The Challenge of Imaging Small Bodies 

What is the most effective way to support high-quality, efficient pediatric interventional cardiology? For Seattle Children’s Hospital and Thomas Jones, MD, at least part of that answer is high-quality imaging and continuous dose reduction.

How the Artis Q.zen helps Seattle Children’s Hospital succeed

What is the most effective way to support high-quality, efficient pediatric interventional cardiology?
For Seattle Children’s Hospital and Thomas Jones, MD, professor of Pediatrics and Medicine at the University of Washington, and the director of the hospital’s Cardiac Catheterization Laboratories, at least part of that answer is high-quality imaging. “In pediatric interventional catheterization, the efficiency afforded by improved image quality allows you to move much more quickly through procedures,” he says. “With high-quality imaging, we can accomplish the same procedures with a whole lot less fanfare and less stress to the staff and the patients. And the image quality on the Artis Q.zen is, I believe, currently the best in the industry hands down.”

challenge of imaging small bodies

Case 1: Melody transcatheter pulmonary valve placement within a 25 mm bioprosthetic pulmonary valve in a 15 year old boy with tetralogy of Fallot.

challenge of imaging small bodies

Case 2: Large patent ductus arteriosus in a 3.5 kg 4 month old girl with failure to thrive. The ductus arteriosus was successfully closed with a transcatheter Amplatzer Vascular Plug II

With 371 licensed beds, Seattle Children’s Hospital serves the Washington, Alaska, Montana, and Idaho markets, and recently underwent an expansion to accommodate new catheterization labs. The previous labs were 15 and 13 years old respectively. In these interventional and electrophysiology labs, the staff performs between 650 and 700 procedures each year. There were two main issues with the prior rooms. First, they were limited in size, and they were equipped with older systems. “We had Siemens Healthineers systems in the old rooms and, despite the age of the equipment, their performance was remarkably solid even after 15 years. We kept up with all the preventative maintenance and took care of the equipment as best we could,” says Dr. Jones. “Actually, I would say that one of our compelling reasons for going with Siemens Healthineers in our new lab was the dependability and durability of our old equipment.”

Within the operating rooms and adjacent to cardiac surgical areas, the new spaces were mindfully designed to take into consideration material utilization and the flow of patient movement. Outfitting the space with equipment that could support the complexity of the program was equally important. “Some of the procedures we do are exclusive to our center,” says Dr. Jones. “We’re leading a lot of investigational studies with patients traveling to our center for these services.” Decision-makers were knowledgeable about the various types of imaging systems and vendors that were available to equip the interventional catheterization lab. They chose, however, to go with Siemens Healthineers, specifically the Artis Q.zen biplane system. “Other vendors could promise whatever they wanted but we all knew that the support we had from Siemens Healthineers was undeniably awesome,” says Sarah Lisinski, clinical practice manager Cardiac Catheterization Laboratories, Heart Transplant & VAD. Dr. Jones agrees. “I work in other hospitals with different equipment and the uptime with Siemens Healthineers just can’t be beat. We’ve proven that with our old equipment too,” he says. “Siemens Healthineers equipment can withstand a lot of continuous use and still perform to specification

“The quality of the imaging on the Artis Q.zen is incredible. It’s important because image quality goes hand in hand with dose reduction.”

In addition to durability, Dr. Jones and the staff wanted to be certain they would get the image quality necessary for complex pediatric imaging. “Small bodies are much more challenging to image,” he says. “The quality of the imaging on the Artis Q.zen is incredible. It’s important because image quality goes hand in hand with dose reduction.” Reducing dose both to their pediatric patients and to their staff is a priority at Seattle Children’s Hospital. The team strongly believes in using as low a dose as possible or, conversely, limiting the number of exposures. “Reducing the dosage for pediatric patients is particularly important for a number of reasons,” says Dr. Jones. “Many of these children have complex congenital heart problems. They face a lifetime of exposure, and the time duration of these radiation exposures are played out over decades of life. The cumulative nature of that is concerning.” From a staffing perspective, Lisinski is, likewise, concerned about the cumulative nature of dose. “I feel part of my job is the wellbeing of the physicians and the staff,” she says. “Knowing that issues like radiation exposure and ergonomics have been thought through by a company with a lot of experience is a positive for me.”

challenge of imaging small bodies

Case 3: 5 year old girl with complex single ventricle anatomy with anomalous drainage of the right pulmonary veins. She underwent Fontan procedure with reimplantation of her right pulmonary veins to the atrium. The right pulmonary veins became completely occluded and required surgical revision. Following surgical revision there was persistent right pulmonary vein stenosis. Successful right pulmonary vein stent implantation was followed by a dramatic improvement in her condition.

The challenge of imaging small bodies

Case 4: Rotational angiogram demonstrates severe compression of a right ventricle to pulmonary artery conduit in a 13 year old boy with complex congenital heart disease. This imaging modality was critical to our complete understanding of the complex nature of his RVOT conduit obstruction.

The data the team at Seattle Children’s Hospital has collected indicates they’ve lowered radiation dose by approximately 75 to 90 percent for most of their procedures with the Artis Q.zen. Every time they use the system to image a patient, this reduction provides significant safety benefits. And the other benefit of exceptional dose reduction technology is that physicians can persist longer in a more complicated intervention without additional risk.

“I really enjoyed working with everyone from the sales people to the trainers.”

“Sometimes it just takes a while to get into some of these more difficult-to-reach locations,” says Dr. Jones. “In the past, we would become increasingly nervous about the exposure to the patient as well as the staff in the room. Having low dose technology enables us to be that much more thorough in getting the job done.” The advantage of improved image quality at a lower dose has already made a difference in some clinical cases at Seattle Children’s Hospital. “In a few cases, the imaging demonstrated that the patient’s condition really required surgical intervention. So, we didn’t waste time or place the patient at any undue risk trying to accomplish the intervention in the cath lab. The imaging really guided us toward an ultimately more invasive option, which was the right thing to do for the patient,” says Dr. Jones. 

In addition to the high image quality and durability the Artis Q.zen provides them, team members at Seattle Children’s Hospital note that they also see the strength of. Healthineers service and support as an asset. “From my perspective, how we were going to close down the old rooms and open the new ones was critical. We still needed to be able to take care of our patients. It had to be timely. We didn’t want to cause a backlog,” says Lisinski. To successfully manage this transition, Siemens Healthineers met with the team at Seattle Children’s Hospital several times to determine the best strategy for installation and provide guidance for training the staff. “Siemens Healthineers gave me examples of the best way to utilize the training we purchased so that we could not only get people comfortable with equipment but also build on their knowledge with each training session,” says Lisinski. “I really enjoyed working with everyone from the sales people to the trainers. I admit I can be a little demanding but they really came through for us.”

“What I appreciate most about Siemens Healthineers is their rock solid stability over the decades. They have an adherence to a vision of excellence that has pervaded the years.”

The Siemens Healthineers team’s dedication to helping Seattle Children’s Hospital provide the best possible care for its patients and reach the highest levels of departmental efficiency has made a significant and lasting impact. “I think putting our team together with the technology offered by Siemens Healthineers and the support they provide has made us one of the premier interventional labs in the country,” says Dr. Jones. “What I appreciate most about Siemens Healthineers is their rock solid stability over the decades. They aren’t just blowing in the wind and following trends. They have an adherence to a vision of excellence that has pervaded the years.”