Dr. Kyo: After I graduated from university in Taiwan, I served as a Medical Intern at the Kyoto University School of Medicine, Kyoto, Japan, and then joined the Department of Cardiovascular Medicine of Shiga Adult Disease Center (now known as Shiga General Hospital), Shiga, Japan. At that time, Dr. Hideo Tamai was affiliated with the same department. He'd spent some time in the United States studying advanced catheterisation techniques and had just returned to Japan after completing specialised training in percutaneous coronary intervention (PCI). At that time, the general understanding was that catheterisation procedures had low success rates and were associated with many difficulties. Hence, when I first saw Dr. Tamai perform PCI, I was astonished at his procedure precision. Over time, Dr. Tamai became widely recognised as a leading expert in PCI, and he played a major role in disseminating PCI skills and techniques. I assisted him in his work and participated in many catheterisation procedures.

Dr. Kyo: Ever since that time, we've been at the forefront of catheterisation. Rapid advances are being made in medical devices and techniques every day, and we need to keep up with this rapid progress in order to provide the best possible treatment options to our patients. Nevertheless, it takes a long time to replace medical equipment at a public medical institution. Moreover, after you've worked for many years at the same facility, you tend to be promoted to a higher seniority, which tends to pull you away from the clinical frontline. Dr. Tamai had the strong belief that the best medical care is only possible with the best equipment, and as a true pioneer in PCI, he decided to establish Kusatsu Heart Centre as a facility providing top-level medical care to patients.
Dr. Tsuji: I met Dr. Tamai and Dr. Kyo during my residency training at the Shiga Adult Disease Centre, where I learned catheterisation techniques. Many patients with cardiovascular disease require urgent treatment. However, at large hospitals, they need to make appointments for echocardiography and cardiac catherisation, which makes it difficult for them to receive the required treatment immediately without delay. I agreed with Dr. Tamai and Dr. Kyo's plans to establish Kusatsu Heart Centre as a facility where professionals with advanced medical skills would offer top-level medical care quickly and equally to all patients.
Dr. Kyo: In order to provide the best medical care, we need not only the right equipment but also the right medical skills and competencies. At our centre, we're trying to pass on many new medical and clinical techniques, such as PCI techniques, to other doctors and the next generation. We're also involved in improving medical techniques through clinical training programs, such as by distributing intraoperative live videos.
Dr. Tamai sadly passed away in 2009, but his spirit lives on at Kusatsu Heart Centre.

Dr. Kyo: When we established the Center, we installed the latest Infinix Interventional X-ray system produced by Toshiba Medical Systems Corporation (now known as Canon Medical Systems Corporation).
At that time, we visited the company's manufacturing facilities and were extremely impressed by their advanced technologies.
Dr. Tsuji: In PCI, it's important to formulate a strategic plan in advance to decide how to conduct PCI based on detailed analysis of the courses and morphological characteristics of the vessels. Such plans are strongly affected by the fluoroscopic image quality. We were the first to install the multi-access C-arm system in Japan. I remember how the engineers adjusted the image quality and colors to achieve natural and easy-to-view images that allowed the blood vessels and background to be visualised in excellent harmony.

Dr. Tsuji: With Alphenix, we can acquire fluoroscopic images with virtually no image lag, even in low-rate pulsed fluoroscopy. Therefore, we can reduce the pulse rate from 15 fps to 7.5 fps, resulting in further dose reduction.
Also, in January 2021, we upgraded the X-ray tube of our Alphenix, enabling us to use a narrower pulse width at 7.5 fps. Using a shorter pulse width is the same as setting a faster shutter speed on a camera, and the moving heart can be observed clearly without the image blurring. Furthermore, since the pulse width is shorter, higher-quality and sharper images can be obtained by increasing the maximum current per pulse without changing the total radiation dose. In other words, a clearer image quality can be resulted in without dose increase. Such parameters, as well as other fluoroscopic and radiographic settings, can be used in suitable cases. Even when the X-ray beam passes through the patient nearly transversely, we can obtain very clear fluoroscopic images - far superior to anything we'd seen before. The greater freedom in setting the angle of the X-ray beam makes it much easier to perform therapeutic procedures.

Dr. Tsuji: Previously, we'd been using an interventional X-ray system produced by an overseas manufacturer. This was because Japanese manufacturers were offering X-ray tubes with lower output than those from overseas manufacturers. However, after using an interventional X-ray system from Canon Medical, we realised that it's not simply a matter of high X-ray output. Canon Medical employs a variety of approaches to achieve better image quality. Faster image processing allows the data from the image sensor to be processed instantly during imaging, and innovative new technologies mean the pulse width can be shortened. I'm very impressed by Canon Medical's outstanding development capabilities, which enable improvement of image quality using a variety of approaches.
I also appreciate our collaborative partnership, in which we communicate and interact closely with the company. For example, before we conduct intraoperative live demonstrations, Canon Medical engineers come to our center and check the system. We appreciate their strong support and friendly attitude, such as listening carefully to users' requests and promptly incorporating these requests into new developments and upgrades.