Cath Labs, New Technologies On The Horizon

Manufacturers are showing a conceptual work-in-progress in AR for cath labs and some have already commercialized AR technology to aid in advanced visualization of patient 3D datasets.

Cardiovascular diseases are the leading cause of mortality in India, with 30 percent of deaths attributed to the disease. It is estimated that 10 percent of the urban adult population and 5 percent of the rural adult population suffer from some form of heart diseases and 20–30 percent of them require specialized investigation and treatment. Rationalizing patient care in the cath lab is an important area of focus for healthcare systems in order to optimize delivery of care. Radiation safety is now being taken more seriously than ever before. The radiation safety kit of an interventionist now includes radiation absorbent goggles and caps and radiation pads and shields. The heavier lead aprons and neck collars are now replaced with lighter material containing barium. X-ray generators are now designed to reduce emissions, working at lower frame rates. Biplane and rotational C-arms are allowing more images to be taken with lesser radiation; however, very few centers in India can boast of having these. The cath lab of the newer generation will become a multipurpose unit, which will be cost-effective for the hospital and allow better space and time utilization.

Technological trends
A totally equipped cath lab is an unmet dream of any interventional cardiologist. Advances in cath lab technology are so fast paced that any new state-of-the-art cath lab starts looking old in less than 5 years. A cath lab now means much more than a fluoroscopy unit. Vascular imaging has become an integral part of any cath lab setup.

Offering a complete cath lab solution. When a hospital installs a new interventional lab, many want a complete package so they do not have to subcontract with multiple vendors. In the cath lab, the hemodynamic system is at the core of all procedures, including cardiac procedures, interventional radiology, vascular surgery and electrophysiology. All the major angiography vendors now partner with other vendors to offer complete solutions with hemodynamics. Newer-generation hemodynamic monitoring systems have interfaces to help document all types of procedures. This may include charting, device usage, specific site identification, fractional flow reserve, sheath exchanges, and automatic timers to record balloon inflation time and pressures applied. The data gathered by the system helps speed workflow by automatically generating reports and auto-fills report fields and billing information.

New echo fusion solutions for procedural navigation. Complex procedures, especially in the structural heart space, require visualization of the surrounding soft-tissue anatomy beyond what 2D angiography can offer. Ultrasound is usually employed for complementary imaging during procedures, usually with transesophageal echo (TEE). A couple vendors have taken TEE a step further with integration with the live fluoro imaging to co-register the images and display them in one fused view. Specifically designed for use in the cath lab, the new systems streamline communication between the interventional cardiologist and the echocardiographer during complex interventional exams. Combining live ultrasound and X-ray information into one fused view, the system helps interventional cardiologists oversee procedures along with the location of key anatomical structures.

Integration of augmented reality in the cath lab. A new technology that is already on the horizon to aid procedural navigation in the cath lab is augmented reality. The technology enables operators to see true 3D images of anatomy in a heads-up display while they are looking at the patient or at the main screen in the lab. Manufacturers are showing a conceptual work-in-progress of this technology and some have already commercialized augmented reality technology to aid in advanced visualization of patient 3D datasets. AR allows physicians to view, measure and manipulate real-time holographic images of the patient’s heart during procedures while still being able to clearly see around the room. Using real-time navigation data feeds rather than MRI or CT, the solution provides clinicians with patient-specific anatomy in a holographic display, including catheter movement. The software is aimed at reducing operating time and radiation exposure to clinicians, and potentially improving outcomes for patients.

Road ahead
The healthcare marketplace is transforming and care pathways and solutions that focus on standardizing the clinical delivery of care and improves patient outcomes and quality will bring profitability to cath labs. There are and will be many advances occurring in cath labs. Next-generation cath labs will improve operator performance, enable more complex procedures, improve patient and operator safety, and expand the use of minimally invasive cardiovascular procedures into new areas. Most modern angiography systems offer rotational 3D angiography, which uses a quick spin around the patient to create a 3D image of the structure. Some systems allow these 3D images to be overlaid or fused with the live 2D fluoroscopic images. This fusion technology is used with planning and navigation software to better guide the procedures. There will be also introduction of free-floating holographic imaging, which will allow image projections in the cath lab above the patient where the image can be rotated or sliced through any axis.

Cath labs have definitely come a long way. Perhaps robot-assisted procedures in the cath lab will become commonplace in the near future. The healthcare aids of the future will require a willingness to think creatively and investigate out-of-the-box solutions.