The mobile
CathLab

During cardiac imaging proce­dures, moving images must be dis­played clearly. In order to acquire high-quality fluo­ro­scopy images, a mobile C-arm is ideal, as it can be con­trolled by the user. At the begin­ning of the exami­na­tion, the user can record a short video of the affected ves­sels and docu­ment the status for analysis, in order to assess the results after­wards. The physi­cian usually uses addi­tional con­trast media for better visuali­zation and inter­pre­tation of ves­sels and cardiac struc­tures. Images in real time are also necessary when inserting and posi­tioning cathe­ters, as this helps pre­vent compli­ca­tions, among other things. In addi­tion, it’s neces­sary to create another video sequence after the proce­dure so that modifi­ca­tions can be carried out immedi­ately if neces­sary. This analysis can pre­vent the need for a follow-up inter­ven­tion for the patient.

Thanks to the flexi­bility of the mobile C-arm, any oper­at­ing room can be used as a mobile CathLab with­out much effort or addi­tional costs. The C-arm is rolled into the oper­at­ing room, con­nected to the power supply, and is imme­di­ately ready for use. This allows a faster return on invest­ment (ROI) com­pared to a fixed sys­tem. When choosing a C-arm for a mobile car­diac catheter­i­za­tion lab, the focus should be on image quality and gener­a­tor power. Detailed and clear moving car­diac images are created by short, high-energy pulses that reduce motion arti­facts, and high contrast imaging.

This is where the Ziehm Vision RFD Hybrid Edition Cardio CMOSline, with the most power­ful gener­a­tor on the market, proves its worth. The 30 kW¹ gener­a­tor power provides the best possible support for imaging fine wires, cath­e­ters, and elec­trodes. This enables the device to per­form clini­cal proce­dures such as coro­nary angio­graphy, and electro­phys­iol­ogical inter­ventions, as well as com­plex proce­dures for the treat­ment of struc­tural heart dis­ease, such as TAVI, mitral valve clipping, and occluder implan­ta­tion. A self-regulating cooling system ensures a con­stant oper­at­ing temper­a­ture and con­tinuous, reli­able oper­a­tional readiness of the C-arm.

The control room is an impor­tant part of every cardiac cathe­ter­i­zation lab. In the mobile Cath­Lab, a hemo­dynamic measuring station replaces a con­ven­tional control room. During a cardio­vascular exam, contin­uous record­ing of the cardio­vascular sys­tem is required. Monitoring the cardio­vascular sys­tem and the analysis of cardio function with the help of the measuring station guarantees patient safety during the proce­dure. The measuring station also simplifies protocol creation for the user and generates the final report, which can be stored in the corre­spond­ing image or commu­ni­cation archiv­ing system and in the electronic patient file. Ziehm Imaging’s mobile Cath­Lab solution relies on the QMAPP mobile hemo­dynamic measure­ment station from our Dutch partner Fysicon, which brings all rele­vant para­meters together in a single front end. Free­dom of move­ment in the OR is increased by the mobile, compact ampli­fier that can be con­nected to the oper­at­ing table with a single cable.

Viewing relevant cardiac images in high quality during sur­gery is very impor­tant for cardiac proce­dures. While there is no need for addi­tional image dis­plays aside from the classic monitor cart that comes with the C-arm, an addi­tional ceiling or wall monitor provides maxi­mum flexi­bility and can increase effi­ciency. The addi­tional monitor should be clearly visible to the oper­ator to allow simul­ta­ne­ous viewing of pressure values and ECG data transmitted from the hemo­dynamic measure­ment station. It should also be able to dis­play real-time fluo­ro­scopic images acquired from the C-arm and stored reference images. This requires both a stable transmission connec­tion and technology that dis­plays real-time data in high quality. In modern cardiac catheterization labor­a­tories, due to the high number of dis­plays needed, a single large moni­tor is usually used that can dis­play images from differ­ent sources in separate win­dows. Image sequences can be trans­mitted from the C-arm to the exter­nal monitor as a live signal via the wire­less inter­face. Wire­less trans­mission reduces the risk of tripping over cables, the user can posi­tion the medi­cal equip­ment where it is needed, and addi­tional hard-to-clean plugs and sockets are avoided – an important hygiene aspect. For dis­playing various image signals in the mobile cardiac catheter­i­zation laboratory, Ziehm Imaging recommends a 55" UHD monitor, which supports up to twelve input signals and can dis­play all vital signs and other image signals simul­ta­ne­ously in addition to the real-time images.

A radio­lucent imaging table enables com­plex inter­ven­tional pro­ce­dures. Care should be taken to ensure that the table has smooth, rounded edges. This prevents motion arti­facts that can occur espe­cially with angled images, i.e., images in oblique pro­jec­tion. If the table has a free-float­ing mech­a­nism, it can be flexi­bly con­trolled by the user. A mobile table can also be quickly moved to another oper­at­ing room at any time, com­pleting the mobile Cath­Lab setting. These require­ments are met by the STILLE imagiQ2, which has a record setting of radio­lu­cency for mobile imaging tables: up to 60% more trans­lu­cency than con­ven­tional fluo­ro­scopy tables.