Using the radial artery to perform cardiac catheterizations is proven to lower the risk of vascular complications, reduce major bleeding and improve patient recovery time when compared to femoral access. The number of cardiac catheterizations in the U.S. done using the radial approach, currently 8 percent, is rapidly growing¹ as healthcare facilities realize the patient benefits. With a commitment from physicians and the right imaging technology, successfully using the radial approach is possible. One example is Shannon Medical Center, in San Angelo, Texas.

In the past few years, Shannon Medical Center, a 250-bed community hospital, focused on making the radial artery the access point of choice, which resulted in improved safety and outcomes for patients. Shannon Medical Center needed a new vascular X-ray imaging system to accommodate the right or left side radial approach and that was flexible enough to perform various cardiac interventional and other procedures.

Dr. J. Chris McClish, interventional cardiologist at Shannon Medical Center, led the search for the new imaging system and selected Toshiba America Medical Systems, Inc.’s Infinix™ VF-i single plane vascular X-ray system.

“Radial artery access is undeniably the future of cardiac catheterization and the flexibility and image quality of the Toshiba Infinix-i system allows safer, more efficient interventions,” said Dr. McClish. “For example, the system’s lateral movement and fingertip-to-fingertip coverage enable catheter exchanges during procedures without adjusting the table and changing alignment. As our default access site, radial reduces complications and improves patient satisfaction.”

The Infinix VF-i single plane is a dedicated cardiac cath lab featuring a floor mounted five-axis positioner, making it possible to obtain images without re-positioning patients. This allows clinicians unencumbered patient access and an ergonomic set-up, along with the ability to maneuver over the heart and down to the wrist. The Infinix-i monitors also float freely around the system and can be positioned for easy viewing regardless of right or left side radial approach.

Shannon Medical Center’s Radial Results

Within months, the Infinix VF-i system helped Shannon Medical Center increase radial procedure volume to approximately 65 percent of the 1,600 catheterization cases done per year, well above the national average. Shannon’s ability to perform this procedure with minimal complications and increased patient satisfaction has created a competitive advantage for the hospital, with patients traveling from all over the region for treatment.

With Toshiba’s Infinix-i X-ray system and a dedicated commitment from the hospital, transradial interventions can be done more frequently for safer exams that drive patient satisfaction and can provide competitive advantage for hospitals.

¹“Wrist May Be Route to Safer Heart Treatment,” Wall Street Journal, February 8, 2011.

“Reducing costs and providing better patient care are top-of-mind in today’s healthcare environment,” said Stephen Bumb, director, X-ray/Vascular Business Unit, Toshiba. “The radial approach to intervention meets these needs, with multiple patient care advantages eventually leading to lower costs.”

Besides providing information on the advantages of the Infinix-i and benefits of the transradial approach versus the femoral approach, the microsite contains videos, downloadable case studies and brochures, related news articles and clinical images.

Visit the Toshiba Transradial Web Site at http://medical.toshiba.com/promo/cv/transradial/.

1. A transradial procedure is an intervention which uses the radial artery near the wrist as the main access point.
TRUE: Transradial refers to diagnostic and interventional procedures using the radial artery near the wrist, rather than the femoral artery near the groin, as the main access point for intervention.

2. Using the radial approach can improve patient outcomes and lead to reduced costs.
TRUE: Performing cardiac catheterizations through the radial artery is proven to lower the risk of vascular complications, reduce major bleeding and improve patient recovery time when compared to femoral access.

3. Radial entry can only be used to perform interventions to the heart.
FALSE: The most popular procedure for radial access is either a diagnostic heart cath or an interventional procedure such as a percutaneous coronary intervention, or PCI, so usually procedures involve the heart. But radial entry can be used to intervene in other anatomical areas such as the kidneys.

4. Either the right or the left arm can be used for radial entry.
TRUE: Either arm can be used. About 80 percent of the procedures are performed using the right arm and 20 percent with the left. Toshiba’s Infinix-i line facilitates both approaches better than any other cath lab available.

5. About 50 percent of interventions in the U.S. use the radial entry.
FALSE: The radial approach is used more than 50 percent of the time globally, but only approximately 8 percent of the time in the U.S. However, more U.S.-based hospitals are turning to the radial approach since it is easier and safer for patients. The low U.S. adoption rate is due to interventionalists being trained with the femoral approach and/or because some vascular x-ray systems do not easily accommodate this alternative procedure.

