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.

Today’s economic environment makes it increasingly challenging for physicians and technologists to travel to educational events. Robb Young, senior manager in the CT Business Unit for Toshiba, explains that this obstacle inspired the company to begin sponsoring webinars on applications for its imaging technology. “Webinars are easier for people to access,” he says. “We can do them during the day, and we can make the expertise of a particular speaker available to a broader audience. A webinar can also be saved online, so if people missed it, they can easily access the information later.”

Toshiba’s first webinar in 2010 featured S. Bruce Greenberg, MD, professor of radiology and pediatrics at Arkansas Children’s Hospital, presenting on how radiology professionals and clinicians can leverage 320-detector row CT to reduce sedation needs and radiation exposure for patients while providing them with high-quality diagnostic images.  This webinar was so well received, that Dr. Greenberg conducted a second session in late February.  “We’re focusing on the needs in the market that drove the development of this technology,” Young says. “In pediatrics, obviously, that’s being able to image patients quickly at a low dose.”  This CME-accredited webinar will be available online in April.  At that time, please visit the following site to view the webinar and receive educational credits http://www.ceconcepts.net/CT/ .

Webinars planned for later in the year include sessions on using 320-detector row CT for cardiac care and stroke triage and diagnosis, as well as on applications and technology for non-contrast MRI. The webinars are each an hour long, are free to all attendees, and are accredited by the Accreditation Council for Continuing Medical Education. Each is worth one CME credit.

“We find these events are particularly beneficial for those who are looking at new applications of a technology, or who want to understand a technology better—especially because they get to hear about it from a user,” Young says. “The webinar format allows us to get the information out to those who need it more quickly and easily.”

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At this year’s annual scientific meeting of the American College of Cardiology (ACC), which takes place on March 14–16 in Atlanta, Toshiba (booth #1944) will showcase a range of advances in and enhancements to its cardiac-imaging technology.  Following is an overview of what Toshiba will showcase:

Infinix-i Hybrid Lab

When performing patient procedures in a hybrid setting, it is critical that the imaging system provides the flexibility to quickly and easily access both the patient and ancillary equipment. Toshiba will showcase its Infinix™ VF-i vascular X-ray system with 12” x 12” flat panel detectors and CAT-880B hybrid catheterization table, designed to create a best-in-class hybrid suite.  The new mid-sized 12” x 12″ flat panel detector expands the versatility of the Infinix-i line that features a five-axis C-arm positioner and enables unprecedented patient access and coverage. Along with the new mid-sized detector, the Infinix-i five-axis systems are now available with the new CAT 880B tilt/cradle hybrid catheterization table. This table is designed to allow greater positioning flexibility and patient access during imaging and surgery. The table functionality, with side-to-side cradle and head-to-toe tilt, permits clinicians to angle the table in the optimal position to quickly and comfortably complete procedures. The system on display will also include ancillary equipment typically used in a hybrid suite.

Cardiac Ultrasound Capabilities

The cardiac capabilities of Toshiba’s ultrasound technology will also be featured. The Aplio Artida™ system is a dedicated cardiac system which provides unique 3D Wall Motion Tracking, allowing physicians to rapidly identify wall-motion defects and the timing of cardiac events, as well as real-time, multiplanar reformatting for assessing global and regional left ventricular function. Also on display is the new Aplio™ MX system, which is midsized and cart-based for better portability. Aplio MX is a multi-modality system which includes Differential Tissue Harmonic Imaging, for better results with bariatric patients; ApliPure, which enhances image clarity and detail definition; Advanced Dynamic Flow, which shows flow with directional information for even the smallest vessels.

Cardiac CT Software Enhancements

CT will highlight cardiac-software enhancements for the Aquilion^® ONE and Aquilion Premium, including new ONE Beat Prospective Reconstruction, which shortens the interval window and reduces radiation exposure time, reducing dose by 21 percent; Real Time Beat Control, which calculates the running real-time average of the heart rate to predict the next beat more precisely (and thus, to time the scan more accurately); and optimizing timing for ^SUREStart, which accurately determines contrast uptake time for a better image. Wide Volume Cardiac Protocol on the Aquilion ONE, a work-in-progress enhancement, will enable clinicians to image the entire heart, lungs, and aorta in two rotations.

Cardiac MR

The wide range of cardiac MR capabilities on the Vantage Titan™ and Vantage Atlas^® systems will be highlighted. The Vantage MRI product line offers a range of advanced cardiac capabilities, including a cardiac coil for the Vantage Titan and noncontrast imaging for patients with renal insufficiency.

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The American Heart Association estimates that nearly one million US residents die of heart disease annually, and according to the US Centers for Disease Control and Prevention it is the leading cause of death for both men and women. As a result, finding ways to detect heart disease earlier and more accurately are becoming increasingly important. Toshiba’s advancements in MRI are helping physicians quantify heart disease, thus improving diagnosis and treatment.

