Monday, April 28, 2008

Cath Labs, Angiography Suites, and EP Labs

A medical equipment planner usually finds the more complex areas of the hospital the most interesting to plan.

These 3 rooms are some of the most equipment intensive and expensive areas within a hospital. All 3 rooms are using similar imaging equipment, however the specifics of what these diagnostic studies are used for vary slightly.

In a catheterization laboratory (Or Cath Lab) the emphasis is on the heart and the blood vessels delivering oxygen to the heart muscle. The images generated by the study will allow doctors to visualize if there are any problems in the hearts ability to pump blood or restrictions in the ability to deliver blood to the heart muscle. Here is a brief video explaining the Catheterization procedure:

In an Angiography Suite (Also called Special Procedures or Angio Lab) the focus expands to other parts of the circulatory system. The legs, arms, neck and head are imaged to determine if there are blocked or compromised blood vessels. A corrective procedure, called an angioplasty, can be done to repair a blocked or narrowed vessel. The differences in designing a Cath Lab or an Angio lab are minimal from an architectural perspective. The Cath Lab is focused specifically on the heart, so the patient will be situated on the table with the imaging device focused on the center of the chest. In an Angio suite, the study may be on an arm, leg, or other area of the body, so the imaging table may be extended to allow the part of the body to be underneath the imaging device. It is this "travel" of the imaging table that requires an Angio Suite to have greater freedom of movement. Of critical importance is designing the room to allow full articulation of the imaging table. In an angio suite, the table may be extended and rotated on an angle to best position the patient.

Here is a video of a patients upper right-side. (Imagine the position a patient would have been be in to accommodate this image.)

Another difference between traditional Cath Labs and Angio Suites is the size of the imaging head - called an image intensifier. This is simply the diameter of the video image. Typical sizes of the image intensifier are in 1 inch increments from 7 inches to 16 inches. The smaller sizes are common for Cath Labs, while the larger sizes are common for Angio Labs. While this may seem counter-intuitive (You might think the heart would have the larger view and the arteries a smaller view) the heart has a very defined location and size, so the smaller image-intensifier is adequate. In an Angio procedure, the additional diameter of view allows for the clinicians to view other structures around the suspect vessels. Essentially, it is the ability to see the forest, not just the tree.

Finally there is the EP Lab or Electro-physiology lab. These rooms are specialized in analyzing the electrical signals controlling the heart. When a patient has issues with a fast,slow, or irregular heart rate, the cause may be with the electrical signals being sent to the heart. The EP lab uses sophisticated monitoring equipment to trace and record the path of the electrical signal and allows the clinician to recommend corrective action. These corrective actions may include invasive procedures, such as implanting a pace maker or ablation therapy. Here is a video offering an overview of how electrical signals control the heart. This particular video references using an EKG, not an EP lab, but the explanation of the physiology of the process is excellent.

Here are photos of each type of room. You will find them to be almost identical in view. A large C-arm shaped x-ray device, an imaging table, and several ceiling mounted monitors to allow the clinicians to view the live video, archived, and other reference images.

Cath Lab

Angio Lab

EP Lab

In addition, CT Scanners are being widely used for angio procedures. The broad functionality of CT scanners allows them to deliver a wide variety of images, helping facilities achieve a greater return on investment. Single-function devices, such as a Cath lab or Angio suite require a return-on-investment to justify the cost to purchase and operate. (1 million is the minimum cost to equip a room). Manufacturers will continue to try and expand the range of applications their devices can provide as healthcare providers are tasked with creating greater value for their dollar. CT, MRI and possibly other modalities will continue to be offered as alternatives. Cath/Angio Suite are also common, allowing the same room to be used for both types procedures.

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