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A look around the evolving cath lab

por John R. Fischer, Senior Reporter | March 09, 2020
Cardiology Operating Room
From the March 2020 issue of HealthCare Business News magazine

Reducing radiation exposure
In the cath lab, the risk of radiation exposure is amplified due to the small size of the room, and the increased scope of the disease that can be managed in it. Weiner says the complexity of procedures being performed is another key factor.

“For chronic total occlusion treated with PCI, they’re frequently involved, complicated procedures that require more radiation and exposure than a normal PCI,” she says. “I think that has to be borne in mind as we do more complicated procedures. There is a downside for the operator and the patient. As part of the accreditation process, we do look at that and at what percentage of cases and operators are getting higher radiation doses.”

Initially used for performing diagnostic exams, cath labs today are the sites of procedures to address vascular and structural heart diseases, such as TAVR, among other cardiac conditions.
Advancements in room design, such as improved lead shielding, are helping to mitigate some of those concerns. Other innovations, such as imaging equipment that uses pulsatility fluoroscopy (as opposed to continuous radiation) and intravascular ultrasound (which can measure size and length of blockages without radiation) are also combating some of those exposure concerns, according to Alaswad. Zero Gravity suspended aprons are another way to protect interventional cardiologists at increased risk of musculoskeletal hazards in the cath lab, while also reducing the weight burden of a conventional lead apron.

“The radiation source — the equipment itself — now emits a lot less radiation than it did 15-20 years ago,” said Mahmud. “Most of the companies that make the equipment — Philips, GE, Siemens, Toshiba — have all worked on lowering the radiation that emanates from the source.”

The emergence of robotic procedures is also poised to reduce these risks, according to Mahmud. “One can be in the control room and be the operator performing the procedure,” he said. “You can sit in the cockpit and control guide wires and stents, and do coronary stenting, being exposed to minimal radiation.”

What the future holds
The role of the cath lab is expected to continuing evolving, with research such as the Ischemia trial — designed to determine the best approach for managing higher-risk patients with stable ischemic heart disease — changing the types of procedures that commonly take place in the cath lab.

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