Innovations in IR

Thanks to sophisticated new solutions, clinicians can maximize their potential when performing minimally invasive procedures.

Since angioplasty and stenting revolutionized medicine decades ago, the use of noninvasive procedures has become increasingly more prevalent. As the list of interventional radiology procedures grows, so do the solutions that assist interventional radiologists to perform these tasks. The Society of Interventional Radiology (SIR)—a national organization of physicians, scientists, and allied health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapeutic interventions—attempts to lead this innovation through hosting its Annual Scientific Meeting (SIR 2012), being held this year from March 24 through March 29 at the Moscone Center in San Francisco.

In addition to the major innovations expected at the annual SIR conference, many manufacturers unveiled their groundbreaking work at the recent Radiological Society of North America (RSNA) conference. Toshiba, Philips, and GE were just a few of the major manufacturers to unveil or showcase their latest interventional radiology solutions at the event. Whether it is laser-guided imaging systems or dose-monitoring methods, the new innovations in the field are changing the way health care organizations deliver interventional radiology services.

Laser-Guided Interventional Suite

One of the most talked about interventional radiology unveilings at RSNA was GE Healthcare’s Discovery IGS 730. The system was designed to capture the advantages of both floor- and ceiling-mounted systems by utilizing laser-guided motion technology on a motorized mobile gantry. It also features Wide Bore 3D for ease in 3D acquisitions and more than 20 advanced applications.

The Discovery IGS 730 is neither floor- nor ceiling-mounted, but enables full patient access without the need to suspend the system above the patient. The laser-guided, motorized mobile gantry allows complete access to the patient and unlimited parking capability, while creating a flexible OR environment. The gantry comes with a wide bore design, which allows for steep angles and ease in 3D acquisition, especially for large patients.

The Discovery IGS 730 C-arm is mounted on an Advanced Guided Vehicle (AGV), a motorized and fully mobile system. Based on laser guidance, the AGV can move freely from imaging position to parking or back-out positions, using predefined trajectories to provide total patient access.

“Our goal was to pioneer a solution that eliminates the historical trade-offs our customers had to make when selecting from the interventional imaging systems,” said Hooman Hakami, president and CEO of GE Healthcare Interventional Systems. “In general, the trade-off between ceiling- and floor-mounted systems means compromising patient access for room airflow and sterility, while the choice between fixed units and mobile C-arms means compromising image quality for mobility.”

GE also introduced the Innova IGS 630 biplane cardiovascular and interventional imaging system. The system features Innova CT HD, which offers advanced 3D imaging, and a comprehensive set of advanced applications for interventional neuroradiology. Other key features include the GE Advantage Workstation; TrackVision, which helps to plan and guide needle procedures; and differentiated sets of enablers to help the dose minimization including core dose efficient technology designed to achieve imaging requirements while adhering to ALARA principles, dose reduction features, and dose management and reporting tools.

Leading the Way with Dose Control

Another group of innovative interventional radiology solutions on display at RSNA was the Philips Healthcare Allura Xper FD family with FlexMove, which is suited for hybrid ORs. The solution moves your x-ray imaging system more freely in the treatment area. It can be parked in a stand-by position near the table, providing more room around the table, and gives access to other equipment.

The ceiling-mounted system frees up floor space for cleaning and accommodates laminar air flows. It also provides full-body coverage on both sides of the table to support complex open surgical and minimally invasive procedures. During hybrid surgery and endovascular procedures, FlexMove can be parked in stand-by near the table, giving the team more room to work around the patient and access other equipment. When needed, you can move the C-arm forward for imaging without having to move equipment. During open surgical procedures, FlexMove can be parked out of the way in a corner to free up extra working space.

Philips also showcased the Allura Xper FD20. The system brings multimodality information to your work area; offers a 2k digital imaging chain, which provides crisp visualization of small details and objects for vascular interventions; features DoseWise, which offers low x-ray dose without sacrificing image quality; and allows for personalized settings to simplify complex positioning movements during vascular interventions.

The integrated workflow, user interface, and personalized settings make it easy for a variety of different users to work with the Allura Xper FD20 system. Each user can personalize their settings for each type of procedure and system movement, and control the system from the tableside.

Philips once again showcased its DoseAware personal dose meter system at the annual conference. The system provides instant, time-stamped feedback in the examination room so staff can immediately adjust their working habits to minimize radiation exposure. The device gives you the information needed to manage personal x-ray dose exposure; tells when and where x-ray dose was acquired so you can take the appropriate action during a procedure; allows users to check their exposure level with a single glance at the colored display in the examination room; and allows facilities to archive, report, and analyze radiation data to maintain high levels of occupational safety.

However, Philips was not the only manufacturer at RSNA with an eye on dose reduction. Toshiba America Medical Systems Inc recently introduced DICOM Radiation Dose Structured Reporting on all new Toshiba Infinix-i vascular x-ray systems. The reports automatically record radiation dose information from every x-ray event based on each pedal push administered by the clinician. The data is transferred into a standard format suitable for storage, making it easier for clinicians to document, manage, and evaluate overall dose usage.

At SIR 2012, Toshiba will be showcasing the Infinix-i x-ray systems. The Infinix-i moves like a hovercraft, featuring unrestricted patient access—from head to toe and fingertip to fingertip—to facilitate advanced, complex procedures. Toshiba will also showcase enhancements to the Infinix-i, including faster reconstruction speeds for conventional 3D angio and low-contrast imaging procedures.

In addition, the Infinix-i design incorporates numerous features to lower radiation and provide clinicians with the ability to attain a blend of image quality and dose management. Quick exam times, system mechanics, shielding, and system technology all contribute to limiting radiation dose to the lowest possible amounts for the desired clinical application.

Expanded Visualization

The Vision RFD from Ziehm Imaging is another recent technological innovation on the interventional radiology market. The Vision RFD is tailored to hybrid OR use criteria. The C-arm features a user-friendly touch screen interface that is mounted to the sterile OR table, an injector interface that synchronizes contrast media with the imaging process, and an interface for external displays.

The system offers distortion-free image quality from flat panel technology; expanded anatomical visualization with 30 x 30 cm panel compared with conventional 12-inch image intensifier; Advanced Active Cooling, which ensures extended performance even in lengthy or back-to-back procedures; and a high-power pulsed fluoroscopy monoblock generator, which lowers dose without sacrificing image quality.

A Bright Future for IR

Thanks to diagnostic imaging, exploratory surgery is a thing of the past. And thanks to the continued breakthroughs in interventional radiology, major surgery can now often be avoided with minimally invasive procedures. Moreover, as dose awareness grows, the recent low-dose trends and innovations can be expected to expand similarly. With ever-evolving imaging software and equipment, as well as annual events like the RSNA and SIR conferences, manufacturers have the tools and incentives at hand to continue improving and revolutionizing the field of interventional radiology. Ultimately, that translates into easier, more efficient ways for clinicians to perform their lifesaving work and promise better outcomes for patients.

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Chris Gaerig is associate editor of Axis Imaging News.