6. The radial approach is more difficult than the femoral approach.
FALSE: While the radial approach does use a smaller artery, with proper training and a system that allows for flexible positioning, like Toshiba’s Infinix-i, many clinicians find this approach easier than the femoral approach and much safer for the patient.

7. Toshiba’s Infinix-i vascular x-ray system can help make transradial procedures easier.
TRUE: The Infinix-i’s innovative 5-axis C-arm design allows for greater flexibility of positioning over the wrist to the heart, with head-to-toe and fingertip-to-fingertip coverage. By keeping the C-arm completely out of the way, it allows clinicians to position the monitor suspension into the most desirable viewing position and move the tableside control and radiation shield to either side of the table, accommodating right side or left side entry.

Toshiba America Medical Systems, Inc.’s imaging technology offers solutions that will assist healthcare institutions in preparing for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment.

Episode-Based Care Payment Model

Episode-based care is a payment approach that reimburses providers on expected costs for clinically defined episodes, rather than on a fee-for-service basis. Episode of care provides one fixed payment for the treatment of a specific illness and combines the technical fee with the professional fee. Since this payment approach provides reimbursement on expected costs for clinically defined episodes rather than fee-for-service, healthcare providers must achieve greater efficiencies and better patient outcomes. For example, if a patient has a stroke, everything done to diagnose and treat that condition is bundled together into one clinically defined episode. The goal is to reduce unnecessary services, duplicity of tests and complications – while compensating clinicians for improving the quality of care and reducing costs.

Medicare will launch the episode-based care pilot program no later than January 1, 2013. With such a large segment of patients with this coverage, it will require healthcare organizations to be even more efficient in how they deliver care.

Diagnosing Acute Stroke in an Episode-Based Care Model

Stroke accounts for approximately one in every 18 deaths and is the third most common cause of death in the U.S., according to the American Heart Association. The estimated annual cost of stroke is $50 billion, including healthcare-related costs, disability and lost productivity. When the new episode-based program comes into effect, clinicians will be tasked to diagnose and treat stroke more accurately and quickly to benefit the patient and reduce costs. When evaluating medical conditions to include in this new payment model, Medicare will look at high-cost, high-volume, chronic and acute conditions like stroke, when vetting case types for the pilot program.

In today’s top hospitals and stroke centers, clinicians use the latest CT technology to perform cerebral perfusion imaging to assess neurological disorders, such as stroke, and to make treatment decisions. Depending on the specific case, patients are often taken to interventional labs where the imaging equipment helps guide treatment and supports device placement.

This was not always the case, as limitations in the coverage volume of CT previously prevented perfusion imaging from being a truly effective tool in diagnosing stroke. However, developments in imaging technology, particularly CT, are enabling healthcare professionals to diagnose and treat stroke faster than ever before.

Diagnosing Stroke with Toshiba’s Aquilion ONE

The introduction of Toshiba’s Aquilion TM ONE dynamic volume CT system changed the scope of cerebral perfusion analysis by enabling dynamic imaging of the entire brain and the ability to reduce diagnosis time from hours to minutes. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements to image an entire organ, including the brain, in a single rotation. It can show the brain’s dynamic blood flow and real-time function, which is crucial for stroke patients and enables rapid and accurate diagnosis when time is critical.

The Aquilion ONE also features a full suite of dose reduction technologies that limit radiation dose to the lowest possible amounts while maintaining the highest clinically-appropriate image quality needed for diagnosis.

Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital and Its Use of Toshiba’s Imaging Technology

Toshiba understands that effectively transitioning to episode-based care requires more than just superior imaging equipment; it requires the cooperation and collaboration of a multidisciplinary team of physicians that appropriately leverage the technology to its fullest capabilities to the benefit of the patient. Toshiba’s technology offers solutions to help healthcare facilities prepare for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment. Toshiba uniquely offers a multidimensional knowledge base, dynamic customer interaction, and a robust support system of training and education to help medical teams transition and prosper within the new healthcare economic models.

One such example is Toshiba’s partnership with the Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital in Buffalo, N.Y. Millard Fillmore Hospital is a 189-bed facility that is part of Kaleida Health, the largest, most comprehensive healthcare system in the region. It is a modern acute care center offering a full range of medical and surgical services, including a world-class neurological and stroke care. The Kaleida Health Stroke Center has integrated Toshiba’s state-of-the-art training and imaging with an outstanding multidisciplinary team of physicians, nurses and technicians, comprehensive education and community outreach. The result has been an improvement in both patient and financial outcomes in the diagnosis of acute stroke that demonstrates a commitment to delivering quality care to the community.

