Image guided therapy for lesser mortals like me

It is hard to miss the fanfare that accompanies Image Guided Therapy (IGT) all over the cardiac care world. Can you imagine someone finagling a guide wire inside your body without opening your chest up, getting a clear look see, fixing things that badly need it and then calmly discharging you immediately afterwards! I was really curious about a system that could reduce the complexity faced by a cardiologist every time a procedure is done.

When I meandered down to a Cath lab, It was inspiring to know that the interventional cardiologist never even looks at the patient on the table but instead all his vice like concentration is on a giant screen that centralizes all the patient data including medical records, reality tv of the catheter moving through your arteries/veins, 3D views of the inside of the blood vessel in order to navigate his guide wire ship and tons of vital information that monitor the patient. Every single physiological reaction is captured on screen and the cardiologist purrs along in his batmobile down the cardiac freeway!

In a couple of hours, the cardiologist has diagnosed the problem, identified the precise location with metronomic accuracy, implanted a stent, perhaps repaired a tear in the blood vessel and ensured that your heart is sending that oxygen rich blood to all parts of the body again. The patient is discharged on the same day or maybe kept for observation for 24 hours.

It is remarkable if we compare it to old times when expert surgeons used to live in our insides for hours on end, lots of surgical wounds to heal, oodles of blood letting carried out and recuperation for weeks on end. IGT has been responsible for easing the job of the surgeon by concentrating on the problem at hand rather than on the entry/exit wounds!

The striking presence of a C shaped arm swinging back and forth while you are still conscious cannot be too good for the blood pressure, would it? But the inimical thing about the arm is that it takes X-ray images of your blood vessels while a special contrast liquid highlights the blockages inside. In addition, the arm is quite noiseless as it moves in a vertical plane around the supine body or angles towards the head or away from it. Just like the parking sensors in a car, the arm has sensors that thankfully stop it before it collides with our body! So, you are in safe hands even though at times you probably think you are stuck in a gravitron!

The beauty of IGT is that it actually creates a holographic projection overlaid on the patient’s anatomy that is customized for the procedure being carried out. Imagine a magical appearance of your spine on your back while the surgeon is using a catheter to probe your spinal column or repair a fused vertebra. IGT will show the device that has been inserted into the patient’s body at scale with the rest of the spine so that the surgeon can make accurate movements and negotiate blocked passages.

It is quite awe inspiring to know the fundamental advantages that IGT has literally brought to the operating table. Precision views of your insides are combined with protocols and devices to solve the problem efficiently, with minimal damage and maximal outcomes. Lasers are used to clear up blockages either due to calcification in the blood vessels or collapsing of tissue around a previously inserted stent.

All of us remember the movie Inner Space, right? An ultrasound catheter is like a small ship floating through the blood vessels taking pictures and sending it back to the surgeon outside. With this they can measure the thickness of the walls, the characteristics of the plaque/calcification, the amount of blood flow that is coursing through the artery and even the pressure on the walls because of the blockage.

What seemed science fiction a few years ago is wonderful reality today. In terms of vascular treatment, IGT is in really the unification of software, graphics, devices, sensors, images and the cardiologist expertise rolled into one long streaming movie. The frenzied overlays are happening in real time and while the patient is the ship, IGT is the cockpit and the cardiologist the pilot.

Make no bones about, we are talking about life saving surgery every time someone is playing around with your blood vessels, clearing out blockages from the brain, repairing torn pathways around your heart muscle and replacing heart valves!

IGT’s biggest impact is perhaps the ability to reduce mistakes, sharply reduce radiation exposure and improve patient experiences. Nowadays you have cardiologists embracing the technology to reduce the time spent operating and reducing the phobia for the patient. The transformation has been the slow unravelling of the fear factor that used to exist where coronary procedures were concerned.

As the technology permeates down to the technicians as well as the nursing staff, it is quite conceivable that most of the common intervention procedures like angioplasty, will be performed far away from specialty hospitals.

Consider that we have 70-year-old strolling into the local village primary care center, being diagnosed with chest pain and immediately being ushered into a room with ceiling mounted IGT devices using optical techniques to image your body. A battery of experts that are 3000 miles away will operate the device, create a treatment plan, perform the procedure and discharge the patient.  Real time updates to the insurer ensures that there is no triaging required for reimbursements. A few hours later, the patient goes home and enjoys life again as if nothing has happened. Maybe we can call it IIR (IGT Induced Reality!).

IGT has gone from being a better way of minimally invasive surgery to being the de-facto way of interventional cardiology. It is no longer the prerogative of any single technology provider but instead has become a standard operating procedure worldwide for pulmonologists, cardiologists, neurologists, etc. Some call it interventional image guided systems while others dub it guided therapy. But the reality is that it is here to revolutionize the field of minimally invasive interventions.

 Imagine that IGT is like a singular platform that integrates artificial intelligence, imaging, intervention protocols, software tools, decision support systems and population analytics. While healthcare interventions are never pleasant, it is the constant endeavor of providers to make it better, more efficient, less intrusive and affordable. IGT ticks all the boxes and then some!

Disclaimer: I represent Philips and am part of IGT solutions.