Inside the State-of-the-Art Cath Lab

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The presence of high-resolution, flat-panel digital systems is increasing in the cardiac cath lab—just in time as placements of drug-eluting stents, coronary angiographies, atrial septal defect closures and EP procedures surge.

in many hospitals, the cardiac cath lab is in a state of transition. Business is booming with increasing patient volumes pushing labs—and staff and equipment—to capacity. Procedures are expanding and changing, and now include advanced procedures, like drug-eluting stent placements, coronary angiographies and atrial septal defect (ASD) closures that require greater precision and a more sophisticated combination of imaging and physiologic data.

At the same time, the cath lab is evolving into a multi-disciplinary center. Peripheral vascular volume is swelling at many sites, placing an additional strain on the cath lab. What's more, the tools of the electrophysiology trade have become more sophisticated and require higher image quality. That means cardiologists performing electrophysiology studies can no longer manage with archaic cath lab equipment or hand-me-down C-arms.

The upshot? The cath lab is ripe for improvement, and digital imaging systems fit the bill. Hospitals that have transitioned to the digital environment report a number of benefits on both the patient care and workflow fronts. The recipe for a successful digital implementation boils down to a few key ingredients:

  • A vision for the cath lab program is essential. This includes an understanding of current and future procedures and volumes as well as the equipment that can support the program. For example, understanding growth in the peripheral vascular and cardiac cath arenas informs decisions about what type of x-ray systems can best meet the hospital's needs.
  • High-quality digital imaging equipment is critical and will bring improvements in both image quality and workflow. Systems to support digital workflow, such as structured reporting tools and electronic image and report distribution systems, bring additional benefits.
  • IT involvement is crucial. A dedicated cath lab IT staffer can help the hospital make the most out of its new equipment by facilitating the digital implementation, servicing the imaging system and ensuring smooth integration with archiving, monitoring and hospital systems.

The Cath Lab Environment

Over the last few years, cath labs already stretched to capacity have faced increased demand. It's not uncommon for cath lab volume to double every few years. The results include a push to open new rooms and pressure to maximize use in existing rooms. Sometimes, new construction may be the best solution.

"It's very difficult to put a cath lab of the future in the footprint of an old cath lab," says John Gurley, MD, director of interventional cardiology at Linda and Jack Gill Heart Institute at the University of Kentucky (Lexington, Ky.). "[Both new construction and retrofits] require a careful assessment of the hospital's strengths and weaknesses, opportunities for growth and the marketplace. There are so many choices to make that the hospital needs a strategic plan. New physical space and equipment should match that plan."

Competitive pressures are a reality in many markets. "We operate in a very competitive environment," explains Rick Stouffer, MD, director of interventional cardiology, University of North Carolina (UNC) Hospitals (Chapel Hill, N.C.). "We're trying to position the hospital as ready for 2010."

The situation is similar in Houston, where Methodist Willowbrook Hospital positions itself as a patient-friendly community hospital. The new cath lab relies on both human resources and technology to advance this mission.

The Clinical Scene

The practice of cardiology is evolving. Advanced procedures like drug-eluting stent placement, coronary and renal artery angiographies are performed daily in the cath lab and create a need for improved visualization of major and minor vessels. "With newer drug-eluting stents, it's crucial to place the right size stent in the right place," explains Stouffer. Digital imaging equipment provides the high image quality needed to facilitate advanced procedures.

There are other clinical issues to consider as well. For some sites, peripheral vascular volume increases outpace growth in traditional cath lab procedures. That was exactly the scenario at the University of Massachusetts Memorial Medical Center (Worcester, Mass.). In 2004, the center installed a GE Innova 3100 digital cardiovascular