Comprehensive Dose Management for Improved Patient Care.

Transcription

1 Comprehensive Dose Management for Improved Patient Care.

2 Set the standard for dose management Toshiba is committed to continuously advancing dose reduction technologies and incorporating these into its Infinix -i X-ray systems. To achieve this, it has focused on innovations in four fundamental areas of system performance time, distance, shielding and technology while maintaining exceptional image quality. The result has been the development of an industry-leading, comprehensive package of dose management features designed to deliver images of high diagnostic value while ensuring safe operating conditions for staff and patients. Infinix-i Safety and Dose Innovations Infinix-i Series Introduction. Table- and ceiling-mounted shielding protects against scatter radiation. Virtual collimator over Last Image Hold (LIH) allows collimator positioning without fluoro use. Grid Pulsed Fluoro provides efficient use of X-ray combined with varying frame rates to optimize dose. Compact tableside control enables dynamic operation of critical dose functions. Flat Panel Detectors (FPD) accelerate exams with highresolution imaging and decrease Source-to-Image Distance (SID) to reduce dose requirements. Agile C-arms with greater flexibility reduce SID and increase coverage, this is designed to speed up exams and limit X-ray exposure. Advanced Image Processing (AIP) filters automatically deploy based on exam parameters to optimize visualization and minimize dose. 4-filter collimator uses copper and aluminum shielding to reduce internal X-ray emissions. Fluoro Record/Store helps to avoid repeat exposures and reduce requirements for higher dose acquisitions. Live Zoom digitally enlarges image and can provide a lower dose alternative than changing traditional field-of-view (FOV) system magnification modes. Structured Dose Reporting retains a detailed dose summary with patient images to provide reporting output. Spot Fluoroscopy utilizes an invisible collimator over LIH to provide live fluoro to a targeted area while expanding the overall FOV. A dose tracking system provides visual guidance as to the amount of radiation and where it is being applied.

3 Achieve outstanding image quality at a lower dose. Toshiba s leading-edge Flat Panel Detector (FPD) technology coupled with its redesigned imaging platform combine to create a robust package of industry-leading dose management capabilities. Maintaining the ability to acquire images of the highest diagnostic quality while reducing dose requirements, many of Toshiba s advanced dose reduction technologies are included as part of standard Infinix-i configurations. Flat Panel Detector Technology The benefits of FPD technology are widely recognized and include superior image quality, distortion-free imaging, high contrast and resolution, wide dynamic range and lower exposure dose configurations. Toshiba takes this technology to a higher level of safety and performance with a platform that improves access and optimizes image acquisition. Enhanced Imaging Technology Advanced processing features that provide clear visualization at lower doses More Choices. More Control. Infinix-i systems offer three different FPD sizes with compact housings mounted on agile C-arms. Optimizing clinical utilization, these provide the ability to achieve complex angles that provide ideal coverage and can reduce patient dose by reducing Source-to-Image Distance (SID). Toshiba Low Dose Philosophy By focusing on low-dose, highquality imaging technologies for accurate diagnosis and treatment, Toshiba continues to improve the quality of life for all people. Dose Reducing Technology Unique protocols and recording capabilities that can lower exposure levels Low-Dose Fluoroscopy Technique A proven approach that reduces unnecessary exposure for patients and operators 8" x 8" 12" x 12" 12" x 16" Not all sizes are available on all systems. Best-in-class compact detector housing enhances patient access. Dose Monitoring Display of exposure data for continuous visualization of total patient dose estimates

4 Reduce dose with Advanced Image Processing. Toshiba s exclusive Super Noise Reduction Filter (SNRF) technology enables ultra-low-dose imaging by analyzing and processing each image frame in real time during fluoroscopy and radiography. Achieving significant noise reduction while maintaining high temporal resolution, SNRF provides enhanced fluoroscopy images that allow clinicians to minimize dose by avoiding unnecessary Digital Acquisition (DA) exposure. SNRF Technology Lower-dose fluoroscopy using SNRF can be a useful alternative for limiting X-ray exposure during challenging PCI procedures such as those requiring delicate guide wire manipulation in patients with chronic total occlusion (CTO). Fluoroscopy Image Recording Various recording modes can be selected for acquiring high-quality fluoroscopic images using SNRF. By choosing fluoroscopic acquisition in the same manner as DA, clinicians can effectively lower X-ray dose. F-REC F-STORE Pressing the fluoroscopy start button records fluoroscopic images up to 9 seconds or 12 frames. (Dynamic image recording) Fluoroscopy images acquired in the last 6 seconds (max.) are recorded and pressing the F-STORE button after fluoroscopy is completed saves these as part of the patient file. (Dynamic image recording) F-REC button Start of fluoroscopy End of fluoroscopy Fluoroscopic image recording Time F-STORE button Fluoroscopic image recording Time F-REC (S) Pressing F-REC (S) records the Last Image Hold (LIH) acquired during fluoroscopy. (Still image recording) Cumulative Dose Savings Comparing the cumulative air kerma measured for cardiac catheterization procedures with and without SNRF as measured in over 4 clinical cases shows fluoroscopy/radiography frame rates (fps) Average cumulative procedure dose (mgy) /patient Over 5% reduction DA image showing stent positioning acquired with an X-ray incident dose rate at the patient surface of mgy/min (SID cm). Lower-dose fluoroscopy of the same stent acquired with a dose rate of 22. mgy/min or approximately one-tenth the radiation exposure. and fluoroscopy times that are similar. However, a comparison in the cumulative procedure dose using SNRF combined with simple fluoroscopic recording techniques that have been proven effective shows a cumulative reduction of more than 5%. 3 2 Without SNRF With SNRF & F-STORE Sawdy, Jaclynn M., et. al. Use of a dose-dependent follow-up protocol and mechanisms to reduce patients and staff radiation exposure in congenital and structural interventions. Catheterization and Cardiovascular Interventions, 78: July, 211.

