on January 24, 2012 |
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Topics: Clinical Technology, Service Lines, Cardiac Cath, Cardiovascular
Di Yu
In conjunction with the long-awaited FDA approval of transcatheter aortic valve replacement (TAVR) therapy, imaging platforms for hybrid operating rooms—where TAVR is performed—have undergone significant innovation.
Because hybrid suites integrate surgical sterility and high-quality fixed imaging in one space, these rooms demand investment in high-caliber angiography systems capable of meeting multi-specialty needs. Historically, GE, Siemens, Phillips, and Toshiba have been the leading vendors in high-end angiography systems; however, with the advent of TAVR, GE, Siemens, and Philips have emerged as true front-runners in the hybrid OR space.
In late November of 2011 at the annual Radiological Society of North America (RSNA) meeting, these three vendors showcased their most updated, innovative angiography models, each of which is described in more detail below.
Phillips
Phillips, the only vendor in the commercial market with a ceiling-mounted system, unveiled its new FlexMove option for the Allura Xper angiography system. This new X-ray technology, for which FDA approval is pending, simplifies workflow and maximizes free space in the hybrid suite. In addition to allowing lateral and longitudinal full-body coverage on both sides of the OR table, the technology creates more space around the table, thus providing physicians and staff greater flexibility in moving about the space.
This technology can also be parked in standby position near the table or tucked away during open surgical procedures, offering a solution to earlier challenges of the ceiling mounted system inhibiting access to the patient’s head. The Flexmove’s ceiling rail aligns with laminar air flow systems in such a way that helps prevent contamination of the interventional field below.
At present, the FlexMove system is only commercially available in Europe and may undergo further technological improvements as it seeks FDA approval in the U.S.
GE
Like Philips, GE also revealed a new work-in-progress angiography model—the Discovery IGS (Image Guided Surgery) 730, an innovation on the original Innova system. The Discovery IGS integrates the advantages of floor- and ceiling-mounted systems to optimize flexibility. To do this, it uses laser sensors that guide the motorized platform across the floor of the hybrid suite. By following predefined trajectory, the robot-propelled C-arm offers the benefits of a mobile C-arm while still allowing for high-quality 3D imaging.
The system also integrates 20 advanced applications, including wide-bore design, which enables steep angulations to capture the skin line during image-guided needle procedures. Compared to the ceiling-mounted system, the floor-mounted design allows for improved compatibility with room layout, especially with regard to sterility and air flow.
Siemens
Although much excitement surrounds the new GE and Phillips platforms, Siemens maintains a market advantage with its Artis Zeego system, which was released four years ago at RSNA. The C-arm of this system integrates a traditional C-arm with multi-access robotic technology that can be adjusted according to physiology and procedural needs. To capture images, the Zeego operates a rotational mechanism that produces 3D pictures comparable to CT technology and allows for integration with radiological images taken preoperatively.
From a flexibility standpoint, the system’s adjustable isocenter has proven highly effective in allowing physicians to move easily in all directions. Moreover, the fact that the system can be folded back as needed further contributes to its flexibilty.
Range of considerations drive angiography selection
All three systems promise to improve operating efficiency, surgical sterility, and flexibility of movement. However, given the different technical components of each system, angiography system selection will require that key administrative and physician stakeholders plan judiciously, visit sites with established models, and adhere to facility specifications.
As cardiovascular services transition to the minimally invasive hybrid arena, new innovations in angiography design will continue to improve upon operational efficiency, compatibility with room design, and imaging guidance.
