Archives

Improving Door-to-Balloon Times With Toshiba’s Infinix-i

June 28, 2010

The American College of Cardiology (ACC) and the American Heart Association (AHA) recently established new national standards for door-to-balloon time, stating that facilities treating ST-elevation myocardial infarction (STEMI) patients with emergency percutaneous coronary intervention (PCI) should consistently reach a door-to-balloon time of 90 minutes or less. When every minute counts, the right diagnostic technology can make all the difference in meeting or exceeding this standard, as Vinit Lal, MD, a member of the cardiology group HeartPlace (Dallas, Texas), discovered when seeking to improve catheterization-laboratory efficiencies.

Dr. Lal wanted a cardiovascular-radiography system that would enable the group to lower door-to-balloon time by reducing the time required for patient setup and loading, as well as by improving clinician efficiency and confidence. The unique C-arm design of Toshiba’s Infinix-i systems—which offers 270-degree positioning for improved access to the patient, ancillary equipment, and fellow clinicians—met these requirements.

“The ability to move the C-arm quickly in and out of the way facilitates quick loading of the patient,” Dr. Lal notes. “Once the patient is in place, the C-arm is immediately moved back into the desired position to begin the case. This system has saved time by enabling us to start catheterization sooner and reducing overall setup and procedure time.”

Toshiba’s Infinix-i systems boast a five-axis design. Allan Berthe, senior cardiology product manager for the company, explains that this enhances clinician workflow by allowing uninterrupted access to the patient. “If the operators are focused on the patient and don’t have to worry about working around the C-arm or pivoting the table, they can get through the required imaging much faster,” he says. “The system provides excellent access and coverage, and the design of the tableside controls allows clinicians to keep their focus on the patient, capture all the required images and control all key system functions while staying right at the patient’s side.”

Dr. Lal offers an example of the C-arm flexibility in some cases when it is necessary to switch rapidly from femoral to radial access while inserting the catheter. “Within minutes, we have reconfigured the system components to accommodate the transradial approach,” he says. “This flexibility permits more comfortable ergonomic positions for physicians, while also keeping the patient comfortable.”

The time-saving benefits of the Infinix-i systems go beyond design, Berthe explains. Toshiba’s Next Generation Advanced Imaging Processing (AIP) technology, a combination of proprietary hardware and software, supports interventionalists using fluoroscopic and fluorographic imaging by enhancing image quality, sharpness, and contrast during procedures. The technology also substantially reduces image lag time, enabling clinicians to perform fluoroscopic procedures with increased efficiency.

“Next Generation AIP greatly improves coronary-artery visualization and the ability to identify disease,” Dr. Lal says. “The great image detail on all patient types has improved diagnostic confidence and treatment planning, resulting in more accurate device selection and placement.” He adds that Next Generation AIP has improved his department’s efficiency by reducing room time, promoting increased patient throughput: “The reduced exam times have improved the utilization of our staff members and increased patient safety,” he says.

With PCI becoming increasingly prevalent as a treatment for STEMI patients, diagnostic speed and confidence are more important than ever before (as the new ACC/AHA 90-minute door-to-balloon requirement underscores). “If you have a door-to-balloon program, speed is of the essence,” Berthe notes. “Little things matter. The combination of the Infinix-i system’s design and its AIP technology creates an environment where everything is working in concert to produce a more uniform, high-resolution image with increased speed and efficiency.”

Dose Management for Cardiovascular Procedures

With renewed attention on cumulative radiation dose as a patient-safety issue, reducing dose wherever possible is increasingly a priority for clinicians and their facilities. Toshiba’s Infinix-i line of radiography laboratories addresses the issue of dose in four ways: by reducing exam time, by minimizing skin dose during long cases, by shielding clinicians from excess radiation, and by offering a host of dose-management tools, including grid-pulsed fluoroscopy/fluorography and virtual collimation.

“If you can make access to the patient easier and get the C-arm into the position you want faster, you can shorten the overall exam time and save dose,” Allan Berthe, senior cardiology product manager at Toshiba, explains. The 270-degree access of the Infinix-i C-arm gives the user an unprecedented degree of patient, equipment, and clinician access, increasing the odds of acquiring the best possible image, on the first try, with minimal difficulty. “Clinicians can see better and are more confident, and when you’re seeing better, you’re spending less time scouting around, emitting radiation ,” Berthe says.

The Infinix-i systems’ C-arm and flat-panel design also enable clinicians to position the detector as close to the patient as possible, while the systems’ flexibility permits positioning the X-ray tube on either side of the patient. “When you can position the x-ray tube closer to the panel, that reduces the radiation scatter and overall dose emission to the patient and staff” Berthe notes.

Toshiba’s table-mounted radiation shield, which includes table scatter-radiation protection, is complemented by a transparent ceiling-suspended shield with flexible positioning, both of which protect clinicians from radiation exposure. The company’s proprietary dose-management tools, including grid-pulsed fluoroscopy/fluorography and virtual collimation, help reduce patient exposure by enhancing clinician efficiency and overall image quality.

Berthe explains that grid-pulsed fluoroscopy/fluorography makes more efficient use of the x-ray signal, minimizing leading- and trailing-edge dose. “We provide, standard, the most comprehensive number of pulse–frame-rate selections in the industry,” he says. “At times the clinician may determine that superior visualization is not critical. The system operator can lower the pulse fluoro frames in these instances and then quickly increase to higher frame rates when more in-depth imaging is necessary.”

Virtual collimation, he explains, permits clinicians to position collimator blades without expending any additional dose.

“Today, dose management is critical and the Infinix-i systems provide a host of dose lowering tools that the clinicians can control right at the tableside ,” Berthe says. “The efficiency, flexibility and technology included in the Infinix-i systems are interrelated in their contribution to lowering dose to patient and staff members”

Improving Utilization With Shared Laboratories

As hospitals continue to want to improve utilization of imaging equipment, many are turning to a new solution: shared cardiac/vascular-catheterization laboratories. “It’s going to become increasingly important for hospitals to find imaging systems that are versatile and can meet all of their imaging needs” Allan Berthe, Toshiba’s senior cardiology product manager, explains.

Berthe says that smaller flat-panel detectors are ideal for imaging the heart, but a larger detector is required to cover a larger anatomical area. Toshiba’s dual-plane Infinix DP-i system solves this problem by incorporating two C-arms and two flat-panel detectors on the same unit: a floor-mounted eight-inch panel and a ceiling-mounted 12×16-inch panel. “The two C-arms operate independently; one is dedicated to cardiac cases and the other is dedicated to vascular cases,” Berthe says. “You can quickly exchange those back and forth in less than 60 seconds—a capability no other system in the industry offers.”

Working with a shared system saves valuable hospital space and reduces both maintenance and staff costs, but the advantages don’t end there, Berthe notes. “The smaller flat-panel detector can easily image the heart, but it’s not uncommon for a patient with coronary-artery disease also to have problems elsewhere in the body,” he says. “If you want to perform two procedures on the same patient (looking at the heart and the legs, for example), the DP-i excels. You could use the small panel to look at the heart and then quickly change over to the large panel to look at both legs in one view.”

The Infinix-i DPi boasts multiple features aimed at bolstering its clinical flexibility, including a flexible C-arm for peripheral angiography, optional 3D angiography, a table that can accommodate patients weighing up to 484 pounds, and two liquid-metal–bearing X-ray tubes, one for cardiac work and one for full-body imaging. “The dual-plane systems allows you to do both types of imaging with a lot of freedom,” Berthe says. “The user will never have to compromise on the anatomy he or she wants to image.”