HospiMedica International November 2022 by Globetech

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WORLD’S CLINICAL NEWS LEADER ISSN 0898-7270 Vol.40 No.4 • 11/2022

MEDICA®

2022 Hall 1• H61

AI-Aided CT Detects Lung Cancer in Seconds

ung cancer, the most common cancer worldwide, is targeted with radiation therapy (RT) in nearly one-half of cases. RT planning is a manual, resource-intensive process that can take days to weeks to complete, and even highly trained physicians vary in

Novel Blood Volume Analysis Cuts Hospital Stay for Heart Patients by Half

ffective management of patients hospitalized for heart failure remains problematic despite advances in medical therapy. Hospitals and clinicians struggle with readmissions, mortality and wasted resources. There is a need for accurate, actionable data to

allow clinicians to optimize treatment plans and individualize care, thereby improving outcomes and reducing duration and cost of care. Now, new data has validated the benefits of a diagnostic blood test in reducing hospital length of stay (LOS) for heart failure patients.

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Ultra-Fast MRI Could Transform Heart Failure Diagnosis

Polyp Detection System Is Gastro Game Changer

olorectal cancer is the second leading cause of cancer-related deaths in the U.S. and Europe, due in part to the high volumes of adenomas – approximately 26% – that endoscopists miss when conducting a colonoscopy. Now, a real-time computer-aided polyp detection device that uses advanced computer vision technology to recognize suspicious tissue and provide real-time feedback to Cont’d on page 22

First Hand-Held Robot for Spinal Surgery

n ewly-developed MRI technique called Kat-ARC produces detailed 4D heart flow images in 8 minutes instead of the previous 20 minutes, thus transforming the speed at which heart failure is diagnosed.

he world’s first hand-held robot framework equipped with a parallel manipulator for orthopedic application has made its worldwide debut in the U.S. Point Robotics MedTech Inc. (Taipei, Taiwan; www.pointrobo ticsinc.com) received clearance from the U.S. Food and Drug Administration (FDA) for its minimally invasive surgical robot, POINT Kinguide RoboticAssisted Surgical System. An

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p to 90% of patients receive IV therapy at some point during their hospital stay, making it the most commonly performed invasive medical procedure in the U.S., and around the globe. Although it is routine,

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Vein Visualization Device Enables Accurate Catheter Placement

Merger Creates World’s Largest Medical Image Exchange Network

ntelerad Medical Systems (Raleigh, NC, USA; www. intelerad.com), a leading global provider of enterprise imaging solutions, has acquired Life Image (Newton, MA, USA; www.lifeimage.com), one of

the largest image exchange networks of curated clinical and imaging data, creating the largest medical image exchange network in the world and laying the groundwork for the elimination of costly CDs as the Cont’d on page 3

News Update . . . . . . . . . 19 Product News . . . . . . 20-24

Industry News . . . . . . . . . . 25 International Calendar . . . 26

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Merger Creates World’s Largest Medical Image Exchange Network Cont’d from cover

primary means of image transfer. Medical record interoperability has been a key component of the 21st Century Cures Act and its focus on eliminating all forms of information blocking. Radiology leaders and industry stakeholders have been champions for establishing a framework for seamless electronic image transfer in an effort to improve patient care and eliminate the burden on caregivers. By combining two of the largest image sharing networks and ensuring open access between networks, Intelerad takes a critical step in advancing access to digital health information. Leading healthcare systems have been pushing for seamless interoperability. With this transaction, Intelerad and Life Image serve many of the largest medical institutions in the world, including Mayo Clinic, Cleveland Clinic and New York Presbyterian Hospital. The combined network manages over 80 billion images globally, enabling 24/7 digital image sharing from any device wherever the provider or patient may be. “As a company, Intelerad has been unwavering in backing the challenge put forth by the American College of Radiology (ACR), RSNA and SIIM to #ditchthedisk. Today’s transaction reflects one of the most important steps we could imagine in reaching that vision,” said Mike Lipps, Intelerad CEO. “Bringing together two of the industry’s leading image exchange providers further solidifies Intelerad’s commitment to helping clinicians and patients lead the revolution in imaging from a world of siloed PACS to a future of interoperable image exchange.” “Together we have both worked to advance patient care and are excited to have the opportunity to bring these two leading networks together to advance interoperability,” said Morris Panner, President of Intelerad and former CEO of Ambra Health, which was acquired by Intelerad in October 2021. “As independent companies we competed, but also pioneered some of the most important cross-vendor exchanges in the industry. By combining, we are able to advance our vision and technology more rapidly and achieve our joint vision of a true nation-wide, electronic image exchange network. We are just getting started.” “As an advocate for radiology’s critical role in health equity, I am so encouraged by the announcement of this expanded

Image: The acquisition combines two leading image exchange providers, managing 80 billion images globally (Photo courtesy of Life Image)

network and its commitment to interoperability,” said Dr. Geraldine McGinty, past President of the ACR. “Patients and physicians alike need an easy way to share images and this is an important first step toward enabling vendors to work together as they should.”

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Diagnostic Wearables Redefining Entire Fields of Medical Monitoring

iagnostic wearable devices enable individuals and medical providers alike to track and understand health status by providing real-time data. The keys to success for diagnostic wearables include ease of use, affordability and wide market availability – plus, increasing data collection capabilities thanks to advances in sensor electronics integration. Wearables that track heart rate, sleep, and physical activity levels are already widely used for sports and fitness purposes, and now diagnostic wearables are primed to deliver innovation for more challenging wellness and medical applications. From diet tracking to cancer detection – diagnostic wearables represent a world of opportunity. However, the path to bringing these products to market is not without its challenges. A global survey called “Diagnostic Wearables: The Future of Medical Monitoring,” by Molex (Lisle, IL, USA; www.molex.com), a global electronics company, explored the market drivers and issues impacting a new generation of diagnostic wearables, including the tradeoffs design engineers in this game-changing field must face – from form factors and battery considerations to data collection and Cont’d on page 4

HospiMedica International November/2022

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HospiMedica International

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Novel Blood Volume Analysis Cuts Hospital Stay for Heart Patients by Half Cont’d from cover

Daxor Corporation’s (Oak Ridge, TN, USA; www.daxor.com) BVA-100 (Blood Volume Analyzer) is the only diagnostic blood test cleared by the FDA to provide safe, accurate, objective quantification of blood volume status and composition compared to patient-specific norms. Over 60,000+ tests have been performed at leading hospital centers across the U.S., enhancing hospital performance metrics in a broad range of surgical and medical conditions, including significantly reducing mortality and readmissions in heart failure and critical care. Daxor has several ongoing multicenter trials in the areas of COVID-19 and heart failure treatment. In the latest study titled “Length of Stay After Blood Volume Analysis in Hospitalized Heart Failure” compared both hospital admission and discharge dates, allowing the calculation of pre- and post-BVA LOS for all patients. Those who received BVA-guided treatment on the day of admission to the hospital had a highly significant (p <0.001) lower total LOS than controls (2.04 vs. 4.56 days) and significantly improved outcomes (lower 30-day readmissions and 365-day mortality). “This important study shows that BVA has the ability to help clinicians treat patients more effectively so that they get out of the hospital faster and have better results in terms of mortality and readmission when compared to those who did not receive BVA-guided care. Annual costs for HF treatment are estimated

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at USD 30.7 billion and expected to grow to nearly USD 70 billion by 2030 if we fail to improve on current treatment outcomes. Notably, in-hospital care comprises the majority of costs across all HF categories, averaging USD 14,000 per admission,” stated Michael Feldschuh, CEO and President of Daxor Corporation. “The clinical evidence continues to demonstrate that our innovative BVA-100 blood test uniquely allows physicians to understand underlying HF blood volume derangements, providing them with accurate, actionable data to individualize treatment plans in both the inpatient and outpatient settings – improving outcomes and reducing the total cost of care,” added Jonathan Feldschuh, Chief Scientific Officer of Daxor Corporation.

Diagnostic Wearables Redefining Entire Fields of Medical Monitoring Cont’d from page 3

management. The survey queried 600 design engineers and engineering managers across the world who are working in organizations developing wearable diagnostic solutions and who broadly agreed that the technology is ready and barriers to innovation can be overcome – it’s just a matter of time. According to the survey findings, patients are predominately driving the demand for wearable diagnostics, followed by first-line personnel such as doctors, technicians, and home care providers who are key supporters of new wearable products. Design engineers expect consumer use to increase in the next five years, but the perceived need for medical supervision is significant. Less than half of most categories are expected to be available to all consumers without medical supervision. The potential applications for medical wearables are extensive. Design engineers expect to see a wide range of new types available for consumer use in the next five years. Tech companies and medical device start-

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ups are expected to lead wearable diagnostic innovation in the next five years. In general, design engineering now has an array of technologies (materials, sensors, data communication, and power management) that are mature enough to deploy for a long list of health conditions. The barrier of widespread adoption seems to lie in placing these capabilities in a single package that all stakeholders will find acceptable. 99.7% of respondents reported that wearable diagnostics have additional design challenges, with issues related to ease of use and Cont’d on page 5

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ISSN 0898-7270 Vol.40 No.4 • Published, under license, by Globetech Media LLC Copyright © 2022. All rights reserved. Reproduction in any form is forbidden without express permission. Teknopress Yayıncılık ve Ticaret Ltd. Şti. adına İmtiyaz Sahibi: M. Geren • Yazı işleri Müdürü: Ersin Köklü Müşir Derviş İbrahim Sok. 5/4, Esentepe, 34394 Şişli, İstanbul P. K. 1, AVPIM, 34001 İstanbul • E-mail: Teknopress@yahoo.com Baskı: Postkom A.Ş. • İpkas Sanayi Sitesi 3. Etap C Blok • 34490 Başakşehir • İstanbul Yerel süreli yayındır. Yılda dört kere yayınlanır, ücretsiz dağıtılır.

