How Customer Needs Impact Product Innovation

Greg Freiherr, Industry Consultant

A volume of contrast agent lingers near the injection site, creating an artifact that can block the visualization of structures. Graphic courtesy of Lior Molvin

 

When it comes to listing needs, patient safety ranks at the top. Just ask an imaging administrator.

“There is no way we can provide good quality customer care any other way,” said Brent Purscelley, director of ambulatory services at the Frederick Regional Health System.

But even when it comes to patient safety, distinguishing between needs and wants can get tricky. This is especially so when the frequency of patient complications gets very low.

Take CT contrast extravasations, for example. The leakage of contrast media from an intended blood vessel occurs very infrequently, only between 0.1 and 1.2 percent of administrations, according to the 2018 edition of the American College of Radiology (ACR) Manual on Contrast Media (version 10.3). Severe injuries due to extravasation may occur even more rarely.

“We have the technology today to monitor patients via sensors,” Purscelley said, “but it (extravasation) doesn’t happen often enough to really justify spending the additional money to do (the monitoring).”

 

The Role Of Smart Injectors

That’s where “smart” injectors come in. Not only do they alert technologists to ongoing problems, but—like black boxes on commercial airliners—they can record the data surrounding events, helping administrators understand the circumstances that led to them. Applied with preventative measures, these smart injectors can make a huge difference in patient safety.

To reduce the risk of extravasation, technologists at Frederick Regional Health System use a large gauge IV needle and tube; make sure needle placement is optimal; and assess patients for risk factors prior to contrast-enhanced scans, according to Christopher Nield, imaging supervisor there. The techs also use saline to test IV lines for stability prior to the injection of contrast agents. Additionally, the health system uses power injectors that alert techs to events that could indicate an ongoing extravasation.

The amount of time expended to do a procedure is also a factor. Increased turnaround time can decrease patient satisfaction, as it can increase provider and technologist frustration, according to Nield.

Bracco-made injectors record and display data about their performance. The appearance of a pressure spike on an injector display may indicate the occurrence of an extravasation. A networked smart injector can alert techs, radiologists and administrators to an ongoing event. The injector data can be interpreted in the context of the patient’s physical signs and the type of contrast-enhanced examination.

SmartInject solutions, built into Bracco-made injectors, display and document CT and MRI contrast administrations. These injectors can inject saline bolus chasers to push the contrast agent. If such a chaser is not used, a substantial amount of the contrast agent may linger near the injection site, potentially causing artifacts that block the visualization of important structures. Saline injections, before administration of the contrast medium, may also be used to test the stability of the IV needle and its placement in the vein.

 

Tracking Radiation Dose

Keeping track of radiation dose is critically important to minimizing the amount of patient radiation, which is essential to patient safety. Bracco’s NEXO [DOSE]® Multi-Modality Radiation Informatics can track patient radiation exposure automatically regardless of the type of imaging system used. The multi-modality radiation informatics system monitors and analyzes exposure data in real time and across the enterprise. When those data veer outside set parameters, NEXO [DOSE] sends an alert to physicians, technologists or administrators—whoever the system has been assigned to notify.

Similar capabilities regarding contrast media is achieved with the NEXO® Contrast Management System, which uses SmartInject technology. As with the dose-oriented software, NEXO updates patient records by synchronizing with the RIS/PACS, EMR, or voice dictation system used in radiology.

The two systems—one for managing contrast, the other for keeping track of radiation—help meet not only patient needs but needs of the provider. Among provider needs is compliance with requirements, for example, ones set by the Joint Commission.

Because neither MRI nor ultrasound exposes patients to ionizing radiation, their use negates the need to track ionizing radiation, which accompanies CT and radiography/fluoroscopy. Issues surrounding contrast media, however, remain. Providers, therefore, must consider all sorts of risks. Among them is the lack of reliability.

Besides being easy to use, power injectors have to be rugged enough to stand up to the beatings that can be dished out in emergency rooms. Overall reliability, according to Nield, is critically important. “If we have an injector down, the scanner is out for some studies,” he said. “Then we have real issues.”

The views, information, or opinions expressed in the video(s) or article(s) above are solely those of the individuals involved and do not necessarily represent those of Bracco Diagnostics Inc. (“BDI”). The primary purpose of this video(s) or article(s) is to educate and inform. This information does not constitute medical or other professional advice or services.

EmpowerCTA®+ Injector System

Caution: Federal law restricts this device to sale by or on the order of a physician.

INDICATIONS:

The EmpowerCTA®+ Injector System is indicated for the vascular administration of contrast and flushing media in conjunction with computed tomography (CT) scanning of the body with an optional interface to a CT scanner and an optional calculator for glomerular filtration rate (GFR).

The Extravasation Detection Accessory (EDA™) is an optional accessory and is indicated for the detection of extravasations of ionic and nonionic contrast during CT procedures using a power injector.

Protocols have been independently developed and are not intended as medical advice. Bracco and Bracco Injeneering S.A. shall not be responsible for any physicians’ reliance on these or any other products.

