Europe - GIT Verlag

12 MEdIcAL tEcHnoLoGY
Hospital Post Europe 04/08
Therapeutic decisions are
based on a widely generalized
patient model that rests on
broad, physiological, pathophysiological
knowledge derived
from studies. This model
forms the basis for therapeutic
guidelines. However, the individual
status parameters of a
patient – such as anomalies in
anatomy, physiology, metabolism,
or genetics – can rarely
be taken into account with
such a generalized therapy
model. Examples from operating
practice indicates, however,
that a stronger consideration
of individual patient
factors leads to significantly
higher success rates and lower
costs for post-surgery treatment.
Prominent authors and
members of the German Association
of Biomedical Engineering
(DGBMT) in the VDE
have published a book on
Every Patient Is Different
Individualized Medicine Improves Quality and Reduces Costs
“model-facilitated therapy”.
The book’s German title is
“Modellgestützte Therapie”
and it is now available from
the DGBMT.
In diagnostics, all quantitative and qualitative
information of a patient is compiled
in order to generate the most realistic, yet
abstract, patient model possible. For therapeutic
planning, this model is currently
interpreted according to evidence-based
medicine, and operative therapies are derived
with the help of the prescribed guidelines.
Consideration of patient-specific and
individual characteristics is only possible
to a limited extent with such a procedure,
and is heavily dependent on the surgeon’s
expertise and experience.
Model-Facilitated Therapy
In contrast, the concept of model-facilitated
therapy (MFT) is based on a highly
individualized, patient-specific model that
takes into account, a priori, all of a pa-
tient’s individual factors during surgery.
All patient data – derived from data bases,
evidence-based medicine, epigenetic information
and electronic patient files – is
networked and made available to the surgeon
in real time and fitting the specific
phase of the surgery. By implementing
and networking technologies and ensuring
their embedding in an IT environment
within the operating room, it is possible
to provide a maximum of patient-specific
data during an operation, and to select and
interpret this data for the surgeon so the
procedure can be individually adapted to
the situation.
Improved Quality and Lower
Costs
With the interoperative use of digital reconstruction
technologies and concepts
of “enhanced reality” – that is, the virtual
visualization and interpretation of anatomic
and functional structures – the DGBMT
believes the quality of results in many interventions,
such as in endoprothetics or in
Hybrid OR’s for Minimally Invasive Procedures
At the SVS Vascular Annual
Meeting Royal Philips
Electronics and Skytron announced
a partnership to deliver
hybrid operating rooms
for minimally invasive cardiovascular
surgical procedures.
The solution combines Philips’
cardiovascular X-ray systems
with Skytron’s surgery room
equipment to enable clinicians
treat cardiovascular patients
in the same room.
Increasingly, clinicians require more versatile
environments that enable them to
carry out complex minimally invasive interventions.
By working together to tailor
solutions to meet each customer’s needs,
Philips and Skytron will deliver operating
rooms that optimize workflow whilst reducing
the length of the planning and installation
process. As a result, clinical staff
will benefit from a more tailored and intuitive
environment that has the potential
to reduce costs for the care provider and
decrease the amount of time the patient
spends in the hospital.
“By working together with Skytron we’re
able to provide hybrid operating rooms
that offer flexibility along with easy to operate
equipment in a room with optimal
layout,” said Bert van Meurs, senior vice
president of cardiovascular X-ray, Philips
Healthcare. “As a result, the amount of
time clinicians spend worrying about technology
is reduced, enabling them to spend
more time focusing on the patient.”
“The hybrid room solution from Skytron
and Philips combines excellent medical
equipment and information solutions,
together with our experience in delivering
turn-key hybrid operating rooms,” commented
David M. Mehney, President & CEO
of Skytron. “By delivering a well-planned
and coordinated design that puts flexible
solutions at the fingertips of healthcare
providers we’re able to improve workflow
and ultimately increase the utilization of
the operating room.”
Philips will provide interventional X-ray
equipment and specialized imaging tables,
whilst Skytron will deliver advanced operating
room communications control integration,
and surgical lighting and boom
technologies specifically designed to support
hybrid surgical suites. As a result, care
providers will be able to carry out a wide
range of image-guided interventional radiology
procedures including cardiovascular,
vascular & cardiac surgery, neurosurgery,
and orthopedics.
Skytron and Philips will work together
across North and South America, including
Latin America and Canada.
www.medical.philips.com
cardiac surgery, can be further improved.
The service life of various hip prostheses,
for example, depends on how precisely
anatomic or individual muscular influences
are considered when positioning the implant.
