Medical technology is becoming a reason that patients choose a facility

 

BY LISA HITCHEN

There are many reasons why patients choose one particular medical facility rather than another. The skills of medical staff, the sophistication of the facility, its international reputation and its standards all play their part. But for well-informed patients, it is increasingly high-tech equipment that is a major draw. They believe that the best equipment can make significant differences to patient outcomes. It is also seen as evidence of a facility being up to date and with impressive financial resources. Here we look at 12 pieces of medical equipment that, increasingly, are being used in Google searches by patients.

1. Intuitive Surgical da Vinci Robot

Minimally invasive surgery took a huge leap forward in the late 1990s when robotics were introduced. US-based firm, Intuitive Surgical, developed the da Vinci Surgical System. The da Vinci has four robotic arms for instruments and the laparoscope. The surgeon co-ordinates their movements from a control panel, allowing his skill to be exercised with pin-point accuracy, the surgeon’s hand and wrist movements translated into corresponding, scaled movements by the instruments while the operation is viewed on a monitor. Used for surgery of the heart, spine, prostate and bladder and for kidney transplants, benefits of the da Vinci are said to be less pain, less scarring, less blood loss and faster recovery times.

High Definition was added to the refined da Vinci, the da Vinci S Surgical System, earlier this year, making it the world’s first robotic surgical system with 3D HD vision, according to its manufacturers. By the end of March 2007, there were 602 unit shipments worldwide.

Prof Roger Kirby, a urologist at the London Clinic in England, says use of the robot has transformed his practice. Previously he used open surgery to perform around 1,200 open prostatectomies. With the da Vinci, he and his seven-strong team have performed over 240 procedures using the robot.

“There is a real improvement in outcomes,” he says. “Patients are out of hospital in three days compared to six with open surgery and there is less blood loss.”

He is also clear of other benefits of using the machine. “It is a useful marketing tool, I think,” he admits. “It promotes the high-tech stuff – 66 percent of all prostatetectomies in the US are done using this robot. Compared with open surgery, there is no question that this is better.”

Intuitive Surgical markets to surgeons and hospital administrators interested in developing their minimally invasive surgical programmes. But recently, it has recognised the growing consumer interest in such technologies and set up a website for patients: www.intuitivesurgical.com and www.thelondonclinic.co.uk

2. Varian Medical Systems’ Trilogy System

Trilogy is a precision radiotherapy medical linear accelerator used for treating tumours.

Radiotherapy has always been a rigorous and taxing treatment for patients with significant short- and long-term side effects. The 1990s saw the development of new, more targeted radiation therapies (Intensity Modulated Radiation Therapy or IMRT), whilst Image-Guided Radiation Therapy pinpointed moving tumours. Stereotactic radiotherapy and surgery allow radiation of a clearly defined tumour, leaving most surrounding tissue intact. With early diagnosis of smaller tumours, this method is becoming more useful.

The Trilogy has the ability to deliver these and all other external beam therapies, meaning it can be used to treat a large number of different cancers anywhere in the body. The machine has a couch controlled by remote control so the patient can be re-angled or moved quickly into another position, which maximises the number of beam angles that can be used. Short or long courses of radiation can be delivered in a single dose or over a number of weeks.

Malaysia’s NCI Cancer Hospital in Negeri Sembilan is the first hospital in Southeast Asia to purchase a Trilogy with Smart Beam, the hospital claims. Operational since March 2006, the Trilogy massively extends the sort of radiation oncology that can be performed at the hospital, allowing over 43 different cancers to be treated.

NCI medical director, Dr Selvaratnam Govindaraju says: “We decided to purchase this system after a thorough investigation of the various linear accelerators available. We thought that this was the most optimal in terms of cost effectiveness, quality, accuracy of treatment, reputation of our centre and the supplier. From the patient’s point of view, the treatment has resulted in less toxicity, greater response, better acceptability and fewer side effects. It gives the treating physician flexibility to choose the optimal treatment option. It gives the confidence to treat difficult tumours.”

Initial results comparing use of Trilogy for IMRT with conventional methods have shown the system is more effective, he adds, with reduced toxicity and increased response for breast and prostate cancer patients.

