Case Study

Cath Lab System Boosts Efficiency of Cardiac Care Services

By Bilal Ezzeddine, Ph.D and Bob Nitti


•Cath Lab Challenges
•Goals and Planning
•The System at Work
•Connectivity with Middletown Hospital
•Plans to Expand

Striving to maintain an advanced level of medical technology, Kettering Medical Center (Dayton, OH) decided to redesign its cardiac catheterization lab capabilities in April 1997. A mere eight months later, the 500-bed facility was operating a first-of-its-kind cath lab system in the U.S. Custom-designed by Kettering and Siemens Medical Systems (Iselin, NJ), the system enables physicians at outlying hospitals to transmit cine images over a computer link for immediate consultation with surgeons and cardiologists at Kettering.

This capability saves valuable consultation and treatment time by permitting physicians at each hospital to consult on best care practices before patients are transferred to Kettering for surgical procedures. Previous efforts had taken hours or even days when the same procedures were recorded on film.

As a result, cardiologists at Kettering are experiencing significant improvements. The new system lets them:

  • review images of the procedures immediately after completion
  • dictate their impressions and instantly share images with other physicians at Kettering or neighboring hospitals

The time-savings benefits both the physician's ability to consult on a case as well as the capacity to diagnose and provide patients with optimal care.


Cath Lab Challenges

Prior to installing the new cath labs at Kettering, the not-for-profit acute-care center operated two biplane (two imaging sides) catheterization labs. However, despite upgrades to digital tape, cardiologists at the facility still found the image quality hazy, making viewing stents at certain angles difficult.

In addition, because the systems produced tape images, cardiologists often had to manually search for patient exams. The review process took even longer when surgeons at Kettering were asked to consult on patient images produced at other regional facilities, such as Middletown Hospital, a 200-bed hospital 30 miles away. Consultations with other physicians were not only delayed, but also valuable treatment time was lost.

Storage posed another problem. Due to space limitations, the film and tapes produced by the two labs were kept at an offsite facility approximately 10 minutes from Kettering, which made retrieving patient records quickly difficult.


Goals and Planning

Internal department moves within Kettering opened up 6,000 sq ft of space for the new cath lab suite, which enabled hospital administrators to develop a system that would not only handle current needs, but also accommodate future growth through links with remote hospitals. As a result, goals for the new labs included the ability to:

  • share quality digital images with departments throughout the hospital and outlying hospitals to provide surgeons and cardiologists with instant access to these images
  • archive patient data from initial images through final outcomes for immediate retrieval
  • eliminate the use of tape and film, as well as the need for archival space in a separate facility

In the next few months, representatives of Kettering visited North Shore University Hospital (Glen Cove, NY), Gross Hagen Clinic (Munich, Germany), and the Siemens Medical Engineering Group headquarters (Erlangen, Germany).

At the two facilities in Germany, Kettering representatives saw demonstrations of Siemens' ACOM.Net advanced digital archiving and communications network for cath labs. Specialists demonstrated the system's ability to provide up to eight simultaneous users with real-time and direct PC access to high-quality digital information networked to a central server and archiving system. Kettering officials also learned how the archive could be expanded to include 19,000 disk files for easy access through the system's patient directory.


The System at Work

The first procedure produced by Kettering's new cath labs was performed six weeks after the cath lab equipment and ACOM.Net system were delivered. The facility's new services include two biplane cath labs and a biplane electrophysical lab. A third cath lab is expected to be operating by year's end.

Currently, ACOM.Net PC review stations are networked and installed within the cath labs' conference room, administrative office and family consulting area, as well as in the teaching amphitheater. Each operates with Windows NT software, which allows physicians to easily point-and-click to an onscreen icon and begin a cine loop of a patient procedure for review with patients and/or other physicians.

Networked connections offering near-instant access to archived files are provided by an ACOM.Server, ACOM.PC.sw and an ATM network running at 155 Mbps. The system also includes an ACOM.Link to offer real-time communication. DICOM 3-compliance ensures connectivity in a multivendor environment.

By summer's end, four workstations are scheduled to be running in two physician offices, the hospital's operating room, and surgical floor for additional access to archived files and faster review and treatment procedures. This is the ultimate advantage of ACOM.Net: it allows immediate access to the exams using inexpensive ACOM.PCs. And its Windows-NT based application doesn't compromise speed of access or playback rate.


Connectivity with Middletown Hospital

Besides internal benefits, Kettering has also designed the cath lab network to connect with neighboring Middletown Hospital via a city-wide network originally installed by the Greater Dayton Area Hospital Association. Using the ACOM.Net PCs located at both hospitals, surgeons at Kettering can now consult with colleagues at Middletown while instanty reviewing patient cine images.

Because Middletown doesn't offer surgical services and often refers cardiac patients to Kettering, the new system benefits physicians and patients in several ways. First, the system allows Kettering physicians to jointly review the catheterization images of Middletown patients with the Middletown physicians within three to five minutes after a procedure. Previously, physicians at Kettering had to wait nearly two hours to review the films, which were either sent from Middletown or transferred with patients.

Second, the new network link streamlines the review and treatment process, allowing more than one specialist at Kettering to be available 24 hours a day for consultation with Middletown physicians and patients via ACOM.Net. As a result, patients, physicians and healthcare systems all benefit from faster consultations and, therefore, optimized diagnoses and treatments.

Plans to Expand

Through last June, cath lab images of nearly 200 Kettering patients were stored on Kettering's ACOM.Server for immediate retrieval over ACOM.Net PCs located throughout the Kettering enterprise. This enables physicians to readily review patient records, update them with descriptions of new procedures and treatments, and allow other physicians to do the same for years to come.

In addition, the network link between Kettering and Middletown Hospitals proved so successful at saving valuable diagnostic and treatment time, as well as improving patient care, that plans are under way to provide ACOM.Net links from Kettering to at least two other area facilities.

Bilal Ezzeddine, Ph.D., has been a full-time consultant at Kettering Medical Center for the past eight years. He is responsible for evaluating, recommending and adding value to medical imaging equipment including MRI, CT, nuclear medicine, cardiac systems, PACS, and other advanced technologies.

Bob Nitti is a product manager within the Cardiology Division of Siemens Medical Systems. He is responsible for sales and strategic planning in the U.S.