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DOTmed Industry Sector Report: Special Procedure Cath & Angio Labs

by Jean B. Grillo, Reporter

This article is from in the January 2008 issue of DOTmed Business News. A list of registered users that provide sales & service can be found at the end.

Heart disease is one of the deadliest and most expensive illnesses, claiming over 500,000 lives annually in the U.S. alone, while costing a staggering $394 billion in health-care expenditures and lost productivity, according to the Center for Disease Control.

Indeed, one in five of us will someday require heart and/or stroke treatment. When seeking care, a single special procedure room often stands between patient life and death.

Called the Catheterization Angiography Laboratory (or Cath/Angio Suite), this hive of overhead "arms," computer screens, camera mounts, generators, ceiling lights and X-ray shields provides minimally invasive catheter-based radiological procedures to inpatients and outpatients seeking diagnostic evaluation and/or therapeutic intervention. Depending on the amount of equipment and staff, these rooms can range from 9X12 to 20X20 and contain some of the most expensive and cutting-edge immediate-care medical treatment available today.

Typically, Cath/Angio labs serve young and old, from neonate to elderly, suffering heart disease, valvular disease, arrhythmias, peripheral vascular disease, intracranial vascular lesions, strokes, and more. The "cath" part of the lab provides the medical procedure. The "angio" part refers to various types of "image" taking, meant to peer as closely as possible into veins, arteries, hearts, brains, and other organs, creating not only two-dimensional, but, often 3-D and now digital views of blood vessels and tissues.

For example, to diagnose heart disease, a lab will perform a Cardiac Catherization (also called a cardiac cath or coronary angiogram). This is an invasive imaging procedure that allows a doctor to actually "see" how a heart is functioning by "testing" it. A long, narrow tube, called a catheter, is inserted into a blood vessel in an arm or leg and guided to the patient's heart with the aid of a special X-Ray machine. Contrast dye is injected thorough the catheter to view blood flow to the valves, coronary arteries and heart chambers.

Biplane Cath Lab
under installation

However, the recent ability to create 3-D reconstructions of blood vessels and soft tissues allows interventions guided by technology that is a "quantum leap in angiographic imaging," according to Dr. Michael Marks, chief of Interventional Neuroradiology at Stanford Hospital & Clinics. Advanced digital tools help physicians see detailed views of the operating area, leading to greater accuracy and better results.

Opened in 2005, Stanford's Cath/Angio Lab took almost two years to complete. The 916-square-foot space serves three to five patients daily using Siemens DynaCT and AXIOM Artis dBA image detectors, one of only three hospitals in the nation to offer this type of advanced digital imaging at that time. Image detectors provide both front and lateral images, creating a three-dimensional view of blood vessels and soft tissue.

The Top Three OEM providers of Cath/Angio special procedure equipment are Siemens, Phillips and GE Healthcare. Each continues to answer the challenges of deadly heart and stroke attacks with an array of new technological features to enhance Cardio Angio Lab effectiveness.

This year, at the 2007 RSNA, Siemens introduced its Artis zeego ® multi-axis angiographic system with imaging that moves into an additional dimension. Greater freedom of positioning accommodates nearly all projections from head to toe while the syngo DynaCT ® application has been expanded, creating not only 3D but 4D image applications.

Meanwhile, Phillips unveiled its own RSNA innovations, including its flagship product, the 256-slice Brilliance iCT scanner, allowing high-quality images with exceptional acquisition speed, including complete coverage of the heart and brain captured with radiation reduced by almost 80 percent. Brilliance iCT ® and a new 64-channel system both feature Philips Essence ® technology consisting of new X-ray tubes, detectors and reconstruction design elements that also provide more detailed and clear 3D images of entire organs.

GE LCV plus
CathAngio System at
Orbit Medical
Technologies, Inc.

GE Healthcare is touting its Innova 2100 next generation of cardiovascular imaging and its LightSpeed VCT for its Cath Labs and EP Labs.

Built on a common platform, the GE Healthcare CardioLab ® IT and Mac-Lab ® IT recording systems provide unmatched versatility. Centricity Cardiology is at the core of both systems with the Mac-Lab Hemodynamic Recording System and Centricity Cardiology DMS the heart of its Cath Lab recording.

