Picker begins installations of interventional x-ray/CT suites

Novel Venue FACTS system shown at SCVIR meeting

Picker International this month began installing the first alpha units of its Venue FACTS (fluoro-assisted CT system) product line, which combines x-ray fluoroscopy with CT technology for speedier interventional radiology studies. The Cleveland company believes that Venue FACTS will offer an elegant solution to interventional radiologists looking for a simple way to combine x-ray and CT into a single interventional package.

Picker first displayed the Venue concept at last year's Radiological Society of North America meeting (SCAN Special Report 12/97). Venue pairs spiral CT technology with x-ray, and comes in two flavors: Venue FACTS combines a CT scanner with an x-ray C-arm for fluoroscopy studies, while Venue C-View pairs the scanner with a full ceiling-mounted angiography system. Picker reprised its RSNA exhibit at this month's Society of Cardiovascular and Interventional Radiology meeting in San Francisco, where the company displayed a Venue FACTS package.

Picker developed the Venue concept to deal with several issues that were hindering the advancement of combined CT/x-ray interventional suites, according to Ken Freeman, product line development manager in the company's CT division. The vendor believed that combined interventional systems would be easier to use if they were designed as part of a package, he said. In addition, some interventional radiologists who were interested in exploring the use of CT with x-ray found that they had to fight other areas of the hospital to gain access to mobile C-arms.

"It is very difficult for departments to get a mobile fluoro unit in the CT room," Freeman said. "They are on the floor; they are in ER; they are in OR. Rather than fight for availability, (interventional radiologists) just went ahead without it. If we can integrate this thing, and if it is purchased as part of the scanner, it doesn't look like you're holding something up."

Venue FACTS rectifies the problem of C-arm availability by attaching the C-arm to the bottom of the CT scanner with a pivoting arm. When the C-arm is needed, it swings out over the CT scanner's patient table; when it isn't required, it swings back and folds next to the CT gantry, out of the way of healthcare personnel in the room.

In addition to x-ray, Picker has incorporated several new technologies with the Venue concept. Rather than build an image intensifier tube into the C-arm, Venue FACTS employs an amorphous silicon digital detector, representing one of the first uses of this emerging technology for fluoroscopy. The detector, which is supplied to Picker by Varian Associates of Palo Alto, CA, is much smaller and lighter than an image intensifier and makes it easier for interventional radiologists to work near the patient, Freeman said. The average image intensifier used with the C-arm would weigh 100 lb or more, while the amorphous silicon digital detector weighs just 15 lb, Freeman said. The Varian detector is also capable of imaging at 30 frames per second, the standard for real-time fluoroscopy studies.

PinPoint precision. Both Venue FACTS and Venue C-View also come with PinPoint, a new frameless stereotactic arm that is mounted on top of the CT scanner. PinPoint is similar in concept to Picker's ViewPoint image-guided surgery workstation, although it lacks the functionality of the latter product, which is designed for surgical environments. Interventional radiologists can use PinPoint as a planning tool, such as to view on a CT scan the path of a biopsy needle to a target before the needle is inserted. PinPoint is not intended to be a real-time biopsy aid, Freeman said.

Using CT and fluoroscopy together enables interventional radiologists to obtain benefits of both technologies. For example, CT's contrast and spatial resolution and tomographic images can be useful for seeing anatomy around a biopsy needle, while the lower dose rates of fluoroscopy mean that the technology is in some ways better than CT fluoroscopy for guiding needles, Freeman said.

The Venue concept can cut down on procedure times because patients don't have to be moved around the radiology department to different pieces of equipment. Freeman believes that Venue FACTS can help radiologists cut the time of an interventional procedure down from 45 minutes to as little as 10 minutes, he said.

Picker plans to begin installing the first Venue FACTS package at the University of Virginia in Charlottesville this month. Other systems will be going into Cleveland University Hospital, Hershey Medical Center in Hershey, PA, and Liège University in Liège, Belgium.

Picker still requires Food and Drug Administration clearance for the PinPoint and FACTS components of the package before it can begin commercial sales of Venue, but Freeman said Picker has already filed regulatory applications. Venue FACTS will carry a list price in the range of $345,000 for a package including PinPoint and FACTS, a price that does not include the CT scanner. Venue can operate with any Picker spiral CT system.

It was still too early for any papers on Venue to be presented at the SCVIR meeting, but Picker expects presentations will be ready for this year's RSNA conference. Picker has high hopes for the technology, based on its reception by interventional radiologists at the RSNA and SCVIR meetings. The increasing use of medical imaging technologies like CT and fluoroscopy as part of therapy procedures should also give sales a boost.

"I don't think everyone is going to get one, but I think it's going to go all the way down to the 50-bed hospital, because of the way healthcare reform is demanding that you do more and more procedures at the same time with the same piece of equipment," Freeman said. "I think it's going to be pervasive in a few years."