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Viewing the imaging market — Interventional X-ray and angiography

April 08, 2024

• The need to allow more access to the patient’s head in critical situations has driven some of the IXR system designs. The need to be able to maintain a clear space above the patient if surgical intervention is required has also been a factor. The surgically focused solutions from all vendors have systems that offer specialized options i.e., Philips Azurion C20 FlexArm, Siemens’ ARTIS pheno (unique floor-mounted design) and GE’s iGS 7 Series. While these are ideally designed, some continue to use traditional ceiling mounted systems primarily.

Image Guided Oncology – This is part of interventional radiology configurations that will assist in specifically guiding oncology interventions using IXR. This has created a resurgence of interventional radiology suites that had largely been combination cardiovascular, driven by cardiologists that expanded outside the heart for peripheral angiography applications (excluding neurology). Often ultrasound guidance will also be part of this application.

Electrophysiology (EP) – The IXR is designed to allow specific placement of specialized EP catheters to diagnose and now therapeutically treat abnormal cardiac electrical signals. There continues to be some evaluation of whether single-plane (diagnostic) or biplane (therapeutic) configurations are the best option for EP procedures. Some therapeutic requires 3D mapping of specific pathways and ablation requiring precise identification and placement of ablation catheters.

Pediatric/Neonates/High renal failure patient population – Biplane has been the standard for this patient population. Biplane allows simultaneous imaging from two orthogonal planes (90 degrees) providing imaging of complex abnormal anatomy. It reduces the amount of contrast material, as limiting volume is critical in small patients as well as a patient population with a high percentage of renal failure. Advances in 3D imaging/reconstruction are helping and may move more of this population to single-plane options with advanced 3D capacities.
CT Angiography (CT-Like) – Provides better visual representation of anatomy and orientation of structures. This is playing a significant role, especially in the transcatheter valve sizing, positioning, and placement. It is also key in evaluating the success of the procedure to reduce the potential for leakage or post-procedure complications.

Associated technologies
Intravascular Ultrasound (IVUS) – This specialized catheter-based ultrasound and intra-luminal pressure solution provides precise data that can determine if placement of a stent will provide improved patient outcomes. By measuring the pressure on either side of a lesion (blockage), the resulting metric can provide clinical justification for placement of a stent or insufficient justification for stenting, which can be a significant cost determination for both the hospital, patient, and insurance provider. The pressure measurement is known as Frequency Flow Reserve (FFR).

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