In this article, Bjoern Suckow (Dartmouth Health, Lebanon, USA) discusses the Allia IGS 7 (GE HealthCare) and its role within his daily practice, sharing how the system has “technologically revolutionised” the way he and his team plan, visualise and perform complex procedures.
Encompassing the entire gamut of vascular surgery, Suckow’s practice has a strong emphasis on aortic pathology and endovascular treatments. In this continually evolving field, safety and efficiency remain key challenges, and interventionists face difficulties managing radiation exposure, visualising complex anatomy, and integrating preoperative planning with intraoperative imaging. To address these hurdles, the Allia IGS 7 system has been deployed as an addition to a hybrid operating room (OR), which Suckow describes as enhancing procedural accuracy and safety by reducing radiation use and improving workflow continuity.
Radiation exposure to both medical teams and patients remains a significant challenge when performing endovascular procedures. Traditional imaging requires high doses of radiation to achieve clear visuals of challenging anatomy, especially when treating advanced vascular pathology. This increased exposure is a persistent concern in endovascular interventions, Suckow states, as treatment of advanced pathology requires improved visualisation and so is “tied” to a high radiation exposure.
The Allia IGS 7 system offers a solution by integrating features that enhance imaging without increasing radiation. During procedures, the system allows for a fusion overlay that aids in visualising anatomy, with reduced reliance on additional imaging.
With this integration, interventionists can plan, execute, and assess procedures within a single software environment, which “helps to streamline workflow, reduce the repetitive nature of what we do, and lower radiation exposure while improving visualisation,” Suckow says. Previously, he and his team would repeat imaging or fuse prior imaging to “see what we can see now [with Allia IGS 7]”, which would have increased radiation dose to the patient.
Allia IGS 7 integrates with GE HealthCare’s ASSIST application, using three-dimensional (3D) guidance for endovascular aneurysm repair (EVAR ASSIST), including the vessel outline, ostia contours and stored optimal angulations for device placement. Suckow notes that the integration of this software into the same workstation for both pre- and intra-operative planning has been “integral” in enabling more accurate measurements and visualisation through segmentation and 3D modelling.
“During the execution of the procedure, EVAR ASSIST is fundamental through its fusion overlay so I can clearly visualise what I’m doing,” Suckow adds. “It clarifies, enhances and magnifies, all while keeping radiation dose low.”
In postoperative assessment, Suckow notes that Allia IGS 7 allows for on-table cone beam computed-tomography (CBCT) imaging, enabling review of placement and integrity of vascular devices immediately following implantation. This removes the need for additional postoperative CT scans, reducing both patient radiation exposure and hospital costs, “eliminating the possibility for errors”, Suckow said. “We can send patients home without further imaging assessments.”
For lower limb procedures, extensive anatomical regions need to be visualised, yet this can often be challenging with a machine with a smaller visual field, Suckow describes. In these cases, manoeuvrability is essential, to move the machine around the patient, or the patient around the machine.
“Much of the work we do in lower extremities is hybrid, meaning we have open exposures or concomitant open surgeries. Having a machine where the footprint and the manoeuvrability allows us to work in a sterile field with minimal complexity to move around and see what we need to see is crucial,” Suckow states.
He points out that the Allia IGS 7’s ability to perform a bolus chase using Innova Breeze (GE HealthCare) facilitates a continuous view of the entire limb during contrast injections. This effectively reduces the need for additional imaging and contrast material. This feature, combined with its flexible manoeuvrability, Suckow details, supports the visualisation required for long, complex limb interventions. Additionally, this technology can be used to recall stored 2D image series to treat lesions without repeat imaging, so that Suckow and his team can quickly confirm location, making procedures “easier, saving time, and lowering radiation”, he reiterates.
Touching on the hybrid OR setup they have achieved at their centre, Suckow explains how their previous system was “cumbersome” when moving from endovascular to open surgery. “For open surgery we need lighting, and with a large ceiling-mounted machine, lighting is difficult, and you cannot achieve optimal visualisation. With Allia, the machine can move entirely out of the way,” Suckow says.
“Allia is rapidly moved in and out, and I can bring in all of the lighting and accessories for true open surgery in a heartbeat. On the flip side, if I’m doing general open surgery in that room and I suddenly need endovascular imaging assessment, I can—from the table side—move Allia, and it does not require any breaking of sterility or extra manpower. We can just move the machine in and utilise it at a drop level.”
Suckow adds that post-hoc analysis can also be done on-table using the digital pen and Allia IGS 7 console. “If you remember back in the day when we would have a picture on our screen, we would come up with a dry erase marker and mark on the screen certain locations that are of interest—that’s a way of the past,” he said. With this technology, a 3D mark can be made, which, if the patient or machine is moved, will stay in place. These marks can also provide length and diameter measurements that are true to size, which Suckow can do “with the click of the mouse”, he adds. “It has become a central part of our workflow and I use it in every single case.”
In the future, Suckow hopes that incremental improvements to safety, ease of device implantation, and workflow can be made, goals toward which the Allia IGS 7 system steps in the right direction. Additionally, integrating emerging technologies, such as radiation-free visualisation through fibre optic or electromagnetic field-based techniques could push the Allia system to the forefront of hybrid OR technology.
In all, the Allia IGS 7 system represents a valuable step forward in hybrid OR settings, through its ability to “visualise, zoom, pan, digitally enhance, lower radiation, and fuse workflow planning”, Suckow highlights. “This technology has revolutionised how I approach these cases—I couldn’t perform to such a standard in any other OR.”