5 See more, expose less with Spot Fluoroscopy. Toshiba developed the industry s first Spot Fluoroscopy technology to overcome barriers to dose reduction created by conventional collimation. With conventional collimation, the interventionalist cannot see outside the collimated area and the patient input dose may be increased as the system compensates for the reduced amount of scatter radiation. In addition, the collimator may enter the ABC region of interest (ROI), which would further increase radiation output. With Spot Fluoroscopy, however, the last image acquired in normal fluoroscopy is continuously displayed while only the spot field is active, making it easier to recognize the guide wire tip and surrounding landmarks during fluoroscopy. The clinician can also choose the position and size of the spot field using the tableside console and activated footswitch. Next generation ABC ROI logic further controls radiation output. Dose Management with Spot Fluoroscopy Spot Fluoroscopy technology gives clinicians the ability to select three different ROI sizes, or freely place and size the ROI anywhere over the LIH to improve efficiency and increase the amount of image information provided. A series of controlled radiation measurements performed by Toshiba using a 2 cm aryilic phantom also demonstrated the ability to reduce the Dose Area Product (DAP) and lower levels of scatter radiation using Spot Fluoroscopy. Reducing Dose Area Product With the cumulative dose for normal field size defined as %, the cumulative DAP was reduced by more than 5%, significantly decreasing the area irradiated. Comparison with (%) DAP (Dose Area product) 73% reduction! Exposure field size Iliac Stent Positioning Last Image Hold using image acquired in nomal fluoroscopy When exposures from different angles are required, Spot Fluoroscopy can greatly reduce the overlap between each one, reducing unnecessary patient dose. Spot field Cardiac EP/Ablation Catheter Tip Placement Last Image Hold using image acquired in nomal fluoroscopy Minimizing Scatter Radiation By limiting the exposure field, Spot Fluoroscopy reduces scatter radiation by over 5%, dramatically lowering dose exposure for both clinical staff and patients. Comparison with (%) Scatter radiation (SID = cm) 67% reduction! Exposure field size Spot field Spot Fluoroscopy enables effective dose reduction while facilitating the performance of interventional procedures.

6 Total dose control at your fingertips. Infinix-i X-ray systems feature an array of integrated dose management features that allow operators to optimize exposure for every procedure and significantly enhance safety for patients and clinical staff. Variable Dose Mode Four programmed fluoroscopy modes with different combinations of pulse rates, dose levels and system parameters are available to optimize dose rates and image quality for various study protocols. Cumulative Dose Virtual Collimation and Filtration Further reducing X-ray dose, virtual collimation software can be used after fluoroscopy to simulate collimator and beam filter positions in order to adjust collimation without using additional fluoroscopy. Auto Beam Filter Automatic selection of up to five beam filters based on a calculated patient thickness and distance information can effectively improve optimization of dose and image quality for each procedure. Ratio (%) % reduction! 38 Auto Pixel Shift for Roadmapping 2 During fluoroscopy subtracted roadmapping, misalignment Conventional mode for EP ablation Fluoroscopy mode Special mode for EP ablation occurs between the live fluoroscopic and background map images when the patient moves. By detecting this Auto pixel shift Operators can select one of four programmable fluoroscopy modes using a joystick on the tableside console. A special protocol for EP ablation or other procedures requiring prolonged fluoroscopy can reduce cumulative dose by over 62%. misalignment and automatically adjusting it with one-touch operation, Auto Pixel Shift streamlines procedures and reduces the need for additional contrast injections and radiation exposure. Live Zoom Live Zoom digitally enlarges images in real time during both fluoroscopy and DA offering the capability to provide a dose savings alternative compared to traditional FOV magnifications. FPD input dose ratio Dose Ratio: FOV Zoom vs. Live Zoom FOV Zoom Live Zoom ( 1.2) Live Zoom ( 1.4) Removable Grid Easily removed by actuating a single button, a removable grid included in the standard Infinix-i configuration can reduce dose by as much as 24% in low-scatter conditions for pediatric applications FOV size (inch) Normal FOV (8 FOV x 8 ). (8" 8") Live X1.4 Zoom (X1.4). Live zoom Live Zoom can offer lower doses than traditional FOV magnifications.

