Game Changers

The latest releases in interventional radiology aim to shift the paradigm of this innovative market, which has seen game changing advances in dose reduction, ergonomics, and multimodality integration over the last year. Axis Imaging News spoke with a few companies to find out more about what they had in store.

Siemens Healthcare

Siemens Healthcare has been hard at work on its Artis zee family of products, for which the company has added and refined functionality. Inspired by robotic technologies of the car manufacturing industry, the Malvern, Pa-based firm has showcased the Artis zeego C-arm, which Claus Grill, vice president of Cardiac, Interventional/Neuro, and X-ray Systems, says has significantly changed the landscape for how interventional procedures are done. ?The product, through its unique ability to have motion in six axes, reaches the most significant flexibility around the patient,? he said.

Grill identified three main drivers for the company?s product development strategy. One of them, imaging excellence, has prompted Siemens to place much effort into imaging improvements. For example, with the Megalix CAT Plus X-ray tube, interventional radiologists can obtain sharp x-ray images. Furthermore, the company has introduced a large-screen, medical grade display. ?Instead of having six to eight monitors in front of the user, there is just one huge LCD monitor in front of them,? Grill said. ?With that, you can adjust the sizes, choose which images are displayed?big or small?and rearrange them as needed.? If an interventionalist wants to image very fine tiny vessels and view them in a larger scale, they don?t need to see all the other images on the other monitors, Grill explained. Rather, the user can reduce them to thumbnails on the side of this monitor. While the interventional procedure is under way, the user can easily view the desired x-ray image.

Another area of focus for Siemens is dose elimination. ?Even though we are proud to boast a comprehensive dose savings package, we continuously strive to improve upon this and employ multiple measures to avoid excessive dose,? Grill said. ?We believe it?s important to prevent the dose that is applied in the first place, as well as measure it. Our focus is really on avoiding dose all together.?

For example, Siemens has introduced new technology called CAREPosition, part of its overall dose savings package. Users are able to get off the foot pedal and not apply the radiation. Instead, a computer graphic on a monitor displays the central x-ray beam that simulates the movement of the table or C-arm, and no radiation is applied.

Lastly, the company has worked on enhancing ergonomic capabilities, which Grill says, ?goes hand in hand with user comfort and also workflow. The way the economy is currently, all hospitals are under cost pressure, so anything we can provide to make our customers efficient is something we will focus on.? Siemens? Artis zee Cockpit, a large screen monitor with one mouse and one keyboard for the control room, can house multiple monitors, keyboards, and mice. By removing the clutter of the control room, the technology promotes an ergonomic environment for the user.

Siemens also has a number of products geared toward nonvascular procedures. According to Grill, the company has received much demand in the areas of needlework for biopsies, RF ablation, and spinal injections. ?Every time you punch the needle into the body of a patient, you want to make sure you precisely position where it needs to go,? he said. As a result, Siemens has responded with a guidance system called syngo iGuide, which enables precise positioning of the entry of the pin to the targeted lesion.

VIDA Diagnostics

The biggest feedback that St Louis-based VIDA Diagnostics received during the annual Radiological Society of North America meeting was the growing importance of quantitative imaging of pulmonary images. This was excellent news for the quantitative imaging software developer, which specializes in advanced analysis of pulmonary diseases.

Susan Wood, president and CEO of VIDA, discussed her company?s recent partnership with Veran Medical Technologies, a leader in minimally invasive delivery of interventional oncology therapies. The pair are jointly developing and distributing an endobronchial lung navigation and biopsy system. ?We provide the path, or the GPS, to get to potential nodules of interest,? Wood continued. ?What the product does is traverse the airways, find the nodule of interest, and do a biopsy in a less invasive procedure.?

Specifically, under terms of the agreement, the companies will integrate VIDA?s lung analysis package, producing quantitative airway maps, lesion locations, and path plans with Veran?s electromagnetic endobronchial solutions. The 3D bronchial map and the exact location of the IG4 Plug-N-Play Navigation System allow for bronchoscopic evaluation of lung nodules, which Wood says results in more informed patient decisions.

?The promise of this partnership is a more accurate and cost-effective procedure to evaluate the indeterminate lung nodule,? she continued. ?VIDA?s PW2 is a highly validated quantitative pulmonary analysis solution with over 25,000 CT exams processed. Combining our quantitative road map and clinical expertise with Veran?s industry-leading navigation and registration tracking technology results in an elegant, exact guidance planning solution with instant registration and breathing compensation.?

According to VIDA, its Pulmonary Workstation 2.0 (PW2) is the first and only comprehensive CT lung analysis tool, generating quantitative, repeatable measurements of lung structure and function. Wood says the system is geared toward quantitative analysis of the lung for density analysis, measuring the loss of lung density for patients with COPD, and an airway analysis, which measures the caliber of the airway for patients with COPD or asthma.

With the Veran IG4 system?s four-dimensional capabilities, the system can capture and display three-dimensional images that were gathered at various moments in time (the fourth dimension) along natural respiratory movement cycles.

In the coming months, VIDA looks to introduce a new product built on a Microsoft paradigm and more distributed within an integrated clinical environment, as opposed to a stand-alone environment.

Philips Medical Systems

Similar to Siemens, Andover, Mass-based Philips Medical Systems has concentrated its interventional radiology efforts on three main pillars.

