- Google Glass is a wearable device that allows the user to experience augmented reality. It is expected for consumer release in 2014.
- This technology could have multiple uses in healthcare.
- Current research has demonstrated the use of Glass in education and for displaying critical patient information.
- While current proposed concepts for Glass in healthcare are interesting, some are of questionable clinical use. The challenge with integrating Glass into healthcare is to find ways it can add true clinical value and ultimately improve patient care.
- Interventional Radiology is a unique specialty that could be well integrated with Glass and we introduce two concepts that could improve patient safety, operator comfort and procedure efficiency.
- Some of the proposed uses for Glass can be achieved using existing technologies like the GoPro Hero 3.
This video illustrates how we use the GoPro Hero 3 camera and its private wifi link to directly observe a trainee performing a procedure. This gives a ‘point of view’ video allowing the trainer to see almost
This patient with a brachiocephalic dialysis fistula has a recurrent stenosis in the subclavian vein. This was stented 5 months prior to these images and has rapidly restenosed. In my experience stenting these is almost always disastrous and leads to repeated re interventions. I used a DCB on this occasion, hoping that it may reduce the reintervention rate.
There is more information on DCBs on Which Medical Device
Liver tract embolisation:
The portal vein was punctured and entered with a Skater set during this PTC. Contrast initially went into the hepatic duct but the wire and dilator then passed into the portal vein. The Hunter biopsy sealing device was used to plug the tract with gelfoam. This kit provides 3 pre formed pledgets of gelfoam, one with a radio opaque marker to aid positioning. This video clip demonstrates the deployment.
This patient has medullary sponge kidney (MSK) with recurrent left loin pain. We did a flexible ureterorenoscopy and removed several small calculi using a Cook NGage basket
You can clearly see the calculi eroding through from the dilated collecting ducts. Some still are within parenchyma and will no doubt cause problems in future
Simple angioplasty complication
Elderly patient with ischaemic toes. There is a short tight popliteal stenosis that I plastied with a 5mm balloon. Unfortunately the post procedure film shows embolus occluding the anterior tibial artery. I aspirated plaque using the Pronto aspiration catheter from Vascular Solutions. This is 6F and goes over a 0.014 inch wire (rapid exchange) giving a large lumen for aspiration. This image show plaque aspirated form another patient, but is similar to that aspirated on this occasion.
Flow improved but required a 3mm angioplasty to the AT to achieve a satisfactory result.
Cordis J and J Outback Device for subintimal angioplasty
I have always been slightly sceptical of this device, feeling that it was a rare thing not be able to get back into the true lumen when doing a subintimal angioplasty. I finally used it for the first time this week and was very impressed!
The patient below was a 100yard claudicant with an approx 10cm mid sfa occlusion. We thought it would be a simple subintimal but we failed to re enter the true lumen despite several attempts.
We inserted the device over an 0.014 inch stabiliser wire which was in the subintimal tract. Following the video we orientated the catheter so the L pointed to the true lumen which became a T shape screening at 90 deg superimposed over the middle of the vessel true lumen. We withdrew the wire and advanced the ‘needle’ then probed with the wire. Its was obvious we had gone too far with the needle and it was probably in the opposite vessel wall. We withdrew it slowly and re probed which then saw the wire pass freely down the true lumen. The device was removed, catheter inserted, wire changed and angioplasty successfully performed.
This interesting device called ‘simplify’ from Neorad allows you to fix a needle eg cryo or RF etc in place for treatment. This is potentially very useful when moving a patient in and out of a scanner. A simple idea, with a low cost.
5 speakers presenting their cases and giving tips on technique in diagnosis and management. All speakers agreed that they think the treatment works in some patients, but they dont know why. Interesting as they all seemed to have slightly different opinions on some aspects of diagnosis. I was left in no doubt that there is a group of patients with MS who seem to have a genuine stenosis of the jugular vein/veins. However I am well aware of many patients without MS who also have this.
A striking case was shown of severe bilateral stenosis in a patient with progressive and severe MS. He was treated with angioplasty and definitely improved significantly beyond what you could expect from any placebo effect. Anecdote I know, but striking. I remain in some doubt as to whether CCSVI is a genuine abnormality that can cause MS.