Teknologi demi Keselamatan

Philips Health Systems

Agustus 2019
 Cath-Lab?

Laboratorium kateterisasi adalah ruang

pemeriksaan di rumah sakit atau klinik
dengan peralatan pencitraan diagnostik
yang digunakan untuk memvisualisasikan
pembuluh darah arteri jantung dan ruang
jantung dan mengobati stenosis atau
kelainan yang ditemukan.

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 Bagaimana Dokter Melakukannya?
❑ Jarum dimasukkan pembuluh Arteri, dan melalui jarum di
masukkan Guiding Wire

❑ Kemudian Jarum dikeluarkan dan dengan bantuan pencitraan

gambar cathlab, dokter melakukan diagnostik dengan
mengarahkan wire menuju jantung

❑ Diagnostik dilakukan dengan merekam vital pasien menggunakan

Haemodinamyc system

❑ Diagnostik juga menggunakan contrast media yang membantu

dokter melihat kondisi pembuluh darah

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4
 Safety – Keselamatan

Objek:
1. Peralatan: kegagalan fungsi, kinerja yang buruk
2. Lingkungan: listrik, suhu, kelembaban
3. Peralatan penunjang: UPS, Injector, pendant, alat operasi, printer, dlsb.

Jenis:
1. Elektrikal
2. Mekanikal
3. Radiasi
4. Bio hazard

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 Keselamatan
Pasien, Pengguna, Umum

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 Kegagalan fungsi alat

- Sebelum pemeriksaan
- tertunda pelayanan kepada pasien
- Saat pemeriksaan:
- Pemeriksaan harus diulang
- Pemeriksaan terhenti tidak dapat dilanjutkan
- Keselamatan pasien pada pemeriksaan invasif
- Setelah pemeriksaan
- Post processing tidak dapat dilakukan
- Hasil pemeriksaan hilang

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 Kegagalan fungsi alat

Kegagalan mempunyai sifat acak, tidak diketahui kapan akan terjadi namun umumnya
memberikan gejala awal
- Dikenali oleh pengguna
- Suara tidak normal
- Gerakan tidak halus
- Respons lambat
- Perilaku tidak seperti biasa
- Dikenali oleh alat
- Selftest
- Counters
- Trends
- Alarm/Alerts

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 Keselamatan elektrikal

Macam Electrical Safety

➢ Earth bonding test
- Melindungi dari sengatan listrik bilamana terjadi kerusakan/kegagalan (fault)
➢ Earth leakage test
- Menjamin alat tidak menghasilkan arus bocor melebihi yang diperbolehkan.
➢ Insulation test
- Melindungi dari bahaya listrik dari peralatan lain

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 Keselamatan Mekanikal

Bagian yang berat dan bisa lepas

- Konstruksi
- Pengunci / kait

Bagian yang bergerak secara otomatis : motor, hidrolik, pneumatis perlu Collision
detection:
- Limit switch
- Pembatas arus
- Bodyguard

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 Keselamatan Radiasi

Kepada pasien:
- Optimum image quality
- Skin dose
- Air Kerma / DAP

Kepada user/operator:
- Proteksi pribadi
- Kolimasi
- Dosis dan filter

Terhadap masyarakat umum:

- Proteksi radiasi di ruangan

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 BioHazard

RS mempunyai pengetahuan dan kompetensi lebih baik

dibandingkan Philips.
Perlu kerjasama untuk menjaga keselamatan bersama.
- Penularan ketika berada di site
- Penularan ketika parts kembali ke gudang

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Philips Technology untuk Safety

• BodyGuard
• Spectral Filter
• Grid switch controlled pulsed fluoroscopy
• DoseWise
• ClarityIQ
• Zero Dose Positioning
• Dynamic Coronary Roadmap
• StentBoost Live
• DoseAware
BodyGuard senses the patient and stops before collision.
Safely move arm with high speed

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 Trends & challenges:
Effects of radiation dose
While the benefits of CV procedures to the patients are undisputable, all these procedures
contribute to high accumulated radiation doses to the patient population with consequent
stochastic effects or skin burns.

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 Allura Xper

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 DoseWise ingredients
DoseWise Allura , standard in ALL fixed systems

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 Leading the way in dose management

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 AlluraClarity

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 Key Benefits of AlluraClarity

Decreased scatter
Dramatically reduces X-ray dose
radiation a,b

Reduced risk of Enabling longer Enabling longer Reducing long-term

complications from procedures to treat more complex health risk for
radiation exposure obese and high-risk procedures a,b physicians and
for patients a, b patients a,b staffa,b

Significantly lower dose- across clinical areas, patients and operatorsa

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 AlluraClarity with ClarityIQ technology
With AlluraClarity we’ve changed the equation
Patient Dose

Allura Xper

AlluraClarity

Localization Characterization

Required Image Quality Allura Xper AlluraClarity @ 50% dose setting

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 ClarityIQ technology
Touches every part of the system, from tube to display
P Real-time Pixel shift with
Automatic Motion Control
I Image enhancement
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1. Powerful image processing
technology
– Pixel Shift, Motion Compensation,
Noise Reduction, Image
Enhancement implemented on real-
time
2. Flexible image pipeline: Tailored
processing and fine tuning for
each and every application area.
“Flexible asset”
3. Clinically fine-tuned parameters
across the entire imaging chain
over 500 system parameters
(tube, detector, image processing)
fine-tuned for each application
area
M Motion compensation
N Noise reduction
 ClarityIQ: “Software and Hardware” connection

Spatial
Patient Filtering Image
Dose Quality

Lower Smaller
mA Focal
Spot

Auto
Cu Pixel
Shift
Temporal
Shorter & Filtering
Steeper
Pulses
P Real-time Pixel shift with
Automatic Motion Control
I Image enhancement

M Motion compensation

N Noise reduction

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 P
Pixel Shift – Neuro roadmap

Balloon
Glue

Without auto pixel shift

Glue
Balloon

Click to animate Automatic pixel shifting

With auto pixel shift
on pixel
Automatic live roadmap
shifting on live roadmap

24 This material is not for distribution in the U.S.A.

 P
Pixel Shift – DSA

Before After

Automatic pixel shift in DSA

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 Same IQ at 73% less X-ray dose*!