Since the NCI’s first IMRT treatment 18 months ago, the hospital has seen increased interest in its services from across Malaysia and neighbouring countries.

The hospital’s international patient centre provides information and support for referring doctors and overseas patients’ families, helping with travel, appointments and accommodation arrangements, including its new residential wing for family and friends of patients.

www.varian.com and www.nci.com.my

3. Accuray CyberKnife Robotic Radiosurgery System

The CyberKnife offers stereotactic radiosurgery to cancer patients in what its manufacturer claims is the “world’s first and only robotic radiosurgery system designed to treat tumours anywhere in the body with sub-millimeter accuracy”.

Its X-band linear accelerator is small and light so it can be placed on a robotic arm to send the precise dose of radiation needed in any direction, avoiding healthy cells. The system is able to track moving tumours and any movement made by the patient.

Its development has meant patients previously thought inoperable or surgically complex can now be treated. This usually happens over one to five visits to the clinic where patients don’t need anaesthetic and can then go home after the procedure.

At Anadolu Medical Center, Gebze in Turkey, the CyberKnife was just one of a range of state-of-the-art equipment purchased for the opening of the new centre in 2005. With three years’ experience using the CyberKnife, the number of patients treated with it has risen from approximately 140 in 2005 to over 300 in 2007.

“We can use CyberKnife by itself as a curative modality or in combination with other radiotherapy modalities or with chemotherapy or surgery or we can use it palliatively to decrease pain or bleeding,” says Prof Kayiham Engin, director of radiation oncology at the hospital.

Lung cancer is the number one cancer type in Turkey so this is one patient group that is often seen at the Center. With conventional radiotherapy, such patients often require up to seven weeks of treatment whilst with CyberKnife, three fractions of radiation in a week can be sufficient, he says.

The hospital is also having increasing success using the machine with pancreatic, liver and prostate cancer with faster, more defined treatment and increasing opportunities to re-irradiate patients previously treated with radiotherapy. People with brain lesions still account for around 60 percent of the clientle where both primary and benign tumours are treated with CyberKnife as a safer alternative to conventional surgery.

“CyberKnife helped a lot with our international reputation,” notes Prof Engin. “It really attracted new patients to the hospital and with its help, Anadolu has become known as the best oncological centre in Turkey.” This includes patients from Europe, the Middle East, Central Asia as well as domestic patients.

www.accuray.com and www.anadolusaglik.org

4. Hippocratech Surgical’s SurgiCube Operation Unit

Minor surgery is increasingly being carried out in health settings beyond hospitals by primary care physicians and nurses where an operating room is not available.

This challenge inspired Dr Gerrit Melles to come up with a portable and accessible operating room that can offer a sterile environment for performing small types of surgery anywhere. Dr Melles, a corneal surgeon at the Netherlands Institute for Innovative Ocular Surgery in Rotterdam, the Netherlands, designed the SurgiCube to help solve many of the efficiency problems he saw in operating rooms globally.

“It can be used for every type of minor incision surgery and most of this is quick and not very complicated,” he says. “If you could get the bulk of it done in the SurgiCube, you could get a lot done and save space for other surgeries.”

The SurgiCube is a box-like metallic structure that can be housed in any dust and germ-free room. Unlike normal operating rooms, the airflow works differently: the clean air flow is restricted to the operating surface and instrument table.

The cube is set up around the part of the patient’s body that is to operated upon. So for head surgery, only the patient’s head will be inside the SurgiCube. This can mean that patients don’t have to get changed for surgery and staff that don’t need to be inside the SurgiCube don’t have to wear surgical scrubs either.

Because microsurgery can be done in this “microclimate” it reduces the restrictions on where surgery can be performed – so it can take place in an office, home or primary care clinic rather than in a hospital.

Nicoline Schalij-Delfos is an opthalmologist at Leiden University Medical Center, the Netherlands. There the SurgiCube is used for surgery under local anaesthesia for the majority of surgical day-care patients. This is usually for cataracts, glaucoma surgery, oculoplastic surgery and removal of radioactive plaques.

“Patients are in hospital for about half the time they needed before,” she says. “That means we can do larger numbers in the same time. Turnover time is much quicker. I think the service to the patients has improved.”

