As medical imaging devices continue to advance in terms of their precision and functionality, the better to be integrated across a seemingly limitless number of clinical applications, technology vendors aren’t only considering ways in which to bring imaging to new users, they’re considering novelties in bringing imaging to patients as well.
Traditionally, stationary CT scanners are housed in securely constructed imaging suites, and patients are scheduled based on the ability of staff to turn the rooms over and prepare device settings for the next patient. However, given certain conditions in which it’s inadvisable to move patients, combined with clever safety workarounds brought about by the novel coronavirus (COVID-19) pandemic, product designers are now considering the value of adding functional mobility to the devices themselves, the better to cut down on infection risk, patient vulnerability and staff resources.
“Whenever we talk about portable CT, it’s really about bringing critical care imaging directly to the patient without having to transport the patient down to radiology,” said Dena Cunningham, director of business development for mobile CT at Siemens Healthineers North America of Malvern, Pennsylvania.
In addition to mitigating the impacts of cross-contamination among multiple patients (especially during the COVID-19 pandemic), and supporting infection controls in a hospital setting, transporting patients also requires personnel resources. It takes staffers away from other duties, adds to table time during potentially critical moments for patients, and exposes patients and staff to the possibility of additional adverse effects during the move.
The 32-slice SOMATOM On.site CT scanner from Siemens Healthineers – its first entry into the mobile CT market – aims to give ICU physicians the freedom to conduct vital imaging studies on patients without transporting them out of critical-care environments.
The SOMATOM On.site CT is a small-format, portable device intended to conduct head imaging of patients suffering from strokes, head trauma, neurological conditions, or other conditions in which repeated, daily head scans are recommended. It’s especially useful for head imaging of patients whose conditions prohibit moving them, and for providing follow-up studies of patients who’ve been triaged.
“Instead of moving critically ill patients to radiology, we’re able to keep them in their beds and provide the imaging,” Cunningham said. “That’s really our focus and our introduction into the market with a mobile CT.”
Among the challenges of developing a self-contained, portable CT scanner are issues related to patient safety. Imaging equipment typically requires the construction of a heavily built room designed to insulate both patient and technologist against the effects of ionizing radiation. The front and rear gantries of the SOMATOM On.site system are self-shielded against radiation; once patients are placed within it, protective drapes can be secured around their heads, and technologists can remain with them throughout the study. Its telescopic gantry houses internal scanner components that move away from the patient, cutting back on scatter radiation as compared with other mobile CT scanners.
Integrated patient support accessories on the SOMATOM On.site include a head holder and body support for neuro imaging without bed adapters or special connectors for differently designed beds. Its motorized trolley and integrated camera enable operators to navigate more easily through crowded hospital hallways through a real-time display.
Cunningham stressed that the SOMATOM On.site is “a true CT scanner” that won’t compromise on image quality for the sake of its added mobility. Its fan beam is “typical of what customers in imaging expect” of a stationary scanner, she said, and its 32-slice Stellar detector and dedicated X-ray tube offer a high level of detail (down to 0.8 mm slice reconstruction) in images captured through the study.
“We have been asked for many years if we were going to come out with a portable CT,” Cunningham said. “We used a lot of existing components, and added new ones, like a telescopic gantry, which moves away from the patient to allow for positioning, and then back into place. This is very comparable to a stationary scanner you would have in the imaging suite.”
Cunningham believes that facilities featuring dedicated neuro ICUs, comprehensive stroke centers or teaching institutions with residency specialties could be among the earliest adopters of the SOMATOM On.site. Patients with neuro critical conditions and post neuro-interventional procedures comprise their first tier of potential beneficiaries of the technology. And although she doesn’t foresee it replacing stationary CT units, Cunningham does believe the value of a device like the SOMATOM On.site will prove itself to be a powerful accessory to the radiology departments of facilities that can demonstrate a need for it among their ICU patients, particularly in pandemic conditions, under which staff and time can be in short supply.
“In some cases, this would be a standalone radiology purchase; in other cases, maybe a joint purchase with ICU,” she said. “It’s not just a benefit for the patient not being transported, it’s a benefit for the staff. If you can contain the patient in the ICU along with the staff, you’re not having that cross-contamination. By keeping the scanner in the ICU, you can clean it between patients.”
Matthew Dedman, director of CT product marketing and operations for Siemens Healthineers North America, said that although the SOMATOM On.site will best serve a specialty market, he’s seen a lot of imaging equipment head into specialty markets in the recent past.
“Increasingly, we’re seeing imaging being either installed directly in a specialty, like the emergency department, for example,” Dedman said. “I think that five to 10 years ago, you didn’t commonly see CT scanners directly installed in the ED. Now, as hospitals are constructing, it’s not a question of if CTs will be there, it’s how many.”
“Increasingly, we are seeing cardiology want to purchase and operate their own CT scanner because of the high number of patients who require imaging,” he continued. “CT is moving closer to the site of care and intervention. If we have success with this first iteration, it’s logical that we could see other places where it would be applicable.”
Cunningham also believes that specialty devices like the SOMATOM On.site could help other customers find their way into the broader family of Siemens stationary scanners, which Dedman described as “a very stable and active market just through normal replacement cycles.”
