Using the radial artery to perform cardiac catheterizations is proven to lower the risk of vascular complications, reduce major bleeding and improve patient recovery time when compared to femoral access. The number of cardiac catheterizations in the U.S. done using the radial approach, currently 8 percent, is rapidly growing¹ as healthcare facilities realize the patient benefits. With a commitment from physicians and the right imaging technology, successfully using the radial approach is possible. One example is Shannon Medical Center, in San Angelo, Texas.

In the past few years, Shannon Medical Center, a 250-bed community hospital, focused on making the radial artery the access point of choice, which resulted in improved safety and outcomes for patients. Shannon Medical Center needed a new vascular X-ray imaging system to accommodate the right or left side radial approach and that was flexible enough to perform various cardiac interventional and other procedures.

Dr. J. Chris McClish, interventional cardiologist at Shannon Medical Center, led the search for the new imaging system and selected Toshiba America Medical Systems, Inc.’s Infinix™ VF-i single plane vascular X-ray system.

“Radial artery access is undeniably the future of cardiac catheterization and the flexibility and image quality of the Toshiba Infinix-i system allows safer, more efficient interventions,” said Dr. McClish. “For example, the system’s lateral movement and fingertip-to-fingertip coverage enable catheter exchanges during procedures without adjusting the table and changing alignment. As our default access site, radial reduces complications and improves patient satisfaction.”

The Infinix VF-i single plane is a dedicated cardiac cath lab featuring a floor mounted five-axis positioner, making it possible to obtain images without re-positioning patients. This allows clinicians unencumbered patient access and an ergonomic set-up, along with the ability to maneuver over the heart and down to the wrist. The Infinix-i monitors also float freely around the system and can be positioned for easy viewing regardless of right or left side radial approach.

Shannon Medical Center’s Radial Results

Within months, the Infinix VF-i system helped Shannon Medical Center increase radial procedure volume to approximately 65 percent of the 1,600 catheterization cases done per year, well above the national average. Shannon’s ability to perform this procedure with minimal complications and increased patient satisfaction has created a competitive advantage for the hospital, with patients traveling from all over the region for treatment.

With Toshiba’s Infinix-i X-ray system and a dedicated commitment from the hospital, transradial interventions can be done more frequently for safer exams that drive patient satisfaction and can provide competitive advantage for hospitals.

¹“Wrist May Be Route to Safer Heart Treatment,” Wall Street Journal, February 8, 2011.

“Reducing costs and providing better patient care are top-of-mind in today’s healthcare environment,” said Stephen Bumb, director, X-ray/Vascular Business Unit, Toshiba. “The radial approach to intervention meets these needs, with multiple patient care advantages eventually leading to lower costs.”

Besides providing information on the advantages of the Infinix-i and benefits of the transradial approach versus the femoral approach, the microsite contains videos, downloadable case studies and brochures, related news articles and clinical images.

Visit the Toshiba Transradial Web Site at http://medical.toshiba.com/promo/cv/transradial/.

1. A transradial procedure is an intervention which uses the radial artery near the wrist as the main access point.
TRUE: Transradial refers to diagnostic and interventional procedures using the radial artery near the wrist, rather than the femoral artery near the groin, as the main access point for intervention.

2. Using the radial approach can improve patient outcomes and lead to reduced costs.
TRUE: Performing cardiac catheterizations through the radial artery is proven to lower the risk of vascular complications, reduce major bleeding and improve patient recovery time when compared to femoral access.

3. Radial entry can only be used to perform interventions to the heart.
FALSE: The most popular procedure for radial access is either a diagnostic heart cath or an interventional procedure such as a percutaneous coronary intervention, or PCI, so usually procedures involve the heart. But radial entry can be used to intervene in other anatomical areas such as the kidneys.

4. Either the right or the left arm can be used for radial entry.
TRUE: Either arm can be used. About 80 percent of the procedures are performed using the right arm and 20 percent with the left. Toshiba’s Infinix-i line facilitates both approaches better than any other cath lab available.

5. About 50 percent of interventions in the U.S. use the radial entry.
FALSE: The radial approach is used more than 50 percent of the time globally, but only approximately 8 percent of the time in the U.S. However, more U.S.-based hospitals are turning to the radial approach since it is easier and safer for patients. The low U.S. adoption rate is due to interventionalists being trained with the femoral approach and/or because some vascular x-ray systems do not easily accommodate this alternative procedure.