HospiMedica International November/2022

Machine Learning Model Uses MRI Data To Identify Candidates for Liver Transplant

ost-treatment recurrence is an unpredictable complication after liver transplant for hepatocellular carcinoma (HCC) that is associated with poor survival. Biomarkers are needed to estimate recurrence risk before organ allocation. A new study has found that machine learning (ML) models applied to presently underutilized imaging features could help construct more reliable criteria for organ allocation and liver transplant eligibility. In the proof-of-concept study, researchers at Yale University School of Medicine (New Haven, CT, USA; www.medicine.yale.edu) evaluated the use of ML to predict recurrence from pretreatment laboratory, clinical, and MRI data in patients with early-stage HCC initially eligible for liver transplant. The study included 120 patients (88 men, 32 women; median age, 60 years) diagnosed with early-stage HCC between June 2005 and March 2018, who were initially eligible for liver transplant and underwent treatment by transplant, resection, or thermal ablation. Patients underwent pretreatment MRI and posttreatment imaging surveillance, and imaging features were extracted from post-contrast phases of pretreatment MRI examinations using a pre-trained convolutional neural network (VGG-16). Pretreatment clinical characteristics (including laboratory data) and extracted imaging features were integrated to develop three ML models – clinical, imaging, combined – for recurrence prediction within 1-6 years post-treatment. Ultimately, all three models predicted post-treatment recurrence for early-stage HCC from pretreatment clinical (AUC 0.60–0.78, across all six time frames), MRI (AUC 0.71–0.85), and both data combined (AUC 0.62–0.86). Using imaging data as the sole model input yielded higher predictive performance than clinical data alone; however, combining both data types did not significantly improve performance over use of imaging data alone. “The findings suggest that machine learning-based models can predict recurrence before therapy allocation in patients with earlystage HCC initially eligible for liver transplant,” wrote corresponding author Julius Chapiro from the department of radiology and biomedical imaging at Yale University School of Medicine.

Diagnostic Wearables Redefining Entire Fields of Medical Monitoring

HospiMedica_clr_4.125x7.375_EngSpn22Oct10_11735.pdf 1 carcinoma 10/5/22 3:10 Image: vc Machine learning models can predict hepatocellular

response (Photo courtesy of Pexels) vctreatment HospiMedica_clr_Eng 4.125 x 7.375 due 10/10/2022

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user interface cited most often, followed by issues around power consumption and battery. Cost topped the charts as the biggest challenge when designing wearable diagnostics. Sensors and connectors topped the list as the most challenging aspects of miniaturization of wearable diagnostics. Design engineers largely saw a need for improvement in materials for wearable diagnostics. There was broad agreement that innovation is needed, with over 60% of engineers highlighting the need for hardware innovation. Design engineers predict that harvesting patient energy (i.e. body heat, sweat, heart beat) to power wearable diagnostics will take time. Movement was considered the most likely source of energy harvesting. 80% of respondents reported that COVID had resulted in changing attitudes towards medical devices in non-clinical settings. Amidst the strong demand for wearable diagnostics, roughly half of those surveyed saw tech companies and medical device startups as the future leaders in this space. However, nearly two-thirds of respondents reported that collaboration across groups is critical for innovation. This suggests a strong need for partnership between non-traditional healthcare players (e.g., tech companies and startups) and those with established expertise.

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Novel PET Imaging Agent Detects Earliest Signs of Alzheimer’s Disease

new highly selective PET imaging agent can detect the presence of overexpressed monoamine oxidase-B (MAO-B) in cognitively unimpaired individuals with high beta amyloid (Aβ) – one of the earliest signs of Alzheimer’s disease, according to new research. The radiotracer, 18F-SMBT-1, allows for a better understanding of the role of inflammation in Alzheimer’s disease, which can enable more accurate staging and prognosis at earlier stages. Brain inflammation that accompanies Alzheimer’s disease involves reactive astrocytes, which are cells that overexpress MAO-B. The newly developed 18F-SMBT-1 radiotracer is highly selective for MAO-B and as a result has increased binding to reactive astrocytes. The study by researchers at the University of Pittsburgh (Pittsburgh, PA, USA; www.pitt. edu) aimed to characterize 18F-SMBT-1 binding to reactive astrocytes across the Alzheimer’s disease continuum. Study participants included three clinical groups: 57 cognitively unimpaired controls, 12 subjects meeting criteria for mild cognitive impairment (MCI), and eight subjects meeting criteria for Alzheimer’s dis-

ease. Participants underwent several types of imaging, including 18F-SMBT-1 PET, Aβ PET, tau PET, and MRI. Images were normalized and statistical analyses conducted to assess 18F-SMBT-1 binding in relation to Aβ and tau pathology burden. 18F-SMBT-1 was found to be highly correlated with Aβ burden, and much less with tau burden. The three clinical groups were then classified based on their Aβ status (either as Aβ+ or Aβ–). No significant differences in 18F-SMBT-1 binding were found among Aβ– participants in the control and MCI groups. In the Aβ+ subjects with Alzheimer’s disease, 18F-SMBT-1 binding was significantly higher. Most importantly, 18F-SMBT-1 binding was significantly higher in the Aβ+ control group as compared to Aβ– control group. “This increased binding suggests that 18FSMBT-1 can potentially be used as a surrogate marker to detect reactive astrogliosis in Alzheimer’s disease,” noted Victor Villemagne, MD, professor of psychiatry at the University of Pittsburgh in Pittsburgh, Pennsylvania. “It’s of note that the brain regions where we saw this higher 18F-SMBT-1 binding in the control group are

regions known for early Aβ deposition. This suggests that reactive astrocytes are associated with early Aβ deposition at the preclinical stages of Alzheimer’s disease and likely play a role over clinical progression.” “Implementation of 18F-SMBT-1 will clarify the role of reactive astrogliosis in neurodegenerative conditions, not just Alzheimer’s disease and its potential independent and/or synergistic effects on pathology, neurodegeneration, cognition, and disease progression. This has the potential to define and refine the diagnostic, staging and prognostic roles of reactive astrogliosis in these conditions,” added Villemagne.

AI-Aided CT Detects Lung Cancer in Seconds Cont’d from cover

their determinations of how much tissue to target with radiation. Furthermore, a shortage of radiation-oncology practitioners and clinics worldwide is expected to grow as cancer rates increase. Now, a newly developed and validated deep learning algorithm can identify and outline (segment) a non-small cell lung cancer (NSCLC) tumor on a computed tomography (CT) scan within seconds. Additionally, radiation oncologists using the algorithm in simulated clinics performed as well as physicians not using the algorithm, while working 65% more quickly.

Researchers at the Brigham and Women’s Hospital (Boston, MA, USA) developed the deep learning algorithm by using CT images from 787 patients to train their model to distinguish tumors from other tissues. They tested the algorithm’s performance using scans from over 1,300 patients from increasingly external datasets. Developing and validating the algorithm involved close collaboration between data scientists and radiation oncologists. For example, when the researchers observed that the algorithm was incorrectly segmenting CT scans involving the lymph nodes, they retrained the model with more of these scans to improve its

performance. Finally, the researchers asked eight radiation oncologists to perform segmentation tasks as well as rate and edit segmentations produced by either another expert physician or the algorithm (they were not told which). There was no significant difference in performance between human-AI collaborations and human-produced (de novo) segmentations. Intriguingly, physicians worked 65% faster and with 32% less variation when editing an AI-produced segmentation compared to a manually produced one, even though they were unaware of which one Cont’d on page 10

HospiMedica International November/2022

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AI Solution Turns Inexpensive POC Ultrasound Devices into Powerful Diagnostic Tools

hronic liver disease is one of the fastest-growing causes of morbidity and mortality in the world, affecting more than two billion people globally and is rising dramatically, driven by a condition called Non-Alcoholic Fatty Liver Disease (NAFLD). NAFLD has grown rapidly due to the rise in obesity, metabolic disorders and type 2 diabetes. Currently, detecting CLD is a challenge, potentially involving high-end imaging systems, specialists, and invasive biopsies. Now, a new AI-driven technology for the low-cost assessment of structural diseases at the point of care aims to disrupt liver care by facilitating easier early disease detection, diagnosis, and patient management. Oncoustics’ (Toronto ON, Canada; www.oncoustics.com) SaMD (software as a medical device) technology is based on its patented approach that utilizes both the ultrasound images as well as the acoustic data derived from raw sound signals to automatically differentiate tissue types. Every different type of tissue in the body bounces back a unique acoustic signature and Oncoustics mines these signals to differentiate healthy versus diseased tissues. Oncoustics has been collecting ultrasound signal datasets and has amassed the largest RF signal data set in the world. This hardware-agnostic approach works on any ultrasound system, including new low-cost point-of-care ultrasound systems, making this an affordable and accessible diagnostic tool. Leveraging the rise of new point-of-care ultrasound systems, Oncoustics takes advantage of all the benefits of these systems, including their low cost, portability and ease of use, and builds on this by guiding the data acquisition and providing easy-to-read results via a smartphone app. Oncoustics offers a suite of disease and anatomy-focused apps that work on any point-of-care ultrasound and can be used by any MD/ Nurse/Tech as a basic primary care office instrument, without the need to look at images. Oncoustics’ AI solutions turn inexpensive point-ofcare ultrasound devices into powerful diagnostic tools for faster, cost effective detection and monitoring of diseases, including diseases in the liver, prostate, kidney, breast and thyroid. Oncoustics’ first product, the OnX liver assessment solution, is focused on detecting structural liver diseases including fibrosis and steatosis (fat) that can occur in all types of CLD. The Oncoustics platform promises a whole new level of access to care with the benefits of ease of use, accessibility, affordability, and optimizing clinical workflows. “There’s a tsunami of need around detecting these types of liver diseases and our ultimate goal is to decrease or eliminate the need for high-end imaging or painful and invasive biopsies,” said Beth Rogozinski, CEO, Oncoustics.

Image: The AI innovation in ultrasound addresses huge unmet clinical needs in liver disease (Photo courtesy of Oncoustics)

Ultra-Fast MRI Could Transform Heart Failure Diagnosis Cont’d from cover

Researchers at the University of East Anglia (Norwich, UK; www.uea. ac.uk) have developed a cutting-edge technology to diagnose patients with heart failure in record time. The state-of-the-art technology called Kat-ARC uses magnetic resonance imaging (MRI) to create detailed 4D flow images of the heart. But unlike a standard MRI scan, which can take up to 20 minutes or more, the new 4D heart MRI scan takes just eight minutes. The results provide a precise image of the heart valves and blood flow inside the heart, helping doctors determine the best course of treatment for patients. The team tested the new technology with 50 patients with suspected heart failure were assessed using the new KatARC 4D heart flow MRI. The team now hopes that their work could revolutionize the speed at which heart failure is diagnosed, benefitting hospitals and patients world-wide. “Heart failure is a dreadful condition resulting from rising pressures inside the heart. The best method to diagnose heart failure is by invasive assessment, which is not preferred as it has risks,” said lead researcher Dr. Pankaj Garg, from UEA’s Norwich Medical School and an Honorary Consultant Cardiologist at NNUH. “An ultrasound scan of the heart called echocardiography is routinely used to measure the peak velocity of blood flow through the mitral valve of the heart. However, this method can be unreliable. We have been researching one of the most cutting-edge methods of flow assessment inside the heart called 4D flow MRI. In 4D flow MRI, we can look at the flow in Cont’d on page 11

