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.

“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”

When patients have to have any diagnostic imaging exam, they are understandably nervous.  Often times the anxiety they feel comes from thinking that a particular exam is going to be difficult, time consuming or uncomfortable.  Toshiba has developed its technology with patients in mind and incorporates many patient friendly features into its systems.  At this year’s RSNA, Toshiba highlighted its patient friendly features.

Magnetic Resonance

For patients undergoing an MR exam, discomfort from claustrophobia and the loud noise of the magnet are among the highest complaints.  To address this, Toshiba developed the Vantage Titan^TM MR, which features a large 71-cm aperture and open bore, offering the industry’s largest clinical field-of-view (55×55×50 cm).  The bore’s diameter reduces the feeling of claustrophobia.  Titan’s ultra short, open bore was designed to increase comfort and improve the imaging of all patients, especially those who are claustrophobic and/or bariatric.  The open bore’s larger diameter enables facilities to scan bariatric patients with greater ease and provides patients with a greater feeling of openness to reduce claustrophobia.

Toshiba’s Pianissimo^TM technology reduces noise by up to 90 percent, making Toshiba’s MR systems the quietest available.  Since the patient experiences lower noise levels with Pianissimo, patients stay more relaxed during exams and fewer motion artifacts are acquired, which helps improve image quality.  Useful for imaging pediatric patients, Pianissimo helps technologists image patients more successfully and reduces repeat exams.

With all of the concern surrounding gadolinium, Toshiba’s proprietary contrast-free MRA techniques enable safer MRA imaging of patients with known renal compromise. These techniques include Fresh Blood Imaging (FBI) for evaluating peripheral vascular diseases of the lower legs and extremities; Contrast-free Improved Angiography (CIA) for easier visualization of smaller vessels; Time-Spatial Labeling Inversion Pulse (Time-SLIP) for evaluating hemodynamic, functional assessments, and visualization of vascular structures; and Time Space Angiography (TSA) to create non-contrast time-resolved imaging with high temporal resolution.  Contrast-free techniques are safer for patients with renal conditions and require less set-up time, so the overall MR exam is completed faster, without compromising image quality.

Computed Tomography

The Aquilion® ONE was specifically developed with patients in mind.  Not only is the comprehensive exam much faster than traditional CT exams – 0.35 seconds versus conventional helical CTs that can take approximately 10 to 12 times longer – but also radiation exposure is dramatically reduced because of volume acquisition.  These patient benefits are especially important during neuro and pediatric procedures.

When a patient comes to a hospital’s emergency department exhibiting stroke symptoms, it can take hours to diagnose and treat the patient when time is of the essence. Toshiba’s Aquilion ONE dynamic volume CT system has the ability to improve the quality of life for patients with neurological symptoms, especially related to stroke, by reducing diagnosis time to minutes. In fact, the system allows physicians to reduce diagnosis time for life-threatening conditions, such as a stroke, from hours or days 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 organ’s dynamic blood flow and real-time function.  The ability to see dynamic function, such as blood flowing through the brain, is critical for stroke patients in emergency settings and enables rapid and accurate diagnosis when time is critical.

Another reason to select dynamic volume CT is for its pediatric applications.  The Aquilion ONE can significantly lower patient radiation dose exposure and decrease the sedation needed for exams.  Traditionally, when children are imaged using multi-detector CT, sedation is required to keep the patient still long enough to obtain a clear diagnostic image.  The Aquilion ONE’s fast exam time means less patient sedation is required. The system also features Toshiba’s ^SUREExposure™ Pediatric software, which automatically takes inputs on the size and age of each patient and tailors radiation dose to achieve the best and safest image quality for each exam. The software uses protocols selected based on the patient’s age, size and type of exam to ensure patients receive only the radiation required to obtain a clear diagnostic image.  ^SUREExposure Pediatric software comes standard on all Aquilion products.

X-ray Vascular

CT is not the only modality in which radiation is a concern.  Toshiba’s Infinix-i product line incorporates features that help to reduce exposure.  For example, the systems come with fluoro dose level settings and fluoro pulse rate settings.  Toshiba offers the industry’s widest range of pulse rates, which means that physicians have the ability to reduce flyoro pulse rate and fluoro dose level in an exam, providing two quick methods of reducing radiation exposure to the patient.  Additionally, Toshiba’s lateral plane variable isocenter on its biplane systems saves time and exposure.  During biplane positioning, the user will fluoro frontal plane and adjust table panning to center the part of interest.  Next, they will fluoro the lateral plane and adjust lateral isocenter to match the frontal set-up.  No additional fluoro is needed.  Not only does this cut down on fluoro exposure, but it also speeds the exam time, reducing the risk to the patient.

Infinix-i systems also provide the greatest anatomical coverage and patient access in the industry, providing more efficient and safer patient care.  Greater anatomical coverage means that the system moves around the patient, rather than moving the patient.  Moving the patient can introduce greater risk.

The Infinix-i’s tables also are more patient friendly.  Not only are the systems’ table weights the highest in the industry at 550 lbs., but also the tables include thicker pads complete with Tempur-Pedic^® technology, making extended procedures more comfortable.  Also, the new the CAT-880B hybrid catheterization table introduced at RSNA offers the lowest table top height of any catheterization table in the industry.  Toshiba has even introduced accessories that expand the width of the system tables to accommodate larger patients and make the exams more comfortable.

Ultrasound

The move toward portability in ultrasound is helping physicians deliver more comfortable patient care.  The ability to bring a diagnostic imaging system to the patient can often mean that someone already in discomfort does not have to be moved in order to be scanned.

In addition to the Viamo handheld system, Toshiba has continued its focus on portability by introducing the Aplio MX.  Thirty percent lighter than traditional cart-based systems, the Aplio MX enables hospitals to complete advanced ultrasound exams, usually performed with larger systems, on a more portable system without sacrificing quality.  Furthermore, it enables medical staff to easily bring the system directly to the point-of-care.  For example, if someone is on a gurney and should not be moved, medical professionals can easily transport the MX to the patient’s location and get a high quality exam.

Toshiba’s Aplio MX ultrasound system includes:

• 4D imaging to produce high resolution renderings and arbitrary volume cuts in real-time or offline allowing virtual reconstruction in formats similar to CT and MRI.
• Differential Tissue Harmonic Imaging for better imaging of difficult-to-image patients, like bariatric, without sacrificing resolution to give superior border and tissue definition.
• ApliPure to enhance both image clarity and detail definition with real-time compounding technology to simultaneously perform spatial and frequency compounding during transmitting and receiving.
• Advanced Dynamic Flow to provide color Doppler imaging at an unprecedented level and show flow with directional information for even the smallest vessels.
• Precision Imaging to provide more detailed ultrasound images by capturing information from multiple lines to improve definition of the structure and minimizing noise and clutter.
• Elastography to enable a non-invasive medical imaging technique that evaluates tumors based on their stiffness (elasticity) compared to normal tissue.
• MicroPure to help physicians detect micro-calcifications using ultrasound, an imaging technique that is less strenuous on the technician and the patient than mammography, the current gold standard.

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