“As we work more efficiently, more surgeons can do surgery compared to the previous system,” says Schalij-Delfos. “Surgeons have to be flexible to make the step from a large operating theatre to a small cube, but you get used to it very quickly and the unit is much less expensive than building a new day-care operating theatre.”

www.hippocratechsurgical.com and www.lumc.nl

5. Philips Panorama 1.0 Tesla Open MRI scanner

Scanners have been regarded as frightening and claustrophobic by some patients, and having a scan can increase patients’ anxiety and trauma during their time in hospital.

So the design of an open scanner has obvious benefits. Philips claims to offer the world’s only high-field open (HFO) MR system. Open on three sides instead of being a long, narrow tunnel, this means patients can see out at all times and staff can always see the patient.

The patient is placed on an MRI table which is moved in and out of the scanner. An MRI coil is put over the area being scanned and each scan takes 30 minutes. The scanner has the disadvantage of being noisy so patients wear earplugs or headphones to reduce the problem.

The HFO is also effective at examining joints in any position – which means injuries are more likely to be picked up. Obese patients might find the open design less constraining and therefore less stressful. Images are of a very high quality and the incorporation of SmartExam technology makes it easier for staff to obtain meaningful results quickly and easily. All this means patients spend less time inside the scanner.

Paul Mezacapa is a radiographer and founder of Desert Medical Imaging, California, US, which bought an HFO earlier this year. California is an open MR market, he admits, and that meant the company had to choose a product that could compete successfully.

“We wanted to buy a piece of equipment that was going to thwart the competition,” he says. Having installed the third HFO in the US, the next challenge was to convince the doctors.

“It is very difficult to get doctors in the States to think that open MRI is good for all things. We had to prove to doctors that this was as robust as other systems such as 1.5 Tesla. It is a very strong statement saying that there were radiologists that could not detect the difference in imaging quality.”

Patient endorsement has been high as well, he says, with the open layout providing immense reassurance to those who are claustrophobic.

Clinically, the HFO scanner is particularly useful for the high proportion of patients with musculo-skeletal problems, he says. Individual joints in motion can also be seen, which was not possible with the previous scanner. This saves money and medicine, Mezacapa explains, as treatments can be more specifically targeted. With less need for sedation and its greater flexibility, the machine has meant faster throughput of patients.

The initial expensive investment has paid off, he says. Turnover in one quarter after acquiring the HFO was the revenue equivalent for the whole year with the previous scanner, according to Mezacapa.

www.medical.philips.com/uk and www.desertmedicalimaging.com

6. Philips Ambient Experience

Philips Ambient Experience allows patients to make choices about visual, lighting and atmospheric effects to accompany them during a medical or diagnostic procedure such as CT scans, PET/CT, MRI and heart catheterisation. The idea is to engage their senses so that any worry they might have of this medical process is forgotten.

Able to be integrated into any hospital room, the various suites have lights and electronics that can be operated by the patient so they can create their own setting. This is especially good for children who might otherwise need to be anaesthetised for a procedure and reduces the need for repeat examinations when patient movement leads to an ineffective first result.

Desert Medical Imaging bought the Ambient Experience to facilitate its scanning procedures and other tests. Mezacapa admits to having reservations at first. “At first I thought it was fluff. We are gamblers and we said: ‘Let’s just do it’.”

His instincts that it would help grab market share paid off with a positive response from patients. “When they come and look at the Ambient Experience, their minds are distracted from the test,” he says. “Patients like to have control of some part of their test. We ask them where would they like to be? In the sands of Africa? We give them a choice and people love it.”

Is it making a difference? It seems so. Eight hours for sedation of claustrophobic patients per week is now down to one hour, he says.

California is well known for offering a comfortable winter retreat for older North Americans and others. The clinic has taken advantage of a doubling of the population during the winter to offer scans within the Ambient Experience suite to a range of clients beyond its local market without the need to advertise elsewhere, he says.

“We have gained 16 percent more market share by having the Ambient Experience. It is a big expense in the first place, but the amount of market share we have gained is worth the investment.”

