Am I the only one facing these challenges in the interventional suite?

When it comes to the interventional suite, I can confidently say that no two procedures have ever been the same.  The varied nature of the field means that I’ve always worked across a wide range of procedures, performing them with an array of equipment. Some good, some not so good. Some cutting-edge and some tried-and-tested. 

But, that variety is why I love it so much.

And while current medical technology is remarkable and has come a long way, innovation in imaging systems must also advance as our image-guided therapy (IGT) procedures evolve.

One of my passions is taking the lessons my colleagues and I learn from our day-to-day use of interventional systems and forging something better; something more flexible, more ergonomic, and more effective in terms of space and time. These lessons have become a ubiquitous conversation in our daily lives, moving beyond just the hospital walls and conference auditoriums now to social media-- in 280 characters or less. It’s pretty obvious the drumbeat online is largely about balancing the increasing complexities of today’s interventional procedures with the latest innovation, all while cutting costs and delivering the best in patient care.

As such, I would like to share my thoughts on the key obstacles I believe industry needs to tackle to ensure this balance, and to even better help physicians and staff, and ultimately our patients.

Navigating a virtual minefield

Let’s start with flexibility. Today, procedures are becoming increasingly complex. In a typical day, I may be carrying out eight or nine entirely different procedures with varied access points, both vascular and nonvascular – including radial, pedal, femoral, jugular, vertebral, trans-thoracic and trans-abdominal. I want to be able to rapidly and intuitively image from wrist to wrist and from the top of the head to the tips of the toes, all with the exceptional image quality required by procedures as varied as transradial uterine fibroid embolization, peripheral vascular interventions, hepatic chemoembolization and prostate artery embolization.  My cardiology colleagues face the same hurdles as they perform transradial coronary procedures and structural heart procedures. Right now this means carefully coordinating my table and my C-arm, with each additional movement coming at a risk. We have been taught that bumping into a machine, injector or colleague could mean dislodging an endotracheal tube, catheter, or IV- all spelling disaster for the patient. A busy interventional suite is a virtual minefield.

"A busy interventional suite is a virtual minefield."

To deal with this, we have been trained to move the table and C-arm cautiously, in what I like to call the “hardware dance,” in order to achieve the desired imaging position. This may have to change at least four to five times throughout the procedure, taking time, coordination and sometimes frankly, a little luck. The fewer parts we have to move, and the more intuitive the process, the less intricate this ballet will become freeing up the clinician and staff to focus on the patient. 

Ergonomics and human design

We also want to have to move ourselves less, too. Or more precisely, we want to decrease the amount of awkward movement. During image-guided procedures clinicians and staff have to wear heavy lead and are constantly contorting themselves, adjusting their stance to get a better look at an image or twisting their head to check a monitor or access a patient. Beyond this, if we choose radial access for a procedure, a form of access that is easier for patients and often exposes clinicians to less radiation, the team in the interventional suite often has to manually pivot to angulate the table (no easy feat with obese patients). These jostling table maneuvers make the patient uncomfortable and can be back-breaking work for staff. 

Current systems can also take up too much space making it difficult to maneuver around the table during procedures. I’ll give you an example. Like most interventionalists, I frequently have done procedures on intubated ICU patients or on patients requiring an anesthesiologist at the head of the table, or people are working on both sides of the patient.  Often, because of the viewing angle required, or the need for a rotational cone-beam CT scan, the C-arm moves or sits where we really need the anesthesiologist or another staff member to be.

"Today, we’re increasingly having to work around the interventional system and I believe a really good system should work around us."

Today, we’re increasingly having to work around the interventional system and I believe a really good system should work around us. The system should be seamless and blend into the background, including its interface. We are physicians, not computer programmers and I want interventional systems to reflect this by being elegantly intuitive.

Location, location, location

Unfortunately, expense often prevents administration from updating yesterday’s older suites to today’s more flexible ones. This is because such an upgrade has traditionally required a much bigger room, and that means a lot of costly construction, higher ceilings and lower floors; something difficult or even impossible to achieve when this room is flanked by others that can’t afford to surrender the space necessary. This may mean moving the new interventional suite to another floor or area, creating a fragmented department and jeopardizing workflow. Wouldn’t it be better if we could easily and more economically retrofit yesterday’s older room with tomorrow’s technology?

"Wouldn’t it be better if we could easily and more economically retrofit yesterday’s older room with tomorrow’s technology?"

If industry could create technology allowing for greater ease of construction and the introduction of more compact, space-efficient components, then it makes it more likely suites will be upgraded without the need to expand or relocate.  This will ultimately lead to lower costs and therefore potentially greater access to care.

The above obstacles may sound troublesome and quite a hurdle to overcome for many hospitals or healthcare facilities. However, I believe calling out these issues is the first step to overcoming them. Each has an achievable solution that can be identified, tracked and addressed through collaboration between hospitals, physicians and technical staff, and industry, lending vital support to resource- and time-poor physicians.

"The system should just work with no need for an instruction manual. "

I look forward to being able to play a role in the future of the technology in the interventional suite, and providing the best secured, seamless, effective and intuitive solutions possible. The system should "just work" with no need for an instruction manual. 

I’m not afraid to admit that I want the optimal interventional suite to work around me, rather than me working around it.  So now it's your turn- what do you think?