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Date: January 4, 2007
WAILUKU – It is state of the art for performing some of the most delicate procedures imaginable in a patient’s brain, Dr. Chris Neal said. It provides him and his colleagues at Maui Memorial Medical Center detailed, three-dimensional, colored images as they treat clogged or damaged blood vessels in the brain while running thin catheters through the vessels to reach the damage without having to actually cut into the brain. "It’s doing neurosurgery without the surgery," Neal said in describing the benefits of the Axiom Artis DynaCT system that was installed in the Maui Memorial Heart, Brain & Vascular Center just in time for Christmas. It’s not exactly a Christmas present for Neal and the interventional radiology team at Maui Memorial. The $2.5 million device manufactured in Germany was installed in mid-December as the best option for replacing an existing imaging device in the Heart, Brain & Vascular Center, said MMMC Chief Executive Officer Wesley Lo. The older device was functional but was in need of repairs. Balancing the need to get a fully operational system in place before the holiday season rush of tourists hit Maui, Lo said Maui Memorial opted to acquire the new equipment that he said puts Maui Memorial at the forefront for treating strokes in Hawaii. No other hospital in Hawaii has anything like it. "It’s an X-ray machine on steroids," Neal said. "What makes it different from other systems is that it provides real-time detailed images with a resolution down to one-100th of a millimeter, which is a fantastic level of resolution when you’re working in something just 2 millimeters around." The DynaCT is a major upgrade in the technology of computed tomography, commonly known as CT scans, in which low-level X-rays are used to produce body-tissue images in three dimensions, allowing a physician to examine an organ or a blood vessel without cutting into the patient. With the DynaCT, the images are clearer; are computer programmed to appear in color; and are taken as a procedure is under way, allowing doctors to see exactly where they’re going with a catheter passing through a blood vessel 4 millimeters in diameter to get to the site of a clog or a leak that is causing a stroke or internal bleeding. One of the more serious conditions that can be treated by the new system is an aneurysm, which is a ballooning in a blood vessel that can burst, causing severe bleeding. With the DynaCT, Neal said he can examine the aneurysm and the condition of the affected blood vessel before beginning a procedure on the patient; follow the passage of a catheter to the site of the injury; and insert a microcatheter or other device to block off the aneurysm, reducing the pressure on the damaged blood vessel and eliminating most of the threat of it bursting. Except for the site where the catheter is inserted into a major vessel, there is no cutting on the patient. Vascular center Coordinator David Russell, a nurse trained in radiological techniques, said the DynaCT system has been used for about two dozen patients since it was installed, including a woman whose uterus began bleeding severely after she gave birth. Inserting a device to block the blood vessels leading to the damaged muscle stopped the bleeding without having to perform major surgery to get to the site. A sheathed stent to reopen the artery in a woman’s left leg restored circulation to the leg. A blood clot in a man’s brain was dissolved to eliminate a blockage causing stroke symptoms. Known to the interventional radiology crew as the "biplane C-arm system" because of the technology that provides for views of an internal organ in more than one view, or plane, the system also includes a lineup of flat-screen monitors along one wall of the surgical suite for the computer to provide multiple views of the procedures under way on the table. It all makes Maui Memorial a leader in stroke intervention and vascular procedures not only in Hawaii but around the Pacific and even in the U.S. Neal, the radiologist who trained his Maui colleagues, Drs. Lee Miyasato and Ronald Boyd, said other imaging systems for similar work are not as sophisticated as the DynaCT "There isn’t anything like this elsewhere in Hawaii. There are only three in the western United States, and one is at Stanford, but it’s not as good as this one. I know because I still teach at Stanford," he said. All of the detail provided through the computer imaging system means physicians can work with greater confidence that they are seeing all of the elements of the blood vessel on which they working. "It means greater safety for the patient and better outcomes," Neal said. "Because we are allowed better images of the brain and the damage it has suffered, our procedures go far more smoothly with much less risk of error of any sort for the patient." It is not just for working in the brain, although it offers the greatest benefits in allowing procedures to fix defects in blood vessels without having to cut through the patient’s skull. It can also treat vascular problems in the liver, kidneys, spleen and other parts of the body, including sites of tumors, without having to cut through surrounding healthy tissue. It works both to allow the physicians to block bleeding from damaged vessels or organs and to restore blood flow in clogged arteries and veins. It also can be used to inject cement into bones of patients suffering from osteoporosis, the debilitating disease of bone loss that can cause painful microfractures in vertebrae mostly in older patients. In addition to Neal, Boyd, Miyasato and Russell, the staff of the interventional radiology section includes six specially trained nurses and six technologists who operate the system while a procedure is being conducted. In selecting the DynaCT system, Neal said it was seen as not only being the state of the art in imaging technology but a system that was likely to remain at the top of the technology for the next five to seven years. "And because the whole processing unit is digital, we feel that when there are technical upgrades for this kind of system, it will be bolt-ons that will just attach to what we already have in place," he said. Edwin Tanji can be reached at editor@mauinews.com.
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