Cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.

Most catheterization laboratories are "single plane" facilities, those that have a single X-ray generator source and an x-ray image intensifier for fluoroscopic imaging. Older cath labs used cine film to record the information obtained, but since 2000, most new facilities are digital. The latest digital cath labs are biplane (have two X-ray sources) and use flat panel detectors.

Biplane imaging is one of the most advanced interventional medical imaging technologies available. It uses two rotating cameras, one on each side of the patient, to take simultaneous images. ... When combined on a computer screen, the two sets of images form a 3-D portrait of the area the doctor wants to study.

Biplane imaging also allows doctors to follow the path of blood flow through your vessels and to create a "roadmap" for reaching and treating the precise location of disease or malformation. Also known as angiography, this process involves inserting a small catheter into an artery, a similar procedure to getting an IV. New Technology Expands Treatment for Stroke, Aneurysms and Peripheral Vascular Disease

Biplane Angiography System expands diagnostic and treatment options for vascular and neurovascular problems, including stroke, aneurysms and peripheral vascular disease. Benefits include:

Procedure times are shorter because two angles of the imaging area are captured simultaneously

Less contrast dye is required and radiation exposure is reduced

The images show spatial relations more accurately, allowing physicians to rapidly target problem areas

Treatment for peripheral artery disease is improved because the degree of blockage is more visible. This allows physicians to view their position throughout the stenting process.

Biplane Specifications

Capture images from two axes using two c-arms

Fast image reconstruction

Shorter examination time

More efficient than single plane

Low radiation dose

Biplane Combines Diagnosis and Treatment

Biplane imaging can also be used to path the blood flow through vessels, which helps to find the precise location of the disease or malformation.

Using a small amount of injectable dye to make the blood flow easier to see, the biplane imaging cameras take x-rays that the doctor can view in real time.

This helps them quickly determine if there are blockages or aneurysms, and determine the best way to provide treatment.

In many cases, the doctor can use the detailed images to help guide minimally invasive procedures to treat blockages, aneurysms or blood clots in the brain – right there in the interventional suite. 

Combining diagnosis and treatment into one procedure saves valuable time, and can make all the difference in recovery for patients with stroke or other severe neurovascular complications. 

Biplane Imaging Capabilities

This versatile biplane technology means our medical team can provide comprehensive care for even the most complex patients.

For example, it enables endovascular coiling for the treatment of aneurysms. Doctors use a catheter to guide a wire into the aneurysm. The wire coils up inside the aneurysm, stopping the blood flow and sealing off the aneurysm from the artery.

Biplane imaging is especially helpful during cerebral vascular angiography, an interventional radiology procedure used to take images of the blood vessels in the brain. The 3-D images can help locate blockages that cause ischemic stroke and identify aneurysms and arteriovenous malformations (a tangle of arteries and veins) that cause hemorrhagic stroke.

Biplane can also assist doctors with stent placement and guiding catheters through the brain. Biplane is also used during neuro coiling, a minimally invasive procedure that blocks blood flow to an aneurysm.

It can also help cut off blood supply to tumors.

Effectiveness of Biplane Angiography Compared to Monoplane Angiography for Vascular Neuro-Interventions

The advantages that a biplane system can provide in terms of safety, quality of care, support to university teaching programmes based on best practices, enhanced capability in performing complex procedures, this technology should be implemented with a responsibility to collect outcome data to optimise the clinical protocol regarding the dose of ionising radiation delivered.

Bi-plane labs-advanced technology for neurovascular procedures

Time is of the essence when it comes to neurological ailments. Be it a stroke, aneurysm or head trauma, fast, safe and timely intervention is essential for a good outcome of the patient. Keeping this in mind, the best hospitals in India are investing in Biplane Cath Labs for Neuro-intervention.

This technology aids in the Diagnosis as well as treatment of disorders related to brain spinal cord, neck and face. 

Diagnostic:

Digital subtraction cerebral angiography

Digital subtraction spinal angiography

Therapeutic:

Cerebral aneurysm,

Subarachnoid hemorrhage

Stroke/ Paralytic attack

Intracranial hemorrhage

Carotid Stenosis/blockage

Brain arteriovenous malformation (AVM)

Spinal arteriovenous malformation and fistula

Cerebral Venous Sinus Thrombosis

Inferior Petrosal Sinus Sampling

Bi-Plane Cath Labs vs Single-Plane Cath Labs

Single Plane Versus BiPlane

There are scads of options on the table as you begin doing your homework and narrowing down the field. One of the major options will run across is whether you want a single or bi-plane cath lab system.

