The Digital Cath Lab: Exploring New Depths

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Newer technologies hitting the market for use in the cardiac catheterization lab include advanced digital imaging systems, drug eluting stents and perfusion balloons. The combination of imaging, diagnostic and therapeutic technology is improving the detection and intervention of cardiac disease. And the newer generations of angiography systems utilize flat-panel detectors that tout superior imaging quality and more efficient radiation dose.

Many thousands of cardiac catheterizations are performed everyday by cardiologists to diagnose and treat cardiac disease, especially coronary artery disease.

Depending on the severity of a patient's case, treatment may include angioplasty and stenting, as well as coronary artery bypass surgery. Accurate, high-quality images are imperative in determining the optimal path of therapy for each patient. Tiny blood vessels of the heart are hard-to-see, and its minute moving structures require an imaging system with finite resolution and distortion-free imaging techniques.

Approximately one-third of patients with coronary artery disease will undergo coronary angioplasty and stenting. At the Cardiac Cath Lab at North Shore University Hospital in Manhasset, N.Y., 1,200 cardiac caths are performed each month. "We do 4,200 cardiac interventions and 10,000 diagnostic cardiac cath procedures on an annual basis," says Stanley Katz, MD, chief of cardiology at North Shore University Hospital, which is part of the North Shore-Long Island Jewish Health System.

"I think that if you look at the outcomes of angioplasty and stent procedures worldwide, there has been a dramatic improvement in morbidity and mortality, as well as the treatment in myocardial infarction patients," says Katz. "When we started doing angioplasties in the '80s, there was a 5 to 7 percent failure rate requiring urgent bypass surgery. That [failure rate] is about zero to 0.5 percent now. I think this is due to improved skills of the physician, but more importantly through improved products such as balloons, wires, stents and x-ray equipment."

The new market player

Cath lab vendors now offer user-friendly, diagnostic and interventional angiography systems that are coupled with high-quality, flat-panel detectors (FPD), as opposed to image intensifiers. The technology touts superior image quality and greater dose efficiency. Flat panels produce distortion-free images with uniform brightness for patients of all sizes - an important component in the cath lab since obesity is a major contributor to heart disease.

Leading system vendors include GE Healthcare, Toshiba America Medical Systems, Siemens Medical Solutions and Philips Medical Systems. Vendors offer systems dedicated to cardiac procedures, systems with larger FPDs to perform cardiac and peripheral exams, as well as dual-plane systems that integrate two C-arms into one system to optimize imaging for cardiac and peripheral angiography studies. Dual-plane systems typically consist of dedicated C-arms for cardiac and peripheral procedures that share a common table, generator, digital acquisition system and monitors. The desire to work outside the heart has been and is a significant trend in the cardiology market.

North Shore's state-of-the-art, seven-room cath lab department will soon expand to nine by the end of the year, says Katz. All of the labs are equipped with single-plane systems and eight of the nine systems have flat plates.

GE's Innova 2100 IQ, the company's newest digital cardiovascular diagnostic and interventional imaging system, has a 20-centimeter FPD. North Shore uses the system strictly for cardiac procedures. For peripherals, the facility installed GE's Innova 4100 that has a 41-cm FPD. "We do quite a bit of peripherals on the 4100," says Katz. "We have gradually increased volumes of peripherals. That is why we got the 4100." Two of the labs are awaiting installation of GE's Innova 3100 that has a 30-cm FPD, which will be used for both cardiovascular and peripheral studies.

While peripheral work in the cath lab is a growing trend with promising outcomes for patients, it has created a bit of friction between cardiologists and interventional radiologists. "Five years ago there was a civil war between the cardiologists and the radiologists and vascular surgeons," say Katz. "It was resolved with the installation of a system that could image [areas outside the heart]."

Five years ago, a defining moment took place at North Shore that determined the cath