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Next-Generation CT Brain AI Solution Improves Clinical Accuracy and Efficiency

n AI-enabled software-as-a-medical device (SaMD) decision-support solution for non-contrast CT brain studies can identify 130 imaging findings, including a wide range of conditions that require time sensitive interventions, making it the most clinically comprehensive decision support AI solution available on the market. The Enterprise CTB (Annalise CTB) from Annalise.ai (Sydney, Australia) is designed to be an assistive clinical tool, empowering radiologists with a ‘second pair of eyes’ to help them improve diagnostic accuracy and health outcomes for patients. The support from Annalise CTB could be particularly impactful to overstretched radiology residents reporting out-of-hours at teaching hospitals and in areas experiencing challenging radiologist capacity constraints. In addition to assisting with the detection of imaging findings, Annalise CTB is expected to streamline patient care workflows - and analyzing non-contrast head CT examinations as they are acquired, the solution can provide a notification signal for urgent cases, helping radiologists to triage high-priority cases in need of rapid action. Annalise Enterprise CTB is the first commercially available medical imaging AI solution to detect over 100 findings on non-contrast CT brain scans and has been trained on one of the world’s largest label datasets of non-contrast CT brain studies, hand-labeled by 143 radiologists, generating over 240,000,000 CTB labels. Designed for clinicians, with features

such as a confidence bar for each finding and a user interface that provides seamless integration into a radiologist’s workflow, Annalise Enterprise CTB automatically highlights the suspected location of findings on multiplanar reformatted images with pathology-appropriate window and level settings. Annalise Enterprise CTB demonstrated improvements in reporting accuracy and changes to patient management in a recent six-week pilot study with 11 radiologists using the solution as an assistive tool. Annalise Enterprise CTB is now clinically available in Australia, New Zealand and the UK where it is in use by many radiologists at a large number of sites. The new Annalise CTB module is expected to help continue to work towards its mission to help one million patients every day. "Annalise Enterprise CTB represents an evolutionary leap forward in AI technology for neuroimaging," said Dr. Rick Abramson, Chief Medical Officer of annalise. ai. "Whereas most other AI products for head CT can recognize only a small handful of conditions, Annalise CTB assists the radiologist with 130 imaging findings - which means more support for the radiologist and a bigger impact on patient care. In our controlled product launch, we have already seen countless examples of critical pathology that could have been missed but were successfully identified by Annalise CTB." Image: The Annalise Enterprise CTB module assists radiologists with interpretation of radiological imaging studies (Photo courtesy of Annalise)

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AI-Aided CT Detects Lung Cancer in Seconds Cont’d from page 6

they were editing. They also rated the quality of AI-drawn segmentations more highly than the human expert-drawn segmentations in this blinded study. Going forward, the researchers plan to combine this work with AI models they designed previously that can identify “organs at risk” of receiving undesired radiation during cancer treatment (such as the heart) and thereby exclude them from radiotherapy. They are continuing to study how physicians interact with AI to ensure that AI-partnerships help, rather than harm, clinical practice, and are developing a second, independent segmentation algorithm that can verify both human and AI-drawn segmentations. “The biggest translation gap in AI applications to medicine is the failure to study how to use AI to improve human clinicians, and vice versa,” said corresponding author Raymond Mak, MD, of the Brigham’s Department of Radiation Oncology. “We’re studying how to make human-AI partnerships and collaborations that result in better outcomes for patients. The benefits of this approach for patients include greater consistency in segmenting tumors and accelerated times to treatment. The clinician benefits include a reduction in mundane but difficult computer work, which can reduce burnout and increase the time they can spend with patients.” “This study presents a novel evaluation strategy for AI models that emphasizes the importance of human-AI collaboration,” added co-author Hugo Aerts, PhD, of the Department of Radiation Oncology. “This is especially necessary because in silico (computer-modeled) evaluations can give different results than clinical evaluations. Our approach can help pave the way towards clinical deployment.

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Medical Imaging

Novel Photon-Counting CT Improves Myeloma Bone Disease Detection

ultiple myeloma is a disease that forms in a type of white blood cell found in the bone marrow called a plasma cell. Bone disease characterized by areas of bone destruction known as lytic lesions is found in approximately 80% of multiple myeloma patients. Low-dose, whole-body CT is recommended to evaluate associated bone disease. Now, a study has found that new CT technology paired with artificial intelligence (AI)-based noise reduction offers superior detection of bone disease associated with multiple myeloma at lower radiation doses than conventional CT. The new technology, known as photon-counting detector CT, debuted in the clinic in 2021 after decades of development, although much less is known about the technology to evaluate associated bone disease. The potential for improved image quality in whole-body low-dose scans inspired researchers at the Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org) to study the technology in people with multiple myeloma. By directly converting individual X-ray photons into an electric signal, photon-counting detector CT can decrease the detector pixel size and improve the image’s spatial resolution. For their study, the researchers compared photon-counting detector CT with conventional low-dose, whole-body CT in 27 multiple myeloma patients, median age 68 years. The patients underwent whole-body scans with both types of CT and two radiologists compared the images. The researchers also applied a deep learning AI technique developed at Mayo Clinic’s CT Clinical Innovation Center to reduce the noise in the very sharp photon-counting images. CT noise refers to an unwanted change in pixel values in the image, often loosely defined as the grainy appearance on cross-sectional imaging. The photon-counting detector CT with deep learning noise reduction demonstrated improvement in visualization and detected more lesions relative to conventional CT. The researchers now hope to conduct follow-up studies on patients with multiple myeloma precursor states to see if photon-counting detector CT finds bone lesions that would upstage these patients to active multiple myeloma. They also want to look at photon-counting detector CT in other instances in which low-dose protocols are beneficial, for instance, in pediatric or pregnant patients or screening applications. “We were excited to see that not only were we able to detect these features of multiple myeloma disease activity more clearly on the photon-counting scanner,” said study lead author Francis Baffour, M.D., diagnostic radiologist at the Mayo Clinic, “with deep learning denoising techniques that allowed us to generate thinner image slices, we were able to detect more lesions than on the standard CT.” “Our excitement as scientists and radiologists in these results

Image: New CT technology paired with AI-based noise reduction improves myeloma bone disease detection (Photo courtesy of Pexels)

stems from our realization that this scanner could make a difference in the staging of disease, potentially impact therapy choice, and ultimately, patient outcomes,” added Baffour.

Diagnostic Imaging

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Ultra-Fast MRI Could Transform Heart Failure Diagnosis

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three directions over time – the fourth dimension.” “This new technology is revolutionizing how patients with heart disease are diagnosed,” said PhD student Hosamadin Assadi, also from UEA’s Norwich Medical School. “However, it takes up to 20 minutes to carry out a 4D flow MRI and we know that patients do not like having long MRI scans. So, we collaborated with General Electric Healthcare to investigate the reliability of a new technique that uses super-fast methods to scan the flow in the heart, called Kat-ARC. We found that this halves the scanning time – and takes around eight minutes. We have also shown how this non-invasive imaging technique can measure the peak velocity of blood flow in the heart accurately and precisely.” “This technology is revolutionizing how we assess heart disease and our research paves the way for the super-fast 4D flow MRI scans by halving the scan time,” added Dr. Garg. “This will benefit hospitals and patients across the whole world.”

HospiMedica International November/2022

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Vein Visualization Device Enables Accurate Catheter Placement Cont’d from cover

venipuncture can be technically challenging. When multiple venous access attempts are required, it is associated with increased patient morbidity, as well as increased utilization of staff and medical supplies. Clinicians often use vein visualization (also known as vein illumination) uses Near-infrared (NIR) imaging for detecting veins. Now, an innovative vein visualization device allows clinicians to accurately view the center-line of a vein regardless of the distance for bet-

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ter- informed decision-making and accurate needle/catheter placement. The AV500 vein visualization device from AccuVein Inc. (Medford, NY, USA; www.accuvein.com) uses the company’s True Center technology that allows clinicians to accurately view the center-line of a vein regardless of the distance. AccuVein’s vein visualization technology projects a vivid map on the skin detailing underlying superficial veins, bifurcations and intraluminal valves, often invisible to the naked eye. The AccuVein AV500 employs two safe barcode-scanner class lasers that work in tandem to provide a real-time image of the subcutaneous vasculature up to 10mm deep. Unlike other vein illumination devices, the AV500 is permanently aligned and there is no need for device calibration prior to use. There are no other currently marketed NIR vein visualization devices that offer these distinct technological advancements. The AV500 has a unique laser camera projector that enables its small, handheld design and always in focus projection, allowing for permanent alignment. All other projection vein systems require preventive maintenance to ensure that they stay in alignment. In addition, the AV500 uses a low power Class 1

Image: The AccuVein AV500 (Photo courtesy of AccuVein)

laser ensuring eye safety without requiring any special protective gear. The AV500 has also been upgraded with a simplified bright OLED display that provides current device status in an easy to read and understand manner using large, very visible icons. Three buttons allow the user to switch from dark veins on a green background to green veins on a dark background, change the brightness to fit the ambient conditions, and set automatic timeout from 10 minutes to always on to fit the specific clinical need. “Starting a peripheral IV (PIV) catheter is the most common invasive procedure in health care. Our mission is to improve the standard of care as it pertains to peripheral venous assessment and access so placing a PIV becomes as safe, effective, efficient and cost effective as possible,” said Thomas Hopkins, Chief Medical Officer at AccuVein Inc. “We are extremely proud and committed to offering our healthcare heroes the latest advancement in NIR vein visualization technology. To further underscore our commitment to clinicians, we now provide customized training and education support to improve confidence and competence at the bedside, and help healthcare delivery teams with onboarding new staff.” HospiMedica International November/2022

World’s First Minimally Invasive Brain Pacemaker Treats Epilepsy

he treatment of patients with epilepsy always begins with medication. However, for decades there has unfortunately been a consistently large group of around 30% of all patients for whom pharmacological treatment is not sufficiently effective. These drug-refractory patients wait an average of 22 years before they are offered further technical or surgical treatment options. Now, a novel risk-minimized brain pacemaker offers a new technological therapy option for drug-refractory focal epilepsies. The minimally invasive brain pacemaker EASEE (Epicranial Application of Stimulation Electrodes for Epilepsy) from Precisis GmbH (Heidelberg, Germany; precisis.de) is a system for individualized brain stimulation, which is placed anatomically precisely over the epileptic origin in the brain but is surgically placed only under the scalp. This means that the cranial bone is not opened, and the brain itself remains untouched. The thin EASEE electrodes are placed under the scalp and send bioelectric pulses to the location in the brain where the epileptic seizures originate from. The thin plane electrodes are not visible from the outside and ensure unrestricted freedom of movement for the patient. The therapeutic pulses can be individually adapted to each patient, and optimizations can be made regularly throughout the duration of the treatment; the patients do not feel the stimulations. The safety and effectiveness of the implant have been proven in two European multi-center studies, and EASEE has received the CE certification based on the data from the two clinical studies. The CE mark certifies that EASEE meets the specified safety and performance requirements. Accordingly, EASEE will be available for adult epilepsy patients with immediate effect. “The primary goal of the studies was to demonstrate the system’s safety. However, it was particularly interesting for the patients and us, to see the reduction in seizures and to see continued improvement in seizure control,” said Prof. Schulze-Bonhage, MD, Head of Department of the Epilepsy Center at the Neuro center of the University Hospital Freiburg, Head of the Clinical Studies on EASEE. “The data evaluation after six months showed

a reduced frequency of seizures of at least 50% in 17 of 33 participants. After six months of stimulation, four patients were completely free of seizures. The low-risk implantation procedure and the outstandingly positive spectrum of side effects suggest that EASEE will be a future therapeutic option for drug-refractory focal epilepsies.” Image: The EASEE minimally invasive brain pacemaker has received CE certification (Photo courtesy of Precisis GmbH)

