Less Radiation, Less Contrast and Improved Images: A Single Plane Rotational Acquisition Technique

Dr. Raman, what were your study results? We compared standard, multi-view coronary angiography and spin angiography for identifying stenoses at various points along the left coronary artery. We found a significant reduction in contrast administration and radiation dose exposure using spin angiography as compared to standard, multi-view coronary angiography. At the same time, we compared image assessment using both techniques, and found that the same quality of information regarding the lesion severity was obtained. Can you talk more about any increase in image quality? I think, in general, OSU and other sites have seen an increase in image quality using the Innova digital flat panel detector system, compared to traditional image intensifier systems. What about contrast usage? The vast majority of patients got Omnipaque, but we did more of a volume comparison rather than comparing the type of contrast used. How much do you estimate was saved compared to conventional angiography? Contrast volume was lowered by 28% and radiation exposure was lowered by 46%. Can you talk about the operator’s role? How does it differ using this technique? The spin acquisition is preceded by a test rotation of the gantry. That’s to make sure that there are no poles or tubing in the way. It doesn’t require any radiation exposure. Once that’s done, then the spin is a rapid rotation in the same trajectory using preset controls. There’s a tableside controller where the technologist usually works. Can you tell us about your facility at OSU? We have 3 diagnostic cath labs, two of which have the Innova system. __________________________________________________________ ABSTRACT Rotational Cardiovascular X-Ray Imaging for Left Coronary Artery Angiography Using a Digital Flat-Panel Cardiac Imaging System S.V. Raman1, R.D. Magorien1, R. Vaillant2, P. Payne2, K. Benali2, C.A. Bush1 1Ohio State University, Division of Cardiology; 2GE Medical Systems Background: X-ray coronary angiography delineates luminal disease by visualizing radio-opaque contrast injected into the coronary arteries. Current single-plane coronary angiography is performed with multiple injections at various camera angles to capture 3-dimensional anatomic information. We tested a novel rotational acquisition technique optimized for coronary artery imaging on a digital flat panel system (Innova2000; GE Medical Systems), and performed an initial analysis for left coronary artery (LCA) angiography. We hypothesized that comparable image information could be obtained with significant reductions in radiation dose and contrast administration. Methods: Subjects requiring diagnostic coronary angiography were enrolled prospectively after providing written informed consent. The rotational LCA acquisition was performed after the standard LCA runs. Dosimetry and contrast volume for all runs were recorded. The rotational acquisition ran from 30° right anterior oblique to 90° left anterior oblique in the anterior-posterior plane. To assess image quality, the rotational acquisition was grouped with a cranial run and a caudal run from the standard acquisitions (spin set). Independent reviewers compared this set to the standard acquisitions in a blinded fashion. Results: Of 21 subjects enrolled, 4 were excluded 3 due to morbid obesity and 1 due to change from femoral to radial artery access. Radiation exposure for the spin set was markedly lower than for the standard acquisitions (by 45.6% ± 10.1%, pConclusion: Rotational x-ray angiography can be used for left coronary artery angiography in the appropriately selected patient with reduction in contrast and radiation dose while capturing similar percent stenosis image information. Reprinted from Am J Cardiol 2002; 90(suppl 6A): 129H, with permission from Excerpta Medica Inc. __________________________________________________________ Brad Fox is GE’s General Manager for the Global Cardiovascular Line, which is based in Paris, France. He is part of the group that has been developing the InnovaSpin technology. What are some of the advantages of using this technology? It allows the clinician to get a lot more of a multi-dimensional look at the artery using a single acquisition and a single contrast injection. We’ve looked at the potential to eliminate some of the runs done in a study and also used InnovaSpin as a follow-up procedure to look at the whole artery. Clinicians can look with a panoramic view at an artery and if there’s a partial stenosis that is not concentric, they can actually understand how it’s working. The technology will help clinicians choose views for the intervention and things like quantitative coronary analysis. Are there any particular conditions or abnormalities that this application would be well-suited to visualize? We need to better understand the answer to this question through study. If you can imagine things like complex stenoses or a bifurcation where there’s a lot of overlying structure, you’re going to get a better visualization with this technology of what’s going on with that artery. Regarding the reductions in x-ray dose and contrast media usage in Dr. Raman’s study, we think that’s going to be extremely important for people that have renal conditions and cannot handle a lot of contrast. What are the studies that are going on now with this application? We’re continuing with Dr. Raman’s study at Ohio State. We’re going to follow up with studies that start to look at more specific situations and at different ways InnovaSpin can be used. InnovaSpin (now FDA-approved) is something that we are now offering to the entire customer base of the Innova 2000. Clinicians have told us that they see an enormous amount of benefit to using InnovaSpin today. The user interface has been integrated very simply into the tableside so there’s not a lot of extra work and setup. We want to get people out there using it and then do some very specific clinical studies to regarding very specific anatomy and patient groups. GE has 300 Innova systems currently installed. How many of those sites are using InnovaSpin? Today only 5 sites are using InnovaSpin; those sites are doing the clinical studies for us. That’s going to be changing now with the FDA approval.

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