6. The radial approach is more difficult than the femoral approach.
FALSE: While the radial approach does use a smaller artery, with proper training and a system that allows for flexible positioning, like Toshiba’s Infinix-i, many clinicians find this approach easier than the femoral approach and much safer for the patient.

7. Toshiba’s Infinix-i vascular x-ray system can help make transradial procedures easier.
TRUE: The Infinix-i’s innovative 5-axis C-arm design allows for greater flexibility of positioning over the wrist to the heart, with head-to-toe and fingertip-to-fingertip coverage. By keeping the C-arm completely out of the way, it allows clinicians to position the monitor suspension into the most desirable viewing position and move the tableside control and radiation shield to either side of the table, accommodating right side or left side entry.

Toshiba America Medical Systems, Inc.’s imaging technology offers solutions that will assist healthcare institutions in preparing for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment.

Episode-Based Care Payment Model

Episode-based care is a payment approach that reimburses providers on expected costs for clinically defined episodes, rather than on a fee-for-service basis. Episode of care provides one fixed payment for the treatment of a specific illness and combines the technical fee with the professional fee. Since this payment approach provides reimbursement on expected costs for clinically defined episodes rather than fee-for-service, healthcare providers must achieve greater efficiencies and better patient outcomes. For example, if a patient has a stroke, everything done to diagnose and treat that condition is bundled together into one clinically defined episode. The goal is to reduce unnecessary services, duplicity of tests and complications – while compensating clinicians for improving the quality of care and reducing costs.

Medicare will launch the episode-based care pilot program no later than January 1, 2013. With such a large segment of patients with this coverage, it will require healthcare organizations to be even more efficient in how they deliver care.

Diagnosing Acute Stroke in an Episode-Based Care Model

Stroke accounts for approximately one in every 18 deaths and is the third most common cause of death in the U.S., according to the American Heart Association. The estimated annual cost of stroke is $50 billion, including healthcare-related costs, disability and lost productivity. When the new episode-based program comes into effect, clinicians will be tasked to diagnose and treat stroke more accurately and quickly to benefit the patient and reduce costs. When evaluating medical conditions to include in this new payment model, Medicare will look at high-cost, high-volume, chronic and acute conditions like stroke, when vetting case types for the pilot program.

In today’s top hospitals and stroke centers, clinicians use the latest CT technology to perform cerebral perfusion imaging to assess neurological disorders, such as stroke, and to make treatment decisions. Depending on the specific case, patients are often taken to interventional labs where the imaging equipment helps guide treatment and supports device placement.

This was not always the case, as limitations in the coverage volume of CT previously prevented perfusion imaging from being a truly effective tool in diagnosing stroke. However, developments in imaging technology, particularly CT, are enabling healthcare professionals to diagnose and treat stroke faster than ever before.

Diagnosing Stroke with Toshiba’s Aquilion ONE

The introduction of Toshiba’s Aquilion TM ONE dynamic volume CT system changed the scope of cerebral perfusion analysis by enabling dynamic imaging of the entire brain and the ability to reduce diagnosis time from hours to minutes. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements to image an entire organ, including the brain, in a single rotation. It can show the brain’s dynamic blood flow and real-time function, which is crucial for stroke patients and enables rapid and accurate diagnosis when time is critical.

The Aquilion ONE also features a full suite of dose reduction technologies that limit radiation dose to the lowest possible amounts while maintaining the highest clinically-appropriate image quality needed for diagnosis.

Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital and Its Use of Toshiba’s Imaging Technology

Toshiba understands that effectively transitioning to episode-based care requires more than just superior imaging equipment; it requires the cooperation and collaboration of a multidisciplinary team of physicians that appropriately leverage the technology to its fullest capabilities to the benefit of the patient. Toshiba’s technology offers solutions to help healthcare facilities prepare for episode-based care by effectively utilizing patient-focused imaging technology and a multidisciplinary collaborative approach to treatment. Toshiba uniquely offers a multidimensional knowledge base, dynamic customer interaction, and a robust support system of training and education to help medical teams transition and prosper within the new healthcare economic models.

