Garry Choy, MD; Supriya Gupta, MD; Onofrio A. Catalano, MD; Michael P. Wejkszner, RTR; Ronald S. Arellano, MD; Debra A. Gervais, MD; Peter R. Mueller, MD; Dushyant Sahani, MD

Designing an Interventional CT Suite to Meet the Current Demands and Future Expectations

M A S S AC H U SE T T S G E N E R A L HO SP I TA L • D e pa rt m e n t o f r a D i o l o g y • HA RVA R D M E DIC A L S C HO OL

The purpose of this exhibit is to discuss the evolution of the Interventional CT Suite.

We will discuss the emerging trends in image-guided procedure for oncologic and non-oncologic applications.

We will also review the latest new technologies that improve image-guided procedures and technologies to improve workflow.

POST-PROCEDURE• Electronic dashboard to facilitate and track follow-up, any necessary consults, lab results, and transfer

• Automated test ordering such as pathology, chemistry and microbiology for specimens that have been obtained

• IT-based result tracking and alerts to close clinical work-up loop and enhancement of follow-up

• Quality and safety

• New tools during CT guided procedures

• Fusion Systems, flat panel systems, and novel configurations for image-guidance

• Better visualization during procedures

• Workflow improvement and optimization

SUMMARY

The major teaching points of this exhibit are:• Continued innovations in procedural-based radiology improve accuracy, ease of performing procedure, and quality of patient care• Interventional radiology suites of the future are already here• Next generation interventional radiology technologies are actively being developed by academic institutions and vendors

• Time out / RFID Improved “Time out” process via IT

• Integrated overhead display with vital sign monitoring and PACS with fusion and multi- planar reconstruction capability • Real-time cumulative radiation dose monitoring

• Robotic guidance

• Voice-based commands of overhead display or headsets to better facilitate with technologists and other staff involved

• Advanced applications tailored to each procedure such as RFA and volume kill

• New room configurations that faciliate near- simultaneous multi-modality image-guided proceduresThe volume in CT guided interventions at our own institution has been steadily increasing

TRENDS IN INTERVENTIONAL CT

PRE-PROCEDURE

• Computerized Order Entry

• Electronic dashboard to enhance scheduling, utilization, communication, and quality/safety. The electronic dashboard is omnipresent, it can be displayed at attending’s desktop, on a large screen in procedure area, mobile [iPhone], or procedure room prior to procedure.

• Evaluate patient and complete use of EMR for pre-procedure labs, allergies, and other relevant clinical information

• Automated screening for safety/adverse reaction/allergies

• Prefetching of patient’s studies from PACS for pre- proceduring planning and intra-procedure guidance

• Patient name on overhead display on CT

INTRA-PROCEDURE

ElEctronic dashboards enhance scheduling, utilization management, communciation, quality, and safety. For example, dashboards can be displayed in numerous patient care settings: mobile devices, procedure area, interventional suite, and physician's computers.

improve patient safety Image above demonstrates how IT will be utilized to improve patient safety. CT scanner and overhead display screens are playing significant roles in identifying the patient, facilitating a "TIME OUT," and ensuring that allergy information is readily available. Multi-Modality iMaGE GuidaNCE

Illustration of intra-procedure heads-up display enabling interventional radiologist to utilize fall information from multiple modalities (CT, Ultrasound, PET) and multiplanar reformations (MPR). Targeting of lesions will be improved by real time use of all available imaging.

Mobile ApplicAtionsFor a busy interventionalist on the run, mobile-based scheduling dashboards can improve throughput in a busy practice.

AutomAted Post-Procedure tAsksPost procedure, work-flow will also be facilitated by information technology. For example, post-procedure checklists and automated lab ordering systems can be deployed.

CritiCal results alertImportant finding alert systems via mobile devices can also be employed to notify the interventionalist of critical lab results.

Radiation Dose Monitoring and Alert

Image Fusion

Interventional CT Suite of the Future

PURPOSE/AIM