April 9, 2009

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Health Power Tools

Hi-Tech Redefines Going Under the Knife

By Mark Dayton

April 9, 2009

Portable and digital are the hot growth areas for devices these days—music, phones, cameras, browsers, x-rays... x-rays? An innovative new handheld x-ray device is working its way out of the emergency field clinic and into everyday use in thousands of dentist and orthodontics offices nationwide. The brain child of Dr. Clark Turner, founder and CEO of Orem-based Aribex, Inc., (pronounced like the Spanish “arriba”) the Aribex Nomad was born out of Turner’s desire to help a dentist friend address the lack of x-ray availability on his humanitarian trips to third world countries. Originally built around a DeWalt power tool battery, the handheld wireless device looks at first glance like an oversized cordless drill with a halo. When pared with a digital target device inside the patient’s mouth, high quality digital x-rays can be captured and processed on a laptop computer virtually anywhere or on conventional x-ray film. In addition to being highly portable, the Nomad is extremely safe from an operator standpoint. The “halo” is actually an x-ray shield that creates a safe zone for the operator who can stand next to the patient, point and fire the device without concern for repeated exposure to harmful radiation. The many advantages of lightweight, portable and safe x-ray capability have fueled 100 percent annual growth for the company since its debut in 2005. With the recent introduction of the Nomad Pro (smaller, lighter, more capable batteries helped shave three pounds and reduce bulkiness), the company is experiencing another surge in sales, which at this point consist of only 20 percent out-of-office deployments versus 80 percent standard dental/orthodontic installations. Turner points to a few key benefits of the Nomad that have allowed it to displace entrenched competitors of large wall-mounted units. “First and foremost is the economic advantage. With conventional radiology, you need a wall-mounted head for every operatory in your clinic. Nomad replaces them all with one portable unit.” Oral surgeons also find the Nomad to be a great alternative to heavy, bulky wheel mounted units trailing a collection of cables that must be wheeled into operating rooms. “It’s also great in pediatrics for kids who can’t hold still,” says Turner. “The operator can stand right next to the child, calm them and get the right position for the x-ray, rather than making multiple trips in and out of the room to reposition the head or asking an adult to hold the child.” Aribex, Inc. plans to eventually expand into the veterinary and medical markets where home health care, emergency room and in-office x-rays of extremities and chest hold bright promise. International expansion is also on the horizon: “The U.S. accounts for only about 40 percent of the dentistry market,” says Turner. “We could double our sales just by going international.” Turner also has his eye on the next generation Nomad—similar to a digital camera with an integrated LCD display. “You can see your snapshots instantly on your camera or phone. It will be the same for x-rays, to help the operator make sure they got the right shot.” So, don’t be surprised if on your next dental visit the hygienist points a halo-encased device at you and says, “Smile and say Nomad!” Surgery without the Scalpel Another state-of-the-art device aiding patients and doctors is the CyberKnife. Sporting a name that conjures up images of a futuristic tool wielded by intelligent droids used to perform bloodless, non-sedated surgeries for previously inoperable conditions—actually, other than the futuristic part, that somewhat describes CyberKnife’s capabilities. In reality, CyberKnife is not a knife at all, but rather a low-dosage radiation stream delivered by a compact linear accelerator (LINAC) mounted on a robotic arm. Through real-time image-guided radiography, CyberKnife delivers hundreds of radiation impulses from different angles that all converge on a targeted tumor. As a result, the tumor receives a cumulative lethal dose of radiation while exposure to surrounding healthy tissue is minimized. Sophisticated robotic/image interactive systems instantly compensate for patient movement, re-aiming the robotically-mounted beam to ensure accurate targeting of the radiation stream. “CyberKnife if very exciting technology that is showing great promise in non-standard surgical procedures,” says Dr. Mark W. Reilly, radiation oncologist and medical director for Salt Lake CyberKnife. “Think of CyberKnife as another tool in the surgeon’s bag, not as a replacement for proven surgical procedures.” Reilly points out that radiation oncologists work in close collaboration with other surgeons—neurosurgeons or cardiothoracic surgeons, for example—to provide treatments where traditional surgical or radiation methodologies are risky or impossible. “For example, a slow growing tumor in the brain may be too large for the surgeon to remove entirely,” says Reilly. “He will remove what he can, and CyberKnife will take care of the remainder.” Dr. John R. Adler, professor of neurosurgery and radiation oncology at Stanford University Medical Center, developed the CyberKnife technology in 1987. Now it’s distributed under Accuray, CyberKnife’s parent company, to 75 surgical centers in the U.S. and other countries. Salt Lake CyberKnife was opened in 2007 as a joint effort between the Salt Lake Regional Medical Center and Gamma West Cancer Services. “The experts in CyberKnife centers around the world all collaborate closely,” says Reilly. “You have the advantage of the experience of all the other centers, and access to some of the leading pioneers in the field—including the inventor.” Patient response to the procedures has been very positive, according to Reilly. Treatments are typically completed in two hours or less, require no sedation and exhibit few side effects. “Patients pretty much live a normal life after the procedure,” says Reilly. “They drive to and from treatments, and have virtually no post-operative recovery time—unlike conventional brain surgery, for example, which can be much more invasive and painful.” While CyberKnife is a fairly recent invention, Reilly sees a range of possible procedures that could benefit from its non-invasive, precise delivery of therapeutic radiation. “As more data and clinical experience are gathered, we will find an expanding role for this technology where extreme accuracy can address a number of other issues.” The technology is showing great usefulness in brain and head conditions, where half of CyberKnife treatments are focused today. Other promising areas include lung, pancreas, liver, bone and prostate cancer conditions that aren’t treatable through traditional surgical or radiation approaches. While CyberKnife may not be the surgical panacea envisioned by sci-fi futurists, it does have one distinct advantage: it’s working to heal patients today.
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