Uniting cardiology and EP

Transcription

1 Uniting cardiology and EP Allura Xper FD20/10 cardiac biplane X-ray system addresses complex multi-disciplinary interventions Who/where Dr. W. Jay Nicholson Dr. William Nicholson Dr. Brian Schuler York Hospital York, PA USA At York Hospital in Pennsylvania, a true mixed-use interventional biplane lab proves a valuable addition to the busy daily routine, by providing physicians with enhanced insight and increased confidence. Challenge To offer an interventional lab one that could satisfy multiple disciplines and help relieve a busy workload. Solution Install a versatile Philips Allura Xper FD20/10 cardiac biplane X-ray system Imagine a single room where peripheral interventionalists, interventional cardiologists, and electrophysiologists all prefer to conduct their procedures. Imagine physicians and staff so comfortable with the technology, that cross-disciplinary support is a common occurrence. In York Hospital s new biplane lab, this ideal scenario is an efficient and effective reality. Choosing the right technology Located between Harrisburg, Pennsylvania and Baltimore, Maryland, York, Pennsylvania is home to busy York Hospital a 558 bed community teaching hospital that serves a population of 520,000 in south central Pennsylvania. With a volume of more than 3500 catheterizations, and 1500 interventions each year across two labs, the hospital was maintaining an aggressive schedule. A recent move into an entirely new complex allowed cath lab director Dr. W. Jay Nicholson, to expand his services. I had a shell designed for a potential new lab, recalls From left, Dr. W. Jay Nicholson, Dr. William Nicholson and Dr. Brian Schuler Dr. Nicholson. Installing the Philips Allura Xper FD20/10 cardiac biplane in this lab enabled us to address our rapidly growing workload and recruit a highly respected electrophysiologist trained in complex ablations. York now has four interventional labs available: Two dedicated to cardiac catheterization/ interventional work One dedicated to electrophysiology (EP) One new multi-use biplane lab for peripheral and EP work

2 "It's really nice for complex coronary interventions where you're doing difficult angulations of the vessels and especially when you're doing total occlusions." The new multi-use lab is operating at full capacity with a staff of five interventional cardiologists, three electrophysiologists and three non-invasive cardiologists. Familiarity with the room s biplane capability has created a unique sense of unity among these diverse practitioners. In addition to work in their own areas of expertise, they have begun to support each other during procedures where multiple disciplines can lead to better outcomes. Perfect for peripheral and cardiac work Peripheral interventionalist and interventional cardiologist Dr. William Nicholson (son of Dr. W. Jay Nicholson) enjoys the diversity of work at York and the opportunity to be primary physician for both peripheral and cardiac cases. The capabilities of the Allura Xper FD20/10 cardiac biplane system allow him to cover a lot of territory. His case mix typically consists of: 60% cardiac work Interventional coronary work Structural heart disease ASD closures for congenital defects of the septum 40% peripheral work Carotid stenting Critical limb ischemia Renal interventions Sub-clavian work Procedures down to the feet We do much of our peripheral work using the single plane 20 detector, says Dr. Nicholson. With the Allura Xper FD20/10 s large detector, Dr. Nicholson gets an astounding 30 cm x 38 cm of coverage at 2480 x 1920 pixels for crisp, virtually distortion-free visualization of small vascular details. The wide field of view, he notes, is particularly beneficial, especially when you re doing runoffs. To be able to get the entire vascular system in the field of view is really nice. Add a second detector and system capability broadens to cover the full range of cardiac and vascular interventions. Dr. Nicholson continues, I ve found the biplane to be particularly beneficial in the coronaries. It s really nice for complex coronary interventions where you re doing difficult angulations of the vessels, and especially when you re doing total occlusions. It s nice to have the ability to quickly bounce back and forth between two different working views to tell if you re working your way through the occlusion in the right direction. Two fields of view are invaluable. Biplane dose reduction Philips interventional X-ray systems are designed to maximize image quality and reduce X-ray dose levels. Through features like automatic exposure control, smart We have a lot of flexibility to work in different body areas without making major changes in the setup of the room. 2