One such example is Toshiba’s partnership with the Kaleida Health Stroke Center at Millard Fillmore Gates Circle Hospital in Buffalo, N.Y. Millard Fillmore Hospital is a 189-bed facility that is part of Kaleida Health, the largest, most comprehensive healthcare system in the region. It is a modern acute care center offering a full range of medical and surgical services, including a world-class neurological and stroke care. The Kaleida Health Stroke Center has integrated Toshiba’s state-of-the-art training and imaging with an outstanding multidisciplinary team of physicians, nurses and technicians, comprehensive education and community outreach. The result has been an improvement in both patient and financial outcomes in the diagnosis of acute stroke that demonstrates a commitment to delivering quality care to the community.

Millard Fillmore’s Results Using 320-Detector Row CT in Diagnosing Acute Stroke

To quantify the results of utilizing the Aquilion ONE in the diagnosis and treatment of acute stroke, Toshiba and Millard Fillmore conducted a retrospective and prospective study on its effectiveness in treating these patients with the new technology. The goal of the non-controlled study was to measure the economic impact that 320-detector row CT has had on the diagnostic workup of patients presenting with symptoms of acute stroke and transient ischemic attack (TIA). Millard Fillmore reviewed the patient diagnostic workup on a retrospective and prospective basis and analyzed all the imaging procedures utilized during the acute inpatient episode of care, focusing on the changes in the diagnostic work-up, inpatient length of stay and discharging disposition since acquiring the Aquilion ONE. Inpatient data sets prior to the Aquilion ONE installation were compared with data sets using the Aquilion ONE, and concerned the top three discharging ICD-9-CM stroke codes.

When Millard Fillmore analyzed the length of stay, discharge disposition and healthcare costs for the top three ICD-9-CM codes for stroke and compared the 2007 and 2009 data sets, the results demonstrated the benefits 320-detector row technology brought to the facility and its patient community. For the three stroke ICD-9-CM codes analyzed, Millard Fillmore found a reduction in hospital stay, had more patients discharged to home and achieved an approximate annualized savings of more than $750,000.

The Kaleida Health Stroke Center at Millard Fillmore is an impressive example of how an exceptional multidisciplinary team with comprehensive education and community outreach can use innovative imaging technology to make a difference in the lives of patients, improve financial performance and result in high quality patient care in today’s uncertain times. Healthcare facilities everywhere can experience the significant cost savings achieved through reduced length of stay, reduction in outpatient services, reduced complications, and lower recurrence of readmission.

The reality is that hospitals that choose not to participate in the national pilot program will be at risk of losing market share because Medicare patients will be encouraged to utilize participating facilities. The healthcare providers which embrace this new, value-based collaborative approach to providing high-quality care can not only retain but even increase market penetration. Toshiba has a proactive approach with the knowledge base, customer support and technology to help healthcare organizations successfully transition and succeed.

“Toshiba is dedicated to continuously improving its imaging systems to meet the changing needs of healthcare providers,” said Tomohiro Hasegawa, director, Ultrasound Business Unit, Toshiba. “These enhancements to the ultrasound product line build upon Toshiba’s advanced technology to allow quicker, safer and more effective diagnosis, particularly for cardiac exams.”

3D Wall Motion Tracking and Tissue Enhancement for the Aplio Artida
For its flagship cardiac system, Aplio Artida™, 3D Wall Motion Tracking and Tissue Enhancement technologies are now available. 3D Wall Motion Tracking, an industry first on the Artida, offers a new era of dyssynchrony imaging and advanced regional wall motion assessment. It aids electrophysiologists in optimizing pacemaker placement and function. It also shows 3D ejection fraction, volumes, and regional and global strain function. A Toshiba-exclusive software, Tissue Enhancement has the ability to improve image uniformity and endocardial border delineation, especially in difficult-to-scan patients.

Auto IMT on Toshiba’s Shared Service Ultrasound Systems
Available on Toshiba’s shared service ultrasound systems, Aplio™ MX, Aplio™ XG and Xario™ XG, the new Auto IMT feature calculates the intima-media thickness of the carotid artery, helping clinicians determine a patient’s risk for cardiovascular disease. Toshiba’s Auto IMT can determine the thickness of the near and far arterial walls from three segments of the carotid artery: at an optimal angle of incidence and two complementary planes. Auto IMT automatically locates and finds the thickness of each segment. These measurements are based on numerous research protocols and the American Society of Echocardiography (ASE) consensus statement, and may be used in stratifying cardiac risk in certain asymptomatic populations.