Testing for Blood Fats Prior To Heart Surgery Could Reduce Postoperative Bleeding

ostoperative bleeding is one of the most common complications after cardiac surgeries, especially in open heart ones. In this kind of surgery, surgeons need to resort to cardiopulmonary bypass, an extracorporeal circuit composed of tubes and machines that replicate the function of the heart and lungs. This allows them to work inside of the heart while it remains still and bloodless. Despite its undeniable utility, the circulation of the blood outside of the body affects the number and function of components that are responsible for coagulation, the platelets. As such, to pre-

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Testing for Blood Fats Prior to Heart Surgery Could Reduce Postoperative Bleeding

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Cont’d from page 13

vent or make up for bleeding, patients often need blood transfusions, which not only increases their risk of death but also brings considerable healthcare costs. Now, researchers have revealed a new way to reduce blood loss in heart surgeries by identifying changes in blood fat levels that relate to the patients’ risk of bleeding. With a simple test before the surgery, clinicians could anticipate this postoperative complication and act to prevent it. Intending to find molecular signatures that could inform the prognosis, researchers from the Instituto Gulbenkian de Ciência (IGC, Oeiras, Portugal; gulbenkian.pt) studied blood samples from 33 patients undergoing heart valve replacement surgery. The samples were drawn before and six and 24 hours after the surgery and compared between patients with and without postoperative bleeding. Changes in the levels of fats belonging to the omega-6 family in these patients’ blood caught the researchers’ attention. Curiously, patients with low levels of this fat in the blood before the surgery lost more blood and needed nearly twice as many postoperative transfusions. Although these fats were known to regulate the aggregation of platelets to form clots, these had never been related with the risk of bleeding. Postoperative bleeding was also higher in patients whose omega-6 levels decreased between the pre and postoperative time points. The alteration could be attributed to yet another example of the complex crosstalk between surgery-related inflammation and coagulation, according to the researchers. An important inflammatory mediator, known for increasing the number and stimulating the function of platelets, seems to be related to the variability in the patients’ blood fat. In particular, this pro-inflammatory mediator seems to decrease in patients with significant bleeding. As such, inflammation could be the reason behind the alterations in this fat and, consequently, the dysfunction of platelets following heart surgery. In summary, the study showed that changes in the levels of fats from the omega-6 family, associated with inflammation, are characteristic of heart surgery with cardiopulmonary bypass. Supplementation with this fat before surgery could be a safe and inexpensive option to secure the normal functioning of these blood components. The researchers are already planning a study “to evaluate the efficacy of this strategy in reducing bleeding and transfusions after surgery”. “Assessing the level of this fat in the blood before surgery could be more relevant than looking at the number of platelets,” explained Luís Moita, principal investigator of the Innate Immunity and Inflammation group at the IGC, and also doctor by training. HospiMedica International November/2022

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ANESTHESIA WORKSTATION

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Leon is a present-day anesthesia workstation that provides maximum technical performance as well as new and expandable platform concepts which can be configured according to personal demands.

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The M3B capnograph monitor provides comprehensive figures for the respiratory system with SpO2 and CO2 monitoring. It features trend table and trend graphs, external memory support, and capabilities to connect to the MFM-CMS.

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Wearable Device with Stretchable Skin-Like Polymer Sensor Monitors Tumor Size

ach year researchers test thousands of potential cancer drugs on mice with subcutaneous tumors. Few make it to human patients, and the process for finding new therapies is slow because technologies for measuring tumor regression from drug treatment take weeks to read out a response. The inherent biological variation of tumors, the shortcomings of existing measuring approaches, and the relatively small sample sizes make drug screenings difficult and labor-intensive. In some cases, the tumors under observation must be measured by hand with calipers. However, the use of metal pincer-like calipers to measure soft tissues is not ideal, and radiological approaches cannot deliver the sort of continuous data needed for real-time assessment. Now, engineers have created a small, autonomous device with a stretchable and flexible sensor that can be adhered to the skin to measure the changing size of tumors below. The non-invasive, battery-operated device is sensitive to one-hundredth of a millimeter (10 micrometers) and can beam results to a smartphone app wirelessly in real time with the press of a button. The device – dubbed FAST for “Flexible Autonomous Sensor measuring Tumors” – was developed by engineers at Stanford University (Stanford, CA, USA; www.stanford.edu) and represents a wholly new, fast, inexpensive, hands-free, and accurate way to test the efficacy of cancer drugs. On a grander scale, it could lead to promising new directions in cancer treatment. FAST can detect changes in tumor volume on the minute-timescale, while caliper and bioluminescence measurements often require weeks-long observation periods to read out changes in tumor size. FAST’s sensor is composed of a flexible and stretchable skin-like polymer that includes an embedded layer of gold circuitry. The sensor is connected to a small electronic backpack designed by the Stanford engineers. The device measures the strain on the membrane – how much it stretches or shrinks – and transmits that data to a smartphone. Using the FAST backpack, potential therapies that are linked to tumor size regression can quickly and confidently be excluded as ineffective or fast-tracked for further study. The breakthrough is in FAST’s flexible electronic material. Coated on top of the skin-like polymer is a layer of gold, which, when stretched, develops small cracks that change the electrical conductivity of the material. Stretch the material and number of cracks increases, causing the electronic resistance in the sensor to increase as well. When the material contracts, the cracks come back into contact and conductivity improves.

Based on studies with mice, the researchers say that the new device offers at least three significant advances. First, it provides continuous monitoring, as the sensor is physically connected to the mouse and remains in place over the entire experimental period. Second, the flexible sensor enshrouds the tumor and is therefore able to measure shape changes that are difficult to discern with other methods. Third, FAST is both autonomous and non-invasive. It is connected to the skin – not unlike an adhesive bandage – battery operated, and connected wirelessly. The mouse is free to move unencumbered by the device or wires, and scientists do not need to actively handle the mice following sensor placement. FAST packs are also reusable, cost just USD 60 or so to assemble, and can be attached to the mouse in minutes. “It is a deceptively simple design,” said Alex Abramson, first author of the study and a recent postdoc in the lab of Zhenan Bao, the K.K. Lee Professor in Chemical Engineering in the Stanford School of Engineering, “but these inherent advantages should be very interesting to the pharmaceutical and oncological communities. FAST could significantly expedite, automate, and lower the cost of the process of screening cancer therapies.” Image: The FAST system measures tumor size regression (Photo courtesy of Stanford University) HospiMedica International November/2022

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Screening for Atrial Fibrillation Using Smartphones More Than Doubles Detection Rate

trial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide. Those affected have a five times greater risk of stroke than their peers. Atrial fibrillation often has no symptoms and remains undiagnosed, leaving patients unprotected from stroke. Prior studies have shown the potential of smart devices for large-scale atrial fibrillation screening but they made no comparison with conventional screening, included primarily younger adults for whom screening has low relevance, and required participants to own certain hardware. It has been unclear to what extent older adults, who would benefit most from screening, could cope with digital technologies and whether screening results in initiation of oral anticoagulation. Now, a new study has shown that atrial fibrillation screening using conventional smartphones more than doubles the detection and treatment rate in older people compared to routine screening. Researchers at Innsbruck Medical University (Innsbruck, Austria; www.i-med.ac.at) conducted a site-less randomized study in older adults at risk for stroke who owned a smartphone. Smartphone screening was compared with usual screening for the ability to detect atrial fibrillation that was then treated with oral anticoagulation. Policyholders with a large healthcare insurance company were invited to participate if they fulfilled these criteria: age 50 to 90 years, no known atrial fibrillation, no prescription of oral anticoagulants, and a CHA2DS2-VASc score ≥1 (men; ≥2 in women). A dedicated study app was used by the researchers to check inclusion criteria and trigger randomization, and to initiate a crossover phase. Participants used the app to answer questionnaires. The trial enrolled 5,551 of 67,488 invited policyholders. The median age of participants was 65 years and 31% were women. Participants were randomly assigned to a six-month digital or conventional atrial fibrillation screening strategy. Those in the digital arm downloaded a certified app to their own smartphone that measures pulse wave irregularities using the phone’s photoplethysmographic (PPG) sensor. To start a one-minute PPG measurement, participants placed their finger on the smartphone’s camera. Participants were instructed to measure twice a day for 14 days, then twice a week – push notifications were used as reminders. In case of abnormal results, participants were posted a patch to record a 14-day ECG which they then returned by post. The researchers evaluated the ECG, sent the results to participants and asked them to consult their local physician, who made the treatment decision and was not involved in the study. The conventional arm reflected atrial fibrillation screening in real world practice which can be by symptoms, routine ECG screening, and other methods. In both groups, information on newly detected atrial fibrillation was collected by the researchers via app-based questionnaires, telephone calls as well as insurance claims data. A total of 2,860 participants were assigned to digital screening and 2,691 participants were assigned to conventional screening. The primary efficacy endpoint was newly diagnosed atrial fibrillation within six months leading to initiation of oral anticoagulation by an independent physician. The primary endpoint occurred in 38 participants (1.33%) in the digital arm and 17 (0.63%) in the conventional arm, for an odds ratio (OR) of 2.12 (95% confidence interval [CI] 1.19–3.76; p=0.010).

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Those who did not reach the primary endpoint in the first six months were invited to take part in a second six-month study phase with crossover assignment to conventional or digital screening, respectively. This gave all participants the opportunity to undergo digital screening, increased the statistical power for secondary analyses, and enabled validation of the primary results. A total of 4,752 (85.6%) participants crossed over and entered the second study phase. Again, digital screening was superior to conventional screening in detecting atrial fibrillation that was then treated with oral anticoagulation (33 of 2,387 versus 12 of 2,365 participants; OR 2.95; 95% CI 1.52–5.72; p=0.001). The researchers concluded that, “screening using common smartphones significantly increased the detection rate of therapy-relevant atrial fibrillation. Importantly, app-based pre-screening was only one part of the programme, which also included electrocardiogram (ECG) validation and assessment of the findings by an independent physician,” as expressed by Prof. Axel Bauer of Innsbruck Medical University. “This trial focused on a target population for atrial fibrillation screening, rather than all-comers. We found that digital screening was well received by older participants, who tended to perform even more PPG measurements than younger participants in the study. Digitally detected atrial fibrillation as well as abnormal PPG measurements per se were of prognostic significance as they predicted MACCE.”

