Digital fluoroscopy is getting a boost in interventional radiology with the release of products built around flat-panel detectors. The latest, Toshiba's Infinix VC-i, is a dedicated vascular system featuring a large field-of-view created by a 12 x 16-inch solid-state detector.
The new system, based on the company's VC-i platform, was launched initially with a 16-inch image intensifier. The flat panel upgrade, available since late 2005, offers advantages in image quality, according to Dr. Tim Cloonan, director of interventional radiology at Parkview Hospital in Fort Wayne, IN.
"The flat-panel images have improved contrast," he said. "The images just appear sharper."
The geometry of the rectangular flat detector also provides advantages over the image intensifier, particularly when performing runoffs.
"With the flat panel, you don't exclude as many important areas," he said. "Your step can be longer and that translates into fewer runs, less radiation, and a decreased amount of contrast."
Parkview staff use Infinix routinely for all kinds of diagnostic and interventional procedures: carotids and cerebral arteriography; upper extremity venography; lower extremity arteriography; TIPS (transjugular intrahepatic portosystemic shunt); and biliary and renal work, including percutaneous nephrostomy.
"You name it, we do it," Cloonan said.
The hospital installed the system initially with a 16-inch image intensifier, providing an opportunity for staff to compare experiences before and after the detector swap. Patients tend to be more at ease with the flat-panel detector suspended above them, Cloonan said, than the physically imposing canlike image intensifier. The flat detector presents fewer difficulties to the staff, when accessing the patient and maintaining a line of sight to the display monitors.
Parkview administrators purchased the Infinix VC-i platform with an image intensifier on the condition that the system would be upgraded to flat panel when the technology became available. A team of Toshiba engineers swapped the detectors in December 2005. The changeover took three days, as promised when Parkview chose the Infinix initially.
"Some of the other vendors were hitting us pretty hard at the time, saying Toshiba couldn't do it," Cloonan said. "They did it."
Advanced capabilities designed into the Infinix platform include Zoom fluoro, which magnifies images on the fly without increased x-ray dose, and 3D angio, achieved using Vital Images' Vitrea 2 workstation. Both are possible with the image intensifier and flat-panel configurations.
The clinical benefits of flat-panel imaging are most apparent in the images, particular those involving difficult cases. One such case involved a 275-pound woman who was barely five feet tall.
"You can imagine the girth," he said. "But the images were absolutely beautiful."
