MAKING THE LEAP

For manufacturers and providers alike, there are hurdles to overcome when moving beyond interventional x-ray suites to hybrid ORs.

PHOTO COURTESY OF SHANNON MEDICAL CENTER

Interventional radiology (IR) has been around for a number of years and has continually evolved over the course of decades to become an established and integral element of many hospitals, both small and large. The adoption of new technology and methodology is usually accompanied by a few hiccups along the way as vendors and clinical teams develop a better understanding of one another’s needs and capabilities. With the recent emergence of hybrid OR suites, vendors and hospitals are keen to understand what works best. A recent KLAS study, “Interventional X-ray 2012: A Continuing Evolution,” brings to light some of the key performance metrics associated with the success of the main vendors in the arena of interventional radiology and the hybrid OR.

The goal of interventional radiology is to diagnose and treat patients using the least invasive techniques currently available in order to minimize risk to the patient and improve health outcomes, to the point where many conditions that once required surgery can now be treated nonsurgically. A hybrid operating room is constructed for facilitating the use of advanced medical imaging devices in the surgical theater to enable minimally invasive surgical procedures. Hybrid operating rooms are currently used mainly in cardiac, vascular, and neurosurgery, but could be suitable for a number of other surgical disciplines.

The main vendors in the interventional radiology market are the same as those that are expected to lead the charge into the hybrid OR arena. Siemens, Philips, GE Healthcare, and Toshiba have a significant presence in interventional radiology labs and bring different features and benefits to the mix. The question is how do these variables weigh in the equation when making the leap to hybrid operating rooms, with unique environmental constraints, varying clinical teams, and different needs?

In this KLAS report, health care providers across North America expressed their opinions regarding these four specific vendors in the interventional x-ray market. According to Kirk Ising, report author and strategic operations director at KLAS, “The goal of the KLAS report was to go out and find who is actually doing a hybrid OR and talk to them, to learn the status of interventional x-ray in a multiuse environment, and find out who is making that next step into hybrid OR, who is poised to do it, and who is leading the way, in a limited sense. We didn’t go out and interview all of the hybrid OR sites in the country. It’s a mixed study on who is doing well and what are the initial challenges and initial successes with it.”

How Vendors Stack Up

Siemens, currently with the biggest presence in the hybrid OR market, introduced the Artis zeego to specifically address the requirements of the operating room. “The zeego with Siemens really had more of a hybrid OR bend to the design. So if you are considering having a hybrid [OR], even if you are not a Siemens customer, you are probably going to look at Siemens a little bit in that regard.”

The Siemens Artis zeego, designed as a floor-mounted unit, provides the laminar airflow sterility benefits. The additional benefit of having the floor-mount further away from the table, so that it’s not so much in the way, is a big draw for a hybrid OR. Siemens has had their Artis zee installed in a few of the centers surveyed, as well. Siemens, which also has several of their ceiling-mounted units in a hybrid OR environment, has [customers] who feel that “Ceiling mount is not necessarily the best answer, though all of the vendors other than GE sell this option, because of the laminar airflow and the particulates that could potentially fall into the surgical field,” said Ising. “[Ceiling-mounted systems] also have some boom issues, and the dilemma of where to position the monitors if you have doctors on different ends of the table who both want to see the monitors.”

Philips, a long time interventional x-ray market leader, offers the Allura Xper FD20, which has addressed this last issue by going with what’s called their FlexMove solution. Designed for the hybrid OR, it has a wider, bigger track for a ceiling-mounted unit, but offers more flexibility so that you can get the x-ray unit further away from the patient.

GE Healthcare, also a big player in the interventional radiology market, has a fixed floor-mounted unit, the Innova 3100. GE provides strictly floor-mounted solutions. They do not have ceiling mounts. This is good for laminar airflow but bad for getting out of the way. “You can imagine that knuckle is where the anesthesiologist wants to stand, or where they want to put information. So their solution has been the Discovery IGS 730 (not rated in the KLAS report). It’s basically a floor unit on wheels, so you have the benefits of being on the floor and then it can go drive itself out of the way. A really interesting proposition. I think there is a lot of potential there,” said Ising. At the point of the KLAS study, GE had just entered the hybrid OR market with this system.

Toshiba, with its floor-mounted Infinix-i, has good flexibility with its extra knuckle for positioning, but it’s still right by the table if in a hybrid OR situation. However, in the realm of interventional radiology, the manufacturer seems to score well.

According to Ising, “Toshiba is not a leading edge vendor. They don’t generally get into the large hospitals. So they have leveraged what they do well in terms of being a company that is easy to work with. They have their five-axis positioning, their great price point, and their unique dual plane system, which is not exactly pertinent to the hybrid OR, but it’s great for a lot of folks in the interventional world, especially if they are price conscious. [Toshiba is] really concerned about their customers, and they show that consistently. So service and support are great, account management is very good, and they are a great company to work with. But they are not going to be leading edge. That’s why they are going to be the fourth horse into the hybrid OR special adaptation.”

According to the KLAS report, Toshiba earned the top score for overall satisfaction, followed by Philips, GE, and Siemens. Providers highlighted Toshiba’s field support, proactive service, and account management. However, Toshiba has only two of their participating customers currently using the Infinix-i in a hybrid OR, while Siemens, with the greatest market penetration in this area, has 13 customers using their equipment in the more challenging OR environment. Although providers rated Siemens fourth place overall, Ising says that may relate to the fact that a hybrid OR requires a much more complex process to set up, and training is difficult to coordinate and execute effectively.

Barriers to Adoption

According to Ising, these main vendors in the interventional radiology market are the ones that are generally considered for the transition to a hybrid OR, but the biggest barrier to hybrid OR adoption is usually the collaboration among the different users to ensure that it meets their needs. The features and technology are only one piece of the puzzle. “Yes, you have [to consider] the architecture of the OR, their feeling on laminar airflow, and how they position things, but it may only be used for hybrid OR a couple of times a week. Then the interventional team or the cardiologists are going to come in and use it, so it’s a good mix use in most cases. Because the setup is not the same, there is a lot more time in between. That’s where that collaboration really can be improved going forward. The training before they get to that go live point is where there is the biggest challenge.”

Although interventional radiology has been around for a long time, hybrid OR is still just emerging and the hospital may not know exactly what they want from the simple standpoint of who wants to use the room. “There is a noticeable lack of standard requirements. It’s a challenge,” said Ising. The research shows that providers are looking to their vendor for help. “[Hybrid OR] is more complicated than an interventional x-ray setup. The vendor is in the best spot to offer best practices around the time of purchase and involving other people. That hasn’t happened enough for the customers’ sake,” said Ising.

“I am hoping that next year we will be looking at what has gotten better and what the next step [will be]…once we are past the initial ‘OK, now we can work together,'” concluded Ising.

To learn more about the interventional x-ray market, the report, “Interventional X-ray 2012: A Continuing Evolution,” is available to health care providers and vendors online at www.KLASresearch.com/KLASreports. Health care providers receive a significant discount off the standard retail price.

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Carol Dawson is a contributing writer for Axis Imaging News.