Cath/angio vendors offering three distinct groups of solutions
March 21, 2017
By Tom Watson
The most active vendors in the U.S. cath/angio market over the past three years (GE Healthcare, Philips Medical, Siemens Healthineers, Shimadzu Medical and Toshiba Medical) offer three distinct groups of solutions:
• Single plane imaging configurations.
• Biplane imaging configurations.
• Single plane specialty imaging configurations.
There are sub-segments for each of these that I will touch on briefly, but for the purposes of this general overview, it is best to consolidate the information into these three large groups of solutions. The core imaging technology, which includes the gantry, imaging chain and imaging table, are effectively the same for different applications within each group. The clinical feature differentiation comes in specialized software and options to tailor the final solution to meet a wide range of clinical needs.
Single plane imaging Configurations
These are the most commonly considered solutions. They can be configured to address dedicated cardiac, dedicated vascular, combination cardiovascular and electrophysiological applications. Most vendors offer floor-mounted or ceiling-mounted solutions (GE Healthcare offers only floor mount). Combination cardiovascular solutions have been the primary focus, but we have begun to see some resurgence for vascular only. This is a result of increasing interest in angiography for image-guided assistance for oncology treatment solutions. Electrophysiology continues to be an active and growing area.
Biplane imaging configurations
Biplane has continued to be a clinically justifiable option for two areas, neurological imaging and intervention and pediatric imaging and intervention. The ability to provide simultaneous imaging from two orthogonal planes provides advantages in real-time 3-D spatial orientation as well as reduced use of contrast. Both of these are critical factors imaging the vasculature of the brain and the sometimes complex anatomy and contrast limitations of pediatrics and neonates.
While more limited, it is also an important consideration in services with populations with a high percentage of renal compromised or renal failure patients. Biplane has also gained attention from advanced interventional electrophysiology programs that are seeing more ablation procedures to treat life-threatening heart rhythms not responsive to medical therapy. However, this continues to be an area that generates discussions as to the clinical need versus clinical preference. There are many successful interventional EP programs using single plane technology.
Single plane specialty imaging configurations
This is an area that has emerged with the growing area of catheter-based therapeutic interventions as an alternative to traditional surgical procedures. The term ”hybrid OR” has been coined for a solution that can be installed in the traditional surgical area and offers an ability to convert from an interventional study to an open surgical study in the same room. Variations can use a modified angiographic imaging table or can integrate a more traditional surgical table or provide a portable surgical table to offer a wider range of surgical procedures if desired. The most highly publicized procedure has been the transcatheter aortic valve repair/intervention, commonly referred to as TAVR or TAVI. This emerging technique has continued to grow as more FDA-approved vendors and devices become available.
The clinical trials have suggested that the minimally invasive surgical or non-surgical approach is at least clinically equivalent to traditional surgery. These catheter-based approaches also provide a therapeutic solution to very sick patients who are not medically stable enough for traditional open-heart surgery and otherwise would have no alternative. This catheter-based approach is expanding into other heart valve procedures and closure of heart defects. It is also offering a non-surgical option for closure of the left atrial appendage, which can be a contributing factor in dangerous heart rhythms.
These clinical applications are not specific to either single or biplane solutions, but most currently are single plane systems. This area of clinical focus has also spurred development of some unique solutions such as the robotic laser-guided C-arm as well as the robotic C-arm design. All vendors have variations of their single plane solutions that can be configured to address the needs of various transcatheter techniques for the interventional and/or thoracic surgery cardiac physician or vascular interventionist and/or endovascular surgical physician.
The core diagnostic applications have remained fairly consistent and defined over the past five to 10 years. Research and development have focused on improving overall image quality while reducing the amount of radiation dose and imaging contrast required to produce high-resolution, diagnostic images. A continuing focus is on the existing interventional techniques to address cardiovascular and neurological diseases.
The most recent and highly exciting areas are taking the catheter-based interventional approach to new levels and providing minimally invasive surgical or non-surgical options to address structural diseases previously limited to surgical solutions.
About the author: Tom Watson is a clinical analyst at MD Buyline. He joined the organization in 1986 and has over 40 years of experience in the field of cardiovascular medicine.