3 With both LAO and RAO views, I can almost always find exactly where I need to be. Brian Schuler, MD, Electrophysiologist beam technology (which removes unwanted soft radiation and minimizes scatter), and real-time dose display, the Philips DoseWise program helps provide the lowest possible X-ray dose for patients. And by imaging two planes simultaneously, the Allura Xper FD20/10 can help to further minimize fluoroscopic X-ray dose. Another benefit of the biplane, indicates Dr. Nicholson is that you cut your contrast load almost in half. This is helpful with diagnostic cases where you re imaging patients who have renal insufficiency. You can realistically do a very adequate cath with 30cc of contrast or less, purely because of the biplane. In cases of carotid artery stenting, Dr. Nicholson likes to have the lateral view in place all the time. This second view shows him the lesion and the carotid clearly, so he can confirm wire placement distally at any point a time saving advantage that also saves contrast dose. People are starting to realize, Nicholson says, that the more injections and the more time spent shooting pictures in the cerebral vasculature, the more issues you encounter. It s a real benefit to be able to do the case in less time and with fewer injections. If you use your biplane effectively, I think you can probably cut contrast volume to about 60% of a traditional case. Speed and quality for EP Brought on board by Dr. W. Jay Nicholson, electrophysiologist Dr. Brian Schuler is a strong proponent of the use of biplane technology. When I use the biplane, it cuts down on fluoroscopy time, and even a lot of the procedure time because I don t have to roll a single camera back and forth, explains Schuler. I use it for all of my left atrium ablations. I do venograms. I shoot them in biplane and it s very helpful. Let s say I m doing a double transeptal puncture using two catheters. I line them up to get into the left superior and left inferior veins, and I shoot a venogram of each. Often the left superior vein doesn t take off the way that you normally would expect, and it is better imaged from the RAO (right anterior oblique) projection. I m dependent on knowing exactly where that vein meets the atrium, and the biplane gives me a lot of information about this that I would otherwise not have. The ability to visualize catheter and lead positions from two directions is not the only benefit Dr. Schuler derives from the biplane system. Philips next generation dynamic flat detectors provide excellent image quality at a low patient X-ray dose. The complete 2k x 2k imaging pipeline breaks new ground for interventional procedures, resulting in exceptional image quality. I ll have to say, says Schuler that the image quality of the Allura pretty much blows away anything else I ve seen. It s fantastic. In EP, when I m doing the pulmonary vein isolation procedure, the right inferior vein is very difficult. It s the toughest one to get to. But since I image it in both views, I can usually see it quite clearly. That really streamlines my work. I have more confidence in where I am and time saved is significant. Cross-disciplinary support A typical week in the new multi-use lab at York finds a split schedule in place two days for peripheral work, two for EP, and the fifth shared between peripheral and EP as required. But the boundaries are not that strict. Teams familiar with the room and its equipment assist each other when difficult circumstances present. Dr. Schuler gives this example, I had a case in the dedicated EP lab that required a left ventricular lead implant for a biventricular defibrillator. I tried to place that lead, but no luck. It took me two hours just to get something into the coronary sinus. The reason for this difficulty was a valve flush with the ostium. A venogram of the right In EP when I m doing the pulmonary vein isolation procedure, the right inferior vein is very difficult. It s the toughest one to get to. But since I image it in both views, I can usually see it quite clearly. Brian Schuler, MD, Electrophysiologist 3

4 I think you can probably cut contrast volume to about 60% of a traditional case. atrium showed nothing. Although I finally managed to get a.035 whisper wire inside of this thing, I could not get anything else to go down through the valve. I stopped the procedure after three hours. A couple of days later, we set back up in the biplane room where Bill Nicholson scrubbed in and went to work with all the peripheral tools. Dr. Schuler had trouble getting into the coronary sinus which often can be difficult to see, continues Nicholson. He asked us to put a catheter up the left vein and do a coronary angiogram. Then, we watched the venous filling to see where the coronary sinus was dumping blood back into the right atrium. This was really helpful to him. He found that it had taken a bit of a posterior position to where it usually is located. The reason we can do this so successfully, adds Nicholson is that we re working in a room with equipment that we re all comfortable with a room designed to be used interchangeably. Everything is there to be accessed without difficulty, by everyone. Ease-of-use features on the Allura Xper FD20/10 establish a comfort level for each physician. Using Xper settings, each physician can customize the system to meet their individual needs and preferences. The Allura remembers these personal settings and automatically implements them tableside when called for. Xper settings are but one aspect of Xper technology that strives to create a fluid work environment, capable of nurturing the kind of cross-disciplinary cooperation seen at York. The relationship of support really goes both ways, says Dr. Schuler. Although we trained separately, we now work as one. Although we trained separately, we now work as one. Brian Schuler, MD, Electrophysiologist 4

