Biplane system leverages flat panels with five-axis positioning for interventions

Toshiba America has developed the prototype of a biplane interventional system featuring flat-panel digital detectors and a five-axis positioner that permits unprecedented maneuverability. The new system has been installed at a pediatric facility at Columbus Children's Hospital in the Ohio capital.

Production models of the Infinix cardiac biplane (CB-i) are available for quotation and sale, with a 90 to 120-day lead time to delivery. List price is $2.8 million.

John Cheatham, director of cardiac catheterization and interventional therapy at Columbus Children's Hospital Heart Center, and Mark Galantowicz, a cardiothoracic surgeon and codirector of the Heart Center, worked with Toshiba engineers in the U.S. and Japan to design the biplane system.

"With their input, we were able to design it specifically to meet their needs for pediatric interventional procedures and combined hybrid procedures that are part surgical and part catheter-based," said Raymond Dimas, product manager for the Infinix-i series.

Biplane x-ray imaging is standard in pediatric cath labs, according to Cheatham, where most patients have congenital heart disease. Unlike coronary artery disease in adults, congenital heart disease requires images showing the precise location and shape of tissues.

To improve image quality in their biplane system, Toshiba engineers incorporated flat-panel x-ray detectors, which have already been used in their single-plane systems for more than a year, Dimas said.

The panels' thin, sleek shape means they can be arranged around a patient at more complex angles than the bulky image intensifiers traditionally used, Cheatham said. The new system also incorporates a novel positioner.

"The five-axis positioner is the first to allow complete motion around the patient," Cheatham said. "This allows complex interventional catheterizations."

The two C-arms of the positioner move in three planes, while the flat-panel detectors rotate in two, so the panels can be positioned flush to the patient.

"It's a very complicated motion, and Toshiba's the first to have done it," Cheatham said.

Freely moving C-arms and x-ray detectors not only allow complicated motions around the patient, but ensure that the machinery stays out of the way of medical personnel involved in pediatric catheterizations. Such medical teams can include a cardiologist, an anesthesiologist, and an echocardiographer, and their assistants.

"With Toshiba's system, we can put detectors in positions that no other positioners can, allowing complete access to the patient by every single individual," Cheatham said.

The flat-panel biplane system includes a newly designed interface for physicians, Dimas said. Toshiba computer engineers have simplified programming to make the operating system more intuitive. They have also increased the speed at which the C-arms move, park, and fix on the desired view.

Staff at Columbus Children's Hospital continue to provide input about system design and functioning, Dimas said. Toshiba will maintain an ongoing relationship, he said, through which they will continue to provide feedback toward a next generation of the technology.