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DEFIBRILLATOR ANALYZER

ORO-NASAL MASK

ADVANCED BEDSIDE MONITOR

The UniPulse 400 is an easy to use defibrillator analyzer with pacer, designed to comprehensively test all defibrillators accurately and efficiently. Its large color screen displays both test results and waveforms in detail.

The 6700 series V2 is an adult oro-nasal (full face) bi-level ventilation mask with anti-asphyxia valve (AAV), no exhaust vents, swivel port and headgear. Intended for single patient use and available in five sizes.

The Life Scope G7 patient monitor conveniently deploys at the bedside and is simple to mount. It incorporates a Data Acquisition Unit to host the BSM-1700 Transport Monitor for uninterrupted data during transport.

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First Hand-Held Robot for Spinal Surgery

Cont’d from cover

integrated surgical system including both image-guided navigation and hand-held drilling features, the Kinguide Robotic-Assisted Surgical System streamlines procedural tasks and considerably reduces surgeon’s burdens during spinal fusion surgeries. Its outstanding performance in terms of precision, stability, and reproducibility of robot motion can improve surgical outcomes which used to earlier strongly rely on the surgeon’s experience. The major difference between POINT Kinguide Robotic-Assisted Surgical System and other similar offerings is the expandability of indication for more complicated herniated disc decompression surgery that is enabled by its unique parallel manipulator mechanism.

Point Robotics is planning to serve various countries through strategic partners and business models, such as joint ventures, licensing, or strategic alliances, etc. The company is now preparing for CE marking in Europe and registration certificate in China to jump start global deployments and to access international markets. “It’s our honor to make the worldwide debut of the cutting-edge robot system starting from the world’s largest surgical robot market - the United States. We aim to promote availability and affordability of robot’s adoption for spinal surgery unaddressed by today’s technology to treat more patients who contracted spectrum of spinal diseases,” said SC Juang, CEO of Point Robotics.

Image: The POINT Kinguide robotic-assisted surgical system has made its debut in the US (Photo courtesy of Point Robotics)

Soft Robotic System Can Grow Like Plants to Allow Surgical Access to Hard-to-Reach Areas

oft robotics is an emerging field where robots are made of soft, pliable materials as opposed to rigid ones. Soft growing robots can create new material and “grow” as they move. These machines could be used for operations in remote areas where humans can’t go, such as inspecting or installing tubes underground or navigating inside the human body for biomedical applications. Current soft growing robots drag a trail of solid material behind them and can use heat and/or pressure to transform that material into a more permanent structure, much like how a 3D printer is fed solid filament to produce its shaped product. However, the trail of solid material gets more difficult to pull around bends and turns, making it hard for the robots to navigate terrain with obstacles or winding paths. Scientists have now developed a first-ofits-kind, plant-inspired extrusion process that

enables synthetic material growth. The new approach will allow researchers to build better soft robots that can navigate hard-to-reach places, complicated terrain and potentially areas within the human body. An interdisciplinary team of scientists and engineers at the University of Minnesota (Minneapolis, MN, USA; www.twin-cities. umn.edu) developed the new means of extrusion, a process where material is pushed through an opening to create a specific shape. Using this new process allows the robot to create its synthetic material from a liquid instead of a solid. The researchers were inspired by how plants and fungi grow. Plants use water to transport the building blocks that get transformed into solid roots as the plant grows outward. The researchers were able to mimic this process with synthetic material using a tech-

nique called photopolymerization, which uses light to transform liquid monomers into a solid material. Using this technology, the soft robot can more easily navigate obstacles and winding paths without having to drag any solid material behind it. This new process also has applications in manufacturing. Since the researchers’ technique only uses liquid and light, operations that use heat, pressure and expensive machinery to create and shape materials might not be needed. “We were really inspired by how plants and fungi grow,” said Matthew Hausladen, first author of the paper and a Ph.D. candidate in the College of Science and Engineering. “We took the idea that plants and fungi add material at the end of their bodies, either at their root tips or at their new shoots, and we translated that to an engineering system.” HospiMedica International November/2022

Novel Endoscopic Hemostasis System Improves Visibility and Controls Upper GI Bleeding

astrointestinal (GI) bleeding is a common condition worldwide accounting a significant proportion of hospital admissions and a major cause of morbidity and mortality. Annual bleeding incidence is approximately 80 to 150 per 100,000 population for upper GI bleeding and 20 to 30 per 100,000 for lower GI bleeding. In most cases, the standard of care for the diagnostic evaluation of suspected GI bleeding is urgent (within 24 hours) upper endoscopy or colonoscopy. Endoscopic hemostasis is frequently the first line treatment and is typically performed during upper or lower endoscopy using different devices available to the physician (clips, injection of agents, argon plasma coagulation, hemostasis graspers, sprays, bipolar probes, etc). Physicians frequently use more than one endoscopic device to achieve hemostasis. Now, a new endoscopic hemostasis system provides gastroenterologists improved visibility and controls upper GI bleeding effectively and with ease. Developed independently by Next Biomedical Inc. (Korea; www. nextbiomedical.co.kr) and distributed globally by Medtronic plc (Dublin, Ireland; www.medtronic.com), the new Nexpowder endoscopic hemostasis system uses a noncontact, nonthermal and nontraumatic hemostatic powder sprayed through a catheter that has a propriety powder-coating technology for minimized clogging which provides improved visibility and control for treating upper GI nonvariceal bleeding. Nexpowder is sprayed on to a target site endoscopically through a catheter that connects to a spray handle. Once sprayed, Nexpowder immediately forms a muco-adhesive and durable gel upon contact, with or without blood, which degrades in one-to-three days. The spray adheres to the tissue with double the adhesive force of other commercially available products, resulting in a durable hemostatic effect. Nexpowder delivers a precise solution for nonvariceal upper GI bleeding with minimal scattering or clogging, enabling direct endoscopic visibility without impairment. Created with a unique delivery system that does not require CO2 or air compressors, the Nexpowder endoscopic hemostasis system combats the inefficiency of clogged catheters and cloudy fields of vision with a proprietary hydrophilic polymer to enable controlled delivery, minimize catheter clogging and maintain endoscopic visibility. The system responds to all types of moisture, not only blood. “We are very excited to bring the innovative, VISIT US AT Nexpowder system to gastroenterologists,” said Gio Di Napoli, president of the Gastrointestinal business, part of the Medical Surgical Portfolio at 2022 Medtronic. “We considered the potential impact Hall 16 • D17-3 on physicians and patients alike, by meeting a clear need to reduce mortality from upper GI bleeding, a condition that causes death for one out of every 1,000 people while also reducing rebleeding, which happens in 20% of all upper GI bleeding cases.” “With a 94% immediate hemostasis rate and a 3.7% rebleeding rate, we’re thrilled to share this effective technology with gastroenterologists,” said Dr. Austin Chiang, M.D., M.P.H., chief medical officer of the Gastrointestinal business at Medtronic. “When we treat patients, we’re looking for immediate and lasting results when it matters most. The Nexpowder system is a powerful tool for GI professionals to add to their toolboxes.”

Image: The Nexpowder endoscopic hemostasis system has received U.S. FDA clearance (Photo courtesy of Medtronic)

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HospiMedica International November/2022

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Easy-To-Use Online Tool Predicts Complications in Patients Undergoing Hysterectomy

ysterectomy is one of the most common surgical procedures, with one-third of women in Canada undergoing this procedure before age 60. Laparoscopic hysterectomies are being performed more frequently as they are less invasive than abdominal surgery. Current practice entails that surgeons discuss benefits of the type of procedure and risks of complications with patients. Researchers have now developed easy-to-use online prediction tools that provide personalized risk estimates for patients undergoing hysterectomy for benign disease. Researchers from the Queen Mary University of London (London, UK; www. qmul.ac.uk) developed and tested prediction models with the aim of supplementing a surgeon’s expert opinion about which

OPTOMEDIC

patients might be at risk of complications from hysterectomy. Complications of hysterectomies may include ureteric, gastrointestinal and vascular injury as well as wound complications. The authors used data from the English National Health Service (NHS) on 68,599 women who had laparoscopic hysterectomies and 125,971 women who had abdominal hysterectomies between 2011 and 2018. Using 11 predictors, such as age, body mass index and diabetes, the researchers also included ethnicity as a potential risk factor, categorizing patients’ self-described ethnicity linked to a recent census. They found women of Asian background were at higher risk of major complications after abdominal hysterectomy compared with women who were white, although the

risk was not associated with laparoscopy. The most significant risk factor for major complications in both procedures were the presence of adhesions, which is consistent with existing evidence. “Historically, a surgeon’s gut feeling has been shown to be a good indicator of postoperative outcomes; however, an expert opinion is the lowest value in evidence-based medicine,” said Dr. Krupa Madhvani, Queen Mary University of London. “Although a surgeon’s experience and expert opinion carries utility, it cannot be used solely to guide risk management. In Canada and globally, the overall rate of hysterectomy for benign disease is declining, and more patients are undergoing surgery by lowervolume surgeons, who may not have expertise in every procedure.”

Implantable Shock Absorber Can Prevent Knee Replacement in Osteoarthritis Patients

f the 14 million Americans suffering with the pain of knee osteoarthritis, more than half are under 65, making a knee replacement undesirable, as the prosthetic would likely need to be replaced in their lifetime. Few options exist to get patients back on their feet or to slow joint degradation without major surgery that permanently alters the anatomy of the knee. Now, the results of a clinical trial show that an implantable device can not only make daily activities more comfortable, but delay the need for a knee replacement. The new implantable device that works as a shock absorber was developed by research-

ers at The Ohio State University Wexner Medical Center (Columbus, OH, USA; www. osu.edu) and may soon give those with progressing knee osteoarthritis a new option to reduce pain, improve functionality and delay the need for a total knee replacement. As part of a clinical trial, the researchers implanted the new device designed to take strain off the knee of patients with osteoarthritis. Nearly three years later, the trial results are positive for nearly all of the participants. The device improved pain and functionality for more than 90% of the patients who received it. The results of the clinical trial with two years of patient follow-ups were recently

presented, and the data has been submitted to the FDA. “It is a shock absorber that is anchored to the bone, and when you’re walking or doing other activities it takes away about 30% of the stress on that knee every time you put weight on it,” said Dr. David Flanigan, professor of orthopedics and director of the Cartilage Restoration Program at The Ohio State University Wexner Medical Center. “Over 90% of the trial patients have been able to get back to the activities that have been causing them pain for quite some time and experienced significant improvements in pain and function.”

