Imaging Technology News experts discuss the trends and latest technology they saw on the show floor and in sessions at RSNA 2012. Their discussions include some of the most innovative new devices and software to solve issues facing radiology today.
VIDEO: Machine Learning for Diagnosis and Risk Prediction in Nuclear Cardiology
Piotr J. Slomka, Ph.D., FACC, research scientist in the Artificial Intelligence in Medicine Program, Department of Medicine at Cedars-Sinai, and professor of medicine in-residence of the David Geffen School of Medicine, UCLA. He explains how his team at Cedars-Sinai is working on intelligent patient risk prediction algorithms that will automatically extract information from medical imaging. He spoke on artificial intelligence (AI) development for medical imaging in sessions at the 2019 American Society of Nuclear Cardiology (ASNC) annual meeting.
One-year results from the ADAPT-DES Trial were presented during TCT 2012. It examined patient hyporesponsiveness to clopidogrel and aspirin in a large-scale, prospective, multicenter study.
Mercy Hospital in Chicago has developed a successful hybrid cath lab program where various specialties work together for the best, minimally invasive patient outcomes. Beyond the coronaries, this cath lab specializes in endovascular aortic stent grafting, peripheral vascular disease, embolization procedures and transcatheter heart valve replacements. Read the related article "Most Innovative Heart Centers: Chicago’s Mercy Hospital." Watch the related Mercy VIDEO "Mercy Hospital Develops Effective, Collaborative Interventional Program."
Mercy Hospital in Chicago developed an interventional program around its hybrid cath labs, fostering collaboration between interventional cardiologists, vascular surgeons and interventional radiologists. This collaboration has helped the hospital improve care and keep costs low in order to serve the Chicago South Side's low-income population. Read the article "Most Innovative Heart Centers: Chicago’s Mercy Hospital." There is also a related VIDEO about Mercy, "Developing a Hybrid Cath Lab Program."
Results from the POSEIDON Trial were presented at Transcatheter Cardiovascular Therapeutics (TCT) 2012. Data showed a positive strategy to prevent contrast-induced nephropathy (CIN) in patients with renal impairment undergoing interventional catheterization procedures. CIN is also referred to as acute kidney injury (AKI). The data is presented in a press conference by Sonjot Brar, M.D., MPH, Kaiser Permanente.
Related CIN Content:
VIDEO: How to Avoid Acute Kidney Injury in the Cath Lab — Interview with Hitinder Gurm, M.D.
VIDEO: Strategies to Avoid Acute Kidney Injury Caused by Cath Lab Contrast — Interview with Roxana Mehran, M.D.
The PC Trial data presented at TCT 2012 looked at transcather PFO closure vs. medical therapy in preventing cryptogenic strokes.
The results of the FAME II Trial were presented at the 2012 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The study showed the cost effectveness of fractional-flow reserve (FFR) therapy vs. standard medical therapy.
Positive results from the RESPECT Trial of transcatheter patent foramen ovale (PFO) closure vs. standard medical therapy were presented by John Carroll, M.D., University of Colorado Hospital, at the Transcatheter Cardiovascular Therapeutics (TCT) 2012 meeting.
Read the article on the trial results — "PFO Closure May Improve Outcomes Over Medical Therapy in Cryptogenic Stroke."
Diagnostic and Interventional Cardiology Editor Dave Fornell shares his choices of the latest advances in cardiac ultrasound from the show floor of the American Society of Echocardiography (ASE) 2012. With the increasing use of more complex interventional procedures, transesophageal echo (TEE) and intracardiac echo (ICE) are being used for guidance to reduce fluoroscopic radiation dose.
This video, provided by Crux Biomedical, demonstrates the implantation of the FDA-cleared Crux VCF inferior vena cava filter (VCF) with bi-directional retrieval. It is designed to trap blood clots that can lead to potentially fatal pulmonary embolisms among patients at risk. The Crux VCF is the first designed to facilitate bi-directional retrieval through either the femoral or jugular veins, a key consideration when access to one or the other vein is limited. The helical shape was designed to self-center and to conform more closely to the shape of the vena cava, as well as to reduce bends and stress that can compromise filter integrity. Read the article "Large-Scale Inferior Vena Cava Filters Study Examines Safety and Effectiveness of These Devices."
