Feature | September 03, 2008| Maureen Leahy-Patano

Cardiovascular Images Connect Enterprise Wide

IT solutions partner with state-of-the-art cardiac imaging to deliver enhanced workflow, patient care collaboration.

The Brilliance iCT from Philips can capture an image of the entire heart in just two beats.

The Brilliance iCT from Philips can capture an image of the entire heart in just two beats.

The landscape of cardiovascular care is changing. In the cath lab alone, the shift in volume and type of diagnostic and interventional procedures has broadened the lab’s scope, increased demand and raised expectations.

“The cath lab of yesterday was a basic suite consisting of an X-ray source, image processor and analog-based cine film cameras,” said Samantha Barbosa, medical imaging research analyst with Frost & Sullivan. “Now cath labs boast digital capabilities that utilize indirect and direct signal cameras, and instead of sorting through films by hand, cardiologists can view images on workstations in about 20 seconds.”

Additionally, Barbosa says some labs have transformed into hybrid cardiac catheterization, suites allowing varying specialist disciplines (e.g., interventional cardiologists, cardiothoracic surgeons, cardiac anesthesiologists, perfusionists, echocardiographers) to interact simultaneously, improving workflow and enabling quick interventions.

Amping up the arsenal

Cardiologists rely on imaging technology to guide their course in providing comprehensive diagnostic and interventional care. As a result, cardiologists more and more are demanding the latest and the greatest imaging equipment.

One of the newest additions to the cath lab cache is the Artis zeego from Siemens, which received FDA clearance last spring. The zeego is a multi-axis, angiographic system for interventional procedures that employs robotic technology to extend imaging capabilities through virtually unrestricted C-arm positioning. System use reportedly results in advanced cross-sectional imaging via its positioning flexibility, which Siemens says is not achievable with traditional C-arm systems. The position of the isocenter can be adjusted according to the procedural needs or the height of the physician; the adjustable isocenter also enables off-center rotational angiography for all areas of the body and supports advanced 3D imaging techniques.

Since its introduction over 30 years ago, CT technology has made significant improvements in the number of detectors and the speed of acquiring images, and is becoming a standard of care in diagnostic cardiology. According to findings presented at RSNA 2007 from the CORE 64 and ACCURACY multicenter 64-slice scanner trials, noninvasive CT angiography is as accurate as an angiogram in detecting coronary artery disease.

Making a big splash with its introduction in Chicago last fall, Toshiba’s AquilionONE CT uses 320 detector elements to image an entire organ in a single rotation, covering up to 16 centimeters of anatomy and showing real-time dynamic movement. At four times more powerful than a 64-slice CT, Philips’ 256-detector Brilliance iCT scanner provides eight centimeters of coverage with a rotation speed of 0.27 seconds, covering the entire heart in two scans.

Enterprise-wide data sharing

Cardiovascular care does not occur in a single hospital setting; patients often undergo a variety of tests at different locations. In order to provide the best care possible, physicians need immediate access to all patient information, no matter where it was obtained. Enterprise-wide solutions tie together data and images from multiple modalities, departments and systems in an effort to break down silos that can inhibit efficiency and patient care.

Philips’ Xcelera R2 multimodality cardiology information management solution feeds all images and patient data acquired from key cardiac subspecialties into a secure, centralized electronic system that users can review from a single workspace. Referring and on-call physicians can review the same images and reports though Xcelera WebForum, an Internet-based system that provides access from inside and outside the hospital.

“Having one workstation to review patient cardiac studies will eliminate the need to continue purchasing, upgrading and supporting individual workstations for each imaging modality,” said Kirk Spencer, M.D., associate professor of medicine, University of Chicago. “The Xcelera platform allows clinicians to work across multiple imaging systems, resulting in faster clinical decision-making.”

Instead of sending slices of data for interpretation, the AquilionONE CT scanner produces a volume of data, and because of this ability, it requires a workstation that can handle dynamic volume data. The Vitrea FX from Vital Images was specially designed to fit the bill.

Vitrea software is an advanced visualization solution that creates 2D, 3D and 4D images of human anatomy from CT and MR image data. Productivity-enhancing tools allow physicians to navigate within these images to better understand disease conditions.

Integrated with a Vitrea solution, ViTALConnect is designed to extend the value of Vitrea’s interactive snapshots and advanced capabilities across the enterprise. The Web-based solution facilitates access to commonly used advanced visualization tools and allows radiologists, cardiologists and referring physicians to collaborate from anywhere in real time.
The syngo Dynamics V.6 cardiology image management and reporting solution, part of the Siemens Soarian Cardiovascular Enterprise, offers integrated image and data management, post-processing and reporting.

The cath lab at Children’s Hospital of Michigan — the beta site for syngo Dynamics V.6 — initially went on board with the solution because of its reporting features. Physicians can dictate their reports directly into the software and fax them off to referring physicians in as little as 20 minutes, with still images attached to the report.

“Our referring physicians are very pleased with this almost automatic feedback feature,” said Paul Webster, lead tech, cardiac catheterization lab, Children’s Hospital of Michigan. “Before we implemented the system, report turnaround was about 10 days,” he explained.

The all-encompassing cath lab performs an average of 50 cath and/or EP procedures for heart and lung per month. The Siemens solution stores not only all this cath lab data, but images from every other imaging modality, as well. While other companies offer Web-access solutions to share data and images, with syngo Dynamics all the images are connected through applications that interface with the EMR.

“We can acquire all images — from the cath lab, MR, CT, echo and PET — for viewing and reporting,” said Webster.

The Archive to Enterprise PACS option enables the syngo Dynamics Server to archive directly to a qualified PACS, while maintaining the database of patient reports and demographics on the originating syngo Dynamics network server. The server can also make the metadata of imaging studies available to an HIS or EMR via an Application Program Interface (API), which means the EMR user can retrieve images from syngo Dynamics without the EMR system actually having to store the images.

Although Children’s Hospital’s cath lab images are currently only available to cardiology staff, Webster anticipates enterprise-wide image availability within the coming year, the advantage of which, he says, is worldwide sharing of information for comprehensive patient care collaboration. In addition to DICOM connectivity, syngo Dynamics also supports HL-7 interface engines to provide open connectivity, making it a forerunner, believes Webster, in establishing a global network for viewing all imaging studies.

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