New TEE Probe
Also at ACC will be Toshiba’s new adult motor-driven TEE probe which improves the diagnosis of numerous cardiac conditions in difficult to scan patients.

Eleven years ago, breast cancer screening at the University of Southern California’s Norris Comprehensive Cancer Center and Hospital (NCCCH), Los Angeles, was conducted in a manner familiar to many caregivers—imaging took place in one department of the facility, while follow-up care was provided in another. “Back then we were all located in different places and were very spread out,” recalls Linda Hovanessian-Larsen, MD, associate professor of radiology at NCCCH. “Doctors would have to physically come to our section to get imaging results for their patients.”

In 1999, Norris opened a new women’s imaging center, one designed to accommodate radiologists, oncologists and surgeons within the same space. “The Breast Center has a U-shaped floor plan—the surgeons and oncologists are in one corridor and we’re in the next, literally six feet away,” Larsen says. “We’ve created a one-stop shop for women: they come in, we’re able to do their full work-up, if they need a biopsy they can get a diagnosis the same day, and if a patient does have cancer, a surgeon can meet her and begin the treatment planning immediately.”

Larsen explains that the goal of the Harold and Henrietta Lee Breast Center is to provide the best possible patient care, which includes minimizing women’s anxiety by arriving at diagnoses quickly. Design plays a key role: co-locating diagnosis, treatment, reconstruction, after-care treatment, image enhancement and genetic counseling enables much faster, more aligned care. Every Wednesday, clinicians meet to review biopsies from the week before and make sure there’s concordance; “if the imaging looks worrisome but the pathology is benign, we may choose to repeat the biopsy,” Larsen says. On Thursdays, clinicians meet to discuss patients currently in treatment as part of a weekly tumor board.

Technology is equally important, enabling the center’s clinicians to provide patients with answers faster than ever before—in many cases, during the same day as their screening exams. “So many recent advances in imaging technology really benefit patients,” Larsen notes. “Digital mammography is outstanding and much quicker than analog. Ultrasound helps distinguish between cancers and benign lesions, and MRI is very helpful in indentifying occult cancers, showing the extent of a cancer or just solving problems. We also use it as a screening tool for women with the BRCA gene.”

Ultrasound also aids in lesion biopsy, which Larsen says can take as little as five minutes, and in ruling out cancer when, for example, a lump in the breast turns out to be a cyst. “With ultrasound we can biopsy lesions very quickly and have final pathology available in 24 to 48 hours,” she says. “When a woman feels a lump, it’s very anxiety-provoking, although the majority will be benign. When possible, we like to have the patient go home with a diagnosis the same day as her imaging exam. That’s the direction medicine is going: patients are becoming the focus, and we, in turn, are focused on how we can take care of patients better.”

Larsen says that the interdisciplinary approach is critical to providing faster diagnoses and better, more comprehensive care—in women’s imaging and other specialty areas alike. “Medicine is dividing into organ systems—I’m part of the breast team, neuroradiologists and neurosurgeons form the neuro team, and so on,” she says. “I don’t see a lot of other radiologists, but I work extensively with the breast surgeons and the oncologists. That’s the way it should be, and that’s the way radiology should be moving in order to provide the best patient care.”

“If you can make access to the patient easier and get the C-arm into the position you want faster, you can shorten the overall exam time and save dose,” Allan Berthe, senior cardiology product manager at Toshiba, explains. The 270-degree access of the Infinix-i C-arm gives the user an unprecedented degree of patient, equipment, and clinician access, increasing the odds of acquiring the best possible image, on the first try, with minimal difficulty. “Clinicians can see better and are more confident, and when you’re seeing better, you’re spending less time scouting around, emitting radiation ,” Berthe says.

The Infinix-i systems’ C-arm and flat-panel design also enable clinicians to position the detector as close to the patient as possible, while the systems’ flexibility permits positioning the X-ray tube on either side of the patient. “When you can position the x-ray tube closer to the panel, that reduces the radiation scatter and overall dose emission to the patient and staff” Berthe notes.