Today, around 10% of all implants are
corrective surgery due to material wear. By
linking digital, patient-specific models with
navigation systems, one can optimize the
adjustment and positioning of prostheses,
extend their service life, and reduce the
number and costs of corrective surgery.
In cardiac surgery, 3-D models can be prepared
prior to surgery with telemanipulators
in endoscopic procedures, and the patient’s
individual anatomic structures can
be made visible to the surgeon. With this
method, target structures such as stenoses
or risk areas can be better identified.
The Future Of MFT
In the framework of projects supported
by the German Ministry for Education and
Research – such as the Preventative Micromedicine
Project (PMM) and the othoMIT
Project (www.orthomit.de) – and in the
Telemedicine Committee, the DGBMT is
working to further develop model-facilitated
therapy as a method for improving
the quality of medical results. Since the
networking of individual technological solutions
is a prerequisite for developing an
overall diagnostic and therapeutic concept,
the interoperability of various technologies
is a focus of the work. The DGBMT brings
together national and international experts
from medicine, the sciences, and industry
for this purpose.
www.vde.com
Correcting Spinal Deformities
DSM Dyneema and University Hospital
Maastricht collaborate.
Combining the materials technology
of DSM Dyneema with the clinical expertise
of the university, this project aims to
develop new solutions that support the
trend toward minimally invasive procedures
as well as the need for preservation
of mobility. The project team will focus on
leveraging Dyneema Purity, an Ultra High
Molecular Weight Polyethylene fiber offering
maximum strength and minimum
weight, to enhance post-operative mobility
and quality of life for surgery patients as a
result. Furthermore, the high strength-toweight
ratio of Dyneema Purity enables device
miniaturization to support minimally
invasive surgical techniques that promote
faster recuperation and reduced scarring.
Dr. Lodewijk W. van Rhijn, orthopedic
surgeon at the University Hospital Maastricht,
explains, “The dynamic nature of
cable constructions made with Dyneema
Purity enable preservation of mobility as
well as fixation. This combination of properties
opens-up numerous possibilities
for improvements of surgical techniques
and devices. The results of the project are
expected to allow me to improve the patient’s
quality of life.”
The research agreement has initially
been set for one year. Both organizations
have expressed willingness to continue the
project over a longer term once the results
in the first year support such continuation.
Development of an actual prototype device
will take several years.
Dyneema Purity fiber is 15 times stronger
than steel on a weight-for-weight basis.
It provides a high level of stiffness and resistance
to fatigue and abrasion. This material
has successfully been independently
tested for cytotoxicity, sensitization, irritation,
and mutagenicity.
www.dsm.com
New CAD System in Fontana Women’s Hospital, Chur, Switzerland
The Fontana Women’s Hospital
in the Swiss town of
Chur installed a Digital Mammography
CAD System from
Carestream Health in June
2007, since when it has successfully
been in full clinical
operation.
“My experience up until now shows that
the Carestream CAD System is a significant
step forward in the diagnosis of breast cancer,”
said Dr. Gerold Reutter, leading physician
in Radiology, Fontana. “The digital
mammograms clearly outclass traditional
images in terms of detail resolution, making
our findings more reliable. Furthermore,
it is a well developed system and
through regular updates it keeps pace with
changes and remains state of the art technology
in computer based diagnostics.”
Images are captured using a Kodak Directview
CR 975 System and displayed on
a high-resolution mammography workstation.
The CAD System highlights suspicious
areas on the monitors with triangular
and star shaped markers. “With these tags,
the CAD system shows me points of potential
interest,” comments Dr. Reutter. “The
triangles clearly indicate the micro calcifications;
the star shaped marks indicate
denser soft tissue relative to the surrounding
tissue structure. We know that there is
a high correlation between the preliminary
stages of carcinoma and the formation of
a micro calcium group of 5 calcifications/
cm 2 . The CAD System from Carestream
Health highlights such a group and this
helps us in our diagnosis. The accuracy of
findings is very high.”
Dr. Reutter also finds image quality to
be better when compared to conventional
mammography with improved contrast,
Carestream’s CAD
System highlights
suspicious areas
on the monitors
with triangular
and star shaped
markers.
detail and resolution and that by comparison,
conventional images have a blurred
and dull effect. The once indispensable
magnifying lens is also now no longer
needed at the workstation with the ability
to enlarge part of the image marked by the
CAD system.
Digital mammography not only enhances
the reliability of diagnosis, it also provides
workflow benefits. For example, the
highly developed, integrated speech recognition
system enables the direct recording
of findings and automatic conversion
into written text files. All the image data is
downloaded and stored for instant recall
and can also be printed or sent via e-mail.
www.carestreamhealth.com