HospiMedica International November/2022

Surgical

To view this issue in interactive digital magazine format visit www.HospiMedica.com To view this issue in interactive digital magazine format visit www.HospiMedica.com Techniques

Skin-Stretching Device Could Help Avoid Surgical Treatment for Closing Large Scalp Wounds

or craniofacial, maxillofacial, pediatric, and adult plastic surgeons, scalp wounds can pose a difficult reconstructive challenge. For defects that cannot be closed directly, traditional methods include dressing changes or skin grafts or flaps. These procedures have significant disadvantages, including long healing times or complicated operations with general anesthesia. Various skin-stretching devices have been successfully used to treat skin and soft tissue defects in other types of the body. However, few studies have examined skin-stretching approaches for the scalp area. Now, a new study has demonstrated that a creative and inno- Image: EASApprox is a new type of skin-stretching device for large scalp defects (Photo courtesy of Creative Commons) vative, minimally invasive skin-stretching device provides a promising alternative for wounds was pressure ulcers in six patients, of final outcomes showed good skin color and surgical treatment of large scalp defects. For avulsion trauma in three, and poorly healed in- elasticity, with acceptable scarring. Through many patients with scalp defects, the relatively cisions in three. Each patient underwent three three months’ follow-up, there were no serious simple skin-stretching technique may avoid the to five stretching cycles. In each cycle, tension complications such as wound tearing or necroneed for complex skin flap or graft procedures of no more than 3 kilograms (about 6.5 pounds) sis (tissue death). None of the patients reported or prolonged healing times – with good func- was applied for four minutes, then released for problems with skin pain, numbness, or other tional and cosmetic results and a low complica- one minute. Procedures were performed using discomfort in the treated area. local anesthesia, with an average total operating The researchers have shared the technical tion rate, according to the study’s findings. details on their use of the EASApprox device, Researchers at the Chongqing University time of about 45 minutes. In 10 patients, the stretching procedure including a video demonstrating their techCentral Hospital (Chongqing, China; www. uicc.org) have reported their experience with provided enough skin for the wounds to be nique in a patient with a scalp defect due to a new type of skin-stretching device, called closed directly using sutures. In the other a pressure ulcer. The researchers have emphaEASApprox, for large scalp defects. Designed two cases, the wounds were allowed to heal sizef the need for further clinical and preclinical for the unique characteristics of the scalp tissue, gradually, with regular dressing changes. The studies of this “innovative and efficient meththe EASApprox device enables the surgeon to scalp defects successfully healed in 11 of 12 od.” In the meantime, they conclude, “treatgently stretch the skin on either side of scalp cases, with an average healing time of about ment [using the] skin-stretching device was efdefects. Over a period of one year, the research- two weeks. The remaining patient experi- fective for scalp defect and has the advantages ers used the EASApprox device to manage scalp enced complications due to infection, related of convenient operation, acceptable functional defects in 12 patients. The cause of the scalp to immobility and poor nutrition. Evaluation results, without severe complications.”

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SURGICAL NAVIGATION SYSTEM

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The StealthStation S8 surgical navigation system is intended as an aid for precisely locating anatomical structures in either open or percutaneous procedures and enables surgeons to track the location of surgical instruments.

The VLS-55 is a 4-LED light source that enables multi-spectrum and multi-mode imaging and offers a boosted image performance and extended life span without the need for bulb replacement for a long time.

The RotexTable is the first electrically-operated positioning aid for surgeons during hip operations, such as hip arthroscopy or endoprosthetics. It enables the hip to remain safely in an ideal position during hip arthroscopy.

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Polyp Detection System Is Gastro Game Changer

Cont’d from cover

gastroenterologists could be a true game-changer for the field of gastroenterology. The device name SKOUT has been developed by Iterative Scopes (Cambridge, MA, USA; www.iterativescopes.com) and is indicated as a computer-aided detection tool to assist qualified and trained endoscopists in identifying potential colorectal polyps during colonoscopy examinations in adult patients undergoing colorectal cancer screening or surveillance. SKOUT’s intuitive user interface seamlessly integrates with existing clinical workflows and does not increase total procedure or withdrawal time. When a potential polyp is detected, the system calls attention to the polyp on the procedure monitor by drawing a blue bounding box around it and tracking the polyp as it moves on the screen. If a medical tool enters the frame, the bounding box automatically disappears to avoid obstructing the physician’s view during polyp removal. SKOUT was evaluated in the largest U.S.based multicenter clinical study for a computer aided polyp detection (CADe) device completed to date, which determined that SKOUT

significantly improved overall adenoma detection in screening and surveillance colonoscopy compared to standard colonoscopy. In its registration trial, SKOUT was found to improve adenoma detection, as measured by adenomas per colonoscopy (APC). Furthermore, increased detection was not limited to diminutive polyps. Higher APC rates have been shown to lead to improved patient outcomes; a recent study showed that the incidence of colorectal cancer within three years of examination decreases with higher APC rates. SKOUT demonstrated a 27% relative increase in the detection of adenomas per colonoscopy, with an average of one additional adenoma resected for every 4.5 patients examined. Importantly, in the proximal colon, SKOUT demonstrated a 44% relative increase in 5-9 mm polyp detection, and a 29% relative increase in 5-9 mm polyp detection overall. These results validate the need for technological advancements that can help improve colonoscopies, and SKOUT’s artificial intelligence capabilities position it to do so. SKOUT has received 510(k) clearance from the U.S.

Image: The SKOUT real-time, computer-aided, polyp detection device has received FDA 510(k) clearance (Photo courtesy of Iterative Scopes)

Food and Drug Administration (FDA) for adults undergoing colorectal cancer screening or surveillance. “Even among the best endoscopists, there is room for improvement in adenoma detection, which can impact patient outcomes,” said Sloane Allebes Phillips, VP of Clinical Operations at Iterative Scopes. “We are enthusiastic about the fact that even gastroenterologists with an already high baseline rate of adenoma detection demonstrated an improvement with SKOUT. Now that SKOUT is FDA-cleared, clinicians will be able to better detect adenomas with more efficiency, and ultimately change the standard of gastrointestinal care.”

Nonlinear Ultrasound Could Give Medical Needles Enhanced Functions in Minimally Invasive Surgery

he diagnosis of diseases like cancer almost always needs a biopsy – a procedure where a clinician removes a piece of suspect tissue from the body to examine it, typically under a microscope. Many areas of diagnostic medicine, especially cancer management, have seen huge advances in technology, with genetic sequencing, molecular biology and artificial intelligence all rapidly increasing doctors' ability to work out what’s wrong with a patient. However the technology of medical needles hasn’t changed dramatically in 150 years, and – in the context of cancer management – needles are struggling

to provide adequate tissue samples for new diagnostic techniques. Previously, researchers had shown that modifying the biopsy needle to vibrate rapidly at 30,000 times per second not only provides sufficient data for 21st century diagnostic needs, but is also potentially less painful and less traumatic for patients. Now, new research explores if nonlinear ultrasound can be used to overcome the limitations of currently used medical needles, such as the pain experienced by patients, inaccuracy and variable quality of needle biopsy samples. Using computer models and experimental studies, the researchers at Aalto University (Es-

poo, Finland; www.aalto.fi) were able to show that oscillations of the needle caused a number of non-linear acoustic phenomena. These include cavitation, the sudden expansion and collapse of air bubbles; the formation of acoustically driven fluid flows; acoustic radiation force, the force exerted by an ultrasonic wave on an object; and the formation of micro-droplets. “In this study, we used needles to generate transverse-like motions at 30 kHz. This allows the acoustic energy to be amplified towards the needle tip, exactly where the effect is needed. This localized ultrasound energy can be used in Cont’d on page 23

HospiMedica International November/2022

Surgical

To view this issue in interactive digital magazine format visit www.HospiMedica.com To view this issue in interactive digital magazine format visit www.HospiMedica.com Techniques

Virtual Reality in the OR May Serve As Effective Adjunct to Anesthesia for Surgical Procedures

ith conditions such as carpal tunnel syndrome and osteoarthritis on the rise, U.S. hand surgeons perform more than half a million procedures each year. Patients undergoing hand surgery commonly receive a regional anesthetic to block pain prior to the procedure, plus monitored anesthesia care (MAC) during the operation. MAC typically consists of an IV-administered sedative – such as propofol – to keep patients feeling sleepy and calm during procedures but awake enough to follow instructions as needed. Too much sedation, however, can lead to low blood pressure, upper airway obstruction and potentially serious complications such as stroke, heart attack or respiratory failure. Now, the results of a randomized controlled trial suggest that virtual reality immersion can minimize the need for sedatives during hand surgery without negatively impacting patient satisfaction. Physician-scientists at Beth Israel Deaconess Medical Center (BIDMC, Boston, MA, USA; www.bidmc.org) used VR technology software from XRHealth (Brookline, MA, USA; www.xr.health) in the clinical trial consisting of 34 patients undergoing hand and wrist surgery. All of the patients were given a peripheral nerve block before surgery. Patients were randomized to intraoperative immersive virtual reality with intravenous anesthesia only given as needed, or to usual care as directed by the anesthesiologist. The VR therapy software provided an immersive, engaging environment that guided patients through relaxation and pain reduction techniques while undergoing the surgery. The results of the trial showed that the majority of patients (13/17) using the XRHealth VR technology did not need any intravenous sedatives during surgery. A postoperative survey demonstrated similarly low levels of pain and anxiety for patients in both control groups. Other secondary findings demonstrated that patients using the VR technology recovered from anesthesia more quickly and left the recovery room earlier than those in the usual care group. These findings could lead to a discussion in the medical industry about using non-pharmaceutical interventions during surgical procedures that both enhance the patient experience during surgery and provide a better postoperative recovery. “Anesthesia providers are always trying to balance the primary interests of patient comfort and patient safety. Our results demonstrate that VR may help provide satisfactory control of pain and anxiety for procedures such as upper extremity surgery with regional anesthesia,” said senior study author Brian O’Gara, MD MPH, Principal Investigator at Beth Israel Deaconess Medical Center. “This is incredibly valuable in that VR may allow for avoidance of risky sedatives without detracting from the patient experience. If the use of this technique can also aid perioperative efficiency, it has the potential to be a real game-changer for both patients and providers.” “Transporting patients to different treatment rooms in the metaverse while undergoing operations in the real world can provide significant medical breakthroughs in the healthcare industry; managing pain and anxiety in a virtual environment can be a game changer for coping through surgical procedures and will help the patients’ body heal faster eliminating the recovery from the anesthesia,” added Eran Orr, CEO of XRHealth.

