An extra set of eyes for interventional radiologists

Jürgen Schönstein|2015-04-28

Radiologists at Iowa Methodist Medical Center in the U.S. explain how the purchase of a new Siemens MIYABI Angio-CT Suite has improved treatment of patients, makes it possible to take on complex cases and will even save money in the long term.

“I couldn’t have done it without this machine,” explains Lacey afterward. “The narrow angles could only be overcome with the CT, and I had to use the angio system for guidance.” The system Lacey is such a fan of is a Siemens MIYABI Angio-CT suite, which combines two modalities – CT and angiography – in one room and one centrally operated unit. This room at Iowa Methodist Medical Center was established as one of the first of its kind in a U.S. hospital in October 2013. And Lacey reports that, in many ways, the MIYABI Angio-CT system has changed how he works.

Each modality has its strengths and can sometimes “see” more than the other, so they truly complement each other. This extra set of eyes brings a level of precision not seen before when guiding needles, guide wires and catheters to their target position. This is what makes routine procedures easier and complex cases possible.

For example, when performing vascular image-guided procedures with 2D fluoroscopy, the large flat-panel detector of the angiography system has better spatial resolution and a larger field of view as compared to CT.

Interventions in complex vascular structures often benefit from 3D-image guidance. Here, a 3D roadmap is overlaid on top of the 2D live fluoroscopy. CT-like images created by angiography (Cone Beam CT) can work well here, so long as patients respond to breathing commands. Often they don’t. This is because patients can be sedated just a bit too much and breathing artifacts occur. Multi-Detector CT-angiography overcomes this problem. Its fast rotation time of about a third of a second overcomes breathing motion. C-arm angiography system’s relatively slow rotation time of several seconds, does not.

Because of these differences in rotation time, 3D needle guidance is generally much quicker on CT.

Often forgotten is that Multi-Detector CT generally has better soft-tissue resolution as compared to angiography’s flat-panel technology. This makes it possible to visualize small tumors with CT, that may have gone unnoticed with angiography.

Because hybrid suites are often perceived as costly, Lacey refers us to Todd Kranpitz to explain how the MIYABI Angio-CT suite lowers the costs and pays for itself.

Todd Kranpitz, Executive Director of Radiology at Iowa Methodist Medical Center

It is impossible to talk about the U.S. healthcare system at the moment without hearing the term “Obamacare.” Coined four years ago by political opponents of the Obama administration, Obamacare is the nickname for the law that is intended to provide better care for patients and lower costs in the healthcare sector.

While talking to Todd Kranpitz, the Executive Director of Radiology at Iowa Methodist Medical Center in Des Moines, the topic comes up very quickly. “It is very near and dear to my heart,” he explains, meaning the attempts to provide better healthcare at a lower cost. “And we are doing it!”

But he does not want to achieve this goal, as critics of the law fear, by cutting back on equipment. On the contrary, just a few months ago, Kranpitz succeeded in installing the new Siemens MIYABI Angio-CT suite in his department, which David Lacey uses for his pancreas patients. The department was faced with the problem of having to replace one of their two CT scanners. “We had to bring in a mobile CT unit, which was installed in a truck,” reminisces Kranpitz.

Kranpitz is convinced that this medical technology will pay for itself in the long term. Since his department works almost exclusively with Siemens equipment, the learning curve for the staff was short and, most importantly, there were no unpleasant and expensive surprises. “In my world, surprises cost lots of money,” explains Kranpitz.

The new system was integrated into an existing angiography suite with no significant renovations, which also lowered costs. It now allows doctors to move complicated procedures from the operating room to radiology, which does not just mean lower operating costs. The advantages are also noticeable for the patients, who are primarily treated on an outpatient basis. Thanks to the combination of the CT and angiography modalities, this regional hospital can now perform procedures that previously required patients to travel to a larger medical center, which is approximately two and a half hours away. As that is cheaper and more convenient, it attracts new patients to Iowa Methodist Medical Center. Since the MIYABI Angio-CT suite was installed, the number of radiology patients alone has grown roughly 20%, from around 530 to 630 patients per month.

As hospital director, Kranpitz is also well aware that even the best equipment is only as good as the people who operate it. It is important that the hospital staff knows the best way to use each system. And that is why he is especially happy to have someone like David Lacey on his team, who has 17 years of experience and a talent for working with the MIYABI Angio-CT suite. Lacey contends that he has “always” wanted the combination of angiography and computed tomography in his work, which ranges from drainages to treating liver cancer with transarterial chemoembolization (TACE) – the latter is a very complex procedure that was once solely the domain of large cancer centers.

Dr. Lacey combined a water-cooled SOMATOM Definition AS CT scanner on a sliding gantry plus the Adaptive 3D Interventional Suite with an Artis Q angiography system.

All Siemens Artis zee, Artis Q, Artis Q.zen and Artis zeego angiography systems can be combined with the entire line of Siemens CTs on a sliding gantry. These include the SOMATOM Emotion 6 or 16, the SOMATOM Definition AS in its 20-, 40-, 64- or 128-slice AS+ configuration and the SOMATOM Definition Edge (128).

Siemens mobile C-arms (e.g. Cios Alpha) can be used in combination with the entire SOMATOM Definition family. Instead of the sliding gantry option a more cost-effective solution is available by increasing the distance between the CT gantry and table to allow the C-arm easy access.

Jürgen Schönstein has worked for DIE WELT, Springer Foreign News Service (New York Correspondent) and FOCUS (U.S. Correspondent from 2001 to 2010). He has been the editor-in-chief of the German science portal since the beginning of 2011 and teaches academic writing at the Massachusetts Institute of Technology. He is also a freelance writer for the German edition of WIRED and lives in Cambridge, Massachusetts.