Key cardiac teaching and research hospitals such as Stanford Hospital in Stanford, CA, Methodist DeBakey Heart Center in Houston, TX and Sarasota Memorial in Sarasota, FL are the ultimate end-users of all the latest bells and whistles. No work could be more rewarding nor more perilous.

"Cardiac vascular attacks are the number one killer in the nation," notes Dennis Holloway, director of the Cath Lab at Sarasota Memorial Hospital in Sarasota, FL, a leading specialist in the cardiac field treating from 4000 to 5000 patients annually.

Sarasota Memorial has four Cath Labs, two EP Rooms and one Outpatient Cath Labs with two rooms. All of the above is carefully monitored by the Siemens Guardian Program which uses various alert systems to continually monitor all Siemens equipment in real time.

Holloway is not a huge fan of re-furbished anything when it comes to Cath Labs.

"While re-conditioned equipment might have its place among a start-up clinic or doctor's office where cost is a factor, in a hospital setting, we need 100 percent reliability," Holloway explains. "We must be trust-worthy. An intervention lab can't have any kind of break down."

Among DOTmed readers who answered our recent questionnaire asking when a pre-owned special procedure suite was appropriate versus a brand-new one, Carl Hoffman, president of Blue Ridge Medical Imaging in Salem, VA suggested there was no one answer "because there are so many variables." According to Hoffman, when some hospitals need an extra room for overflow, when the present system is failing and facility needs a special suite, and when tight budgets dictate, a pre-owned suite makes sense.

On the other hand, he agrees that most major hospitals and teaching institutions usually purchase new equipment.

"They want the latest and greatest even if there is no significant increase in image quality," Hoffman adds. "Sometimes, that's for their image and sometimes to attract certain doctors. Or the facility may have had a bad experience buying used or improperly refurbished equipment."

Peter Chen, president, Global Medical Equipment of Harleysville, PA, agrees.

"Pre-owned is for a hospital in a developing country or for a doctor's office," Chen says.
Adds Chris Hogan, president and owner of MEPS Inc. of Gallatin, TN, "A lot depends on the size of the facility and services offered, and whether a pre-owned is going to be a back-up or a primary system. Also, whether it's a combo system (cath/angio) or dedicated cardiac or angio also plays a role."

"We mainly provide hospitals with replacement parts," notes Ralph Frizzle, president of GECO (German Electronics Company), a big provider of Siemens parts.

"Third-world countries would benefit from pre-owned or businesses or doctor offices with budgetary concerns."

Frizzle notes the dollar variables are not small. "We have certain labs that can be upgraded for $200,000 versus millions for something totally new," he explains. "The key is camera and tube upgrades since image quality deteriorates over time."

Frizzle is keen on the new flat panel digital image screens now available from Siemens and others.

"It's like going from watching analog television to digital, the quality of picture is that good."

"Today, the new kid on the block is the digital flat panel detector (FPD) replacing the Image Intensifier and TV chain," Hoffman agrees, but he notes he's heard from doctors who like the Image Intensifiers better. "Image perception varies between doctors," he notes. "However, the future is with the FPD. The major drawback is the high cost of service contracts."

Indeed, all of the DOTmed readers who responded to our Cath/Angio questionnaire underscore the best way to upgrade a Special Procedures Suite in the field is to do a digital upgrade.

"I would bring in a mobile and upgrade the whole suite," says Hogan, who also recommends upgrading to new style generators/new style monitors/add-on Dicom option/image upgrades and II-pickuptube-monitors.

Other technological advances within the Cardi/Angio Suite cited include lower doses per patient with higher-grain II-pulsed fluoro, High-Frequency generators, and, better safety features (less collisions between patient and equipment) and high voltage generators with chopper inverter.

Considering the ongoing advances and the truly fatal cost for any error, what should a buyer look for, and look out for, when buying a refurbished Cath or Angio Lab?

"Absolutely know the company doing the refurbishing," Carl Hoffman begins. "Go see their facility. Are their people trained or is the refurbishing farmed out? Is the company ISO certified?"

"I would only go one generation back in age/image quality-even with a company with experience," adds Chris Hogan. Nelson Espinosa, whose company is based in Buenos Aires, suggests buyers get a field engineer's opinion while looking at service records, tube and II rate replacement, number and kind of parts replaced and user experience.

"Most of all, make sure the refurbishing company isn't a 'spray and pray' company," warns Hoffman.

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