Toshiba’s table-mounted radiation shield, which includes table scatter-radiation protection, is complemented by a transparent ceiling-suspended shield with flexible positioning, both of which protect clinicians from radiation exposure. The company’s proprietary dose-management tools, including grid-pulsed fluoroscopy/fluorography and virtual collimation, help reduce patient exposure by enhancing clinician efficiency and overall image quality.

Berthe explains that grid-pulsed fluoroscopy/fluorography makes more efficient use of the x-ray signal, minimizing leading- and trailing-edge dose. “We provide, standard, the most comprehensive number of pulse–frame-rate selections in the industry,” he says. “At times the clinician may determine that superior visualization is not critical. The system operator can lower the pulse fluoro frames in these instances and then quickly increase to higher frame rates when more in-depth imaging is necessary.”

Virtual collimation, he explains, permits clinicians to position collimator blades without expending any additional dose.

“Today, dose management is critical and the Infinix-i systems provide a host of dose lowering tools that the clinicians can control right at the tableside ,” Berthe says. “The efficiency, flexibility and technology included in the Infinix-i systems are interrelated in their contribution to lowering dose to patient and staff members”

Ultrasound – Carotid Intervention
As with many other conditions, ultrasound is often the first modality physicians turn to when evaluating a patient presenting with stroke symptoms. It’s a key tool for evaluating the carotid arteries to identify the presence and type of plaque buildup the patient could have. Two key Toshiba features for ultrasound are particularly useful in stroke imaging.

Precision Imaging: This technology enhances image clarity and resolution to help physicians visualize plaque in the carotid arteries. Precision Imaging increases diagnostic confidence by providing more detailed ultrasound images so physicians can quickly determine the next steps in a patient’s treatment. As a multiresolution signal processing technology, it not only evaluates images line by line but also includes information from adjacent lines to enhance the amount of information obtained. As a Toshiba exclusive software, Precision Imaging’s ability to capture information from multiple lines improves the definition of the structure, provides more detail and minimizes noise and clutter.

Advanced Dynamic Flow™: Advanced Dynamic Flow improves very high resolution for greater diagnostic confidence for vascular structures. This sensitivity helps to better visualize the degree of stenosis in the carotid arteries. Using the same ultra-high bandwidth normally used only in B-mode for doppler signal processing, Advanced Dynamic Flow simultaneously provides both high spatial resolution and high frame rates to accurately display flow with directional information, even in tiny vessels.

CT – Faster Stroke Assessment
When a patient comes to a hospital’s emergency department (ED) exhibiting stroke symptoms, it can take hours to diagnose and treat the patient when time is of the essence. Toshiba’s Aquilion® ONE dynamic volume CT system has the ability to improve the quality of life for patients with neurological symptoms, especially related to stroke, by reducing diagnosis time to minutes with half the dose of conventional CT.

The Aquilion ONE allows physicians to reduce diagnosis time for life-threatening conditions such as stroke from hours or days to minutes. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high-resolution 0.5 mm detector elements to image an entire organ, including the brain, in a single rotation. It can show the organ’s dynamic blood flow and real-time function. The ability to see dynamic function, such as blood flowing through the brain, is critical for stroke patients in emergency settings and enables rapid and accurate diagnosis when time is critical. Coverage can also be collimated to a smaller area to reduce the dose to the patient.

This Neuro ONE acute stroke imaging protocol on Aquilion ONE combines non-contrast CT, cerebral blood flow analysis and four-dimensional digital subtraction angiography (DSA) into a single exam. By combining these exams into a single low-dose protocol, full stroke workup can be performed in less than five minutes.

Magnetic Resonance – High-Sensitivity Stroke Imaging
MRI is particularly beneficial for diagnosing acute ischemic stroke because it is highly sensitive to detecting microscopic changes in blood and oxygen in the brain. Toshiba MR integrates other techniques that further enhance MR’s role in stroke diagnosis.

Non-contrast techniques: Not only are there safety concerns when imaging with gadolinium, but also having to add contrast injections to a stroke evaluation can take time that is not a luxury in these emergency situations. Toshiba offers the most robust suite of non-contrast techniques that are beneficial for stroke analysis. For example, the V-TRACE sequence can shorten brain imaging time.

