Dr H.S. Somanath, Chairman – Cardiology at Nayati Healthcare
- Cath lab imaging technology has now evolved from the Analogue-based Image Intensifiers to fully Digital Flat-Panel technology with high resolution that leads a long way in serving healthcare to its fullest extremity. There are enormous advancement in combining various features like inclusion of Hybrid Systems, Intravascular Ultrasound (IVUS), Rotablation Atherectomy Device, 3D Rotational Angiogram, Fractional Flow Reserve (FFR), Stent Boost and many more.
- Although there has been an evolution of care in the cath lab, the core technology of Angiographic Imaging, Wires, Catheters, and Balloon Interventions has not changed dramatically over the years. Some of the incremental advancements that have changed the way cardiac care is delivered.
- Nowadays, we can automatically, without radiation exposure, collimate an image by using the previous images to collimate on, which reduces direct and scatter radiation exposures to our patients and to clinical team as well. In addition, we have lowered up frame rates from 60 frames/second to 7.5 to 30 frames/second.
- In the beginning phase Cath-Lab, X-ray images were of very high-dose, images from low-quality image intensifiers, were recorded on 16-mm or 35-mm film with Aero techno film magazines and video reel-to-reel tapes for playback. The Jamison or Combulator processor in the darkroom could engage a person’s entire day’s work. The transformation has been through C-arms to Aerotechnic cameras, mounted overhead as image intensifiers, form intensifiers to flat-panel technology, pulsed fluoroscopy, digital enhancing of images, subtracted images and bolus-chasing, 3D visualization tools that are enabling cath labs to perform as a highly specialized research center and multipurpose facilities. The 3D rotational angiogram allows for a single dye injection and rotational images, the ability to view all coronaries/cerebral arteries with one shot, lets the clinicians use less dye which reduces the risk of any future side-effects.
- We have also witnessed the advancement in PACS archival technology that transmits images via the web viewing the patient’s films which have gone from a noisy Tagarno film-snagging projector to a completely digital based PACS system that constantly needed our diligent attention and up-gradation.
- The introduction of stents significantly altered the care landscape. The evolution of stent technology from the bare-metal stent to the approval and adoption of drug-eluting stents (DES), had a major impact on improving clinical outcomes. Stent Boost subtraction feature shows the enhanced stent image in relation to the vessel wall to support precise pre and post stent deployment.
- Access techniques have migrated over the years from Judkins percutaneous approach through the femoral artery to more recently Radial Artery Approach, which can significantly decrease the risk of post-procedure bleeding (Hematomas) and reduce the post-procedure length of stay (LOS), thus influencing the care delivery model to a significant level.
- Valvuloplasty, the widening of stenotic aortic valve was introduced into the cath lab procedure armamentarium. The endovascular approach for the valvular disease has developed significantly over the years, with the advent of Transcatheter Aortic Valve Replacement (TAVR) procedures.
- Vascular Closure Device has been widely accepted over manual compression that includes patient comfort, early mobilization, and discharge, avoidance of local compression and its sequel and less time constraint on staff.
- The cardiac cath lab of the future projects the functionality as a hybrid suite, supporting cardiac and vascular catheter-based interventions and associated complex staged/combined interventional and open surgical procedures under the same roof.
- In order to conclude, we may say cath labs have come a long way, but we also need to think upon, what is next on the horizon? Will cath labs as they exist today, become obsolete with CT and MRI technological advances? Or, will robot-assisted procedures in the cath lab become common practice in all hospital set up? These are few of the contemporary issues concerning the future of the technology.