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Versitile Interventional Hi-tech Equipment
Written by Communications Team   

The expertise of the radiology department at Ashford and St. Peter's Hospitals NHS Trust has been matched by the installation of one of the most State-of-the Art pieces of equipment available in the highly specialised field of imaging and angiography.

The Trust has spent £800,000 on purchasing and installing in the Trust’s new Interventional Suite an “Angio C Arm” which was officially opened this week (02-03-10) by Lucy Siegle, the Consumer Affairs correspondent of BBC TV’s “The One Show.”

The equipment has a broad range of functions enabling it to be used with maximum precision for a wide variety of specialist interventional procedures including Kyphoplasty work on the vertebrae of the spinal cord; complex biopsies; aspiration of abscesses; vascular and arterial work. Apart from scheduled sessions it will be available for emergency cases seven days a week, during the day.

Said Consultant Interventional Radiologist Dr Robert Davies: “This is a very exciting development for our patients, and puts Ashford and St Peter’s Hospitals NHS Trust at the forefront of hospitals in the UK for Interventional Radiology.

“The Philips Allura Xper FD20 combines conventional x-ray fluoroscopy with CT capability and real time 3D guidance, giving the radiologist the ability to perform all kinds of interventional radiological procedures with unprecedented accuracy, and as a result take less time and with potentially fewer complications. It is no exaggeration to say that this is life-saving technology.”


There are very few CT and 3D capability vascular interventional “Angio C Arm” units in the UK, and Dr Davies and two colleagues visited three other hospitals while researching what would be best for the Trust. They selected the Philips Healthcare system which enables the clinician to see 3D images of soft tissues and bony structures allowing for easier, more accurate diagnosis and for better planning of procedures needing to be performed.

During treatment in progress the high quality 3D real-time images allow the Consultant to see precisely where coils, clips and stents are being placed, and the area surrounding those items. The CT-like images enable the clinician to see an on-screen image of areas where a tumour may have formed or bleeding is taking place. Additionally the road-mapping technique allows for catheter navigation, in real-time, during very complex cases.

The Trust is the major vascular unit for Surrey attracting referrals from across the county as well as emergency work. Until now the vascular interventional work was carried out either in the cardio-angiography suite at St. Peter’s or at the adjoining Runnymede Hospital.


Said Consultant Vascular Surgeon Mr Kieran Dawson: “The installation of the new “Angio C Arm” means that waiting times for our patients have decreased considerably. This is obviously especially important for our urgent patients, which is particularly pleasing.

“We are delighted with the capabilities of this state-of-the-art machine. We can achieve speedy and accurate diagnosis thanks to the high definition imaging of the patient’s arteries. We can go on to perform complex technical procedures on blocked leg, groin or neck arteries using the minute balloons, umbrellas and stents of the angioplasty world, with which the general public have now become more familiar.”

A new service bringing relief for women suffering from painful fibroids can now be offered at the Trust by the interventional radiology team and the obstetricians and gynaecologists. For women needing a hysterectomy the benefits of using the new Angio “C” Arm are huge.


Said Consultant Obstetrician and Gynaecologist Mr Saikat Banerjee: “The introduction of the new Angio-C arm is essential for women who wish an alternative non-surgical approach to the treatment of their fibroids, and for the Trust to fully comply with current recommendations by the National Institute of Clinical Excellence (NICE) that this should be provided in hospitals for women, as a treatment choice. This is called fibroid embolisation. I am delighted to see this is now available here at St. Peter’s.

“Such a procedure is also beneficial for our local patients as a useful method of cutting the blood supply to the womb at the time of hysterectomy, when hysterectomies may be complicated due to their size and the wish to carry the procedure out laparoscopically in order to aid patient recovery. This has been recently performed with four Consultants from within our Trust. The result is that we have successfully performed a laparoscopic hysterectomy on a uterus filling half the abdomen. Instead of performing the standard open operation via a midline incision with a 5 day stay in hospital the procedure was performed with the patient discharged home the following morning and with an improved haemoglobin reading, thus demonstrating the additional benefit of reducing the risk of possible blood transfusion.

“Experience of this case, and many others in the future, may open up the pathway to also stopping life-threatening bleeding in women who have just delivered their babies, called a severe post partum haemorrhage.”

The new Angiography Imaging suite is at St. Peter’s Hospital, Chertsey. The suite includes a new entrance, scrub area, utility rooms, the angiography room and a recovery room. In the angiography room the system consists of a ceiling-mounted x-ray “C” arm with a digital detector. A tilting table enables full body imaging of the entire vascular system.


For some procedures the patients are anaesthetised but in most cases they are made pain-free and can listen to the team and watch on-screen, if they wish. In the angiography room there are screens at both ends of the tilting table. Screen A shows the positioning of the needle line and the route to be taken for the biopsy; aspiration or drain - which once in place may be left in position. As the “C” arm rotates 360o around the patient the image appears on Screen B, and on one of the four screens in the adjoining control area.

The control area has four screens which hold the following images: a reference image, a normal line image; a CT image superimposed over a line image enabling the consultant to see which point he is guiding the needle to, and an ultrasound scanner or ECG monitoring image.


Clinical Director for Trauma and Orthopaedics at Ashford and St. Peter's Hospitals NHS Trust, and Consultant Orthopaedic Surgeon Mr Chris Schofield is one of the surgeons who uses the equipment.

Said Mr Schofield: “The new “C” Arm installed in X-ray is a great advance in imaging, which makes the task of placing cement in the center of a vertebral bone much safer. The procedure, called ‘Kyphoplasty', involves inserting two very small balloons within the bone. By using the CT facility of the new machine this can be planned in a 'virtual' model, which allows for great accuracy. Kyphoplasty is used to stabilise osteoporotic fractures of the spine and some selected cases of vertebral collapse due to cancer.”


The range of versatility of the “C” Arm is extensive and includes avoiding surgery for non-cancerous but painful swelling of the male testis by a process called Varicocele Embolisation. Access via the femoral artery in the groin enables the blood supply to the scrotum to be diverted away, either by the insertion of a tiny coil or special fluid, which reduces the swelling.

Urology patients who experience difficulty passing urine because the tube from the kidney to the bladder has become blocked can now have the obstruction relieved by a consultant interventional radiologist inserting a plastic stent in the tube, relieving the obstruction and allowing urine drainage to flow again.

In some cases it is also possible for the consultant to relieve the blockage by inserting a catheter, through the skin, into the kidneys allowing the urine to drain from the kidney into a collecting bag outside the body, on the surface of the skin.

Apart from the versatility of the Angio “C” arm there is also the added advantage that the installation of this equipment means that extra time is now freed-up on the St. Peter’s CT scanner and the CT scanner at Ashford Hospital, allowing more patients to be seen. Time is also saved for a full team of doctors and nurses who, in the past, would have routinely performed these procedures on patients transferred to the Runnymede Hospital adjoining St. Peter’s, where an earlier version of the “C” Arm is installed.


Footnote:

Imaging the vascular system, a procedure known as Angiography, is carried out by the use of ‘contrast’ material (X-ray dye) injected into the artery or vein, so that soft tissue can be seen and the condition of the arteries revealed on screen. Since the development of angiographic techniques more than 30 years ago, the technology has become more and more sophisticated and it is now possible not only to diagnose disease of the arteries but also to treat conditions by the use of interventional procedures.

Last Updated ( Monday, 08 March 2010 14:36 )