By: David Handler, Contributor

Coronary artery disease is the leading cause of death in America. Percutaneous coronary intervention (PCI), commonly known as angioplasty, is the most common treatment, with more than 900,000 procedures performed annually in catheterization laboratories across the country. Despite improvements in the devices used in cath labs, the actual procedure has remained largely unchanged for nearly 40 years. While standing over the patient, an interventional cardiologist snakes wires and catheters up from either the femoral or radial artery, reaching the heart to re-open blocked vessels. Often, a stent is inserted to keep the artery open. The procedure uses X-ray (fluoroscopy) to visualize the patient’s anatomy, placing the physician within feet of a radiation source for every procedure.

Physicians frequently spend six or more hours daily in procedures, wearing 20 pounds of lead aprons in an attempt to protect themselves from ionizing radiation emitted by fluoroscopy. Angioplasty saves patients’ lives, but there is a mounting body of evidence highlighting the significant occupational hazards physicians face in the cath lab. Leading hospitals in the country, including the recent installations at the Mayo Clinic and Massachusetts General Hospital, have implemented a vascular robotic system to refine the procedure and decrease occupational risks for physicians and staff. Let’s look at what hospitals should consider when evaluating robotic technology for the cath lab.



Long-term health for cath lab workers
Occupational exposure to low-dose ionizing radiation has been shown to have many health consequences for interventional cardiologists, who receive the highest amounts of radiation of any medical professional.

Brain tumors: Over a career, interventionalists receive 1,000 mSv exposure to the head, equivalent to 50,000 chest X-rays. Increased exposure to radiation may cause incidents of cancer, specifically brain tumors. One study of self-reported brain tumors in interventionalists showed that 86 percent of those tumors were left-sided, the side of the head most exposed to radiation during procedures.

Orthopedic injuries: Heavy-leaded personal protective equipment worn for radiation protection may result in orthopedic injuries. The incidence of spine issues for interventionalists practicing over 21 years is 60 percent.

Cataracts: Cataracts are reported as another effect of radiation exposure in interventionalists. In the RELID study, 50 percent of interventional cardiologists had posterior subcapsular lens changes (precursors to cataracts, caused by radiation exposure) versus less than 10 percent in the control group.

As a result, some experienced physicians are speaking out about the health consequences to protect the next generation of interventionalists and advocate for improved safety measures. One proven safety measure is robotic technology. It allows physicians to perform procedures seated in a radiationshielded interventional cockpit. The physician uses digital controls to advance guidewires and catheters. The PRECISE clinical trial showed that robotics reduces radiation exposure for the primary operator by 95 percent.

Benefits to the patient
Clinical benefits come from the precision in robotic technology, which enhances visualization of the X-ray images. This helps physicians to accurately measure anatomy, which may optimize stent selection. Recent studies show visual estimation of lesion length, which is the most common method, is often inaccurate and can result in the unnecessary placement of a second stent. Robotic technology also allows discrete 1 millimeter movements enabling cardiologists to position stents exactly where the patient needs them. Without robotics, the STLLR trial showed that 47 percent of the time a portion of the lesion is left uncovered by a stent, which leads to increased repeat procedures.

Building a successful robotics program
Adoption of robotic programs continues to grow. Hospitals are recognizing the value of protection for their staff and investing in the safety of their employees. In addition to the value of protecting cath lab teams, precision and accuracy of stent positioning may reduce operating costs in the cath lab. Imprecision in stent positioning or size selection can result in the use of more stents than necessary, raising the cost per procedure.

The introduction of any new technology requires operator and staff training and may require changes to the workflow. Success requires commitment from everyone involved to maximize the value robotic assistance can bring. When launching a robotics program, all team members are involved to ensure physicians, staff and patients receive the benefit of robotic-assisted PCI.

Robotics is no longer a technology of the future. It is transforming health care, including the practice of interventional cardiology. When considering options to update cath labs with robotics, hospitals should consider both the benefits for patients and the longterm health and safety of their employees. You can obtain references to clinical trials supporting claims herein directly from Corindus by contacting the company at info@corindus.com.

About the author: David Handler is the president and CEO of Corindus Vascular Robotics.