One major area of focus is multimodality integration, bringing primarily MR and CT data into the interventional suite for a variety of benefits. XperGuide Release 2, which made a recent debut, is a needle guidance software utilizing both MR and CT data to guide needles synchronized with live fluoroscopy. Rich Fabian, vice president for x-ray, North America, explained that the software?s original version used internally sourced CT made by the angio system. With the newest release, interventionalists, such as interventional oncologists, can use imported MR and CT data.

Philips? MR/CT Roadmap has great significance for patients who are contrast and dose sensitive. The functionality synchronizes live fluoroscopy with previously acquired MRA/CTA datasets to reduce x-ray dose and contrast media use. ?We use those vessel road maps from yesterday or 4 hours ago in order to navigate catheters and wires to different parts of the body,? Fabian explained. As a result, users reduce the amount of contrast to the patient, as well as the amount of x-ray dose, because data is reused from MRA and CTA.

Additionally, Fabin pointed out that ultrasound is being further integrated into the interventional toolkit as well. Ultrasound images can be combined with angio images and the user interface, he added.

Another driver has been improvements in display technology. Through the 56-inch, 8 megapixel Flex Vision XL HD, Philips has taken away the need for multiple single monitors in the angio suite. Instead, one large monitor allows for scalability, zoom, and other controls in a high definition setting. Shipments begin this summer.

The final impetus for technological development has been in dose awareness. ?As a general concept, there is a heightened awareness of both patient and operator dose,? Fabian said. Philips? DoseAware is a system that in real time monitors the operator?s dose and provides feedback. Unlike TLDs, which only keeps gross track of x-ray exposure, DoseAware is a wireless badge that transmits instantaneously the dose users receive to the display. As a person gets closer to the x-ray source, the display moves from green to yellow, and then yellow to red.

According to Fabian, he predicts that technology will continue to drive the imaging business, and he welcomes the innovative efforts of Philips? competition. ?We get paid to leap frog each other,? he noted, adding that he expects further advances in stroke care and interventional oncology in the future.

GE Healthcare

Over the last year, GE has showcased a large volume of interventional radiology products that look to impact the wide spectrum of different end users.

New Volume Navigation tracking capabilities through a sensor-tipped needle has brought added functionality to the company?s LOGIQ E9 ultrasound platform. According to the company, the new feature assists in overcoming the traditional challenges of ultrasound needle guidance, such as needle visualization and deflection, determination of entry points, and avoidance of critical anatomy. As a result, accuracy can be increased in procedures such as biopsies, ablations, drainage, fluid aspiration, and general injections.

?LOGIQ E9?s advanced needle tracking can now help medical professionals utilize ultrasound during in-plane and challenging out-of-plane interventional procedures,? said Brian McEathron, general manager of General Imaging Ultrasound, GE Healthcare. ?This can reduce time, limit repeat procedures, improve outcomes, and result in a better overall patient experience.?

Representing another major advancement is the Venue 40, a miniaturized ultrasound system with advanced touch-screen technology. Because of its mobility, users can perform diagnostics and needle-guided procedures right at the patient?s bedside, enabling real-time results. Offering high resolution imaging, the lightweight system boasts five applications, including vascular access, anesthesia, musculoskeletal, point of care, and interventional, which visualizes biopsy guidance, line placements, and rapid diagnostics.

GE has also sought to improve its Innova line of image-guided interventional care innovations. The Innova 4100IQ is a comprehensive x-ray imaging solution combined with advanced software applications that offer precise anatomical detail. It is ideal for a full gamut of procedures, including peripheral, oncological, and neurological imaging. Innova with Subtracted 3D allows users to visualize vessels without the need to remove surrounding bone, tissue, and implanted devices. Innova with Blended Roadmap superimposes any DSA or InnovaBreeze bolus image with fluoroscopy and provides dedicated registration tools. And the Innova Tilt Table features Smart Tilt, which provides variable-force positioning and fully motorized panning even while tilted.

Other Innova advancements include Innova Dose-Efficient X-ray Technology, whose AutoEx System is said to reduce patient dose by as much as 40% without affecting image quality, and Innova Vision, which dynamically overlays 2D fluoroscopic images and 3D models from multiple modalities. This creates a fused road mapping display.

?What does that mean for customers? It?s the real-time use of 3D information to better understand complex anatomy,? said Anita Makhija, general manager of marketing for interventional.

Makhija agreed that an upcoming area in interventional radiology is interventional oncology. In response, GE has delivered new Innova Track Vision functionality, which allows users to superimpose fluoroscopic images on predefined needle trajectories.

?GE has always had some core basic functionality around image quality,? said Makhija. ?Now, having these features, with uncompromised registration, especially when doing needle-based procedures, is such a big deal for customers. Once you register your 3D and 2D image, if you move the table or the gantry, the registration follows.?

Additionally, VolumeShare T4 multimodality volume view software integrates 3D images from Innova datasets to produce new interventional visualization functions that are targeted toward image-guided interventional therapy. In a single workstation, processing, integration, and image overlay can be achieved.

In an agreement with Veran, images captured by GE?s Innova systems can be exported to the Veran IG4 Navigation system in the same imaging suite during the same interventional procedure. According to GE, the Innova CT image is displayed along with a virtual needle over the anatomy for use in navigation during the procedure. As a result, physicians will be able to insert biopsy needles, ablation probes, and other devices through the skin more rapidly and with improved accuracy.

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Elaine Sanchez is a contributing writer for Axis Imaging News.