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Long Island Jewish Medical Center: A New Cath Lab Offers Reduced Radiation Exposure to Better Serve Patients and Team Members
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CLD talks with Alexander Lee, MD
Director, Cardiac Catheterization Laboratory; Director, Department of Cardiology Quality; Director, Interventional Cardiology Fellowship Program Long Island Jewish Medical Center / Northwell Health, New Hyde Park, New York
Can you tell us about your hospital and share some details about the updated cath lab?
Long Island Jewish Medical Center (LIJ), part of Northwell Health, is in Queens, New York, and is a tertiary hospital with 600-plus beds. We don’t have cardiothoracic surgery on site, so we send our surgical cases to our sister hospital, North Shore University Hospital, just a few miles down the road. LIJ has all the necessary capabilities in performing primary percutaneous coronary intervention (PCI) including cardiogenic shock cases and most complex PCI, but for other high-risk cases like an unprotected left main or when there is a need for more advanced mechanical circulatory support, those patients are typically transferred to North Shore Hospital.
Queens is a very densely populated and ethnically diverse county. We serve high numbers of people in the community who are either undocumented, recent immigrants, or are visitors who literally step off the plane at JFK Airport, experience chest pain, and come straight to LIJ for care, given our proximity. Our hospital is making ongoing investments in the invasive cardiology space to further bring us up to date and provide the latest technology available whenever possible.
LIJ is a high-volume center with four cardiac cath labs. One of our existing labs was long overdue for a system update, so we recently had an Artis Icono system (Siemens Healthineers) installed. I have had some prior experience using the system at our sister hospital and decided to install it here at LIJ given some familiarity. It is great to have an updated system with integrated technology that provides constant image quality while maintaining significant radiation dose reduction. Operator-dependent factors of course remain a constant. We continue to focus on things like source to distance and collimation to further reduce radiation exposure for both the patient and operator. From a technical side, the Siemens system offers us a major upgrade compared to our old equipment. The new cath lab opened in April 2024 and is a fully integrated lab with intravascular ultrasound (IVUS) imaging, optical coherence tomography (OCT), and FFRangio (CathWorks). Having these integrated diagnostic tools will help us better manage our patients.
Photo credit: Northwell Health
Can you share more about the system’s ability to provide quality imaging at a lower radiation dose?
Image quality is based on the tissue you are trying to expose. For larger patients, the images tend to be more degraded due to factors affecting x-ray penetration, while for thinner patients, the image quality tends to be better because of greater penetration. In the past, the technology inside the detector was adjusted based on how much radiation was necessary to achieve adequate X-ray penetration and sufficient image quality. In essence, the larger the patient, the more radiation exposure. Siemens has a software called OPTIQ which uses self-adjusting algorithms to provide constant image quality with significant dose reduction, regardless of the type of procedure performed, patient size, or C-arm angulation. OPTIQ looks at what Siemens calls contrast-to-noise ratio, or CNR, to recreate the image in a way that makes the contrast portion pop versus distinguishing other things like the surrounding tissues. The system also has a feature called Structure Scout that helps you better see certain device structures. Newer generation stents, after deployment, can be very difficult to visualize. The current generation of coronary stents has thin struts, and some have ultra-thin struts and are made from different metal alloys. While the technological evolution of stents has yielded many advantages, stents with ultra-thin struts are very difficult to see with standard fluoroscopy. Whether it is stainless steel, cobalt chromium, or platinum chromium, the Structure Scout software recognizes the composition of the metal alloy and is able to make the stent more readily visible without potentially increasing radiation exposure.
Do you plan to track radiation dosing to evaluate the impact of the new system?
Yes, we internally track our radiation exposure and monitor dose area product (DAP) as it is a requirement for the New York State Department of Health, and we will compare results amongst our labs just as a point of interest. It will allow us to better understand the real-world impact of how some of these technological advances actually perform regarding dose reduction. So far, our technologists who document the DAP and other dose monitoring parameters have already indicated that the radiation dose is much less with the new system. It is a good sign and hopefully in the near future, we will have objective data to support it.
Do you anticipate directing more complex cases to the new lab?
Yes. If I have an obese patient, it certainly makes little sense to put that patient in the lab with the oldest system, which would lend itself to higher radiation exposure for both the patient and provider. With the new lab, we also opted for a larger table size (width) so that we can better accommodate patients who have a high body mass index (BMI). At LIJ, our vascular surgeons enjoy performing many of their cases in the cath lab. Vascular procedures can be long in duration so they will reap the benefits of doing some of their cases in this new lab. LIJ also has a large OB-Gyn program, and on a rare occasion, we may see a pregnant patient present with an acute coronary syndrome due to spontaneous coronary artery dissection and in need of an emergent cath. Although we have practical means to limit radiation exposure to the patient and fetus, having this new cath lab system will allow us to further minimize the risk.
Can you share what you are most proud of at LIJ?
I have been in the Northwell Health system for 20 years and at LIJ since 2013. First, I am proud of our ability to serve the greater Queens community, which consists mostly of working-class families that may be underserved due to lack of familiarity with the health care delivery system or due to low literacy for some. They are hardworking individuals with ethnically diverse backgrounds who may not have ready access to care due to socioeconomic factors or other barriers. To be able to not only treat this population, but to offer them the highest level of care and the latest technologies, gives me a feeling of contentment. I am very proud that our hospital and health system supports that and constantly seeks out ways to improve access. Providing care to the Queens community is top priority for us in the Department of Cardiology at LIJ, which just celebrated its 70th anniversary.
Another thing I am proud of is the performance of our cardiac care team. The New York State Department of Health (NYSDOH) has a registry that tracks PCI outcomes. Each reporting cycle, the registry provides data covering a span of three years. For the last two reporting cycles, LIJ performed well and had the lowest risk-adjusted mortality rate for emergent PCIs in New York state. It speaks to not only having high-performing cath providers doing ST-elevation myocardial infarction (STEMI) cases, but also to the tremendous care provided by our emergency department and cardiac care unit. My colleagues and staff have spent a lot of time caring for these patients, who come from all walks of life, with disease that is sometimes very challenging and difficult to treat. It is a tremendous hospital-based effort and true testament of dedication and commitment from the care team to achieve these marks.
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