The Gateway to Innovative Clinical Pathways

CEO Fabian Hubacek is convinced that image-guided interventions are a crucial part in the spectrum of minimally invasive treatments and therapy: “We are sure that many open surgical procedures will be replaced by this technology”. But there are not yet many hospitals in Germany with a dedicated ward staffed by interventional radiologists. Patients treated using interventional techniques are often accommodated on the surgical ward – a perceptual problem that Moche hopes to overcome using his hospital as a model: “Interventional radiology must become a clinical partner for colleagues from other disciplines. In order to do so, we need to specialize even further. We need even more new, committed recruits. Above all, however, we need the opportunity to operate interventional radiology wards and to be integrated into patient preparation and aftercare.” In Nuremberg, Moche can put his ideas about interventional radiology into practice in a dedicated ward that he designed and gave shape according to his wishes.

Moche set up the new department in record time: It took him three months of planning plus three months of construction to go from a bare industrial building to the first intervention in an IR environment whose indoor air classification even permits open surgery and where he was able to realize his vision for a dual-room solution. Hubacek: “The efficiency of the collaboration with Siemens Healthineers was impressive. Short communication paths, maximum technical support, and ongoing consultancy are the keys to success. This allowed the project to be implemented in a short time, whereas it usually takes much longer to complete.” Today, with the exception of neuroradiology, the 310Klinik can cover the entire spectrum of interventional radiology – from acute care to interventional oncology and from peripheral revascularization to embolization for benign diseases in every organ of the body. However, Moche is especially proud of an organizational aspect: “We are an interventional radiology department with its own beds – an independent clinical location that can count on 310Klinik’s entire infrastructure covering surgery, internal medicine, orthopedics, intensive care, and intermediate care.”

Angiography and computed tomography (CT) are the workhorses of interventional radiology. “We have an especially innovative system with our Angio-CT suite which leverages the strengths of both,” says Moche. He is evidently proud that this is the first system in Germany to be set up as a dual-room solution. Moche believes that dual-room solutions provide key advantages: “Even in procedures where both systems are needed, CT is only applied for a relatively short time during the procedure in many cases. In such cases, CT can be used separately in the second room, e.g., for regular diagnostic scans.” Accordingly, it quickly became clear that the dualroom option would be the solution of choice for 310Klinik. Hubacek justifies the decision: “In 70 percent of cases, this system will be used independently so the two-room solution can help to increase the utilization rate and enhance return on investment.”

Moche describes the clear advantage for his workflow: “Although we use the CT scanner for emergencies or to perform complex interventions in combination from the outset, we can slide it into the adjoining room on rails when it’s not in use. This gives us more room to move and allows us to work more efficiently, because the CT is then meanwhile available for diagnostics or smaller interventions in the other room.” By means of this flexibility, Moche plans to perform regular diagnostics or shorter minimally invasive procedures, for example biopsies, on about eight to ten patients per day in the CT room. On average, these will be joined by five to eight regular angio or two complex interventions with combined percutaneous and endovascular access – for instance, treating an endoleak – where both modalities are needed.

In addition, Moche believes that a new interventional procedure could also benefit from the combined dual-room solution: “Patients with pancreatic cancer often have a poor prognosis – the tumor is rarely resectable and systemic chemotherapy is often ineffective. For these patients, interventional therapies will play an increasingly important role.” One increasingly common procedure is known as Irreversible Electroporation (IRE). It uses ultrashort pulses of high-voltage current to damage tumor cells in a relatively selective manner. “Because no heat is generated in the process, vascular structures are preserved – so the procedure is well suited to treat this aggressive cancer, which is often richly surrounded by vital vessels.” Until now, treatment was often performed via open surgery using sonographic guidance. Moche wants to make the procedure minimally invasive, safer, and more efficient for the clinician to plan. He therefore favors combined treatment, in which he uses fluoroscopy for angiographic visualization of vessels and CT guidance to precisely navigate the probes around the tumor without injuring the vessels: “Intra-arterial injections leverage the strength of both modalities. The superior soft tissue resolution and the better 3D capability are clear advantages over the treatment planning and image guidance under ultrasound.”

Seamless integration

• The common coordinate system unifies CT and angiography. With Instant Fusion1, CT volumes – with intra-arterial injection – are instantly overlaid on live fluoro images, allowing fast and easy access to the relevant visuals.
• Quick Switching2 with smart collision protection:
• By simply sliding the table between the two modalities, it will be easier than ever to perform CT-guided ablation and angio-guided embolization in one session and on one table.
• Fully connected, the interventionalists will be able to access angiography, CT and ultrasound sources side-by-side on a single, large display in the exam room and via a single Cockpit2 in the control room. Common Patient Registration1 allows automated patient data transfer with only one registration at the start.

Versatile design

• The unique 2-room design of the nexaris Angio-CT allows independent usage of each modality:
• Different disciplines can work in parallel and potentially raise the utilization rate and return of investment.
• Mounted on rails up to 12 meters in length, the CT gantry slides easily into a dedicated ‘garage’, while the C-arm swings into the foot-side park position3, making space for key personnel by moving the major components out of the way.

Pioneering potential

• With instant access to optimal imaging technology on one table, a broad range of clinical pathways can be re-shaped, such as bone metastasis, blunt poly trauma, and acute stroke. Advanced functional imaging may make intraprocedural endpoint-determination more precise.