The Subang Jaya Medical Centre (SJMC) in Malaysia purchased the country’s first 3.0 Tesla MRI and Ambient Experience suite in August 2007.

www.sjmc.com.my

7. Dutch Opthalmic Research Center’s (DORC) One Step 23 Gauge Vitrectomy System and Xenon BrightStar

Huge, high-tech machines might steal all the glory in promotions by hospitals vying for overseas business, but possession of small and precise instruments to do a specific job can be just as important.

On the market since January 2007, the 23 gauge vitrectomy system has some distinct advantages over older systems. Vitrectomy is eye surgery that involves removing some or all of the vitreous humour. The new one-step cannula set that is part of the system contains special closure valves that sit on the eye and can be removed with forceps at the end of the operation. This means surgeons don’t have to sucture??? incisions, resulting in less trauma and quicker recovery times for patients. There is also less risk of post-operative low intraocular pressure or inflammation of the inner linings of the eye.

The company has specialised in developing 23 gauge instruments for 15 years. These allow the whole operation to take place inside a tiny (0.6mm or 23 gauge) incision. This equipment actually looks and feels the same as 25 gauge instruments because only the end of the instrument is smaller. Retinal specialists across the globe have praised the Vitrectomy System for the advantages it provides for their surgery in comparison to 20 gauge and 25 gauge instruments.

Prof Peter Stalmans, an opthalmologist at University Hospitals Leuven, Belgium says: “At present I perform up to 80 percent of my vitrectomies using the 23 gauge transconjunctival approach. Average surgery time has decreased compared to 20 gauge surgery. In our centre, we recently conducted a retrospective study of almost 900 patients, which confirmed a statistically significant better and faster postoperative recovery compared to a 20 gauge approach.”

DORC’s Xenon BrightStar is a lighting system for eye surgery that was developed in response to clinical concerns over photo-toxicity. Eye surgery can often take longer than expected and the surgeon will keep going without having a full idea of how longer exposure to a light source might be damaging the retina.

This machine takes such dangers into account. It has four UV safety filters that can be cut off, so the surgeon has control over the spectrum of light that gets to the retina. The machine can calculate exactly how long the surgeon can stay in the eye. With a particular filter for a particular procedure selected, they can work for longer close to the retina. Its increased illumination helps the surgeon to see better during the operation even when using tiny light fibres.

www.dorc.nl

8. IntraLase Femtosecond Laser

The IntraLase is used for creating a corneal flap in Laser-assisted in Situ Keratomileusis (LASIK) surgery without the need for a surgeon’s knife. This refractive laser eye surgery is widely used to correct short- and long-sightedness and astigmatism. Faster and less painful than photorefractive keratectomy, it is a procedure highly conducive to medical travellers and ends the need for wearing of glasses or contact lenses.

The IntraLase is also used for making shaped incisions for corneal transplantation or keratoplasty procedures.

A femtosecond is less than one quadrillionth of a second. This tiny burst of laser activity, known as IntraLASIK, creates a series of cavitation bubbles within the cornea. These bubbles, made of water and carbon dioxide when arranged next to each other lead to the separation of the corneal stroma to create the flap. Once the flap is made, a hinge is left at one side and it is then folded back to give access to the stroma. A glass plate placed in the corneal surface and attached to the eye by a low pressure suction ring is then ready for the LASIK treatment.

Earlier this year, the Grewal Eye Institute in Chandigarh, India, bought an IntraLase as well as the Advanced Medical Optics’s STAR S4 IR Excimer Laser System (see 9). There it is used for all three of its clinical applications – LASIK, corneal rings for keratoconus and in corneal transplants.

“It offers the best visual results after LASIK surgery,” says Dr Satinder Pal Singh Grewal, the chief operating officer at Grewal. “The flaps created are of uniform thickness throughout and the thickness is also highly accurate, with a standard deviation of 12 micrometres. This level of accuracy and predictability is reassuring for the surgeon and helps to improve the visual outcome and reduce the incidence of complications like glare and post-LASIK ectasia.”

www.intralase.com and www.gei.co.in

9. Advanced Medical Optics’s VISX STAR S4 IR Excimer Laser System with the WaveScan WaveFront System

This system enables individualised LASIK treatment for each eye through fourier-based wavefront technology called CustomVue. STAR S4 also has iris registration, an automatic, non-contact method of aligning the correct treatment to the corneal site. It also offers variable spot scanning where beam sizes from 0.65mm to 6.5mm can be scanned over the treatment area, preserving tissue and reducing treatment times. Its ActiveTrak 3-D system tracks all intra-operative eye movements while automatic centering finds and sets the treatment centre to the middle of the eye’s pupil.

