Through February 16, 2010
Volume 3 • Issue 15
Cath Lab Uses “Jumbotron”
to Super-size Patient Care
UCH physicians Frederick Grover (foreground) and Ernesto Salcedo (background, right) look at images on Philips
FlexVision screen.
Medicine’s version of the giant-screen
“Jumbotron” familiar to sports fans has
come to the Cardiac Catheterization Lab
at University of Colorado Hospital.
FlexVision, a 56-inch, high-definition,
liquid crystal display screen from Philips, is
like “Home entertainment for physicians,”
quips John Carroll, MD, director of Interventional Cardiology for UCH’s Cardiac
& Vascular Center (CVC). The hospital is
one of the first to use the technology in the
interventional cardiology setting.
The system allows clinicians in the lab to
display and size full-color two- and three-
dimensional images, divide the giant
screen into multiple views, and zoom in
for a closer look at a particular area.
Size matters. The most obvious feature
of the system, however, is its size, and
yes, Carroll says, that matters in a room
crowded with specialists trying to see
catheters guiding tiny, lifesaving devices
into miniscule spaces in the heart.
“It’s a great facilitator,” he observes. “The
display is the key component in imageguided procedures. The system is biometrically well designed. Everyone in the
room is able to see the details better.”
Continued
Through February 16, 2010
Volume 3 • Issue 15 • Page 2
The improved imaging paid off during a recent procedure in the Cath Lab.
Carroll was part of a team operating on
a patient admitted for repair of an atrial
septal defect, or opening between the
two upper chambers of the heart.
Three-dimensional image of patient heart. Center of screen shows catheter carrying device to be inflated to plug hole in septum.
Carroll and his colleagues looked at
three-dimensional, real-time images of
the heart, produced by an ultrasound test
called a transesophageal echocardiogram
that was performed by Ernesto Salcedo,
MD, director of the Echocardiography
Laboratory at UCH. An ultrasound transducer, inserted through the esophagus,
produces images of the heart that are not
blocked by the ribs and lungs.
“We would have missed it.” After
the first attempt to repair the hole, the
clinicians gazed critically at the large
screen before deciding there was still too
much blood leaking from the left atrium
back to the right. “It was a big, complex
defect, a tunnel of rigid tissue,” Carroll
explains. “The device did not conform
well to it.”
Echocardiogram shows device (top center of field) to repair atrial septal
defect (ASD).
So they removed it and tried again, this
time with much better results from a different closure device. Then they realized
they had more work to do.
“From the outside,” Carroll says, “we
had seen just one atrial septal defect. But
as we were checking the results of our
repair, we saw that something else was
wrong, far away, at the other end of the
septum, where it was hard to image.”
Device (top center of field) being deployed to repair ASD.
They discovered the patient in fact also
had a fenestrated septum: five smaller
holes clustered together.
Continued
Through February 16, 2010
Volume 3 • Issue 15 • Page 3
The team then placed a device in the
middle of and overlapping the “five little
windows,” which ranged in size from 2
to 6 millimeters, Carroll relates. “We’re
optimistic we have blocked the majority
of the abnormal blood flow in the upper
chamber,” he adds.
“We discovered we hadn’t gotten it all”
with the first try, Carroll says. Without
the improved imaging, he adds, “We
would have missed it…We were able to
navigate live, using 3-D images. That
made it easier and more straightforward.”
While he gives full credit to the technology, the procedures “require a huge team
effort.” For example, he notes, Salcedo
produces the ultrasound images while
Carroll and others perform the procedure. “Dr. Salcedo is the eyes of the
operation,” Carroll says.
Cath Lab Ponders More Uses for Big-Screen Technology
The Philips FlexVision system has already proven its worth in the Cath Lab, but John
Carroll believes he and his colleagues have only scratched the surface of what it can
do to revolutionize patient care.
“Right now we are able to display different images that are big enough for everyone
to see,” he says. “But in the future we may be able to display other information in different quadrants of the screen that will refresh our memory on things like the proper
sizing of devices [used to make repairs in the heart]. We can use it as an extension of
our cerebral cortex.”
Carroll envisions hooking up a Mac or PC to the big screen to display “information on
the fly.” For example, he says, the screen might display complications of a particular
procedure in a checklist. “We could methodically go through the protocols for a rare
situation, when the information is not fluid in our minds.”
The strategies for marrying information and display technology are limited only by the
imagination, Carroll believes. “It’s part of the future of making procedure rooms more
efficient and better organized,” he says. “We love to have these kinds of opportunities
to use our imaginations to improve patient care.”
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