The Alphenix Biplane Cardiac Solution: Toyohashi Heart Center Delivers High Image Quality and Lower Dose Exposure

In June 2018, the world’s first installation of the new Alphenix
Biplane was completed in Cath Lab 1 at the Toyohashi Heart Center in Japan. For Dr. Kenya Nasu and his team, it was the start of something truly remarkable.

I can’t deny that the Alphenix Biplane came at precisely the right moment for me and my team. Every day, we diagnose and treat a large number of patients with cardiovascular disease, and while our current Infinix-i system was doing a great job, we always felt that it wasn’t quite hitting the spot in terms of image quality and exposure dose. We needed something more advanced.

Having used the Alphenix Biplane for more than a year now, I am pleased to report that we got exactly what we needed and more. Overall, the system has achieved both better image quality and lower exposure dose. In addition, we have been more than satisfied with its performance during routine clinical practice, endovascular treatments, percutaneous coronary interventions, and procedures for structural heart disease.
Dr. Kenya Nasu / Director of Cardiovascular Medicine / Toyohashi Heart Center / He specializes in cardiac endovascular treatment and is recognized as a leader in this field both in Japan and overseas.
Here are some of the highlights we have experienced:

Drastically improved image resolution

I have now performed several PCI procedures on the Alphenix Biplane. In comparison with the Infinx-i system, it provides significantly enhanced visibility and improved contrast at vascular margins. This is particularly useful for channel tracking chronic total occlusion.
With the conventional system, we used a frame rate of 15 fps, but with the Alphenix Biplane, a rate of 7.5 fps was perfectly acceptable for most patients. What’s more, image lag near vascular margins was suppressed to minimal levels, even with view angles strongly affected by cardiac motion, and the system’s performance was further improved by a standard update, installed in October 2018.

A new Stent Mode for routine practice

The Alphenix new Stent Mode enhances signals from devices such as stents through high-speed image processing, thus improving the visualization of these devices in real-time. Stent images can be improved with or without the use of a balloon marker, and there is no need to fix or add the stent. This feature is particularly helpful because it allows us to perform all procedures according to our standard workflow.

In addition, we now employ Stent Mode routinely in our clinical practice. When a stent fracture is suspected in diagnostic cardiac catheterization, Stent Mode is extremely effective because it allows the stent to be clearly seen. Other manufacturers offer similar functions, but these cannot match Canon Medical’s real-time visualization capabilities, permitting the balloon site and overlapping stent to be fully visualized.
The edges of stents are enhanced without affecting the dose (marker-less application).

Minimal dose during fluoroscopy

Designed to maintain the required level of visualization at a much lower dose, Spot ROI and Spot Fluoroscopy are both intuitive breakthrough technologies only available for Alphenix interventional systems.

With Spot ROI, the standard level of radiation exposure is used only in the region of interest, while a substantially lower level of radiation exposure is used in surrounding areas – in some cases, 60-70% less. In addition, Spot ROI minimizes scattered radiation and reduces exposure not only to the patient but also to the operators by limiting it to the area in which intervention is performed.

What’s more, I frequently use Spot ROI in situations where I need to focus on a limited area, such as in bifurcation wiring procedures. With the conventional system, when we attempted to reduce the exposure dose by collimating the area to be treated, the areas outside the ROI were completely black, and there was a risk of structures or devices moving out of the frame due to cardiac motion. Operators were also forced to maintain a high level of concentration when viewing through a small hole in a totally black background. With Spot ROI, on the other hand, the surrounding reference areas appear as if seen through frosted glass, and the entire image moves in synchronization.

“The C-arm movement through various positions during a set of routine examination procedures, was around one minute and forty seconds – considerably far less than it took for other systems.”

Dr. Kenya Nasu
Director of Cardiovascular Medicine

A new Dose Tracking System to visualize real-time estimated skin dose

The Dose Tracking System (DTS) is considered to be particularly helpful for inexperienced operators, who tend to perform entire procedures without changing the imaging exposure angle. DTS can assist the operator by providing a visual warning of potential hot spots. Plus, the estimated exposure dose to the patient's skin is calculated in real-time and displayed as a color-map on a patient model.

Smooth C-arm movement

Toyohashi Heart Center currently has four catheterization labs: one with an Alphenix Biplane, and three with systems from other companies. Compared to the systems from other manufacturers, the Alphenix Biplane’s C-arm is considerably faster and smoother. In fact, the time required to move the C-arm through various positions during a set of routine examination procedures, was around one minute and forty seconds – considerably less than the two minutes or more it took for the systems from other companies.

Easy-to-use controls

The Alphenix Biplane features a tablet console (Alphenix Tablet) that allows a variety of operations to be performed easily by pressing a single key or button. I have not yet used this tablet, but it definitely appears to reduce the workload for our radiology technicians. When new functions are added to a device or system, operation tends to become more complicated, but Alphenix has successfully streamlined the process by offering simple and intuitive touch-panel operation.

Expert support from Canon Medical

We find it easy to communicate with Canon Medical because it is a Japanese company. We enjoy excellent support and follow-up, and the company provides a meticulous service.

When the Alphenix Biplane was installed at our hospital, it was first assembled at the Canon Medical factory and then minimally disassembled for shipment. The system was installed in an astonishingly short period of time, and we have not encountered any problems since. I appreciate the pride of the company as a manufacturer of high-quality equipment.
The world's first commercial installation of Alphenix Biplane.

Looking towards the future

As our partnership with Canon Medical moves forward, I am particularly interested in the combined use of angiography and CT to improve diagnostic accuracy, for example, to achieve precise phase synchronization in both diastole and systole.

I would also like to see closer integration of angiography and ultrasound and improved integration with intravascular ultrasound (IVUS) and optical coherence tomography (OCT). It is my hope that it will soon become possible for sites of interest that have been identified by IVUS to also be pinpointed in angiography images.

Another area for future improvement could be finding the optimal balance between the size of an angiography system and its performance capabilities. At present, angiography systems are very large and consume a lot of power. Hopefully, we can expect further improvements in the future, allowing us to see the same things with less power.

Of course, it is also important to continue our efforts to obtain even more detailed information than we can now. Today, artificial intelligence (AI) is being introduced in a wide range of technologies, and I have high hopes regarding the usefulness of AI in angiography – especially when it comes to obtaining optimal views and controlling the dose in an even smaller area of the patient.//
Toyohashi Heart Center is one of Japan's top hospitals specializing in cardiac disease. It was founded by Dr. Takahiko Suzuki, Hospital Director, where he was the first to pioneer the treatment of interventional cardiology in Japan. The center provides community healthcare services and contributes to medicine within and outside Japan.
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