For Children?s Mercy, Two Vascular X-rays Are Better than One
Not only is the US birth rate increasing demand for advanced pediatric medicine, but recent news about imaging radiation overexposure cases makes hospital administrators seek radiation reduction features for any new equipment purchases.
For Children?s Mercy Hospital in Kansas City, Mo, one solution for increased demand was replacing their 11-year-old biplane interventional suite with a new Toshiba Infinix system?plus building a second Infinix suite. Second, the hospital incorporated hybrid surgical-diagnostic teams who could use the new interventional suites for both diagnostics and related pediatric surgeries. In addition, the two Infinix CF-i/BP?s real-time radiation monitoring systems allowed hospital clinicians to reduce the amount of patient radiation exposure.
Children?s Mercy is using the two new Toshiba Infinix CF-i/BP vascular x-ray systems for a host of procedures, including cardiac catheterizations, interventional procedures, electrophysiologic studies, device implantations, as well as general diagnostic imaging. The hospital has designated one of the suites for mainly electrophysiologic studies, while the other is being used for more diagnostic and standard interventional procedures.
Expanding to two units was just one of the ways Children?s Mercy increased their throughput. Another strategy was to use the new suites for hybrid procedures that bring multiple clinicians together in one operating room. Under this system, surgery and interventional catheter procedures are all done at the same time. While more efficient, the hybrid system also means tight operating conditions with clinicians around the table along with C-arms and a host of other devices.
Marius Hubbell, MD, director of the pediatric cardiovascular laboratory at Children?s Mercy, has been working in new Infinix suites since November 2009. He explained why the hybrid teams needed an interventional suite that was compact, yet physically flexible. ?We?ll actually open the chest and do cath procedures, and to do that, we need to have fluoroscopic imaging. You need to be able to put the tubes in rather unique positions so you can have access to the chest, head, and other areas without being cumbersome.?
The Infinix CF-i/BP met that need with a small footprint and a five-axis biplane system. Its floor-based C-arm rotation mechanism allows 180 degree access around the head end of the table. The system also includes a mobile 8? x 8? flat panel detector. As a result, the hybrid team can perform cardiac diagnosis and interventional procedures without repositioning of the patient and with minimal repositioning of staff.
?It allows us to really position the C-arms in unique ways so we can get good access to the head as well as the inguinal areas of our patients,? added Hubbell.
For radiation exposure concerns, the Infinix x-ray system has a comprehensive dose management package that provides real-time measurement of the radiation dose being administered during the exam. The feature is especially useful for hybrid operations, where physicians can rely on more than just fluoroscopy time in determining the radiation dose emitted during each study.
In addition, Hubbell said that his team has been able to reduce the radiation dose to patients by capturing some fluoroscopic images when high-resolution images aren?t essential. ?When we?re just documenting to see whether the patient has a single superior vena cava coming into the right atrium, we actually capture those fluoroscopic images rather than doing a cineangiographic run, and that cuts down on the radiation dose quite a bit,? said Hubbell.
As a result of the two Infinix installations, the hybrid team protocols, and putting diagnostic patients under general anesthesia, throughput has dramatically increased. Generally, the hospital performs more than 400 interventional procedures a year, according to Hubbell. However, in December 2009, Children?s Mercy reportedly completed 60 procedures in a month.
If that trend continues throughout 2010, the hospital?s two interventional suites will have dramatically increased Children?s Mercy?s workflow, while providing safe and efficient pediatric care.
Good News for Young Patients
Biospace Medical, Cambridge, Mass, has received 510(k) clearance from the Food and Drug Administration (FDA) to market its proprietary sterEOS 2D|3D workstation for pediatric use in spine applications. Previously, the workstation had been approved only for adults.
The EOS system is now able to deliver standing, head-to-toe x-rays to pediatric patients with significantly less radiation than conventional systems. The newly approved workstation for pediatric applications adds the ability for clinicians to analyze and compare imaging studies in three dimensions with 1,000 times less radiation exposure than a typical 3D CT study.
Peter O. Newton, MD, is the director of the Scoliosis Service and Orthopedic Research and chief of surgery at Rady Children?s Hospital in San Diego, where the new EOS system is being installed.
He explained that one of the EOS advantages is that it is able to give clinicians a more accurate image of the scoliosis than a combined AP and lateral x-ray.
?When we take a standard AP and a standard lateral, we move the patient and take one film, and then we move the patient and take another film. So, it?s not clear that the patient was in the same position when those two radiographs were taken, and it is more difficult to correlate the two images,? said Newton.
With EOS, the patient doesn?t move between the x-rays because the views are acquired simultaneously. ?That makes the correlation between the points on the AP and the points on the lateral much more precise,? he said.
The EOS workstation also makes it easier to manipulate views of the patient?s spine in 3D. However, Newton notes that an EOS study is not quite the same as having a reconstructed 3D CT scan.
?You don?t have real data for every point,? said Newton, ?but you have a pretty good representation of the 3D space where one vertebra is relative to the next. And for things like scoliosis, that becomes pretty important to know that it?s not just a curve in the coronal plane.?
Newton also sees EOS? 3D nature as having the potential to further the development of new scoliosis classification schemes. If researchers were to use the EOS system?s 3D studies as benchmarks, levels of fusion could one day be based on classification schemes that take all three planes into account. With more precise classifications, surgeons could potentially become more accurate at fusing vertebrae at the right levels and with fewer complications from fusing too short or too long, which can lead to a second surgery.
In addition to potentially better pediatric diagnosis and treatment planning, EOS can also significantly reduce the amount of radiation given to patients. In fact, compared to conventional radiographs, EOS emits 10 times less radiation.
A tenfold reduction is meaningful for any patient, but the reduction can truly help the future cancer risk of pediatric patients who can be regularly x-rayed once a year or more for 10 years or even longer.
Of course, 3D reconstructions and the lower radiation do come at a premium compared to conventional two-dimensional x-ray systems. Furthermore, there is currently no extra reimbursement for exams to compensate for the extra cost of the EOS system. However, the same is true for premium CT scanners.
While more expensive, Newton suggested facilities might be able to justify the extra cost to administrators because of EOS? lower radiation dose and the potential to attract more patients concerned about their lifetime radiation exposure.
But even without the potential extra patient volume, Newton noted that the EOS could inherently become a justified cost for pediatric centers, because they can then say to parents that they are doing their best to minimize the radiation risk exposure given to children.