Millard Fillmore’s Results Using 320-Detector Row CT in Diagnosing Acute Stroke

To quantify the results of utilizing the Aquilion ONE in the diagnosis and treatment of acute stroke, Toshiba and Millard Fillmore conducted a retrospective and prospective study on its effectiveness in treating these patients with the new technology. The goal of the non-controlled study was to measure the economic impact that 320-detector row CT has had on the diagnostic workup of patients presenting with symptoms of acute stroke and transient ischemic attack (TIA). Millard Fillmore reviewed the patient diagnostic workup on a retrospective and prospective basis and analyzed all the imaging procedures utilized during the acute inpatient episode of care, focusing on the changes in the diagnostic work-up, inpatient length of stay and discharging disposition since acquiring the Aquilion ONE. Inpatient data sets prior to the Aquilion ONE installation were compared with data sets using the Aquilion ONE, and concerned the top three discharging ICD-9-CM stroke codes.

When Millard Fillmore analyzed the length of stay, discharge disposition and healthcare costs for the top three ICD-9-CM codes for stroke and compared the 2007 and 2009 data sets, the results demonstrated the benefits 320-detector row technology brought to the facility and its patient community. For the three stroke ICD-9-CM codes analyzed, Millard Fillmore found a reduction in hospital stay, had more patients discharged to home and achieved an approximate annualized savings of more than $750,000.

The Kaleida Health Stroke Center at Millard Fillmore is an impressive example of how an exceptional multidisciplinary team with comprehensive education and community outreach can use innovative imaging technology to make a difference in the lives of patients, improve financial performance and result in high quality patient care in today’s uncertain times. Healthcare facilities everywhere can experience the significant cost savings achieved through reduced length of stay, reduction in outpatient services, reduced complications, and lower recurrence of readmission.

The reality is that hospitals that choose not to participate in the national pilot program will be at risk of losing market share because Medicare patients will be encouraged to utilize participating facilities. The healthcare providers which embrace this new, value-based collaborative approach to providing high-quality care can not only retain but even increase market penetration. Toshiba has a proactive approach with the knowledge base, customer support and technology to help healthcare organizations successfully transition and succeed.

An ACO is a group of providers that follows a healthcare delivery model in which the primary care physician is responsible for coordinating patient care. ACOs are connected by an electronic health record system, or EHR, which is an electronic infrastructure connecting all points of care. ACOs reward providers with incentives for improving quality of care and reducing costs, ensuring that patients stay healthy and avoid costly and unnecessary hospital admissions.

To understand the benefits of ACOs consider how care is often provided today. Typically, it is the patient’s responsibility to keep track of the care received. For instance, if a primary care physician (PCP) suspects a patient has developed breast cancer, the PCP would order tests and even surgery from many different centers of care. Each time the patient goes to a new place, they are required to provide surgical and pathology reports, X-rays, CT scans, lab results and medical history. Often, each of these centers of care will order duplicate procedures rather than rely on the results the patient provides. Each of these duplicate procedures comes with a complicated fee-for-service payment model behind the scenes. With an ACO, this would change. PCPs and affiliated specialists would be responsible for ensuring patients receive only the most necessary tests and keep track of all of the records in the EHR system.

How will imaging be impacted by these changes? Because ACOs will be penalized for excessive imaging use and costs, radiologists will play a greater role advising PCPs on ordering the right test and collaborating with PCPs on appropriate use, working as a team to ensure patient outcomes are improved and at a lower cost.

Helping Improve Care Delivery

The ACO pilot program is set to launch no later than January 1, 2012, but many major providers are already implementing these changes. For example, UnitedHealthcare, AETNA and Wellpoint have selected to work with certain oncologists to coordinate and manage care for cancer patients who are members of their health plans.

“You don’t have to look far to realize that providers and payers of healthcare services have started to address delivery reform at a local level,” said Tom Szostak, manager, Healthcare Economics, Toshiba. “Healthcare’s new concentration on creating value and increasing quality will prove to be much more meaningful than a system that only emphasizes volume and revenues.”