 Single and bi-plane cath labs differ from one another in several main ways:

1. Image Acquisition Speed

2. Specialization

3. Space Requirements

4. Site Preparation

Image Acquisition Speed

 Because bi-plane systems capture image data from detectors on two axes, they are able to acquire 3D images faster. This is especially useful in neurovascular and electrophysiology (EP) procedures. Single-plane labs are also capable of 3D imaging, but the time it takes the C-arm to move and the software’s reconstruction process cause a delay. Additionally, 3D software is not native to single-plane labs and must be added for 3D imaging to be done.

Specialization

The type of work you plan to use your lab for will have at least as much (if not more) weight in your decision between a bi-plane and a single-plane cath lab as any other difference we'll discuss here. Bi-plane and single-plane cath labs are designed with certain specialties in mind. If your facility is planning for a dedicated neuro or EP lab, for example, you'd be best served by a bi-plane system. And if other study types come into that room on occasion, you can adjust settings to use only one of your system's C-arms.

If the work leans in a more general/blended direction (balloons, stents, angio runs, etc.) a single-plane lab can be flexible across a number of specialties and, if properly equipped with 3D software, also suffice for Neuro and EP.

Space Requirements

With a second C-arm and the cabinets of electronics required to run it, anyone would guess that a bi-plane system has a larger footprint than a single-plane system, but many don't realize how much bigger. Take for instance the GE Innova series: GE recommends a space almost 200 square feet larger for bi-plane! If the work you're planning to do calls for bi-plane technology, don’t get scared by these dimensions. Experienced installers can do a lot to get either version of a system into more conservative spaces, but be aware that you might need more room than you think.

Cath Lab Site Preparation

 We can probably guess what this paragraph is going to say: double the c-arms = double the site prep. That might be an oversimplification, but there will be significantly more involved in getting your space ready for a bi-plane cath lab. There needs to be a ceiling support installed for the second c-arm, additional rigging is necessary, and the system has an overall larger footprint.

Any cath lab has both ceiling (monitors, maybe the gantry) and floor-mounted (table, maybe gantry) components. For a bi-plane, you have to plan for both a floor and a ceiling-mounted gantry. In the case of the Innova biplane, there’s around 2,000 lbs of additional weight hanging from the ceiling vs. its single plane counterpart, including the ceiling “Lateral Positioner” (gantry), additional rails, and additional monitors.

Cost Difference

 Bi-plane cath labs simply come with more "stuff", therefore they cost more than single-plane systems. However, while there are double the critical components (tubes, collimators, detectors, computers), service pricing isn't twice as much. Currently, service coverage for a bi-plane cath lab averages 25-30% higher than service for a single-plane system.

Hello everyone, good morning,  

Yesterday on 01-12-2022 a patient came to my clinic and told me about her complications with urine discharge, Actually, she was  suffering from multiple time involuntary urination through the vagina (especially at night) and pain in the internal vagina, 

When I heard that the Involuntary discharge of urine through the vagina, It immediately hit in mind that it could be a case of VVF(vesicovaginal fistula).

On ultrasound, I saw a Fistulous track between the posterior wall of the bladder and the vaginal loop and an echogenic stone trapped there.

The gap was measuring about 5.t mm and the minimal collection was noted in the vaginal loop which echoes the pattern same as the filled urinary bladder .so in my view it is the case of VVF.

So here I want to tell you all about the vaginal fistula. The actual vaginal have mainly two portions anterior wall and the posterior wall, if a fistula( gap) forms in the anterior wall, it is called an anterior genital fistula, and whereas gap forms in the posterior wall it is called a posterior genital fistula,  anterior genital fistula can be formed between the urinary bladder, ureters, and urethra 

Note 

-Fistulous track between urinary bladder. and vagina- vesicovaginal fistula.

 -ureter and vagina - ureterovaginal fistula.

-Urethra and vagina - urethrovaginal fistula.

Posterior genital fistula can form between the colon/intestine and rectum,

If a fistulous track between 

-Colon and vagina- colonovaginal fistula /enterovaginal fistula.

-Rectum and vagina- rectovaginal fistula.

Other causes of genital fistula:

Genital injury,conginital birth during childbirth prolonged labor presses the unborn child tightly against the pelvis, otherwise, it can happen after DNC, Hysterectomy, or any pelvis operation. But in my experience, I had always found it after hysterectomy. some other causes like rectocele, colonel, cystocele, etc.

Symptom - vaginitis, recurrent infection, recurrent discharge, lower pain.

Let's discuss treatment,

 guys once a fistula forms then the only way to treat is a surgical procedure 

The vesicovaginal fistula is typically repaired either by transvaginal approch or laparoscopically, if the patient had multiple transvaginal procedures done then sometimes attempt the final repair through a large abdominal incision or laparotomy.

Here some complications may possible after surgery. 

1- recurrent formation of fistula

2-injury to ureter, bowel, or intestine.

3-vaginal shorting.

 ...

By- Dr.Suraj Rai.