As the physical size of today's Americans continues to expand, so must medical equipment to adequately and safely treat obese (or bariatric) patients. To answer the need, Baptist Hospital in Nashville opened a medical imaging suite this spring to accommodate large patients and equipped the room with a first-of-its-kind X-ray system.
"As a diagnostic radiologist, one of the major problems that we have with the obese patient population in the United States is obtaining quality imaging on them. One of the reasons is much of the equipment has been standardized to weights at around 350 pounds and less," explained Dr. Alan Horn, a Baptist Hospital radiologist.
The new Sonialvision Bariatric R/F, manufactured by Japan-based Shimadzu, takes care of that problem. The multipurpose radiographic/fluoroscopic X-ray system can handle patients who weigh up 700 pounds, and the table can actually move and tilt while holding patients who weigh up to 500 pounds. Frank Serrao, North America marketing manager for Shimadzu Medical Systems USA, said the Sonialvision Bariatric is the first system manufactured specifically for the oversize population, and Baptist bought the first one in the United States. As a result of site visits by physicians and other healthcare providers to Baptist over the last few months, half a dozen installations are underway at other American hospitals with completion expected by the end of the summer, he said.
Shimadzu started working toward this product nearly three years ago, Serrao said, after he began talking to radiologists and bariatric surgeons about their needs and letting Japanese designers know what he was hearing. He said many expressed liability and safety concerns inherent in using equipment not designed to support excessive weights, and many more admitted to him that obese patients oftentimes were transported by private ambulance to large-animal veterinarian offices for diagnostic imaging. At the 2006 annual meeting of the American Society for Bariatric Surgery (ASBS), Shimadzu's booth experienced "a flurry of activity" from excited physicians at the prospect of the Sonialvision Bariatric, he said, and he plans to be at the 2007 ASBS convention this month to show off the finished product.
Not only is the Sonialvision Bariatric table sturdier and its gears more heavy-duty, the table is also wider; thus, it's safer because the patient's shoulders don't fall off the edges. The table can be raised and lowered for patient loading and unloading at comfortable heights. Horn praised the redesign of the Shimadzu product, which also provides more room for patients between the table and equipment above. That's possible because the image detector is below the table and the X-ray tube is above the patient, which is the opposite of typical X-ray systems. The X-ray tube is easily moved up and down to accommodate larger patients. "The X-ray tubes and the tables move very freely compared to some of the more restricting tables that we have used in the past," Horn said.
The excess tissue of a bariatric patient also makes imaging difficult. "X-rays work by basically penetrating the tissue, and when they bump into the tissue, they are essentially deflected. Some of them get through, and some of them don't," Horn explained. Thus, the Sonialvision Bariatric boasts a 1 million-pixel, charge-coupled device (CCD) camera, which produces high-definition, high-contrast images that Horn said are particularly valuable for gastrointestinal exams. The camera captures images at up to 15 frames per second, five times faster than typical cameras.
Baptist's new bariatric imaging suite has wider doors, and the rooms are simply bigger. "Standard hospital imaging rooms are not built to fit oversize beds and oversize wheelchairs to even get the patients into the room safely. Often these patients can't ambulate well," Horn said.
Baptist's radiologists and bariatric surgeons worked as a team, Horn said, to design the suite, which represents an investment of about $540,000. Baptist's Metabolic Surgery Center is designated as a Center of Excellence by the ASBS. "It's important before bariatric surgery to do an adequate exam of the patient's esophagus and stomach in order to make sure there's nothing abnormal either from a congenital basis or pathologically that might be a reason to, number one, avoid the surgery, or number two, that should be addressed prior to having the surgery," he said. Imaging after the surgery is also critical, he added.
Serrao anticipates that bariatric imaging will see growth as a niche market. "Bariatrics is pretty much a North American phenomenon, but it's starting to creep up in the rest of the world," he said. He said the Sonialvision Bariatric is "going through its third evolution now, and I can honestly say we have the only dedicated imaging system out there."