Health Imaging & IT - March 2008 - (Page 19)

share the same work space. Who will be using the equipment is a very important consideration when designing a cath lab, he says. “The majority of hospitals will need to consider having multifunctional cath labs which service not only the coronary arteries, but the peripheral and carotid arteries, electrophysiology neuroradiology, renal services (especially the maintenance of dialysis shunts) and other subspecialty needs.” Qualit y and safet y Aside from wider range of use, newer equipment helps clinicians be more precise than ever, says Davis. For example, a rotational angiogram “gives us the equivalent of 16-slice CT overlay images. We can send them to a physician in surgery and tell him the exact slice of the aneurysm. Taking the digital technology of multiaxial modality readings into the surgery suite with the patient is tremendous.” Another big concern, says Davis, is dye consumption. “It’s one of the biggest safety issues.” Her facility uses Philips’ StentBoost which helps pinpoint stent implantation and therefore reduces contrast needs. Davis has used the tool in other labs and says it allows for better stent placement. During her 30 years in healthcare, Davis says she’s seen fluoroscopy time decrease from 60 minutes to no more than 25 minutes. “There’s been such an evolution and [radiation reduction techniques] are being developed more and more.” Greater scrutiny of care standards as well as insurance coverage changes have led to a change in the condition of patients arriving in cath labs, Karlsberg says. “Patients getting to cath labs now are in greater need of intervention and are potentially sicker than before and have already failed medical management. Workflow becomes increasingly important.” Noninvasive coronary imaging with cardiac CT (64 slice or greater) and the CourAGe trial, which addresses the issue of medical therapy for some patients instead of primary stenting, is already associated with reduced volume in laboratories across the country. So, “it’s increasingly important, when designing and planning, to have flexible, reliable equipment that will accommodate a multi-functional lab and the ever-changing approach to the diagnosis and treatment of the cardiac patient.” However, percutaneous coronary intervention remains absolutely proven to be the best treatment for acute myocardial infarction, Karlsberg says. That raises the level of reliability for cath labs—they need to be read and available 24 hours a day and within minutes. “Cardiac CT is a force that needs to be considered in reducing diagnostic volume and improved medical approaches challenges intervention,” Karlsberg says, so cath labs need to be a more versaHealthImaging.com [ Toshiba’s Infinix DP-i, with two image intensifiers, helps cath labs be more flexible. ] tile workplace. And hospitals should consider an open policy in the lab that maintains volume by cooperating with the specialties that may benefit from a well-planned lab. “Many patients do not need to go to the cath lab when you can image their coronary arteries with cardiac CT. We solved the problem of designing a flexible lab with the Toshiba Dual Plane DP-i which enables one lab to perform like two.” one C-arm has an 8 X 8 inch imaging chain optimized for cardiac work and the other C-arm, which can be exchanged in seconds, is 12 X 16 inches optimized for work outside of the heart, such as the carotids, renals and legs. OngOing advances Karlsberg also uses Advanced Image Processing from Toshiba to upgrade an older lab. “Because of the ability to image coronary arteries outside of the cath lab, cath labs will need to be increasingly fine-tuned for performing [non-traditional] interventions, and upgrades should be routinely considered,” he says. often, the coronary anatomy is known, but complex stenting increases imaging demands. “Most systems have to be set up to adjust for arms, legs, even the brain and the abdominal vasculature.” The Toshiba Duel System DP-i Infinix can change image intensifiers during a case whenever needed so optimal imaging is always available. Another technological advancement for the cath lab is development of fifth access, Karlsberg says. “Fifth access as available from the Toshiba CF-i/SP Infinix allows you to take radiographic equipment down to the toes or hands. No matter what angle you set the C-arm at, up is always up, unlike other equipment that may rotate the image at, for example, 45 degrees.” “Cath labs today are infinitely more flexible than those designed just for cardiac patients,” Karlsberg says. Now interventional cardiologists can replace aortic and mitral valves and even perform procedures to treat aortic aneurysms previously treated with invasive surgery, among other newer procedures. ongoing advances can be an obstacle when purchasing for a cath lab, Davis says. She advises that you arrange for an inclusive package for software upgrades and, since lead time can be up to six months, make sure your vendor contract allows for inclusions of upgrades available since your time of purchase. March 2008 | Health Imaging & IT 19 http://HealthImaging.com

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Health Imaging & IT - March 2008 Table of Contents On the Web The Enterprise: Communicating Better News Update Critical Test Results Management: The Human Touch The Changing Face of the Cath Lab Cardiovascular CT: A Clinical Boon Cardiology PACS: Solutions to Fit Your Needs ACC 08: Building Quality & Value Together Picking the Perfect PACS Displays PET/CT: A Game-Changer in Cancer Patient Management DR: You Gotta Have IT – Delivering Speed, Efficiency, Savings Laser Imagers: Answering the Call for Hard Copy Reader's Resources Stat Sheet

Health Imaging & IT - March 2008

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