Working with this is the WaveScan WaveFront System that makes a detailed wavefront map of the cornea. This map is like a fingerprint of the eye, providing data on all individual imperfections and curvatures of that particular cornea. This information is relayed back to the STAR S4 that then customises LASIK treatment for that cornea.

Both systems are in use at the Grewal Eye Institute. “Custom laser vision correction results in significantly improved visual results with better contrast sensitivity and reduced glare at night,” says Dr Grewal.

“All this equipment serves to differentiate us from other eyecare organisations,” he explains. “They also give the surgeon greater confidence in operating and enhance the visual results for the patient.”

www.amo-inc.com

10. Bristol Maid Hospital Metalcraft’s Resus:Station

As well as efficiency, safety is crucial to confidence in new machines and new methods of working.

That was the thinking behind the design of a new emergency trolley currently being trialled by a team in the UK. Once launched, the Resus:Station crash trolley will ensure that heart attack emergencies in hospitals are dealt with more efficiently and safely, says one of its designers, Jonathan West, a senior research associate at the Helen Hamlyn Research Centre (HHRC), London, UK.

The impetus for a better trolley came through research from the country’s National Patient Safety Agency, which found that poorly stocked crash trolleys led to error and poorer outcomes for patients.

The brief was to design a trolley which would facilitate resuscitation and restocking afterwards. “Crash trolleys were put on wards in the 1940s before cardio pulmonary resuscitation was defined in the 1960s,” explains West. “Products got left behind in a system that is constantly being updated and one of those was the resuscitation trolley. Staff were just left with a tool chest on wheels.”

Researchers from the Helen Hamlyn worked with staff from Imperial College and St Mary’s hospital to come up with something that could cope with the demands of today’s resuscitation process. The team involved industrial designers, clinicians, clinical psychologists and patient safety academics.

Interviews and workshops led to a prototype with all the equipment laid out openly for ease of access. The design also allowed the trolley to be divided into three sub-trolleys so parts of the team can work separately from one another. It has a touch screen so one person can take a lead role in coordinating and logging what the team is doing. Radio Frequency Identification technology tracks all equipment on the trolley and flashes if stock is not complete, when the item was removed and when drugs have reached their expiry date.

A first prototype has already been tested with great success in simulated cardiac arrest scenarios. “With a conventional trolley it took eight separate searches and 25 seconds to find a cannula whereas with our system, people found it straight away,” says James Kinross, clinical research fellow at Imperial College.

Similar testing at the Chelsea and Westminster hospital gave a clearer idea of which features on the prototype needed to be changed and a second prototype is now being developed with manufacturer Bristol Maid Hospital Metalcraft.

After that the team hope to see it marketed across the world. “We are hoping it is going to shape high-tech solutions for emergency healthcare,” says Kinross.

www.bristolmaid.com and www.hhrc.rca

11. Siemens Biograph Truepoint High Definition Positron Emission Tomography Computed Tomography scanner (HD PET-CT)

Adding high definition to Siemens’ PET-CT systems is the latest innovation from the company. This will improve the quality of molecular imaging over and above what high resolution PET-CT scanners already offer.

The technology is a step up on old scanners because it eliminates the problem of image quality decreasing with increasing distance from the centre of the scanner. The HD PET uses a proprietary reconstruction technique to get around this. This allows a 2mm resolution (other scanners only go to 4mm) so clinicians can see the tiniest of lesions anywhere they appear on the scan.

“HD PET eliminates this effect providing increased diagnostic confidence to more accurately resolve peripheral lesions,” says Dr David Townsend, director of the molecular imaging and translational research programme at Tennessee University School of Medicine.

