Coming soon to BWH’s hybrid OR, the ARTIS Pheno will be used to provide state-of-the-art care to patients undergoing minimally invasive or percutaneous cardiac, endovascular or thoracic interventions or implants. Copyright

BWH surgeons and interventionalists working in the hybrid operating room will soon be among the first clinicians in the Northeast to use the new ARTIS Pheno angiography imaging system. The new system is a powerful, floor mounted robotic C-arm system for individualized preprocedural planning, intraoperative guidance and immediate assessment – regardless of patient condition or procedure complexity. Installed at the beginning of February, the Pheno will improve intraoperative imaging while it delivers less radiation load to patients.

The Pheno builds on Brigham’s rich history of bringing pioneering technologies and imaging tools into the hybrid operating room to bring the most advanced care to patients. BWH was the first hospital in the U.S. to use the ARTIS Zeego system – the Pheno’s predecessor — in the operating room. A team of Brigham clinicians, including the late Michael Davidson, MD, as well as team members from Vascular and Endovascular Surgery, Radiology and Anesthesia, worked together to install – and troubleshoot – the Zeego. Both the Pheno and the Zeego are designed to rotate completely around a patient’s body, making it easier to make a diagnosis in the operating room, and, if necessary, immediately operate.

The Pheno, which offers several improvements over the Zeego, will be used to provide state-of-the-art care to patients undergoing minimally invasive or percutaneous cardiac, endovascular or thoracic interventions or implants.

Faster and Better Imaging for Complex Procedures

Within BWH’s hybrid operating room, clinicians use “C-arm” imaging systems like the Zeego and Pheno to facilitate real-time X-ray imaging during angiograms and therapeutic procedures. Its name stems from the C-shaped arm that connects the X-ray source and X-ray detector.

BWH clinicians are using these imaging systems to guide increasingly complex therapeutic procedures, such as aortic valve replacements, transcatheter aortic valve replacements (TAVRs), and branched and fenestrated stent grafts.  These require high-quality, granular imaging according to Michael Belkin, MD, chief of the Division of Vascular and Endovascular Surgery.

“The Pheno algorithms will allow us to better perform these procedures,” he said. By better, Belkin means faster imaging, less radiation exposure for the patients and interventional surgeons, and improved enlarged images. Resolution for two-dimensional imaging in Pheno is four times higher than in the older device.

The new device also has a smaller footprint. Pheno’s single monitor can display 22 inputs, compared with multiple monitors used in the Zeego. The single large monitor will display live images, vital signs and older images, with support for third-party software applications.

Clinicians using the new device will be able to digitally manipulate images in new, advanced way, Belkin said. “I will be able to electronically fuse a preoperative CT scan that was done here or elsewhere with live images during a procedure from the Pheno machine to produce an overlayed 3-D image,” he said.

In February, BWH clinicians will begin enrolling patients in a clinical trial for transcatheter mitral valve replacement, a study that the Pheno will support, according to Tsuyoshi Kaneko, MD, cardiac surgeon. “This will require a thoracotomy, which we will perform in the hybrid OR. It’s a perfect example of where Pheno will be really useful,” he says, as the newer system will provide better visibility and resolution with less contrast load.

Improved Maneuverability and Rapid Scanning

Additionally, Kaneko looks forward to smoother steerability of Pheno’s C-arm. “The Zeego moves like an old-generation robot, whereas Pheno will be silky smooth when the arm moves and will make our procedures much, much easier.”

While the Pheno is bolted to the OR floor, its wider-space robotic C-arm moves more easily in and out of the patient field without interrupting the sterile surgical field. And as a more closed system compared with the Zeego, Pheno is easier to keep sterile.

The new device also offers expedited imaging acquisition. “We want to see the image in a matter of seconds, especially when working on an urgent or complex case,” said Kaneko. This isn’t only a matter of convenience; it also improves patient safety. Because the Pheno scans up to 15 percent faster than earlier systems, images are produced with less IV contrast, an added benefit as contrast can tax the kidneys.

While the Pheno will probably not be used for conventional open cardiac, thoracic or endovascular procedures, Belkin is enthused about the potential benefits of the Pheno for patients for whom its use is appropriate. “We are already doing hundreds of cases every year in the hybrid OR room now,” says Belkin. “With this newest machine, all of them will be done better.”