: you look to see where you are planning to insert, so you look at a hemostat in relation to the femoral head. I think that in and of itself decreases groin complications and the possibility of high sticks and low sticks. It doesn’t eliminate them, because everybody’s anatomy can be a little different. Occasionally, we will take pictures after the sheath is in, and we can see that there could be a little extravasation of dye with blood outside of the femoral artery — at that point, you are certainly not going to give a GP IIb/IIIa inhibitor. If the patient is on a GP IIb/IIIa inhibitor, you are likely to stop it. If the patient is stable, you are likely to avoid any further complications. I think that has been helpful in minimizing our groin complications, not eliminating them, but minimizing them. The fact that it is easy to do, I think, helps. It is something we are all doing now and we weren’t doing a year ago. If something is easier to do, you are more likely to have buy-in. Any other enhancements to workflow? Dr. Giugliano: The table moves very easily with power assist. I think there is also a patient comfort benefit with the Tempur-Pedic mattress pad. It is much more comfortable than the thin mattress pads used by the competitors right now. That is something that the physicians aren’t always aware of, but the patients, I think, have noticed the difference. Dr. Schweiger: There are 10 interventional cardiologists who use the lab. We have 3 interventional fellows yearly, so you have a lot of people utilizing different laboratories, and every time you have a new lab, people have to learn the controls because they are always a little bit different. Despite the number of people we have using the various labs, adapting to use of the Artis zee was fairly seamless from my perspective. What about tools for designing optimal views for PCI? Marc J. Schweiger, MD Gregory R. Giugliano, MD, SM, FACC, FSCAI B aystate Cardiology’s most recent digital lab installation was the Siemens Artis zee digital cath lab. Dr. Schweiger and Dr. Giugliano discuss how the lab makes it easier to visualize the femoral head to help with sheath insertion, as well as its ergonomic, workflow and image quality advantages compared to other labs. Can you describe your cath lab and imaging systems? Dr. Schweiger: Baystate Cardiology has 4 digital labs, with the most recent being the Artis zee (Siemens Medical Solutions, Malvern, PA). We actually have 2 Siemens labs and 2 Philips (Bothell, WA) labs. As the only interventional cardiology center in western Massachusetts, we are very busy with an acute patient population. We see most of the patients with coronary disease admitted to the 12 referral hospitals taking care of patients in western Massachusetts. We do somewhere around 1400 coronary interventions, 300 peripheral interventions, and 4,000 diagnostic catheterizations per year. We treat roughly 300 acute myocardial infarctions each year. Can you describe the image quality of the Artis zee? Dr. Giugliano: Our Artis zee is our newest lab, and when I compare it to our other three labs, it is clear that the image quality is best in that room. In particular, the ability to see vessel edges and stent edges — as well as the distinction of where a stent is within a vessel — is clearly better with the Artis zee. In the past, we’ve had equipment where it was impossible to see where you were implanting a stent in obese patients. It was very difficult unless you took a cine image as you positioned the stent. Yet we’ve had very successful experiences with several people over 300 pounds in the Artis zee room. Does it accommodate peripheral procedures? Dr. Schweiger: For us, the Artis zee is mainly a coronary lab because it does not have the large flat-panel, but you can pan down to the mid-thigh if need be. Dr. Giugliano: You can also do digital subtraction in this room, which would allow you to perform certain peripheral procedures, such as renal angioplasty.

Table of Contents Feed for the Digital Edition of Cath Lab Digest - March 2008

Cath Lab Digest - March 2008 Are You Being Paid Fair Market Value in 2008? A Cardiac Cath Lab Professionals Survey by Cath Lab Digest and the Society of Invasive Cardiovascular Professionals Saint Joseph’s Hospital Invasive Imaging Tools for Optimizing Coronary Stent Deployment Contents Clinical Editor’s Corner A Workflow Revolution in Cath Lab Reporting Advantages of a New Digital Lab at Baystate Medical Center Cardiac Computed Tomography: What Does it Mean for the Cath Lab? The Latest in Cardiac Magnetic Resonance Imaging (MRI) Cellular Cardiomyoplasty and Cardiac Regeneration Intravascular Ultrasound in the Cath Lab: A Powerful — and Underutilized — Tool to Improve Patient Outcomes The Stentplus™ Patient Success Program Cardiac Cath Lab Clutter — or, Spring into Action! Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relevant Issues Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab What Do You Think? Experience with a New Guidewire: The Terumo Runthrough NS The Ostial Pro™ Stent Positioning System: Perfecting Aorto-Ostial Stent Placement Precious Minutes The Ten-Minute Interview with…Mark Bowles, BSN, CCRN Vascular Care in the Cath Lab: Planning a Smooth Transition Cath Laughs CMS 2008 OPPS Final Rule Review An Extensive Set of Review Courses for the CCI Basic Science, Non-Invasive Echocardiography and Vascular, and ARDMS Ultrasound Exams Meetings Calendar CEU Education Center Clinical & Industry News STEMI Interventions Classifieds Advertisers Index

Cath Lab Digest - March 2008

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