Contrast is better, too, with an improvement in signal to noise that makes images sharper. This can help doctors to work out which tissue is malignant and which is healthy.

Clinically it is hoped the increased clarity will allow doctors to spot small lesions more easily including those in the lymph nodes, abdomen, head, neck and brain. This will help them to get earlier and more accurately targeted treatments to patients so improving outcomes.

PET scanning is becoming more popular as a means of measuring therapeutic response to oncological treatments and HD PET can help make this process even better, says Dr Joe Busch, a diagnostic oncological radiologist for Diagnostic Radiology Consultants in Tennessee.

The company has two Siemens Biograph High Resolution 16 PET-CT scanners. Busch says the combined PET-CT scanner has made a significant difference to both staff and patients’ experience in diagnostics and therapeutic scanning.

“With a combined scanner the patient lays down on the table, and in less than 20 minutes we have completed the diagnostic CT and the PET scan. That saves them a lot of hassle as they don’t have to go somewhere else to get the CT,” he says.

Clinical benefits include the ability to spot reactivation of lymph nodes following therapy. “With lymphoma tumours, most people just do CT scans to follow the lymph nodes and see if they get smaller but if a lymph node reactivates, we will see the activity on PET.”

And the addition of PET means other cancers are also more likely to be picked up when radiologists are looking at scans. For example, a colon tumour was spotted in the abdomen of a lung cancer patient through PET.

In the last year, the company has also used the scanners for checking up on cancer patients who have undergone radiofrequency ablation. Usually used for liver, lung and kidney cancer patients, the scanners can pick up a failure in treatment or a recurrence of cancer in 90 days, says Busch, so the tumour can be re-treated quickly. Previously a six month or one year wait was the norm before the old scanning system was able to pick up changes.

The company has 10 staff working across four clinics and one 150-bed hospital. Patients are referred by doctors for diagnostic or follow-up scans. With the two scanners, they carry out 15 to 17 scans daily and can get results back to patients’ physicians very speedily using a combined Siemens Radiological Information System and Picture Archiving and Communications System (RIS-PACS).

Both technologies have meant faster turnaround time for the patient and fewer staff overheads for the business. Three years ago prior to purchase of the two scanners, they saw around two to four patients a day; now 15 is the norm.

“It is difficult to have a good cancer programme unless you have a PET-CT scanner,” says Busch. “This stages the patient and then restages them after therapy. It can actually measure the therapeutic response.”

www.siemens.co.uk

12. GE Healthcare Mobile Prodigy Dual-Energy X-ray Absorbtiometry (DEXA) scanner

Access to bone density scans, even in rich, Western countries has always been difficult. GE Healthcare has put its X-ray bone densitometer technology into a van so that DEXA scanning can go to the patients instead of the other way around.

DEXA scans calculate bone mass. In doing so, they can pick up the bone thinning disease, osteoporosis and other skeletal diseases and perform vertebral imaging.

As the population lives longer, more and more women, as well as some men, could develop osteoporosis. The National Osteoporosis Foundation says it affects over half of all women aged over 50 in the US. In the UK, the figures are much the same: one in two women and one in five men over 50 will break a bone usually due to osteoporosis, says the National Osteoporosis Society.

The Mobile Prodigy has the same technology at the company’s Lunar Prodigy, but allows patients’ fracture risk to be measured without them having to drive somewhere for diagnosis.

“Rather than the patient driving farther for bone mineral density and body composition testing, we can bring it closer to their homes,” says Laura Stoltenberg, general manager of GE Healthcare’s Lunar business, “delivering the benefits to smaller, rural hospitals and clinics that don’t have a dedicated system.”

Purchase of such a van could be shared by hospitals and clinics in one region – adding another valuable marketing tool to promote themselves to domestic or overseas patients.

With obesity on the rise world wide, the GE Lunar Body Composition software allows measurements of fat distribution in adults.

This can help doctors to work with patients on weight reduction through exercise and diet.

The software can also provide knowledge of patients’ relative amounts of lean or fat tissues, where a condition or its treatment can affect this. As well as obesity this might include anorexia nervosa, chronic renal failure, AIDS and HIV and cystic fibrosis.

www.gehealthcare.com

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