TORONTO – As one of the top neuroradiologists in the world, Dr. Karel Terbrugge speaks bluntly about the risks involved in interventional radiology for the brain. “We cannot make a mistake because if we do, the patient is basically dead. That is the negative thing about what we are doing – if we have a complication, it is usually pretty bad.”

As such, top-notch imaging tools for interventional neuroradiologists are of the utmost importance. Thanks to progress on the technological front, and the growing expertise of interventional neuroradiologists, great medical strides have been taken in the last two decades.

The hardware (catheter, wires and “little plastic tubes” in Dr. Terbrugge’s words) have gotten finer and more easy to manipulate, while imaging technology has allowed radiologists to see what they are doing more precisely – a crucial requirement given the delicate and tiny pathways of the brain.

Using these devices, neuroradiologists are able to close off aneurysms and bleeding vessels which produce debilitating strokes in patients. They’re also able to remove clots within the brain – which can also cause strokes.

“We used to do one stroke every month or two – now we’re doing one stroke every day or two,” said Dr. Terbrugge, who is a professor of radiology and surgery and head of the Division of Neuroradiology, University of Toronto and Toronto Western Hospital.

Ontario’s stroke strategy, which has established stroke centres across the province to which patients are shuttled

to in the first crucial hours, has also greatly increased the demands on neuroradiologists.

Because neuroradiologists are completely reliant on remote images to carry out procedures, they are quick to adopt the latest generation of technology. In Dr. Terbrugge’s case, the next step in imaging technology at Toronto Western Hospital is Toshiba’s Infinix VF-i/BP interventional angiography biplane system, which utilizes a new flat-panel detector to present high-quality fluoroscopic and fluorographic images.

The flat-panel images produced by Toshiba’s biplane system “are much superior to anything that we have ever had in

the past, so this allows us to do things more safely and treat patients more safely,” said Dr. Terbrugge. Instead of the “fuzzy” images of older generation systems, with the flat-panel images “everything is sharp and the pictures are just unbelievably beautiful. The blood vessels are just like anatomical textbooks.” Toronto Western was the first facility in the world to use Toshiba’s

next-generation biplane system, said Behram Engineer, general manager of Toshiba Canada’s Medical Systems Group. The stepped-up resolution and magnification have been a boon to the intervention-al radiologists.

“They are using wires that are smaller than your hair, so to see these things [with the naked eye] is almost impossible,” he said. Besides better imaging and a lower radiation dose, Toshiba’s continuous imaging Infinix system is smaller and easier for medical professionals to work around, compared with older analog systems. “Angio units near the head used to be the size of a bucket. Ours is now the size of a picture frame and you can get much closer to the patient’s head,” said Mr. Engineer.

In a one-to-two hour procedure, neuroradiologists like Dr. Terbrugge have a long route to take to the brain. A frontal projection helps guide a catheter and specialized tools through the abdomen and chest up to the neck, where a side-view image proves crucial in navigating the delicate and narrow vessels of the brain. “We can simultaneously see the catheter, the plastic tube and the wire moving through the vessel,” he said. “We create a roadmap and we inject the vessel, we superimpose the movement of the device, go to the target and do whatever we need to do, take our pictures and hopefully fix the problem.”

Neuroradiological treatment of stroke is “probably the most sexy” procedure his team is doing, Dr. Terbrugge says, because of the headlines it has generated in recent years. But it also provides the most bang for the medical buck. Quick treatment of strokes (along with positive long-term lifestyle changes) can get patients back as functioning members of society. Rather than lengthy hospital stays, rehab and lingering symptoms, patients are today going back to work within days of suffering a stroke. “This is a major difference,” said Dr. Terbrugge.

Some of the credit for the revolution in stroke treatment can go to the so-called ‘clot busting’ wonder drug tissue plasminogen activator (tPA), although it can’t be used on all patients and it doesn’t guarantee all effects of a stroke will be minimized. Intravenous injection of tPA reopens vessels about one-third of the time, said Dr. Terbrugge. “If you do what we do with the catheters and imaging equipment…we can now open up the vessels in as many as 80 percent of patients.”

Dr. Terbrugge’s hospital and other facilities are now doing what he terms “bridging” therapy. Stroke patients are given a one-half dose of the anti-stroke drug through an IV with the remainder injected directly into the vessel-blocking clot. “The only negative thing is that not everybody has a Toshiba biplane unit which means that people have to go to regional stroke centers like ours,” he said.

“But if it you do it that way, the number of patients doing well nearly triples,” concluded Dr. Terbrugge.