Three big trends were seen in cardiovascular ultrasound during the American Society of Echocardiography (ASE) 2012 meeting. Malissa Wood, M.D., co-director of the Women's Center at Mass General Hospital, Boston, and chair of the ASE Public Relations Committee, explains these trends. The biggest is the expanding use of ultrasound and transesophageal echo (TEE) in the cath lab and hybrid OR for structural heart procedural navigation. Other trends include use of pocket ultrasound and new software advances to simlify and reduce the time it takes to use 3-D echo and make quantifications. For more information: www.dicardiology.com/article/ultrasound-sees-increasing-use-interventional-procedures
Siemens' syngo Aortic ValveGuide software enables transcatheter aortic valve replacement (TAVR) procedural guidance with integration of 3-D images on live fluoro imaging. This video shows the valve guidance technology used during the implantation of a Medtronic CoreValve device. For more information: www.DIcardiology.com
To help hospitals upgrade their electrophysiology (EP) reporting systems and integrate EP into cardiovascular and hospital reporting systems, Michael Mirro, M.D., FACC, medical director, cardiology/electrophysiology, Parkview Physicians Group, Ft. Wayne, Ind., offers suggestions of what to look for in systems. He spoke about cardiovascular/EP IT integration and the impact of healthcare reforms during the Heart Rhythm Society (HRS) 2012 scientific sessions. For more information: www.DIcardiology.com
Data was presented during the Heart Rhythm Society (HRS) 2012 scientific sessions that showed the Riata ICD lead had a higher malfunction rate than comparable leads. The results from "Independent Multicenter Study of Riata and Riata ST Implantable Cardioverter Defibrillator (ICD) Leads" were presented by Raed H. Abdelhadi, M.D., FACC, a cardiologist and electrophysiologist researcher at the Minneapolis Heart Institute Foundation.
Diagnostic and Interventional Cardiology Editor Dave Fornell shows some of the most innovative new technology displayed on the show floor at the Heart Rhythm Society (HRS) annual scientific sessions. The tour includes new devices and trends in electrophysiology. For more information: www.DIcardiology.com
Heart Rhythm Society (HRS) President-Elect Hugh Calkins, M.D., FACC, director, cardiac arrhythmia services and EP lab, Johns Hopkins University, Baltimore, Md., offers an overview of trends and top news in electrophysiology at the HRS 2012 scientific sessions. For more information: www.DIcardiology.com
Pivitol trial data regarding the safety and efficacy of the Cameron Health Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) system was very positive. The system is currently pending FDA approval and would be the only subcutaneous lead electrophysiology device cleared for use in the United States. The system eliminates the need for venous leads and intra-cardiac securement, greatly simplifying the implant procedure. Data from Cameron Health's IDE trial was presented by Martin Burke, DO, FACC, FACOI, FRCP, director, Heart Rhythm Center, University of Chicago, at the Heart Rhythm Society (HRS) 2012 scientific sessions. For more information: www.DIcardiology.com
Implantable cardioverter defibrillators (ICDs) are safe in patients who participate in sports, according to a study presented during Heart Rhythm Society (HRS) 2012. Rachel Lampert, M.D., associate professor of medicine, section of cardiovascular medicine, Yale School of Medicine, explains the study findings during a press briefing at HRS. For more information: www.DIcardiology.com
The ACRIN-PA trial showed computed tomography (CT) coronary angiography can be more cost-effective than the standard-of-care in evaluating patients with chest pain in the emergency department. The data was presented by Harold Litt, M.D., during the American College of Cardiology (ACC) 2012 scientific sessions. For more information: www.DIcardiology.com
Related ACRIN-PA Study Content:
New data from the PARTNER trial for the Edwards Sapien Valve were presented during the American College of Cardiology (ACC) 2012 scientific sessions. The new information included two-year clinical and echocardiographic outcomes after transcatheter vs. surgical aortic valve replacement in high-risk surgical patients. For more information: www.DIcardiology.com
One of the most interesting educational exhibits at the recent American College of Cardiology (ACC) 2012 Scientific Session was "The Heart of Innovation" display on the show floor. The ACC in collaboration with marquee sponsor Philips Healthcare and several other industry leaders created this non-accredited, hands-on education experience. The exhibit explored the evolution of the standard-of-care for heart disease and heart failure caused by valvular disease. It looked at these issues through the lenses of personalized medicine, techno-biology, minimally invasive procedures and physician-patient engagement. The exhibit included technology from the past, present and future of healthcare. To incorporate a historical view, the entrance to the display included the ACC's special collection of historic artifacts encompassing medical books, stethoscopes and device technology dating back hundreds of years, including a stethoscope from 1535. This historical perspective was juxtaposed with a modern attendee experience that included the option to explore the entire exhibit with a specially provided iPad tour. The centerpiece was a mockup of a hybrid OR. It included a Corindus CorPath robotic cath lab intervention guidance system. Other partners included Maquet, showing a portable heart-lung machine the size of a small suitcase and the CFI Medical Solutions ZeroGravity radiation protection system. What made the hybrid OR particularly unique was that it was situated across from the Minimally Invasive Gallery, which featured many of the innovations that are driving procedures performed in the hybrid OR. The gallery encompassed solutions from Medtronic and Edwards Lifesciences, including Edward's breakthrough Sapien transcatheter heart valve. The display discussed current treatments and what the future technologies will likely be from the standard-of-care in the future.