Nonlinear Ultrasound Could Give Medical Needles Enhanced Functions in Minimally Invasive Surgery

Cont’d from page 22

a variety of applications, such as improving the quality of needle biopsy samples,” said Professor Heikki Nieminen, who is leading the project. “The investigated approach has the potential to give conventional medical needles new enhanced functions in medical applications not only in needle biopsy but also in drug or gene delivery, cell stimulation, and minimally invasive surgical procedures.”

HospiMedica International November/2022

Image: Virtual reality reduced the need for sedation during hand surgery (Photo courtesy of XRHealth)

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TruLight 3000 surgical light combines light performance and efficiency, making it a reliable and flexible solution for typical surgical environments. Its powerful LEDs emit a high light output while producing minimal heat.

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Needle-Like Flexible Imaging Endoscope Could Improve Biopsies

lexible graded index (GRIN) lens, originally developed for the telecommunications industry, are commonly used to perform fluorescence microscopy approaches that can image deep into tissues. However, the fact that they are rigid components has limited their use clinically. GRIN lenses are silica glass rods with a continuously changing refractive index that focuses light coming through the rod without requiring a separate focusing lens. Since their development about 50 years ago, it has been generally thought that GRIN lenses can only be used as rigid imaging probes. Now, researchers have created a flexible needle-like endoscopic imaging probe that can acquire 3D microscopic images of tissue with its bendability made possible by a new GRIN lens. The new GRIN lens was developed and incorporated into an endoscopy probe by researchers at the Harvard Medical School (Boston, MA, USA; www.hms.harvard.edu). Experiments showed that the probe’s imaging properties are maintained even when it is bent. In order to explore if it was possible to image through a bent GRIN lens, the researchers custom-designed a GRIN lens 500 microns in diameter and about 100 mm long. The lens’ long, thin shape and its lack of a rigid outer casing give it the flexibility to bend about 10 degrees without breaking. They then incorporated the new GRIN lens into an endoscopic imaging probe and tested it by performing two-photon 3D fluorescence imaging through it. To simulate the real-world bending that would be experienced deep inside tissues, the lens was positioned vertically and pushed to introduce the type of beam deflection that would be experienced if the probe was used in the working channel of a needle used for a biopsy. The experiment showed that the resolution and signal level did not obviously deteriorate when one end of the probe was displaced laterally by 6 mm. Although further development and testing would be needed to bring the endoscope into the clinic, the device is already finding applications in biomedical research. The researchers are pairing the endoscope with a new type of microdevice to test a method for quickly evaluating the effectiveness of various cancer therapies. The team’s new microdevices are designed to be implanted directly into a tumor and carry small amounts of up to 20 drugs. To measure the effectiveness of the various drugs without removing any tumor

Image: New endoscope uses bendable GRIN lens for 3D microscopy (Photo courtesy of Harvard Medical School)

tissue, the researchers insert a GRIN-based endoscope directly into the microdevice where it can be used to image fluorescence signals inside the tumor. Although this setup is currently being studied in mice, it could eventually be used in patients to quickly figure out which treatment options are best for fighting each patient’s specific tumor. To move the probes toward clinical application, the researchers are also working to develop longer bendable GRIN lenses to allow deeper imaging and more flexibility. They also want to enhance the mechanical durability of the optical components using a thin polymer coating that won’t affect flexibility. “When a traditional biopsy is performed, it represents a single moment in time and can take days to get results back from the laboratory,” said research lead Guigen Liu from Harvard Medical School. “Our bendable imaging probes could shorten the waiting time to minutes and enable new approaches that use imaging to dynamically monitor tissue changes, for instance, how tumors react to treatments over time.” “The bendable nature of these GRIN probes makes measurements in living subjects, such as animals or human patients, much more streamlined and practical,” added Liu. “It could be useful for precise, minimally invasive microscopy-guided placement of needles and catheters for tissue biopsies and tumor ablation, for example.”

HospiMedica International November/2022

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Industry News

MEDICA 2022 Health IT Forum to Focus on Sustainability in Health Care

hen it comes to current developments within international health IT, there is no way around MEDICA (Düsseldorf, Germany; www.medica-tradefair.com), the world’s leading medical trade fair and its accompanying program, which offers further professional insights. Apart from the new products of the more than 4,200 participants from about 70 nations at MEDICA 2022, many of whom showcase health IT solutions, the MEDICA HEALTH IT FORUM, an integrated part of the trade fair, will from 14 to 17 November once more offer an overview of top trends in data-driven medicine, provided by highly acclaimed speakers hosting presentations and talks. With the “Digital Patient Journey”, for example, an important topic will be presented right at the start of MEDICA 2022 on Monday, 14 November, on the program stage of the MEDICA HEALTH IT FORUM. Moderator Prof. Felix Hoffmann, from the Apollon University for Health Care Management in Bremen, has already emphasized that processes in healthcare need improvements. For example, a fracture of the lateral malleolus (ankle bone) usually would only need standard treatment. But if a patient arrives at the hospital late in the evening, it could happen that rather less experienced doctors have to carry out treatment, according to Hoffmann. In this case, software-based check lists could render valuable support – for example those offered by Kumi Clinical. With the help of this software, clinical teams can plan, organize and synchronize treatment following a digital check list. From their arrival to check-ups in the aftermath of inpatient care, patients follow a digital treatment path, which is based on medical standards (SOPs) and can be flexibly adapted. All roles that share a part of the treatment process are integrated: doctors, care givers, service staff, hospital occupancy and discharge management, as well as medical controlling. This is to ensure that all participants are kept current at all times regarding the latest information, and the entire treatment path is followed correctly. The digital voice recognition software “voize” strives to contribute to the optimization of these processes using digital speech assistants, and will also be represented at this forum’s symposium. In a further symposium on Tuesday afternoon, 15 November, there will be a discussion of therapy plans based on artificial intelligence (AI). Alfa AI, for example, uses AI to create a therapy plan. The inherent intuitive application follows patients throughout the entire process, offers transparency as well as the prescribed training plan, including video lessons. In this way, Alfa AI brings together medical knowledge, long-term experience with sports and fitness, insights about proper nutrition and state-of-theart technology. There are, however, misgivings concerning “check list medicine”. According to Prof. Felix Hoffmann though, these are more

HospiMedica International November2022

a matter of the proper mindset. “How do I approach treatment?”, “When is a customized form of treatment really necessary?”, and “When can treatments be standardized and carried out following previously defined paths?” are important questions in this context. For Hoffmann who is himself a trauma surgeon, it is a given that digitalization alone does not improve processes. The processes themselves also need improving. As a bad example, he cites the electronic prescription, which would in theory be unnecessary if medicines could be accessed directly, without going through a pharmacy. The pharmacists, however, probably beg to differ on this. Improving processes in health care could also help fight climate change – for example through beneficial use of information technology. “How can Healthcare become more sustainable with digital help? ” is a question that Armin de Greiff, technical director at the university hospital in Essen will ask during the expert panel at the MEDICA HEALTH IT FORUM on Wednesday, 16 November, which is wholly dedicated to the issue of “Green Health & Sustainability”. “You cannot quite align furthering modern data-driven medicine with saving energy,” states de Greiff. However, he emphasizes that using medical networking does save energy, for example by helping to avoid repeat examinations. Images and findings should not be printed, faxed, sent by post and above all not be transported by taxi. Rather, it should be possible to access them anywhere, at any time. Armin de Greiff further describes the use of AI for the generation of “virtual contrasts”. With appropriate training, networks are said to be able to predict different contrasts from simple data sets and thus save on time intensive examinations. AI could also help to reduce or eliminate the need for contrast agents during CT examinations. Saving on examination time while reducing radiation and contrast agents could be viewed from a sustainable perspective. On the other hand, this also means, according to de Greiff, that the persistent wish for the

newest end user devices runs counter to sustainability. He goes on to explain in this context that the ever shortening product cycles serve to improve performance more than to reduce energy consumption. At the same time, he warns: “We are facing a paradigm shift.” With this, de Greiff calls attention to the fact that higher energy consumption in data centers is not necessarily the same as overall higher consumption of energy. Virtualization of the work place, e.g. through mobile working and by outsourcing applications with high processing demands to servers at a data centre, leads to a concentration of consumption, but not necessarily to raised levels of consumption overall. Dr. Anna Levsen from the Deutsches Krankenhaus Institut, the German hospital association, also strives to improve processes. Her tech talk centers on “Circularity in the Healthcare Industry” on Wednesday, 16 November at 12:00 noon. Expanding on her presentation at the forum, Levsen calls attention to the strict limitations that hospitals face in their actions for sustainability and protection of the climate. However, she insists: “There is a big lever we can use here.” Levsen, too, sees the more sustainable use of, for example, large equipment as a chance. Outdated technical equipment is rather wholly renewed than repaired and kept in the system, as a circular economy would do. One solution could be a service contract with a manufacturer for medical technology, who could maintain the device in good working order. “Hospitals then would not own a device which they would have to throw away in the end, but they would own a contract according to which the company would provide the device, which would be kept usable as a high-quality product,” Dr. Levsen describes this approach. In this approach, manufacturers of medical technology would retain control over their devices. Some of the topics in the program are “Gender-Sensitive Medicine” and “New Work & Occupational Health” as well as new developments in AI.