V-TRACE Sequence: This non-contrast MRA sequence available on all Vantage Titan™ and Vantage Atlas® systems, streamlines MRA brain imaging. The sequence acquires four image contrasts in one sequence, providing an imaging application for visualizing slow- and fast-flow vessels separately and together, as well as the brain tissue surrounding the vessels.

V-TRACE MRA is a dual-echo 3D FE sequence in which the first echo is acquired using Time-Of-Flight (TOF) and the second echo is acquired using Flow Sensitive Black Blood (FSBB). The sequence combines the advantages of both techniques to produce MRA images that depict blood vessels with both high and low velocity. The sequence design reduces the Specific Absorption Rate (SAR), which is a measurement of heat generated to the body during a MRI. Additionally, the TOF data can be used to evaluate the brain parenchyma. The images produced by the V-TRACE sequence improve the speed and accuracy of diagnosis.

Patient-friendly features: Toshiba’s patient friendly MR features make imaging easier for the patient. Several features reduce the feeling of claustrophobia that often accompanies MR exams. For example, the Titan’s large bore allows patients more room during the exam. Also, Toshiba’s head coil – important in the imaging of stroke – has 10 elements and very high signal to noise, which means it is not always necessary to utilize the top of the coil to image, reducing claustrophobia during an exam.

Infinix™-i Biplane Vascular X-ray System – Efficient Stroke Treatment
Toshiba’s Infinix-i biplane system has been developed with a number of tools to provide methods for neuro-interventionalists to develop treatment plans for patients more quickly. There are four key components of the system that make it ideal for stroke analysis.

Two 12×12-inch detectors: The midsize flat-panel detectors are ideal for brain imaging because they allow physicians to get two complete views of the cerebral vascular anatomy with each contrast injection, which not only helps to minimize the contrast load to the patient, but also provides better visualization due to the increased anatomical coverage when compared to two small detectors. Additionally, these midsized detectors allow physicians to obtain steeper compound angle views than can be obtained on systems with two large detectors.

3D angio visualization: This technology provides a three-dimensional image volume that can be rotated and manipulated in real time to ideally sort out superimposed vascular anatomy. Additionally, the two-dimensional multiplanar reformations enable physicians to dissect the image data from a variety of angles.

Variable isocenter: This key feature can dramatically improve patient safety during imaging. For example, some patients who are experiencing an aneurysm or subarachnoid hemorrhage may need a ventriculostomy to monitor and control intracranial pressure. Changing the table height in order to get the best imaging angles can present a dangerous challenge for physicians, because changing the table height can negatively impact the intracranial pressure and potentially injure the patient. Toshiba’s lateral plane variable iso-center feature allows optimal positioning for imaging the brain, eliminating the need for table height adjustment, as is done on all competitive biplane angiographic systems. Physicians do not have to raise or lower the table to get the best angle, eliminating simple positioning as a concern for causing change in intracranial pressure.

Five-axis positioner: Toshiba’s Infinix-i C-arm offers unprecedented patient access with a C-arm five-axis positioner that allows head-to-toe and fingertip-to-fingertip coverage. The freely moving components, ergonomically friendly design and five-axis positioner enable physicians to obtain optimal angles for neurological diagnosis and interventional procedures without repositioning the patient. Neuro-interventions typically are done with the patient under general anesthesia or heavy sedation, requiring anesthesia support during the procedure. The five-axis c-arm provides multiple setup configurations to provide unrestricted access to the headend of the table for patient care while preserving biplane projection capabilities.

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Toshiba’s Aquilion® ONE dynamic volume CT system has changed the scope of brain perfusion analysis by enabling dynamic imaging of the entire brain and dramatically improving the ways physicians diagnose and treat stroke. One feature, available only on the Aquilion ONE, due to its ability to image the entire brain in one rotation, is the Singular Value Decomposition Plus (SVD+) perfusion algorithm. The SVD+ algorithm produces advanced CT perfusion imaging that is unmatched in the industry.

“The Aquilion ONE dynamic volume CT system with the SVD+ perfusion algorithm is emerging as a new standard of care for brain perfusion analysis,” said Erin Angel, PhD, manager, CT Clinical Science, Toshiba. “The fast exam time, high image quality and lower radiation doses of the Aquilion ONE, combined with the more accurate perfusion analysis produced by SVD+, are changing the ways physicians identify and treat stroke quickly.”