7 Monitor dose in real time. Toshiba's Infinix-i dose monitoring capabilities enable real-time and comprehensive reporting that facilitates improved dose control during procedures and enhances clinical capabilities for increased safety for patients and staff. Dose Display Monitoring radiation exposure in real time, an integrated digital display lets operators observe levels in both examination and control rooms and alerts them when the cumulative dose exceeds the threshold level. Radiation Exposure Monitoring Radiation exposure details can be monitored using the Radiation Exposure Monitoring Profile and the export of a DICOM Radiation Dose Structured Report (RDSR) sent from the digital processor to a compatible PACS/Archive server. A comprehensive set of technical parameters that includes C-arm gantry angle and table position information is also provided to improve the understanding of X-ray dose usage during an exam. Dose Tracking* Dose rate and cumulative skin dose with color segmentation corresponding to various dose levels can be displayed on a graphical patient model, giving operators the ability to adjust the point of exposure to better manage skin dose levels. *Not currently approved for certain clinical applications in certain markets.

8 Move the system. Not the patient. Toshiba s exclusive and agile C-arm construction lets operators move it freely around the patient to capture images of the highest diagnostic value while also limiting radiation exposure. Reverse Geometry of Ceiling Suspension The Infinix-i bi-plane system s ceiling suspended C-arm can perform left/right inversion based on its reverse geometry, a unique capability that helps operators minimize scatter radiation from patients by as much as 5%. Both inversions are registered to the autopositioning function, so the X-ray source can easily be placed on either side of the patient using simple tableside controls. Reverse Operator X-ray exposure with normal C-arm positioning. Inverted C-arm positioning minimizing operator exposure. Lateral and Vertical Stroke Capabilities Lateral and vertical C-arm stroke capabilities can optimize detector positioning to provide additional dose control. The lateral stroke changes the X-ray-focus-to-detector distance to bring the detector as close as possible. While the vertical stroke adjusts the detector position without changing patient height, which minimizes unnecessary exposure and can reduce dose by up to 17%. Lateral and vertical stroke capabilities simplify detector positioning for dose management.

9 medical.toshiba.com technology history For over 13 years, Toshiba has been a world leader in developing technology to improve the quality of life. Our 5, global patents demonstrate a long, rich history of leading innovation. It might surprise you to learn about some of the things we ve invented Founding of Toshiba 1915 First X-ray tube 1973 First real-time ultrasound scanner 1989 First helical CT scanner 199 First tissue Doppler imaging system 1993 First real-time CT fluoro 1998 First quiet MRI 2 First all-digital multipurpose X-ray 23 First 64-slice CT scanner 23 First compact dual plane cath lab 25 First 5-axis C-arm cath lab 27 First dynamic volume CT scanner First premium hand-carried ultrasound First Spot Fluoroscopy First real-time dose tracking system AwArd-winning service And support Developed with customer input, Toshiba s innovative support programs have resulted in greater satisfaction when using Infinix products as reflected in customer surveys time after time. InTouch Center A centralized service facility that provides applications and service support expertise for Infinix customers 24 hours a day, seven days a week. InnerVision Plus Monitored around the clock, remote system diagnostics help identify problems and provide potential solutions before care is interrupted or an engineer can arrive. InTouch Agreements Tailored to meet specific customer requirements, these range from an a la carte approach that helps manage risk to full security agreements that provide complete system protection. Technical Assistance Customer support specialists are available 24/7 to identify and resolve technical issues in real time. Application specialists are also on hand to assist staff with protocol and image quality issues. Local Customer Teams A single call mobilizes a local team of Toshiba Customer Engineers. Averaging 1 years of experience with Toshiba and 15 hours of specialized training per year, they can quickly resolve almost any performance issue. Parts Support A complete inventory of Infinix product parts is ready for shipment when and where they re needed, any time day or night. Actual radiation output should be monitored using the dose display information, due to dynamic factors that can vary and affect total dose output, such as; different patient sizes, anatomical structure, user application and system techniques. Estimated values cannot be guaranteed under all conditions Michelle Drive, Tustin CA 9278 / Toshiba Medical Systems Corporation 213. All rights reserved. Design and specifications are subject to change without notice. Made for Life and Infinix are trademarks of Toshiba Medical Systems Corporation. InTouch Center is a trademark of Toshiba America Information Systems. InnerVision is a registered trademark of Toshiba America Medical Systems, Inc. MCAXR213EB