Medical Device Dailys

If it works for brain surgeons, who else might be interested in full-color digital subtraction angiography (DSA) reconstruction?

Siemens Healthcare (Erlangen, Germany) is shifting the sales focus for its syngo iFlow image enhancement software from neurology, where it has enjoyed a solid take-up, to other 'body' interventionalists, such as interventional oncologists and specialists keen on visualizing blood flow for organs and tumors.

Black-and-white photo sequences depicting blood flow have been a staple of medical practice for as long as anyone can remember.

As many as 30 angiographic images that have been digitally subtracted, that is stripped of all background and displaying only blood vessels, are typically taken for a diagnosis of aneurysm coiling and vasospasm, dural arteriovenous fistula, and arteriovenous malformation, for example.

More recently such images have proven essential in both pre- and post-operative assessments for percutaneous interventions to place a stent, a coil tube to support vessel walls.

Even more recently, with advances in contrast agents, blood flow to a tumor can be studied in detail using DSA.

These sequential X-ray images remain in a grainy black-and-white and surgeons flip through them rapidly to study the blood flow as it enters a surgical target and then exits, to assess the extent of any blockage, or the effectiveness of a procedure to remove such blockage.

"The very experienced interventionalists can fuse a DSA sequence in their heads by flashing through the multiple images to understand the blood flow," said Thomas Hartley, marketing manager for interventional radiology at Siemens.

"But for newer doctors and radiology staff, it takes an effort and there is a learning curve" for decrypting DSA images, he said.

The syngo iFlow process combines the 25 to 30 photos in a DSA sequence into a single image where blood flow is color-coded and renders an easy to understand, almost intuitive view of the contrast-loaded blood flowing through the brain, the leg, or organs.

Vessels appearing in red show the early flow while blue depicts late flow in vessels.

syngo iFlow is a software-based upgrade to the Siemen's Artis zee family of systems used for interventional radiology and cardiology.

"It is not terribly expensive to add this feature," Hartley said. "And it certainly is not expensive if it proves to be clinically useful."

Because the software works with routine DSA sequences, there is no additional exposure to radiation for the patient, which would be the case if blood flow concerns caused the physician to order a 3-D computed tomographic scan.

Hartley said syngo iFlow processes a single frame in less than one second, "so it does not take very long to recompose the series into a single image of the dynamic flow," he said.

The learning curve is not steep, either.

"The radiologists marks a tart and an end point and clicks a button," he said.

"We see a strong potential for clinical procedures outside of neurology, which remains our primary focus," he said, adding that for leg stenosis syngo iFlow should prove clinically significant for pre- and post assessments.

"There is also a whole class of interventionalists working on the liver, kidneys and other blood-intensive organs that we are targeting," Hartley said.

Syngo iFlow has also proven useful in making more vivid a phenomenon known as "tumor blush", the sudden visualization of a tumor as it fills with a contrast agent, indicating that interventional oncologists hay find the software upgrade helpful.

Syngo iFlow holds a CE mark, clearing it for sale in more than 30 countries, and is currently being reviewed in a 510(k) application to the FDA.

An added benefit for an easy-to-understand image of blood flow is for the patient, Hartley said.

New neurosurgery systems from Renishaw

Renishaw (Wotton-Under-Edge, UK), a leader in engineering technologies, is introducing an exciting line of high precision systems for functional and stereotactic neurosurgery at the 15th quadrennial meeting of the World Society for Stereotactic and Functional Neurosurgery (WSSFN) taking place in Toronto from May 24-27.

These include the neuromate surgical robot, and image-guided stereotactic technologies, some of which are still in development.

To mark the introduction, the company will also be hosting a special satellite event at the Toronto Cricket Club on May 24, with two leading neurosurgeons to speak about their experiences with surgical robotics and other new stereotactic technologies, and their vision for their future use.

Dr. Olivier Delalande, pediatric neurosurgeon at the Fondation Rothschild Hospital (Paris), will discuss his pioneering use of the neuromate stereotactic robot to perform paediatric procedures, including Stereo Electro-Encephalography for epilepsy, and neuroendoscopic disconnection for hypothalamic hamartoma.

Professor Steven Gill of Frenchay Hospital (Bristol, UK), who is well-known for his pioneering work in placing deep brain stimulation leads, will also discuss the clinical applications of new technologies in the targeted delivery of therapeutics and their drive towards the requirement for advanced stereotactic systems.

Renishaw Chairman/CEO Sir David McMurtry said, "Our commitment to the neurosurgical market is built around listening to the needs of our clinical customers and then delivering advanced precision systems to meet their requirements."

Other Renishaw product lines include laser calibration systems for machine performance analysis, 3-D dental scanning and milling systems, linear and rotary position encoders, Raman spectroscopy systems for spectral analysis of materials, and most recently medical devices for neurosurgical applications.

In the year ended June 2008, Renishaw had revenues of £201.2 million and profit before tax of £41.7 million. The Renishaw Group has some 50 locations in 31 countries, employing more than 1,800.