Toshiba’s SVD+ Perfusion Algorithm
Brain perfusion imaging in CT is used to determine if the patient has had a stroke and to distinguish which areas of the brain are beyond repair and which areas of the brain may be saved through intervention. Perfusion analysis can help clinicians estimate treatment response and develop therapeutic pathways designed specifically for individual patients. The advanced SVD+ algorithm was developed for the Aquilion ONE to improve the quantitative maps produced by perfusion imaging and to give physicians more accurate data for the evaluation of stroke.

Standard SVD algorithms can sometimes produce perfusion maps that are not completely accurate, since they have difficulty calculating certain delays in blood flow. These blood flow delays, if not identified appropriately, produce perfusion maps that provide unclear results to the physician. Toshiba’s SVD+ is an advanced perfusion algorithm that eliminates these issues. SVD+ is a delay-insensitive SVD algorithm that uses an innovative technique to account for delays in blood flow and perform calculations with faster computation times. The SVD+ algorithm is unique in that it always begins prior to the contrast’s arrival to more accurately quantify the region of the brain being imaged.

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She went about her daily routine, until one day, after blacking out at work, Pamela found herself at St. Elizabeth Healthcare’s emergency room (ER). Unbeknownst to her and her doctors, she was on the verge of suffering a stroke.

According to Dr. Jeff Dardinger, director of Imaging, Vascular Institute, St. Elizabeth Healthcare, a typical patient presenting with these symptoms would have to undergo a battery of tests and be admitted to the hospital before a diagnosis could be made. For example, a patient would likely have had a CT exam of the head and neck and been admitted to the hospital while an MRA exam was scheduled. After a consultation the next day, the patient would have the MRA. According to Dr. Dardinger, this process could take anywhere from two to four days. For anyone who has had a stroke or knows someone who has, you know this timetable can prove fatal or debilitating.

Fortunately for Pamela, she was taken to St. Elizabeth – the first hospital in Kentucky to purchase an Aquilion® ONE. Because of the Aquilion ONE’s ability to capture the entire brain in one rotation, as well as its ability to show function over time, physicians diagnosed Pamela within an hour and prevented a stroke from occurring at all. This system is ideally suited for detecting neurovascular conditions quickly. It uses 320 ultra-high-resolution detector rows to capture up to 16 cm of coverage, enough to image the entire brain or heart and show organ movement.

Images confirmed that Pamela’s right carotid artery was 90 percent occluded, which significantly reduced blood flow to the brain. By diagnosing this condition within the hour, physicians immediately planned stent treatment to open the artery passage, preventing a stroke.

“Toshiba’s Aquilion ONE allowed us to accurately diagnose the patient quickly, dramatically improving her quality of life,” explained Dr. Dardinger, who interpreted Louderback’s images. “Without dynamic volume CT, the patient would have undergone a series of tests for two to four days, at a minimum, to uncover the occlusion. Being able to diagnose the patient within an hour allowed us to plan treatment immediately and prevent a stroke from occurring.”

“I truly believe this system saved my life,” explained Louderback. “I had several exams over the past few months, none of which could detect why I was having dizzy spells. It wasn’t until I was imaged in the ER, using the Aquilion ONE, that a definitive answer could be found.”

Introduced in November 2007, dynamic volume CT scans an entire organ in a single pass and produces 4D videos that show an organ’s structure, its movement and its blood flow. In comparison, a 64-slice, 128-slice or 256-slice CT scan can capture only a portion of an organ in a single pass, requiring physicians to “stitch together” multiple scans of an organ to get a full image. The new technology helps reduce multiple exposures to radiation and exam time.

Designed for today’s healthcare environment, the Aquilion ONE reduces overall healthcare costs and streamlines diagnosis by replacing several tests with a single, comprehensive exam. The Aquilion ONE’s single exam helps reduce unnecessary testing, as well as the accompanying accumulative radiation and contrast dose.

“The Aquilion ONE can dramatically improve patient care by providing a fast, comprehensive exam for patients suffering from life-threatening conditions, like stroke and heart attack, while helping to lower healthcare costs,” explained Robb Young, acting director, CT Business Unit, Toshiba. “St. Elizabeth Healthcare is an excellent example of where the Aquilion ONE enabled physicians to diagnose and treat a patient before a serious stroke occurred.”

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