Cardiovascular Business - October/November 2007 - (Page 20) New iNtelligeNCe iNside CONtrast media iNjeCtOrs and injector manufacturers including Acist Medical Systems, E-ZEM, Mallinckrodt, Medrad, Medtron AG and ulrich medical. Smarter contrast delivery also includes the new extravasation detection technology. The Stellant CT Injection System uses a pressure sensor to detect mild pooling of blood under the skin before the extravasation becomes moderate or severe. When the system detects the start of an extravasation, it stops injecting contrast until the clinician can examine the patient. “Extravasation technology is not new,” says Platt. There has been some reluctance to use it because of false positives and the cost/benefit considerations of implementing it for every case. “They must work reliably all the time for all patients in order to be incorporated into existing workflow,” says Platt. The real test will be to put these into use all the time, for all patients. Platt’s department handles about 100 cases per day. Today, intelligent contrast delivery means better timing for optimum imaging of the heart and coronary arteries. With a more robust injector-scanner interface, the latest contrast delivery systems are much smarter. “A more sophisticated approach is to deliver the best bolus for the patient,” says Herbert I. Litt, section chief of cardiovascular imaging at the Hospital of the University of Pennsylvathe Medrad Xds extravasation detector, which integrates with the stellant Ct injection system, nia. “If you have a protocol was introduced in July. it utilizes a sensor that is that allows you to change applied around the injection site during a contrastenhanced Ct imaging procedure. the sensor uses the contrast parameters for radio frequency wave technology to directly sense contrast media pooling under a patient’s skin and a particular patient, you can automatically signals the stellant Ct injection include such simple things system to stop. as height, weight and body surface area. You can then determine the circulating blood volume and calculate contrast you would need.” This would allow Toward patient specific medicine calculation of not only the amount of contrast, but also the rate of delivery, if there should be a mix of contrast and saline.” The first efforts to include these parameters started with the need to enhance imaging. “More recent efforts allow you to keep the same degree of enhancement, but reduce the amount of contrast significantly,” Litt says. Litt and his colleagues are using mathematical models of contrast flow rates that might serve as the basis for algorithms to calculate the optimum contrast delivery. This software could reside on a PC next to the scanner, or it could be on board the injector, Litt says. After entering the specific parameters, the software would propose an optimized protocol. These developments are “not that far down the road,” he says. Of course, he adds, with software control, there will be regulatory review. In addition, such innovations will significantly affect the current workflow. More comprehensive patient information The injector-scanner software interface has far-reaching implications for the use of IT in practice. With better integration between injectors and scanners, and interfaces between scanners and PACS, real-time actual flow rates, scan rates, dual flow rates, and peak pressures can be captured and stored with the image and as part of the patient report. “I am cautiously optimistic about integration into the workflow,” says Platt. Like many IT applications, the new data capabilities must be incorporated into the existing workflow in a way that does not interfere with patient safety and staff efficiency. “These technologies are designed to supplement the things we do every day,” says Litt, “not replace them.” Rather than removing control, they provide an additional set of tools for the clinician. Contrast delivery systems no longer just offer power in contrast injection, they are smart, too. Microprocessor control now provides a more robust interface between the injector and scanner, bringing the possibility of customized protocols and integration of injector data into the cardiovascular information system, radiology information system and PACS. “Those who’ve resisted upgrading to this technology because ‘it’s just a power injector’ may find themselves at a disadvantage in a rapidly changing multidetector CT world” says Platt. 20 Cardiovascular Business October/November 2007
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