 

CONTRAINDICATIONS:

The EmpowerCTA®+ Injector System is not intended for use as a long-term infusion pump, nor is it intended to be used to inject any agents other than contrast or flushing media. Do not attempt to use the Injector for any other purpose (such as chemotherapy or drug infusion). The EmpowerCTA+ Injector System should not be used to inject substances into nonvascular body cavities. Any applications of the EmpowerCTA+ Injector System other than those described in its Operator Manual are inappropriate and should not be attempted.

Not all products available in all global markets.

EmpowerCTA+ is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Bldg. H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Professional Services: 1-800-257-5181 (Option 2); EmpowerCTA+ Email: empowerinfo@diag.bracco.com; Website: https://www.braccoimaging.com/us-en/products/injectors-informatics/empowercta

EmpowerCTA+ is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. http://imaging.bracco.com

 

EmpowerMR® Injector System

Caution: Federal law restricts this device to sale by or on the order of a physician.

INDICATIONS:

The EmpowerMR® Injector System is indicated for vascular administration of contrast media and flushing media in conjunction with magnetic resonance imaging (MRI).

Protocols have been independently developed and are not intended as medical advice and Bracco shall not be responsible for any physicians’ reliance on these or any other protocols.

Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.

Not all products available in all global markets.

EmpowerMR is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Bldg. H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Professional Services: 1-800-257-5181 (Option 2); Website: https://www.braccoimaging.com/us-en/products/injectors-informatics/empowermr

EmpowerMR is manufactured by Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. http://imaging.bracco.com

 

NEXO® Contrast Management System

Intended Use:

The NEXO® Contrast Management System is a server-based application intended to be used as a data-management and visualization system. The NEXO Contrast Management System is able to read, store, share, compare/relate, as well as graphically display data and injection programs coming from RIS, PACS and multiple enabled EmpowerCTA® Injector Systems. This device provides users with record-lists, graphics and reports about data and performances.

This device is intended for retrospective and statistical data management and visualization. It is not intended for real-time data visualization, diagnostic applications or for any other use for which the device is not indicated. This device is only to be operated by and under quasi-continuous supervision of qualified and trained staff in an appropriate licensed healthcare facility.

The NEXO Contrast Management System is compatible with the EmpowerCTA Injector System version 8.0, and EmpowerCTA®+ Injector System version 9.0 and higher.

Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.

Not all products available in all global markets.

NEXO is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Building H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; NEXO Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO questions: Nexo.Answers@diag.bracco.com; NEXO U.S. Technical Service and Support: Phone: 888-670-7701; Fax: 609-514-2448; NEXO Email:  customer.support@acistmedical.com; Website: https://imaging.bracco.com/us-en/products/injectors-informatics/nexo

NEXO is manufactured by Bracco Injeneering S.A., Avenue de Sévelin 46, CH-1004 Lausanne, Switzerland. http://imaging.bracco.com

 

NEXO [DOSE]® Multi-Modality Radiation Informatics

Intended Use:

NEXO [DOSE]® Multi-Modality Radiation Informatics is a server-based application that acquires, stores, and reports radiation dose index data from medical imaging procedures.

NEXO [DOSE] Multi-Modality Radiation Informatics is intended to be used by qualified medical personnel only.

NEXO [DOSE] is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Building H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; NEXO [DOSE] Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO [DOSE] questions: Nexo.Answers@diag.bracco.com; Website: https://imaging.bracco.com/us-en/products/injectors-informatics/nexo-dose NEXO [DOSE] Technical Support provided by PACSHealth, L.L.C: 1-877-299-6587

NEXO [DOSE] is manufactured by and is licensed from PHS Technologies Group, L.L.C, 32531 N. Scottsdale Road, Suite #105-282, Scottsdale, AZ 85266; a wholly-owned subsidiary of PACSHealth, L.L.C.

Not all products available in all global markets.

 

About Bracco Injeneering S.A.

Bracco Injeneering S.A., located in Lausanne, Switzerland, is the most recently added Business Unit of Bracco Imaging. Bracco Injeneering is committed to develop the best-in-class integrated injection solutions with a strong heritage in research and innovation. It provides quality solutions for state-of-the-art radiology centers, offering proven injection technology, built on Bracco Imaging’s expertise.

Thanks to this strengthened product portfolio, including the CT Exprès® 3D Contrast Media Delivery System, EmpowerCTA+ Injector System, EmpowerMR Injector System, NEXO Contrast Management System and NEXO [DOSE] Multi-Modality Radiation Informatics, Bracco Imaging will be able to focus on constant innovation, not only for devices, but also for software development and data management.

CT Exprès, EmpowerCTA, EmpowerMR, IRiSCT, NEXO and NEXO [DOSE] are registered trademarks of Bracco Injeneering S.A.

EDA and FastLoad are trademarks of Bracco Injeneering S.A.

These are representative images from reference studies; individual results may vary.

© 2022 Bracco Diagnostics Inc. All Rights Reserved.