The CX Imaging Day offered delegates a comprehensive programme of state-of-the-art imaging technology, incorporating both scientific presentations and product demonstrations. Kicking off the day was a session on peripheral arterial imaging, followed by talks on venous imaging, aortic imaging, and an abstract presentation session.
Klaus Overbeck (Sunderland, UK) presented a talk on the value of fusion imaging for the treatment of complex aortoiliac occlusions. “Complex aortoiliac occlusions up to the renal arteries are being increasingly treated by endovascular approach, and retrograde luminal guide wire re-entry into the patent vessels fails in up to 2/3 of cases,” Overbeck told CX Daily News. “Subintimal antegrade techniques and more recently re-entry devices are used instead,” he said. Since occluded vessels do not enhance with intraluminal contrast injections, Overbeck highlighted the fact that imaging is limited to relying on bony landmarks and 2D static roadmaps to visualise the re-entry point. Bilateral femoral and brachial artery punctures in bilateral iliac or aortic occlusions are therefore required. The iliac arteries can be tortuous, he noted, which adds to the complexity of tracking through the vessels without direct imaging.
“Fusion imaging can provide a mobile real-time 3D roadmap to facilitate wire passage,” said Overbeck. “Luminal or subintimal approaches, including the successful use of re-entry devices, are supported by ‘making the occluded vessel visible and can avoid multiple arterial punctures.”
Barry Katzen (Miami, USA) then went on to discuss his experiences in imaging complex pathologies with robotics and 3D imaging. “Over the past several years…we have been exploring a diverse group of applications to try to define the role of robotics for interventional and endovascular therapy,” he told CX Daily News. “This technology has made a difference in virtually every category in which it has been applied, and we have begun to be able to predict where clear value can be defined,” he said. Noting its success in complex procedures, Katzen said that robotic catheterisation has contributed to the success of getting to the target area, and providing stability for therapy such as delivering embolics, stents and covered stents. In some cases, he explained, robotic catheterisation had contributed to success even after failure with manual techniques. Katzen asserted that the combination of robotics with image fusion, 3D imaging, modelling, and other techniques, gives the interventionalist the tools to ensure success, all the while reducing radiation exposure in the lab.
An afternoon of practical demonstrations from a number of companies allowed delegates to get hands-on experience with state-of-the-art imaging technology.
Eric Verhoeven (Nuremberg, Germany), demonstrated Siemens’ automated workflow imaging solution for EVAR procedures. Speaking to CX Daily News, he commended the year-on-year improvement in the CX Imaging Day, saying, “It is very enjoyable. My overall impression is a very good one.” Commenting on the session’s educational opportunities, he highlighted the importance of seeing equipment in person. “Here at Siemens, the session is really educational. It provides, for example, awareness that radiation is dangerous. This is something Siemens has worked really hard at improving. Physicians have to use every available tool to reduce radiation. This session gives me the opportunity to demonstrate the use of software tools, like collimation, to reduce radiation.”
Stéphan Haulon (Lille, France) showcased the integrated planning and sizing solutions offered by the EVAR ASSIST 2 platform from GE Healthcare. “The idea is to show real-life experience. This is actually a workflow that we use every day in the hybrid room. This set-up allows us to share that with the CX participants which is very interesting because it is not just about showing slides,” noted Haulon.
One of the demonstrators of the Phillips Volcano imaging technology, Stefanie Antonis-Klerks, told CX Daily News that “For us it is really very important to have our system here, to demonstrate it and show what it can do.” The session gave her the opportunity to showcase the tablet-like user interface of the company’s mobile C-arm. “Everyone who can work with a tablet can work with our system,” she said.
Hansen also presented talks on their robotic imaging technology. Describing the importance of yesterday’s session, demonstrator Alan Lumsden (Houston, USA) asserted, “We are proceduralists; we want to do things with our hands. We want to touch, we want to feel, and we want to play with these devices.” Complementing his experiences over the years at CX, he said, “What has been important about this meeting over the years has been its emphasis on imaging. In the past, imaging was done in a radiology department. Now you look around here and see hybrid rooms and fixed imaging systems. There is a huge need for education in the surgical community about imaging capabilities.”
Ziehm Imaging demonstrated their hybrid operating room equipment at their booth. Wolfgang Keller, who presented the technology, complemented the opportunity to engage physicians with their products hands-on, “Radiologists and interventionists have worked with C-arms in the past and had bad results due to image quality. As we have solved these problems, we need to change their minds. We have to show them—today is really a very good opportunity to show them our solutions. We have clinical images, so we can show them the whole workflow.”
