Interventional News visited Dr Jos van den Berg at St Antonius Hospital, Nieuwegein, The Netherlands, to find out about advances in the use of 3D rotational angiography (3D-RA) in covered stent placement and the assessment of patients for peripheral arterial aneurysm treatment. Dr van den Berg was one of the first interventional radiologists to use this technology, and developments within the industry are now matching his needs and ambitions in this area. 3D-RA, a technique first developed by neurointerventionalists, requires a short rotational run (not multiple projections) by the x-ray system before the system reconstructs a 3D image within 75 seconds. The obtained 3D volume can be rotated and viewed in any direction for optimal viewing and is of a very exact measurement (less than 2% error).
During Dr van den Berg's tenure as Manager of Medical affairs at the Department of Radiology at St Antonius, 3D rotational angiography techniques have improved significantly and this has helped the team to use 3D-RA in stent sizing and placement and interpretation of anatomic morphology of the aneurysm and surrounding vessels. Most centers use helical CT, CT or MR angiography for interpretation and action.
The Philips FD20, installed first at St Antonius, breaks new ground in interventional imaging with a unique 2k2 digital imaging chain and enhanced 3D capabilities. As well as setting a new standard in image clarity, the improvements Dr van den Berg called for back in 2002 (see Interventional News, Issue 5, page 16) have been given considerable attention. The merging of images, enabling vessel wall calcifications to be seen on a 3D-RA image has been enabled, as well as the rotation of 3D images and a greater understanding of anatomy. The time it takes the computer to produce an image is much quicker, and a reconstruction is available after 75 seconds. Time remains an important factor in interventional radiology, although increased resolution quality, leading to clearer diagnosis and improvements in interventional techniques are the key benefits.
Dr van den Berg highlighted the system's use primarily in "identification" as well as in the "navigation and placing of catheters". 3D catheter tracking also "allows for real time integration of 2D live fluoroscopy and 3D reconstruction". Before this there was an "inability of the user to perceive the procedure", but 3D-RA is now used routinely in van den Berg's interventional work.
In addition, Dr van den Berg and his team work unusually closely with cardiologists at St Antonius, to great effect, and he has noticed significant interest in 3D-RA from his colleagues across the board at this 560 bed hospital. Among features of interest is the Stentboost, an interventional tool for improved visualisation of stents in coronary arteries. Stent sizing, tracing the central vessel line and plotting the distribution of stents are all important parts of the process. Of course, as Dr van den Berg points out, what happens in practice can still be quite different to a 3D model.
The installation of the same technology used by Dr van den Berg is now imminent in the USA - at the Baptist Cardiac and Vascular Institute of Miami. As "...the first ever installation of 2k2 imaging for x-ray outside of Europe, this installation represents another important step in the world of interventional x-ray technology," said Dr Barry Katzen, Medical Director of the Baptist Cardiac and Vascular Institute of Miami.
These developments all tie in with a growing trend in healthcare devices for information management, as well a shift towards integration of systems - with the St Antonius's system, users will be able to access patient information such as CT, MR and Ultrasound, during the intervention.
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