Allura Xper AlluraClarity with 73% less dose

In an interventional application, the AlluraClarity Series an equivalent similar diagnostic image quality in digital subtraction neuro-angiographic exams at an average of
73%* lower X-ray dose compared to the previous default settings.
* In a clinical study, the measured dose reduction ranged from 70%-75% at 2 frames per second.
NOTE: In clinical practice, the use of AlluraClarity Series , the X-ray dose reduction may vary, depending on the clinical task, patient size, anatomical location, and clinical
practice. To determine the appropriate X-ray dose to obtain diagnostic image quality for the particular clinical task, please consult your physicist or radiologist.

Images courtesy Karolinska University Hospital, Stockholm, Sweden. Two separate injections: iodine not fully comparable

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 N
Noise Reduction

Before After
Note vessel delineation

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 AlluraClarity with ClarityIQ technology
83% dose reduction in Endovascular Applications
AlluraClarity

Allura Xper AlluraClarity

2 frames/second DSA
@ 48cm FOV; 30° oblique
0.00 mm Cu + 0.00 mm Al
DAP: 3338 mGy∙cm2 / frame
AK: 8.5 mGy / frame
2 frames/second DSA
@ 48cm FOV; 30° oblique
0.10 mm Cu + 1.00 mm Al
DAP: 464 mGy∙cm2 / frame
AK: 1.2 mGy / frame

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 M
Motion Compensation

Raw image Basic Temporal Filtering ClarityIQ Temporal Filtering

More images = less noise More images = less noise

But, motion between images = Motion-compensated temporal filtering
shadow = less shadow

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 Procedural patient dose per cardiologist
- Results on dose and IQ: one patient comparison -

Patient (male, 60 years old, 169 cm, 63 kg) treated with AlluraXper and AlluraClarity by
cardiologist 1.
CA performed with Allura Xper:
FT= 5.4 min, CMV= 55cc, nr images= 2110, DAP= 102Gy.cm^2.

Eight months later the patient returned for a routine follow up, with AlluraClarity:
FT= 6.9 min, CMV= 76 cc, nr images=2300, DAP=43.5 Gy.cm^2 (reduction of 57%)

Left Coronary Artery (RAO30°, CAUD25°)

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 Optimized cardio X-ray acquisition chain

Fluoroscopy:
AlluraXper EDL [R/min] 5 10 10
AlluraClarity EDL [R/min] 2.5 5 9
Cardio AlluraXper Exposure

Exposure (cine acquisition):

Coronary Biosense
AlluraXper 15 fr/s ClarityIQ
EP Biosense

Left Coronary Right Coronary Left Coronary Left Ventricle

AlluraClarity 25% 50%
15 fps
100%
15 fps 15 fps 15 fps

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 AlluraClarity – clinically proven
Significantly lower dose – across clinical areas, patients and operatorsa

Monoplane – FD20 Biplane – FD20/15, FD20/20, FD20/10

Radiasi = laju dosis x durasi paparan

Advanced Tools

Allura 3D-RA XperCT 3D Roadmap MR/CT Roadmap XperGuide/Ablation 2D Perfusion

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 Azurion

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 Azurion

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 Azurion setup with PRO functionality

FlexVision PRO & TSM PRO

Exam Room Control Room
Customizable & resizable pre-configured layout, change
signal sources on-the-fly, Quick Access & Control 3rd party
applications at tableside

Organize, View and Control via

…
FlexSpot
Customizable & resizable pre-configured layout, change
signal sources on-the-fly & Fast access to all application
including 3rd party within one screen
 • flexvision pro, TSM pro membuat workflow menjadi lebih efektif dan efisien,
karena semua bisa dilakukan di table side. Selain itu juga meminimalisasi “sterility
break”karena user tidak perlu bolak balik dari Control room ke procedure room.

• Dengan Flex Spot maka efisiensi workflow di Control room juga menjadi lebih baik,
operator tidak perlu pindah dari 1 workstation ke workstation lain karena bisa
diakses dari flexspot saja (5 monitor menjadi 2 monitor juga meminimalisir “room
occupation”)

• Dengan “Ïnstant Paralel Working” maka kerja beberapa pekerjaan di cathlab yg

tadinya dilakukan secara bergantian (serial) sekarang bisa dilakukan secara
berbarengan sehingga mengurangi total procedure time di cathlab”.

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 Dynamic Coronary Roadmap
Making the difference in Coronary Interventions

Key benefits

• Real-time, automatic, motion-

compensated coronary imaging for easier
image guidance

• Store and easily re-display previously

acquired roadmaps and enhance
procedure efficiency

• Integrates seamlessly into standard of

care workflow and daily clinical practice

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 StentBoost: Built on Legacy
Evolution of StentBoost
2012 – R4
Vascular StentBoost

2010 – R3
StentBoost Subtract
2003 – R1
2007 – R2
StentBoost

Classic Angiography

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StentBoost Live
To help save lives,
you have to see live
 make the invisible visible

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DoseAware
DoseAware Xtend
Live screen

Real-time radiation in mSv per hour

PDM battery
level indicator

Performance
indicator that
no lead
shielding is used
for X-ray
protection
TERIMAKASIH