In this ACO environment, increasing the quality of care is even more important. This is where Toshiba comes in. Toshiba’s imaging products provide customers with a complete solution and the operational efficiency and financial performance needed to keep up in this new value-based system.

For more information on ACOs, click here to watch the Conversational Healthcare video, “The ABCs of ACOs,” featuring Szostak, or visit the Toshiba America Medical Systems YouTube page to view all the Healthcare Economics videos.

Szostak’s presentation, “Health Economics Driving Integration,” gave an overview of the healthcare landscape and factors influencing physicians and group practices to integrate with hospitals, providing attendees with information about the Affordable Care Act and a view of new health economics. With these changes rapidly approaching, providers of healthcare services are looking to vendors like Toshiba for guidance in navigating through the new payment models, requirements and terminology.

For more information from Tom about healthcare economics, view Szostak’s video, “The ABCs of ACOs,” or visit the Toshiba America Medical Systems YouTube page.

After working with the Infinix-i systems, two leading interventional cardiologists at Memorial Hermann Heart and Vascular Institute – TMC, Dr. Colin Barker, assistant professor at The University of Texas Health Science Center at Houston (UTHealth), and Dr. Richard Smalling, professor and director of Interventional Cardiovascular Medicine at UT Health, embarked on a quality initiative to elevate the organization’s already excellent patient care to an even higher level by instituting the transradial approach for interventional procedures.

Femoral Versus Radial Access Intervention
When it comes to percutaneous coronary intervention (PCI), most healthcare providers in the U.S. rely on femoral access despite its inherent risk of complications. Most U.S. fellows are taught PCI using the femoral artery, an artery accessed through the patient’s groin, which offers a wide pathway to the heart.

Despite the potential technical challenges, research shows radial intervention significantly reduces bleeding complications during angioplasty and stenting, cutting by nearly 60 percent the risk of bleeding complications following PCI, while maintaining a high procedural success rate1. In addition to being safer for the patient, it is also more comfortable. After radial intervention, patients experience rapid ambulation. The lower risk of complication coupled with faster ambulation results in speedier recovery, better patient comfort and reduced length of stay. By reducing the complications and improving recovery time, patients are discharged from the hospital faster to help lower overall healthcare costs.

Infinix-i’s Role in Radial Access
Relying on their Infinix-i vascular labs, the interventional team at Memorial Hermann Heart and Vascular Institute – TMC transitioned into performing more transradial procedures. The design of Toshiba’s Infinix-i systems with the flexible five-axis C-arm movement facilitates the radial approach with ease, as it allows clinicians to access the patient from either side, move the C-arm seamlessly and situate the monitors and control panel to meet the needs of the interventional team.

Dr. Barker is now using the radial approach in 80 percent of the interventional cases he handles, including both low risk and high risk cases, such as diagnostics, type A lesions with a single blockage, ST-Segment Elevation Myocardial Infarction (STEMI), PCI, chronic occlusion, and stenting in patients with weak hearts. He only relies on femoral access when radial access is not a viable option due to the patient’s situation, such as patients who are very small, have limited blood supply in their arms or have swelling or dialysis in the arm.

“Toshiba’s Infinix-i vascular lab is ideal for radial interventions as it allows equal access to the right and left radial arteries,” explained Dr. Barker. “The design of the system enables us to move the monitors and change the positioning of the C-arm, without having to pivot the table to reposition the patient, so we can operate from either side. This creates an ergonomically comfortable environment for the interventional team and the patient.”

Improved Collaboration: Using the Radial Approach Moving Forward
After a nine-month period of bringing the team up to speed on radial intervention using the Infinix-i systems, Memorial Hermann Heart and Vascular Institute – TMC is now performing between 200 – 300 transradial cases annually. The excellent range of motion offered by the Infinix-i five-axis C-arm and the system’s overall ergonomics have helped improve workflow and collaboration between cardiologists, interventional cardiologists, anesthesiologists and clinical staff during exams, making it an ideal system to support radial intervention.

¹Cath Lab Digest article, Source: Journal of the American College of Cardiology (JACC): Cardiovascular Interventions, August 2008.

“Toshiba is dedicated to continuously improving its imaging systems to meet the changing needs of healthcare providers,” said Tomohiro Hasegawa, director, Ultrasound Business Unit, Toshiba. “These enhancements to the ultrasound product line build upon Toshiba’s advanced technology to allow quicker, safer and more effective diagnosis, particularly for cardiac exams.”