Siemens' AcuNav V 3-D intracardiac echo (ICE) catheter offers detailed, live 3-D images of the interior of the heart. This video shows an example of the catheter imaging a transseptal puncture. This new ICE technology may help better guide these punctures, which are routinely used in catheter ablations and transcatheter left atrial appendage (LAA) occluder delivery. The technology was shown as a work-in-progress during ACC 2012.
The Crux inferior vena cava (IVC) filter was designed for easy deployment and later retrieval. This video clip shows retrieval of the device, which has has radio-opaque markets for easier visualization under angiography. IVC filters are designed for the prevention of pulmonary embolism.
Siemens' AcuNav V 3-D intracardiac echo (ICE) catheter offers detailed, live 3-D images of the interior of the heart. This video shows an example of the catheter imaging the function of the aortic valve. The technology was shown as a work-in-progress during ACC 2012.
Siemens' AcuNav V 3-D intracardiac echo (ICE) catheter offers detailed, live 3-D images of the interior of the heart. This video shows an example of the catheter imaging the left atrial appendage (LAA). The technology may play a role in guiding and properly seating transcatheter LAA occluders. The technology was shown as a work-in-progress during ACC 2012.
Several interventional cardiology experts share their views on how fractional flow reserve (FFR) and optical coherence tomography (OCT) have changed their clinical practice. Increased accuracy and understanding of vessel lesion hemodynamics is cited as a way to better patient outcomes and lower healthcare costs.
Siemens' AcuNav V 3-D intracardiac echo (ICE) catheter offers detailed, live 3-D images of the interior of the heart. This video shows an example of the catheter imaging the pulmonary vein. The technology may play a role in better guiding transcatheter electrophysiology (EP) ablation procedures. The technology was shown as a work-in-progress during ACC 2012.
The Crux inferior vena cava (IVC) filter was designed for easy deployment and later retrival. This video clip shows deployment of the device, which has has radio-opaque markets for easier visualization under angiography. IVC filters are designed for the prevention of pulmonary embolism.
Diagnostic and Interventional Cardiology Editor Dave Fornell discusses trends and shares his choices of the most innovative technologies shown on the floor of the American College of Cardiology (ACC) 2012 Scientific Session, held March 24-27 in Chicago. A couple of key trends were evident on the show floor — new technology to support trans-aortic valve replacement (TAVR) and the launch of new cardiovascular image and information systems (CVIS) to support healthcare's adoption of proposed Stage 2 meaningful use (MU) requirements. Other highlights include a balloon-inflatable TAVR/EVAR introducer sheath, 3-D intra-cardiac echo, a mobile angiography system for hybrid ORs and chocolate for heart health. For more information: www.DIcardiology.com
During the American College of Cardiology (ACC) 2012 Scientific Session, McKesson displayed new features for its cardiovascular information system (CVIS). These included an electrophysiology (EP) reporting workflow, the addition of stress and Holter support and integrated inventory management. The features were shown as works-in-progress as part of the upcoming release of McKesson Cardiology v13.0, slated for release by early summer 2012. The EP reporting module integrates diagnostics including tilt tables, implantable devices and ablation treatment EP recording systems. For more information: www.allaboutCVIS.com
New evidence shows that with appropriate preparation, angioplasty can be safely and effectively performed at community hospitals without on-site cardiac surgery units. This was according to data presented from the CPORT-E trial during the American College of Cardiology (ACC) 2012 Annual Scientific Session. The study is the first randomized controlled trial to investigate elective cath lab angioplasty (or percutaneous coronary intervention, which includes stenting and balloon angioplasty) in community hospitals in the United States.
