bscs-1243

1.  Williamsburg, Nov 2014
Technical Developments in
Cardiovascular Imaging
Heinrich Kolem, Forchheim, Germany

2. Conflict of Interest
Heinrich Kolem is employee of Siemens
Healthcare

3. Content
Imaging in Interventional Cardiology
2D, Dose, FFR
Imaging in Structural Heart Disease
3D, Echo+Angio combination
Imaging in the EP Lab
Multimodality Approach

4. Interventional Cardiology:
Not much will change
Proximal LAD stenosis – before and after succesful PCI

5. Current and (potential) Future Developments in IC
 Integration of Angio and IVUS
 Better tools for CTO
 Limited use of „Imaging based“ FFR
 Dose considerations

6. Demonstration of CFD
(Computational Fluid Dynamic)
 Calculate flow based
on patient specific
parameter
 Calculate Functional
Flow Reserve (FFR)
based on these data

7. Dose
 Biggest Influence on Dose is by User
(frames/s, filtering, collimation)
 Besides User Support the only Way to improve is new
Technology
 Look at all Dose Calculations with Common Sense:
natural yearly dose 1-10 mSv (avg. 2.5mSv)
1mSv=1 000 000 nSv
 All Dose values can be calculated based on ABSOLUT
VALUES (nGy/frame)

8. Crystalline Silicon Sensor for ultra low dose fluoroscopy
Page 8
Amorphous Silicon
Passive Matrix
Sensor
Scintillator
Low Dose X_Ray
Electronic Noise
electronic noise
visible
in low dose imaging
Amplifier

9. Crystalline Silicon sensor for ultra low dose fluoroscopy (CMOS technology)
Page 9
Crystalline Silicon
Active Matrix
On Pixel Amplification Electronic Noise
On Pixel Amplifier
Sensor
Scintillator
less electronic noise
Ultra Low Dose X_Ray
visible
in low dose imaging

10. Amorphous silicon detector Crystalline silicon detector
Visualization of transseptal needle with ultra-low-dose fluoroscopy at 1 nGy,
zoom 16 cm
PaPgaeg 1e0 1 0
© Siemens AG 2012. All rights reserved. HIM-AX-12-13-063
Crystalline silicon detector
For imaging at ultra-low-dose levels
November 2012 Siemens Healthcare, Angiography & Interventional X-Ray Systems

11. Dose Reduction using CMOS detector technology
© Siemens AG 2012. All rights reserved. Created for HAKM 2012.
For internal use only – note that certain products and/or product claims may not be available for use in every country.
Page 11
40 nGy 6 nGy
Courtesy of University Hospital Basel

12. Structural Heart Disease
3D and Multimodality Applications
Page 12 2014-10-20

13. Aortic Valve Replacement

14. Fusion with Trans-Esophageal Echo (TEE)
Real-Time Fusion
Fusion

15. The Electro Physiology Lab
 3D, Special Dose Saving, Multimodality Combinations

16. Intern © Siemens AG 20XX Alle Rechte vorbehalten.
Seite 16 XX.XX.20XX
Autor / Abteilung
Cardiac 4D roadmap

17. Electro-Magnetic Tracking
gMPS – guided Medical Positioning System
MPS sensor

18. X-ray proof of catheter tip position Radiation-free navigation with gMPS
 Record one flouro scene
with ECG and
respiratory signal
 Play continuously back
triggered by ECG
 Overlay catheter tips
localized by
electromagnetic tracking

19. Development and Clinical Evaluation of Multi-Modality
Applications –
Evolution of Multi-Modality

20. of Multi-Modality Applications –
Evolution of Multi-Modality

21. Summary
Imaging in Interventional Cardiology:
2D will stay, Improvements in Dose, FFR
Imaging in Structural Heart Disease
3D, Echo+Angio combination
Imaging in the EP Lab
Smart Dose Reduction, Multimodality Approach