3D Wall Motion Tracking and Tissue Enhancement for the Aplio Artida
For its flagship cardiac system, Aplio Artida™, 3D Wall Motion Tracking and Tissue Enhancement technologies are now available. 3D Wall Motion Tracking, an industry first on the Artida, offers a new era of dyssynchrony imaging and advanced regional wall motion assessment. It aids electrophysiologists in optimizing pacemaker placement and function. It also shows 3D ejection fraction, volumes, and regional and global strain function. A Toshiba-exclusive software, Tissue Enhancement has the ability to improve image uniformity and endocardial border delineation, especially in difficult-to-scan patients.

Auto IMT on Toshiba’s Shared Service Ultrasound Systems
Available on Toshiba’s shared service ultrasound systems, Aplio™ MX, Aplio™ XG and Xario™ XG, the new Auto IMT feature calculates the intima-media thickness of the carotid artery, helping clinicians determine a patient’s risk for cardiovascular disease. Toshiba’s Auto IMT can determine the thickness of the near and far arterial walls from three segments of the carotid artery: at an optimal angle of incidence and two complementary planes. Auto IMT automatically locates and finds the thickness of each segment. These measurements are based on numerous research protocols and the American Society of Echocardiography (ASE) consensus statement, and may be used in stratifying cardiac risk in certain asymptomatic populations.

New TEE Probe
Also at ACC will be Toshiba’s new adult motor-driven TEE probe which improves the diagnosis of numerous cardiac conditions in difficult to scan patients.

Dr. Michael Poon, professor of Radiology and Medicine and director, Advanced Cardiovascular Imaging Program, Department of Radiology at SUNY-Stony Brook School of Medicine, and Dr. Chris McClish, board-certified in Cardiovascular Diseases at Shannon West Texas Memorial, will be presenting on “Helping You Prepare for Today’s Healthcare Environment.”

Dr. Poon and Dr. McClish will give presentations on how cardiovascular computed tomography can help in an emergency department and improving outcomes with interventional radial techniques.

In August, Toshiba and AHRA: The Association for Medical Imaging Management announced the third year of the Putting Patients First grant program, which provides funding for facilities seeking to improve pediatric or adult patient care and safety in diagnostic imaging. This year, AHRA will provide six grants of up to $7,500 each to hospitals and imaging centers; three grants will be awarded for projects that improve the safety and comfort of pediatric imaging, and three grants will be awarded for projects that improve overall patient care and safety in imaging. Winning organizations will use the grants to develop their programs and to share the results with others.

In 2009, Memorial Hermann Healthcare System, Houston, Texas, was awarded a Putting Patients First grant for its pediatric CT technologist education and auditing program. With over 40 CT scanners spread between its eleven hospitals and 21 outpatient imaging centers, the organization performs around 14,000 CT exams a year on children under the age of fifteen. “The technology nowadays has outpaced a lot of the education when it comes to CT, and we found that a lot of our CT techs really wanted some education and guidance when it came to pediatrics,” saidKelly Firestine, RT, CT clinical quality manager at Memorial Hermann. “We needed to empower them with better education.”

With the help of its physicists, Memorial Hermann implemented new pediatric CT protocols, then put a monthly auditing process in place to ensure technologists were utilizing them. The organization also developed a one-day educational seminar on pediatric CT for its technologists, and worked with the American Society of Radiologic Technologists (ASRT) to have it approved for eight CE credits. “We want to keep this knowledge fresh in their minds and keep them excited,” says Firestine. “We really want them to look at every single patient every single time and say, ‘Am I doing the best thing for this patient?’”

Firestine says the pediatric CT seminar was a huge success—popular enough, in fact, that Memorial Hermann is now splitting it up into webinars to host on its intranet as refresher courses. The new monthly audits reinforced the program’s efficacy; beginning in February, they revealed 100% compliance with the new pediatric CT protocols and criteria. “Our sales team loves to share our progress with our community and referring physicians,” Firestine says. “We’re very grateful to Toshiba and the AHRA for the grant.”

Prospective Putting Patients First programs should seek to address one or more of the following: reducing radiation and/or contrast dose; reducing the need for sedation; improving communication with patients regarding the process; improving patient comfort; and/or improving the overall clinical pathway. Applications for this year’s Putting Patients First grants are due October 15; they can be completed and submitted at AHRA Online.