Results showed no difference in death rates among patients undergoing elective angioplasty at facilities with and without on-site cardiac surgery units. There were also no significant differences in rates of complications such as bleeding, renal failure and stroke. "The study shows that under certain circumstances, non-primary angioplasty can be performed safely and effectively at hospitals without on-site cardiac surgery," said Thomas Aversano, M.D., associate professor of cardiology at Johns Hopkins University and the study's lead investigator. Until a recent guideline change by the American College of Cardiology and the American Heart Association, community hospitals without cardiac surgery units performed only emergency angioplasties. Patients needing elective angioplasty were transferred to facilities with on-site cardiac surgery units. "The study supports and reinforces the [new] guidelines," said Aversano, adding that the findings can help hospitals and healthcare planners more efficiently allocate financial and human resources. The ability for community hospitals to offer elective angioplasty benefits patients, Aversano said. Other studies have shown that patients are often reluctant to transfer to a hospital that may be farther away or more expensive than their community hospital. "It's not just a question of patient convenience — it's also a question of access," he said.
For more information: www.DIcardiology.com
This video, provided by Boston Scientific, shows how to implant the subcutaneous implantable cardioverter defibrillator (S-ICD) system. Unlike conventional implantable cardioverter defibrillators (ICDs), which require thin, insulated wires (leads) to pass through the venous system and into the heart, the entire S-ICD System sits just below the skin and leaves the heart and blood vessels untouched. This technology has the potential to expand the reach of ICD therapy, offering physicians and appropriate patients a new alternative to traditional ICDs. Read the most recent article on the S-ICD — “FDA Clears MRI-safe Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) System.”
DAIC editor Dave Fornell explains some of the most innovative cardiovascular imaging technologies showcased by vendors at the Radiological Society of North America (RSNA) meeting in December 2011.
Toshiba (Canon) unveiled its Aplio 500 ultrasound system at RSNA 2011, , which offers a unique 3-D fly-through imaging capability. The system takes the image dataset and processes it to create a cine loop fly-through of any hollow, fluid-filled blood vessel, duct or organ. The example in this video is of a blood vessel in the liver. The capability and image quality is similar to what is seen in a virtual colonoscopy created from CT datasets. The technology was highlighted in our editor's choice for most innovative new technologies at RSNA 2011. The future applications of this technology may include 3-D ultrasound navigation aids for vessels in the cath lab.
The Miracor Picso Impulse system is supposed to prevent reperfusion injury and the no-flow phenomenon following percutaneous coronary intervention (PCI) by increasing the microcirculation in the ischemic area. The device uses a balloon catheter in the coronary sinus to temporarily increase venous blood pressure.
Paramedics in Bellingham, Wash., used the Lucas device on patient Nancy Olson, who went into cardiac arrest following a heart attack. The device provided chest compressions while she was enroute to the hospital, helping to perfuse her brain and other organs, prior to her undergoing emergency percutaneous coronery intervention (PCI). For more information on the Lucas, visit www.physio-control.com.
Three companies showed different versions of a combined positron emission tomography (PET)-magnetic resonance (MR) (PET-MRI) system during the Society of Nuclear Medicine (SNM) 2011 annual meeting. Representatives from Siemens, Philips and GE Healthcare explain how their systems work and how PET-MR may be used as a new modality to show both physiologic and anatomical information.
Each company took a different approach to how they create PET-MRI images. Siemens integrated both modalities into one gantry. Philips uses two gantries with a table that moves between the two that maintains patient alignment for fusion imaging. GE Healthcare uses a cot that can move between the MR and PET rooms and fits both systems to maintain alignment and does not require buying a new decicated scanner.
Society of Nuclear Medicine (SNM) President George Segall, M.D., offers insights into the trends he saw at the society's 2011 annual meeting, including PET/MRI and amyloid plaque imaging.
This podcast explains how syngo Dynamics can be used to integrate cardiac imaging picture archiving and communication (PACS) and cardiology reporting systems into one platform.
Death rates are similar at one year for a catheter-based aortic valve replacement procedure and conventional surgery in older high-risk patients. Results from Cohort A of the PARTNER trial found that survival of patients treated with the Edwards Sapien transcatheter aortic valve was equivalent to those treated with surgical aortic valve replacement in the head-to-head comparison.
The data were presented at the American College of Cardiology's (ACC) 2011 Scientific Session in New Orleans.
For more details, read the article at www.dicardiology.net//article/transcatheter-valve-equals-surgical-outcomes-one-year