Partnership in progress

On a computer screen in the Department of Radiology at Caritas St. Elizabeth's Medical Center in Brighton floats a three-dimensional image of a human heart, enclosed in its bony cage of ribs. With a couple of keystrokes, Dr. Jeffrey Mendel, chair of radiology, strips away the ribs to lay bare the structures that interest him, the coronary arteries, with their potentially fatal blockages and narrowings.

The computer image, obtained by a CT scan, can be rotated, sectioned, and probed, giving the physician visual access to the interior of the heart. Research is underway to compare these 3D CT images with those obtained using cardiac catheterization, a much more invasive procedure. With catherization, the doctor must insert a spaghetti-sized plastic tube into an artery or vein in the leg or arm, from where it is manipulated until it reaches the chambers or arteries of the heart.

"We're on the verge of being able to look at the coronary arteries without cardiac catheterization," says Mendel, thanks to a year-long collaboration with Philips Medical Systems that has revolutionized the processing of computed tomography (CT) scans of the heart. Only a year ago, says Mendel, it would have taken him and his colleagues an hour at the computer screen to construct a detailed, 3D image of the heart from CT scans. Now, processing images from the Philips Brilliance 16-slice CT scanner with the latest software takes 10 minutes. The 3D cardiac imaging research at Caritas St. Elizabeth's is part of a 10-site trial being conducted by Philips with partners in the U.S., Japan, Europe, and Israel, to compare the accuracy of non-invasive 3D cardiac CT with cardiac atheterization, as a way of diagnosing coronary heart disease.

Without wishing to pre-empt the results of the study, due to be published later this year, Mendel says, "It's looking very promising." With global headquarters in Andover, Philips Medical Systems supplies the latest in medical diagnostic imaging and patient monitoring technology to healthcare facilities worldwide. Partnerships with leading hospitals all over the world are an integral part of the company's drive to identify new, clinician- and patient-friendly ways in which imaging technologies can improve the diagnosis and treatment of disease. The key to maintaining an edge in a super-competitive market, says Philips Account Manager Fred Roberts, is "to understand customers needs by involving them in the development of new systems and applications."

No-stitches alternative
Caritas St. Elizabeth's multi-million dollar investment in Philips products to date in 2004 suggests that the relationship adds value for both parties. In conjunction with CT, high-resolution ultrasound is also enabling new techniques for the removal of benign breast nodules, says Mendel. Using one of the hospital's four Philips ultrasound machines, he is about to carry out a procedure that will remove nodules entirely from a patient, using needles guided by ultrasound.

Caritas St. Elizabeth's is the first hospital on the East Coast to offer this no-stitches, fast-recovery alternative to surgery. One of Mendel's patients, a marathon runner, was back in training 24 hours after her operation.

Mapping the heart
Dr. Charles Haffajee calls himself an electrician of the heart. Director of Cardiac Electrophysiology and Pacing at Caritas St. Elizabeth's, he specializes in the correction of potentially lethal disturbances in heart rhythm "arrhythmias" by ablation using x-ray-guided catheters. This involves removing minute areas of the interior of the heart wall around the pulmonary veins by a series of precisely controlled burns. "Like spot welding," says Haffajee, whose self-deprecating comparisons belie a passionate commitment to improving precision, efficiency, and patient safety.

The ability to map the heart accurately is crucial to Haffajee's work, as he must remove all the offending tissue without damaging delicate neighboring structures like the veins and esophagus. Currently, he says, owing to limitations in imaging capacity, at least one third of his patients need follow-up procedures to complete the process. He hopes this will change radically over the next 12 to 18 months, with the opening of the $5 million McGrath Family Cardiovascular Center, presently under construction, which will house a new Cardiac Electrophysiology and Pacing Laboratory.

In anticipation of the new lab, Haffajee is working "feverishly" with Mendel and Philips to develop 3D real-time cardiac imaging, using a new Philips x-ray system with solid-state flat detector technology, which offers sharper images at lower radiation dosages than conventional machines. According to Haffajee, combining these 3D xray images with CT images offers the potential for visualizations of the heart with even greater detail.

The Philips imaging systems and software will work with the Niobe Magnetic Navigation System manufactured by Stereotaxis of St. Louis, MO. This uses computer-controlled magnets, placed outside the patient's body, to guide catheters with magnetic tips through the cardiovascular system. Working remotely, explains Haffajee, guided by a highly-detailed screen image, the physician can manipulate the catheters by joystick more accurately than by hand.

He is optimistic that ablation procedures that now typically take up to six hours may be carried out more accurately, with better results, and less radiation exposure, in two to three hours. The doctor concedes that "there is still a lot of work to be done,"but is confident that in collaboration with fellow clinicians, medical technicians, and Philips' developmental engineers, the goal will be reached. He sees the relationship between clinicians and manufacturer as mutually beneficial: "We tell them what we want, and what we want is not always easy to make. They need to test and get feedback, and this type of partnership allows this marriage to occur."