Hartford Hospital Stroke Clinic
Using Apple technology to bridge a medical imaging gap
A Mac Pro and two Apple Cinema Displays have replaced five monitors and 3 CPUs in Dr. Gary Spiegel’s office.
On October 11, 2006, Marissa Arnold, an athletic 20-year-old who was captain of her college soccer team, was having her hair braided by her roommate when she suddenly lost the ability to speak. The right side of her body was immobilized. Her attempts at speech were garbled and incoherent.
The symptoms were classic indicators of a stroke. A 911 call brought emergency treatment, but Marissa failed to respond. She was taken by helicopter to Hartford Hospital Stroke Center, where Dr. Stephen Ohki used medical imaging techniques to reveal a clot that was blocking her left middle cerebral artery. He inserted a device called a MERCI retriever, snared the clot, and withdrew it from her body. It took only 45 minutes from the time the catheter was inserted to restore Marissa’s circulation. She left the hospital fully recovered after a few days of observation and treatment.
Ohki and his partner, Dr. Gary Spiegel, have performed these routine miracles for years. They have been frustrated, however, by a technology gap. There was no useful way to store and review the data-rich images they captured during treatment. Now, with the help of imaging specialist Dr. Roger Katen and the judicious use of Apple technology, Spiegel has arrived at the level of efficiency, cost-effectiveness, and patient care that he wanted for the practice.
Neuroangiography: An Imaging-Based Surgical Specialty
Acute stroke treatment is a specialty within a specialty, and it’s relatively rare. There are only about 250 practicing interventional neuroradiologists in the United States, and only a fraction of that number are treating strokes. This does not mean that strokes are not a major problem. They are the third leading cause of death in the United States. Every 45 seconds someone, somewhere in this country, is having a stroke. The most urgent cases come to someone like Dr. Spiegel.
“The strokes we treat here are almost always life-threatening,” says Spiegel. “But if we can get patients soon enough, our success rate is fairly high.”
Spiegel is Director of Neurointervention at the 850-bed Hartford Hospital, and Co-Medical Director of the hospital’s Stroke Center. He and Ohki, members of the Jefferson Radiology practice, insert a surgical catheter into a blood vessel at the patient’s groin and, using a Siemens AXIOM Artis BA biplane neuroangiographic system, navigate to a target area in the patient’s brain, spine, or neck. They take a burst of images at up to 30 frames per second as X-ray dye is injected, and visualize them as 3D images on a workstation to plan treatment. The problem Spiegel struggled with was finding a way to store and retrieve the big image data sets he was creating, which he needed for followup treatment and legal reasons.
“I persevered for three years without a workable image archiving solution,” says Spiegel. “I printed representative frames from my movies as an archive for clinical and medico-legal purposes.” But help was on the way.
Spiegel called on Roger Katen, M.D., a radiologist, imaging specialist, and principal of The Katen Consulting Group, to design a solution. They had collaborated as radiologists. Now, leveraging Katen’s computer-engineering expertise and his extensive experience with the Mac platform, they created an Apple-based neuroarchiving solution that met all the Stroke Center’s criteria, including superior 3D visualization – at spectacularly low hardware cost.
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Selling the IT Department
IT departments are naturally resistant to adding another platform to their infrastructure for several reasons – unfamiliarity with new vendors, the cost of training IT personnel, and concerns about compatibility between hardware and operating systems. This was true at Hartford Hospital, which is almost exclusively Windows-based.
“It was difficult for the hospital’s IT department to work with us on this,” says Spiegel. “They’re Windows-trained and the hospital is populated with Windows PCs.” Spiegel and Consultant Roger Katen were able to overcome this resistance step by step.
First, they used Stroke Center funds to buy a quad-core Mac Pro, which they used to access the hospital PACS. Katen used OsiriX image management software on the Mac Pro and installed an Apple Xserve RAID in the clinic’s conference room, where it operated flawlessly for a year and a half. He then moved the Xserve RAID to the angiography suite, where it performed beyond all expectations, easily handling the largest files.
Finally, Spiegel presented the hospital with a proposal for a Mac-based image archiving solution that would pay for itself – by enabling the Stroke Center to stop filming angiography procedures.
The Fantastic Voyage Becomes A Reality
When Gary Spiegel M.D.C.M. was a little boy, he watched Fantastic Voyage, the epic 1966 sci-fi movie in which Raquel Welch and her companions, shrunk to microscopic size, navigate human blood vessels on an errand of mercy. The adventure fired his imagination.
“That movie is the link between me as a child and what I do today,” says Spiegel. “This is the closest thing to Fantastic Voyage that exists in medicine. We navigate through the blood vessel system to treat illness in much the same way that Fantastic Voyage used the vascular tree as a highway.” Spiegel went on to attend medical school at McGill University. His future in neuroangiography was sealed by working as an undergraduate, and after his medical training as a fellow, with Dr. Alex Berenstein, a pioneer and leader in endovascular surgery.
Hollywood recently announced that a remake of Fantastic Voyage is on the way. Spiegel is certain to be watching.
Images created by the OsiriX DICOM viewer of an aneurysm in a carotid artery. Left: a 2D image with bones and other structures digitally deleted for clarity. Right: the same blood vessels volume-rendered from images taken by the rotating Siemens imaging system. The 3D model can be manipulated for study by OsiriX.