International Calendar

For a free listing of your event, or a paid advertisement in this section, contact:

SAGES 2023 – Annual Meeting of Society of American Gastrointestinal and Endoscopic Surgeons. Mar 29 – Apr 1; Montreal, Canada; sages.org

E-mail: info@globetech.net

WCN 2023 – World Congress of the International Society of Nephrology (ISN). Mar 30 -

International Calendar, HospiMedica International

2022

Apr 2; Beijing, China; theisn.org

CRITICARE 2023 - 29th Annual Conference of the Indian Society of Critical Care Medicine (ISCCM). Feb 22-26; Indore, India; isccm.org

DECEMBER WINFCOUS 17th World Congress. Dec 1-4; Virtual Venue; winfocusworldcongress.com ESC Asia 2022 with APSC & AFC – European Society of Cardiology – Asian Pacific Society of Cardiology. Dec 1-3; Singapore; escardio. org Zdravookhraneniye 2022 – Russian Health Care Week. Dec 5-9; Moscow, Russia; zdravo-expo.ru

2023

JANUARY ISET 2023 – International Symposium on Endovascular Therapy. Jan 16-19; Miami Beach, FL, USA. iset.org Medical Japan 2023 Osaka– International Medical and Elderly Care Expo. Jan 18-20; Osaka, Japan; medical-jpn.jp 4th MedExpo Ethiopia 2023. Jan 19-21; Addis Ababa, expogr.com/ethiopia/medexpo Critical Care Congress 2023 – 52nd Annual Meeting of the Society of Critical Care Medicine (SCCM). Jan 21-24; San Francisco, CA, USA; sccm.org Arab Health 2023. Jan 30 - Feb 2; Dubai, UAE; arabhealthonline.com

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SAR 2023 – Annual Scientific Meeting of the Society of Abdominal Radiology. Feb 26 - Mar 3; Austin, TX, USA; abdominalradiology.org

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ECIO 2023 – European Conference on Interventional Oncology. Apr 16-19; Stockholm, Sweden; ecio.org

ECR 2023 – European Congress of Radiology. Mar 1-5; Vienna, Austria; myesr.org

ARRS 2023 Annual Meeting – American Roentgen Ray Society. Apr 16-20; Honolulu, HI, USA; arrs.org

50th Annual Meeting of the Japanese Society of Intensive Care Medicine (JSICM). Mar 2-4; Kyoto, Japan; jsicm.org

HIMSS 2023 – Healthcare Information and Management Systems Society. Apr 17-21; Chicago, IL, USA; himss.org

ACC.23 – American College of Cardiology’s 70th Annual Scientific Session & Expo. Mar 46; New Orleans, LA, USA; accscientificsession. acc.org

SEACare 2023 – 23rd Southeast Asian Healthcare & Pharma Show. Apr 19-21; Kuala Lumpur; Malaysia; abcex.com

SIR 2023 –Annual Meeting of the Society of Interventional Radiology. Mar 4-9; Phoenix, AZ, USA; sirmeeting.org AAOS 2023 Annual Meeting – American Academy of Orthopaedic Surgeons. Mar 7-11; Las Vegas, NV, USA; aaos.org EMIM 2023 – 18th European Molecular Imaging Meeting. Mar 14-17; Salzburg, Austria; e-smi.eu

12th Asian Conference on Emergency Medicine (ACEM). Apr 20-23; Manila, Philippines; asiansem.org 143rd Annual Meeting of the American Surgical Association (ASA). Apr 20-22; Toronto, Canada; americansurgical.org AAEM23 – 29th Annual Scientific Assembly of the American Academy of Emergency Medicine. Apr 21-25; New Orleans, LA, USA; aaem.org

ExpoMED Eurasia 2023. Mar 16-18; Istanbul, Turkey; expomedistanbul.com 42nd ISICEM Brussels – International Symposium on Intensive Care & Emergency Medicine. Mar 21-24; Brussels, Belgium; isicem.org

AOCR 2023 – 21st Asian Oceanian Congress of Radiology. Feb 9-12; Bangkok, Thailand; aocr2023.com

KIMES 2023 – Korea International Medical & Hospital Equipment Show. Mar 23-26; Seoul, Korea; kimes.kr

24th Tanzania MedExpo Africa 2023. Feb 16-18; Dar-es-Salaam, Tanzania; expogr.com/ tanzania/medexpo

UltraCon 2023 – Annual Meeting of the American Institute of Ultrasound in Medicine (AIUM). Mar 25-29; Orlando, FL, USA; aium.org

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APSCVIR 2023 – 17th Annual Meeting of the Asia Pacific Society of Cardiovascular and Interventional Radiology. Apr 12-15; Seoul, Korea; apscvir.com

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MAY WCO-IOF-ESCEO 2023 - World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. May 4-7; Barcelona, Spain; wco-iof-esceo.org SIOP Europe 2023– 4th Annual Meeting of the European Society for Paediatric Oncology. May 8-12; Valencia, Spain; siopeurope.eu Vietnam Medi-Pharm Hanoi 2023. May 10-13; Hanoi, Vietnam; vietnammedipharm.vn ESTRO 2023 – Annual Congress of the European Society of Radiology & Oncology. May 12-16; Vienna, Austria; estro.org ECE 2023 – 25th European Congress of Endocrinology. May 13-16; Istanbul, Turkey; ese-hormones.org SPR 2023 – Annual Meeting of the Society for Pediatric Radiology. May 16-20; Austin, TX, USA; pedrad.org KIHE 2023 – Kazakhstan International Healthcare Exhibition. May 17-19; Almaty, Kazakhstan; kihe.kz ATS 2023 – International Conference of the American Thoracic Society. May 19-24; Washington, DC USA; thoracic.org

123rd Congress of the Japan Surgical Society (JSS). Apr 27-29; Tokyo, Japan; jp.jssoc.or.jp

MedtecLIVE 2023. May 23-25; Nuremburg, Germany; medteclive.com

Medical Fair India 2023. Apr 27-29; New Delhi, India; medicalfair-india.com

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ATTENTION: Due to the CORONAVIRUS PANDEMIC, many events are being rescheduled for a later date, converted into virtual venues, or altogether cancelled. Please check with the event organizer or website prior to planning for any forthcoming event May 24-26; Munich, Germany; eso-conference.org EFORT Congress 2023 – 24th Annual Congress of European Federation of National Associations of Orthopaedics and Traumatology. May 24-26; Vienna, Austria; congress.efort.org Nordic Congress of Radiology 2023. May 2426; Helsinki, Finland; ncr2023.fi EUROSON 2023 – 34th Congress of European Federation of Societies for Ultrasound in Medicine and Biology. May 25-27; Riga, Latvia; euroson2023.com EULAR 2023 – European Congress of Rheumatology. May 31 - Jun 3; Milan, Italy; congress. eular.org

JUNE EuroAnaesthesia 2023 – European Society of Anaesthesiology. Jun 3-5; Glasgow, UK; esaic.org 2023 ISMRM & ISMRT Annual Meeting & Exhibition – International Society for Magnetic Resonance in Medicine. Jun 3-8; Toronto, Canada; ismrm.org ESTS 2023 – 31st Meeting of the European Society of Thoracic Surgeons. Jun 4-6; Milan, Italy; ests.org Medical Taiwan 2023. Jun 8-10; Taipei, Taiwan; medicaltaiwan.com.tw EHA 2023 - Annual Congress of the European Hematology Association. Jun 8-11; Frankfurt, Germany; ehaweb.org ESGAR 2023 – 34th Annual Meeting of the European Society of Gastrointestinal and Abdominal Radiology. Jun 13-16; Valencia, Spain; esgar.org

CARS 2023 – Computer Assisted Radiology and Surgery. Jun 20-23; Munich, Germany; cars-int.org 23rd MEDEXPO Africa 2023. Jun 21-23; Nairobi, Kenya; expogr.com/kenyamed

ESHRE 2023 – 39th Annual Meeting of the European Society of Human Reproduction and Embryology. Jun 25-28; Copenhagen, Denmark; eshre.eu

Global Health Saudi Exhibition 2023. Sep 1719; Riyadh, Saudi Arabia; globalhealthsaudi. com

9th Congress of the European Academy of Neurology (EAN). Jul 1-4; Budapest, Hungary; ean.org SCCT 2023 – 18th Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography. Jul 28-30; Boston, MA, USA; Web: scct.org

AUGUST ASCI 2023 – 16th Congress of the Asian Society of Cardiovascular Imaging. Aug 10-12; Bali, Indonesia; ascibali2023.org Medical Fair China 2023. Aug 23-25; Suzhou, China; www.medicalfair.cn ESC Congress 2023 – European Society of Cardiology. Aug 25-28; Amsterdam, Netherlands; escardio.org WICC 2023 - 16th World Intensive and Critical Care Congress. Aug 26-30; Istanbul, Turkey; wicc2023.org Expo Med 2023. Aug 31 – Sep 1; Mexico City, Mexico; expomed.com.mx

SEPTEMBER ERS International Congress 2023 – European Respiratory Society. Sep 9-13; Milan, Italy; erscongress.org

SIIM 2023 – Annual Meeting of the Society for Imaging Informatics in Medicine. Jun 1416; Austin, TX USA; siim.org

EANM 2023 – 36th Annual Congress of the European Association of Nuclear Medicine. Sep 9-13; Vienna, Austria; eanm.org

60th ERA Congress – European Renal Association. Jun 15-18; Milan, Italy; era-online.org

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ICEM 2023 – 22nd International Conference on Emergency Medicine. Jun 13-16; Amsterdam, Netherlands; icem2023.com

Society of Europe. Sep 9-13 Copenhagen, Denmark; cirse.org

FIME 2023 – Florida International Medical Expo. Jun 21-23; Miami, FL, USA; fimeshow.com

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Medical Fair Brasil. Sep 26-28; Sao Paulo, Brazil; medicalfair-brasil.com.br ESVS 2023 – Annual Meeting of the European Society for Vascular Surgery. Sep 26-29; Belfast, UK; esvs.org EUSOBI 2023 – Annual Scientific Meeting of the European Society of Breast Imaging. Sep 28-30; Valencia, Spain; eusobi.org UAA 2023 – 20th Urological Association of Asia Congress. Sep 28 - Oct 1; Dubai, UAE; uaanet.org

OCTOBER ASTRO 2023 – 65th Annual Scientific Meeting of the American Society for Radiation Oncology. Oct 1-4; San Diego, TX, USA; astro.org EASD 2023 – 59th Annual Meeting of the European Association for the Study of Diabetes. Oct 3-6; Hamburg, Germany; easd.org ISS 50th Annual Meeting – International Skeletal Society. Oct 7-13; London, UK; internationalskeletalsociety.com MICCAI 2023 – 26th International Conference on Medical Image Computing and Computer Assisted Intervention. Oct 8-12; Vancouver, BC, Canada; miccai.org Medic West Africa. Oct 11-13; Lagos, Nigeria; medicwestafrica.com Medical Japan 2023 Tokyo– International Medical and Elderly Care Expo. Oct 11-13; Tokyo, Japan; medical-jpn.jp UEG Week 2023 – United European Gastroen-

South-East Asian Healthcare Show 19 - 21 April 2023 - KLCC

www.abcex.com terology. Oct 14-17; Copenhagen, Denmark; ueg.eu/week ISUOG World Congress 2023 - International Society of Ultrasound in Obstetrics & Gynecology. Oct 16-19; Seoul, Korea; isuog.org ESMO Congress 2023 - European Society for Medical Oncology. Oct 20-24; Madrid, Spain; esmo.org 46th World Hospital Congress of the International Hospital Federation (IHF). Oct 25-27; Lisbon, Portugal; worldhospitalcongress.org

NOVEMBER WUFMB Congress 2023 – World Federation for Ultrasound in Medicine and Biology. Nov 4-7; Muscat, Oman; wfumb.info MEDICA 2023. Nov; Dusseldorf, Germany; medica-tradefair.com RSNA 2023 - Annual Meeting of the Radiological Society of North America. Nov 26-30; Chicago, IL, USA; rsna.org

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Vol. 40 Issue 4 11/2022 Page

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