MRI has long been used to assess the structure and morphology of the heart, but as the technology advances, so do the procedures available to clinicians for quick and accurate diagnosis of heart disease in their patients. “The bread-and-butter sequence is called SSFP [steady-state free precession] cine imaging,” Erin Kelly, clinical science manager for MRI at Toshiba America Medical Systems, explains. “It gives an image of the heart as it moves through the cardiac cycle to tell the clinicians how the muscles are functioning, and they can use these images to calculate ejection fraction and left-ventricular volume.”

The ability to perform SSFP cine imaging is one of many cardiac-friendly features included in Toshiba’s Vantage™ Titan MRI, a 1.5T system that also includes a 16-element cardiac coil that can be combined with the 32-element spine coil. The center elements are smaller, resulting in higher-resolution imaging of the heart, and “the elements in the coils can be turned on and off to optimize the signal-to-noise ratio,” Kelly notes. Various sequences and parameters are selectable from the scanner to facilitate successful evaluation of the heart, including delayed-enhancement, myocardial imaging, retrospective gating, black-blood imaging, and real-time motion correction to name a few. Non-contrast techniques are also available on all Toshiba MR systems. For example, Whole Heart Imaging is one contrast-free sequence that allows physicians to assess the coronary arteries without contrast.

Timothy Albert, MD, is medical director of the Cardiovascular Diagnostic Center at Salinas Valley Memorial Healthcare System, Salinas, California, and he uses the Vantage Atlas system. He says, “We try to use noncontrast imaging as much as possible, both for patient convenience and safety and because of concerns about patients with kidney problems. For scar imaging, you still need contrast, but the other stuff, we can often do without it.”

Albert says that MRI has an important place in the portfolio of modalities used to detect and plan treatment for heart disease. “I use CT for coronary imaging, but that’s a small part of the cardiac question,” he says. “MRI’s strengths are really in functional imaging—the shape of the heart and how it’s beating. There’s an increasing amount of scientific data coming out about new uses for MRI in cardiac care.” Albert and his team even run a two-day training course designed to help educate referring physicians on the robust applications of cardiac MRI.

“MRI is ideal for assessment of the heart-failure patient, looking at the potential causes to guide treatments and diagnostic tests, and we use it to determine whether someone would benefit from being revascularized after a heart attack,” Albert says. “For patients with congenital abnormalities, it’s the gold standard, since CT radiation could be cumulative over time. In the future, we hope physicians will hear about these new uses for MRI and recommend it more frequently.”

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As procedure mixes continue to shift in facilities nationwide, it’s increasingly important for capital investments in imaging technology to offer versatility, according to Allen Berthe, X-ray senior product manager for Toshiba America Medical Systems. That’s why the company’s vascular labs come automatically equipped with features for cardiovascular procedures.

“One of our philosophies is that customers’ needs are changing and it is very likely a system will be required to perform cardiac and vascular procedures, so we’ve tried to gear our systems to maximize room utilization,” Berthe says. “A hospital today may know exactly what it wants, but five years from now, its staffing may change, its requirements may change, and its clinicians may like to do different types of procedures—so we created a system that would give them flexibility.”

Features that are part of the company’s vascular labs include digital subtraction angiography provided, standard, irrespective of system type or panel size, and a stepping feature that allows more efficient and accurate lower-body exams. A third feature is what Berthe calls a “true multitasking digital processor,” which, he explains, “means that if a physician comes in and wants to look at the images taken yesterday on a particular patient, he or she can do that without affecting the procedure currently in progress.” This parallel-processing capability is also included, standard, in Toshiba’s vascular labs.

Berthe notes that all labs are 3D ready; if a facility chooses to upgrade to 3D, the base system is configured to accept it, “so if your practice changes in three years, you can add it.” Labs are also optimized for fingertip-to-fingertip, head-to-toe patient access and coverage. “Our systems are designed to give you unprecedented patient access,” Berthe says. “Sometimes, cases require on-the-fly changes, and our systems can adapt to that. If there’s a lot of additional equipment around, then having an easy-to-position C-arm is really helpful.” He adds that all Toshiba systems are configured using the same base platform, the same features, the same user interface, and the same consoles. “If you’re buying multiple systems from us, you can go from room to room with high confidence because everything’s going to perform virtually the same way,” he says.

Berthe emphasizes the importance of versatile, flexible purchases in an environment of fluctuating reimbursement and potential health care reform. “We’re just making sure we give you a room that can address your clinical needs,” he says. “If you don’t have a cardiovascular program and choose to start one, you can do that. You have a system that’s ready to do it.”

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