5 Dr. Brian Schuler, MD Dr. William Nicholson, MD Dr. W. Jay Nicholson, MD Flexible and efficient workflow I think the system s greatest asset is its flexibility, declares Dr. William Nicholson. We even push this flexibility beyond expectations. I will typically do two or three lower extremity cases mixed in with a difficult coronary case, or an acute MI, the same day. Then there are some days that Dr. Schuler will do an atrial ablation in the morning and I ll do an ASD closure or carotid stent in the afternoon, and it s really not a big deal to go from one to the next. I was initially worried that it was going to be difficult. But from our perspective, it s almost a seamless transition from one to the next. It s just a couple of simple changes in the room settings. The turnover time for our staff is 15 to 20 minutes from patient to patient EP to peripheral to coronary. The geometry of the Allura Xper FD20/10 is designed for fast and flexible imaging. The combined floor mounted C-arm stand, with the ceiling suspended double C-arm in lateral plane, provides virtually unlimited projection capability and allows for maximum floor space with superb accessibility around the patient. Dr. W. Jay Nicholson selected the Philips system for just such attributes. For a biplane room, it s probably the least bulky system that I ve seen. It enables you to have For a biplane room, it s probably the least bulky system that I've seen. W. Jay Nicholson, Sr., MD much more operating room while getting the complex angles required from the equipment without any limitations. Since he s in the room on a daily basis, Dr. William Nicholson knows how easy it is to maneuver around the Allura Xper FD20/10. We can easily move the booms for the monitors out of the way, and we can swing the C-arm 180 o around the patient so we don t have any restrictions going from one side of the table to the other. It s physically compact enough that it s not in your way restricting what you want to do, adds Nicholson Sr. My staff is able to move through procedures much more quickly. Right for today, right for tomorrow EP Navigator for enhanced guidance during EP procedures, dynamic 3D roadmapping to support catheter navigation, and StentBoost for enhanced stent visualization are some of the features that make the Allura Xper FD20/10 one of the most advanced multi-use X-ray systems on the market today. They are features designed to boost physician 5

6 Equipment simplicity for these procedures is a must and the Allura Xper FD20/10 system is the answer. confidence during interventional procedures that continue to require the very best in clear vessel morphology. Add the speed, dual-plane clarity and X-ray dose reduction that two detectors provide, and the Allura Xper FD20/10 shapes up as an X-ray system strategically positioned to meet today s requirements and take on tomorrow s challenges. In just a few short months, the system has helped interventionalists at York Hospital manage an increase in patient volume, while at the same time providing an opportunity for new avenues of cross-disciplinary cooperation. As procedures become more and more catheter based, they are going to become more and more complex, explains Dr. William Nicholson. They re going to require multiple disciplines to be involved, with less defined separation. Equipment simplicity for these procedures is a must and the Allura Xper FD20/10 system is the answer. His father concurs, It has brought a new level of enthusiasm to our department to the point where it has really contributed to how fast our programs are expanding. With the Allura Xper FD20/10, we get an all encompassing system, concludes Dr. William Nicholson, good for coronary cases, more than we need for structural cases, invaluable for neuro-interventional work, acute MIs and strokes, and perfect for EP. By far, it s my favorite lab to work in Koninklijke Philips Electronics N.V. All rights are reserved. Philips Healthcare reserves the right to make changes in specifications and/ or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. Philips Healthcare is part of Royal Philips Electronics healthcare@philips.com fax: Printed in the USA * MAR 2009 Philips Healthcare Global Information Center P.O. Box BG Eindhoven The Netherlands