“A lot of these markets are coming to us because they want to improve the patient care from the ICU perspective,” Cunningham said. “Then, when the radiology department hears about it, they might be familiar with our equipment. It could be that customers aren’t aware that we have a mobile CT because it’s new for us.”
“I think we’ll investigate and see where the market takes us,” she said. “A lot of it is finding out what the customers need.”
One of the first users of the SOMATOM On.site has been Dr. Mara Kunst of Lahey Hospital & Medical Center (LHMC), a 344-bed adult hospital in Burlington, Massachusetts. Kunst has been its neuroradiology section head since 2017, and is a decorated teacher with interests in stroke, artificial intelligence and quality improvement in neuroradiology.
LHMC ticks a lot of the boxes Cunningham had identified in potential customers for the SOMATOM On.site: it’s a comprehensive stroke center and a Level 1 trauma center with a large neurosciences practice, receiving patients from surrounding states for treatment of a broad range of concerns: stroke and trauma, brain tumors, demyelinating disease, and rare autoimmune and infectious etiologies.
“Our goal in utilizing the portable CT scanner for our practice is to bring this potentially lifesaving imaging technology to the patient’s bedside, thereby limiting the risk of patient travel,” Kunst said. “Those risks are numerous, and include misplaced lines and tubes, disconnected monitoring equipment, and the disruption to the ICU by the removal of staff to accompany the patient to the CT scanner.”
Urgent CT studies can be particularly useful for conditions like intracranial hemorrhage, stroke, impending herniation or the evaluation of a recent surgery, Kunst said. Bringing the scanner to the patient mitigates the impact of risks associated with moving patients facing any of those circumstances, she said, but also “translates to economic advantages as well,” in terms of staff resources and potentially faster, more accurate resolution of conditions that must be closely observed.
That’s not to say that the SOMATOM On.site doesn’t demand its share of resources. Kunst notes that operating the portable unit requires a trained technologist and assistance from ICU nurses to help position the patient; she notes that those considerations should factor into any decision to add a portable unit to a practice.
Kunst said that although she only used the device for head CT, “the scanner is capable of performing contrast enhanced exams and CTAs.”
“I would, however, imagine limited coverage of the neck for CTA given the configuration of the scanner, depending on the patient’s anatomy,” she said.
“Certainly, these technologies could prove useful in an interventional neuroradiology suite, prior to intervention or even in the operating room, although the clearest indication seems to be for monitoring of ICU patients,” Kunst said. “When not in use for these indications, it is capable of performing routine outpatient head CTs.”
Adding the function of mobility to imaging technology doesn’t necessarily mean only incorporating it within the devices themselves. In the case of the “CT in a Box” solution from GE Healthcare, the manufacturer created a purpose-built product intended to support medical imaging demands in high-risk environments – like Wuhan, China, amid the onset of the COVID-19 pandemic.
While the capital city of the Hubei province was rapidly becoming overwhelmed by thousands of patients who’d fallen ill with an as-yet-unknown ailment, clinical demands from overcrowded hospitals and their exhausted staffers led to the city constructing 16 “mobile cabin hospitals.” These pop-up facilities eventually supported some 12,000 patients and provided another 13,000 beds in the city, according to the Baltimore journal Medicine. GE Healthcare Beijing was invited to support these operations with medical imaging technologies like ultrasound, X-ray, and CT, which were used to help diagnose and monitor patients. The company responded by rolling out an all-in-one, portable CT scanning room that supported social distancing and safety requirements. From concept to design and production, the product was in use in less than 20 days; normally, a hospital can take two to three weeks simply to get a new CT system operational and compliant with required safety regulations.
“If you were going to sell a traditional CT, you have to prepare the room, general construction has to happen; but in terms of the concept of the box, you can build that unit offsite, put the scanner in it, and then ride it to the site, drop it off, hook up power, and be up and running and not have to do room construction,” said Chad Smith, chief hardware engineer, CT, GE Healthcare.
“It really gives you the versatility to get the CT up and running without having to impact internal operations.”
Although the emergent conditions under which the CT in a Box was rolled out is unlikely to replicate itself in the United States, where the saturated market for medical imaging devices has its own economics, Kaz Sato, general manager of performance and value CT for GE Healthcare, said the U.S. imaging trailer business reflects a comparable circumstance in remote areas that need additional imaging capacity.
“The U.S. is one of the biggest trailer mobile markets,” Sato said; “we’re starting to see this in China, too. The real needs we saw from the pandemic in a global market is accessibility to CT, which is used to scan for COVID-19.”
“Most importantly, patients need to be treated,” he said. “Imaging devices are one point of the workflow. It used to be that the patient got sent to the hospital, where other solutions were needed to access the patient. From a big vision perspective, it should be patient-centric treatment and workflow.”
“Our approach to mobile is more that we want to make sure people have access to the CTs they need, not only for COVID right now, but also in general,” he said. “Rural [global] communities are using these CTs in a Box; we’re just focused on a different part of it.”
The key to focusing on that expanded access could again center on the value and utility of mobility in imaging, Smith said; while it is one of the factors contemplated by design teams at GE, “overall, general workflow is key,” he said.
“How we can make the scanners more efficient in the hospital?” Smith said. “Whether it’s mobile or AI technologies, camera-based technologies; anything that can provide the workflow, we want to work with our customers to gain insight into what areas are going to be the best to help them.”