Advancing interventional cardiology at Baystate Medical Center with Philips imaging technology

Baystate Medical Center is a 780-bed, independent academic medical center and a teaching site for UMass Chan Medical School – Baystate. It is the only comprehensive cardiac center in western Massachusetts, serving patients across western Massachusetts, northern Connecticut, southern Vermont, and New Hampshire. The Medical Center also oversees three additional regional hospitals and accepts referrals from seven more, making its reach substantial. Baystate Medical Center performs more than 6,000 cath lab procedures annually, including over 1,300 coronary interventions. Their percutaneous coronary intervention (PCI) program is among the largest in the state and consistently ranks in the top 6% nationally by National Cardiovascular Data Registry (NCDR) data, with rolling NCDR mortality in the 90th percentile for survival. And the electrophysiology (EP) colleagues perform more than 1,000 atrial fibrillation ablations each year.

In March 2023, the Baystate Medical Center opened four new cath labs and two new EP labs, and has since added a third EP lab as volumes continue to grow. These labs allow the Medical Center to bring the latest technology to its patients. State-of-the-art labs ensure that, whether it’s an emergency STEMI, a complex PCI, or a structural case, the teams can deliver the highest quality care with advanced imaging, physiology, and device platforms.

Baystate has always been a major regional presence, but over the past decade, its programs have grown substantially, both in volume and in sophistication. For cardiology alone, the Medical Center went from two aging cath labs to four brand-new rooms, each equipped with Philips Azurion systems with FlexArm. The result was a tremendous upgrade.

With Philips Azurion with FlexArm, a ceiling-mounted system that can move around the patient in virtually any configuration, Baystate found the right system for its needs. "That capability is important because structural heart disease procedures often require anesthesia at the head of the bed, echocardiographers at the left shoulder, and plenty of ancillary equipment," said Dr. Goldsweig. "With a fixed C-arm, accommodating all of that can be frustrating. The FlexArm eliminates those bottlenecks."

Radiation safety is also a priority for Baystate. According to Dr. Goldsweig, “Philips’ ClarityIQ algorithm has cut patient radiation exposure by about 70% compared to our previous systems [1]. We can now perform long chronic total occlusion cases while keeping kerma well under 500 mGy.” Another feature from ClarityIQ that Baystate finds valuable is the ability to adjust dose on the fly. “From the tableside controls, I can toggle between three “fluoro flavors.” Most of the time we work at the lowest dose and at 7.5 frames per second, but if I need to see fine detail, I can temporarily increase the dose and then step right back down. That balance of safety and image quality is a big advantage.”

The Baystate Medical Center also established a departmental priority to minimize contrast exposure. With Philips Dynamic Coronary Roadmap, a technology that creates a motion-compensated, real-time view of coronary arteries, clinicians can navigate without repeating contrast injections. When used, Dynamic Coronary Roadmap has been shown to reduce contrast in PCI by more than 28% [2].

The cardiology team makes sure to include in every operative report the actual contrast used, and every patient is also enrolled in a hydration protocol modeled on the POSEIDON trial, using left ventricular end-diastolic pressure (LVEDP) to guide fluid administration. Dr. Goldsweig adds, “Together, these steps have dropped our acute kidney injury rate from middle-of-the-pack to the lowest 10% nationally, according to recent NCDR data. That degree of renal protection is a tangible patient benefit.”

Baystate uses physiology in roughly 25% of coronary cases and intravascular imaging in nearly 100% of cases. As these technologies are absolutely central for the Medical Center, they now use Philips tools such as the IntraSight platform integrated into the Azurion system in each room, IVUS and instantaneous wave-Free Ratio (iFR) to assess vessel function and structure in real time during PCI. “The Philips IVUS is plug-and-play, so we can quickly place a catheter and perform a pullback to evaluate stent landing zones and vessel size. A major step forward has been the integration of IVUS and iFR Co-registration. We no longer just have an angiogram and a separate IVUS pullback. Instead, the two are linked.”

Baystate relies on Philips EPIQ CVxi echocardiography systems to help guide structural heart procedures like left atrial appendage occlusion and mitral transcatheter edge-to-edge repair. "A major advance has been the Philips VeriSight Pro 3D Intracardiac Echo Catheter," said Dr. Goldsweig. "VeriSight Pro delivers TEE-like images without the need for general anesthesia. About half of our LAAO cases are now performed with ICE under conscious sedation and with same-day discharge." The EPIQ CVxi also integrates with Azurion's EchoNavigator echo-fluoro fusion technology, combining live echocardiography images from the echo system with live X-ray images from the image-guided therapy system to provide guidance during demanding procedures.

The combination of high-volume experience, cutting-edge Philips technology, and a culture of quality improvement means that Baystate Medical Center can now offer its patients the most advanced care right there in Springfield. According to Dr. Goldsweig, “We are now positioned to deliver world-class interventional cardiology care for our community while advancing the science through research.” The most gratifying part, as Dr. Goldsweig mentions, “is knowing we are doing procedures more safely, meaning with less radiation, less contrast, and greater precision, while also leading clinical trials that will define best practices for years to come. That’s a rare and exciting combination, and it reflects the strength of the entire Baystate team.”

And how does Philips technologies position Baystate for future needs? Dr. Goldsweig says, “Philips has positioned its systems as platforms that evolve. We didn’t just buy today’s fluoroscopy; we invested in continuous updates and education. Philips provides ongoing in-service, software upgrades, and training. This relationship is a long-term partnership.”