Insightful Interview With Dr. Allen – The Dangers Of Fluoroscopy

As a part of the medical device community, our team is incredibly excited about some of the advancements currently being made in our field. Though we are a large part of many of these advancements, learning more about progress is a priority for us. No matter how intricate and precise our product becomes, we know that there will always be more to learn and understand about interventional medicine and medical system advancement. It is this focus on education that keeps our company growing.

We sat down with Dr. Allen to discuss his field and ours, to glean some unique insight on the future of the medical community and how he views the progress that’s being made. If you missed our first post about the interview, you can read it here.

We wanted to reflect on some of the information we didn’t get to in the first blog, to give a more complete representation of how this incredible surgeon and researcher feels about the future. Specifically, we wanted to touch on some hesitations or concerns that he and other medical professionals may have about 3D shape sensing technology in heart surgery and cardiology.

What Concerns Would Surgeons or Cardiologists Have That Could Slow Down Shape Sensing Adoption?

Though all doctors take their patients’ safety seriously, and are therefore hesitant to change something that is working, Dr. Allen seems to think that adaptations to new, better technology will be easily made. He said, “There’s certainly a resistance to change, but not just because people don’t want to change, but because when a patient’s life is at stake it’s always easiest to follow the familiar; you know the outcome of doing what you’re used to.

There’s also an element of time required to learn a new technology. However, I’m a believer that when a technology is better, it’s not going to matter, people will adopt it. It reminds me of when surgeons were first putting artificial heart valves into the aorta via a catheter instead of using open-heart surgery.

Initially, not a lot of surgeons wanted to do it, they were skeptical, but now it’s commonplace. If something works and it’s better, you have to learn it or you’ll fall behind.  Shape sensing is one of those things. If you can see it and use it, you will get excited about the ways it can improve the lives of doctors and patients.”

Part of the reason that surgeons may be open to new methods is the stark limitation of current procedural practices. We wanted to know just what kind of limitations arise in current interventional cardiac procedures.

What is the “Gold-Standard” for Navigation in Minimally Invasive Surgery Today? What Limitations Does This Have?

Dr. Allen said, “The gold standard, by far, is doing almost all cardiac interventional procedures with fluoroscopy or radiation. It’s the way we’ve always done it. It allows us to see clearly and know exactly where we are.”

However, he expanded greatly on how current methods can be improved. He elaborated by saying, “First of all, it requires radiation exposure– not just to the patient, but to all the staff that are in the room. Everyone has to wear a lot of lead all over their bodies, and we keep increasing the amount of lead to cover more areas – we wear lead glasses, as there are incidents of cataracts developing in medical staff. We wear lead around the neck to prevent thyroid problems.

If you’re a nurse or doctor that’s doing multiple of these procedures a day, you’re exposed to a lot of radiation, the patient is too. Unfortunately, we can’t cover everything.  There is now a concern for brain tumors since the head is usually not protected by lead.  Radiation is definitely a limitation.

Next, fluoroscopy is only 2D, meaning that you only can look at a flat screen. If you want to see where something like a catheter is in another dimension, you have to move that flat screen to a different view to understand if you are anterior or posterior , above or below something, etc. You need fluoroscopic equipment and a special table. You can’t use just any table, you need the X-ray beam to go through it.

This often requires a special suite that has all the equipment. If you’re in the operating room with a patient and you unexpectedly need fluoroscopy, a lot of shifting needs to occur. Everyone needs to put on lead, you need to make sure the table is compatible with the X-ray unit, and then bring in the fluoroscope and a monitor to see the fluoroscopic images. However, even with these limitations, it’s still the gold standard.

Finally, in order to see with fluoroscopy, you often need to use dye. The dye is what helps to show the blood vessels; because they are not opaque, they don’t show up on an X-ray. The dye is also associated with complications for the patients. If you have kidney problems, too much dye can cause renal failure. Some patients are allergic to the dye and have an allergic reaction. If we have a patient with marginal kidney function or low blood pressure, we have to think twice about whether we can do the procedure and we need to ensure we can do it using very little dye. It’s another problem that I’d like to get rid of if we could.”

The radiation piece was a concern for us. We asked him to speak further on potential complications for medical staff.

We’ve Heard Many Stories About Damage Caused to Physicians, Technicians, and Nurses Due to Radiation Exposure During Minimally Invasive Procedures. Have You Experienced This Personally, Either to Yourself or One of Your Colleagues?

He spoke openly about this saying, “I haven’t experienced this personally, but there certainly are a lot of reports out there, and I have heard some surgeons and especially cardiologists speak of developing cataracts or other problems. The hope is that increased lead protection will help prevent most of these complications. However, you have to remember something about radiation: damage is a cumulative effect. You often don’t see the effects right away, they usually show up later.

There is growing evidence of the hazards fluoroscopy presents to the doctor, the staff, and even the patient. Because of lengthening procedure times and the commonality of minimally invasive cardiac procedures, clinicians and ancillary staff are assuming even greater risk that they may develop a problem. These risks include tumors, premature brain and vascular aging, cognitive decline, reproductive problems, early development of cataracts, skin lesions, and increased cardiovascular and mortality risk. It would be nice if the technology developed so everyone didn’t have to wear all of that lead all the time.”

The Future is Coming

Though these concerns are valid, our team and many others around the globe are working to mitigate or eliminate risks by implementing new 3D shape sensing technology. We believe this is a powerful navigation solution as we work to rewrite the standard process. When we listen to and address the concerns of professionals like Dr. Allen, we can make a more reliable, truly innovative product that will give the industry exactly what it needs.

If you are interested in implementing our shape sensing technology into your product, machinery, or industry, contact us online today.