UK Visions Edition 8

MAGAZINE FOR UK HEALTH PROFESSIONALS UK Edition // No. 8 // November 2023

Delivering Health Equality Through Wellness 10 // THE CANON MEDICAL ARENA

Locally-Led Healthcare for Local People

Renewed Support for Young People in Sheffield

Solving the Colonoscopy Conundrum

18 // MULTIMODALITY

24 // ENVIRONMENTAL,

27 // HEALTHCARE

SOCIAL & GOVERNANCE

INFORMATION TECHNOLOGY

MAGAZINE FOR UK HEALTH PROFESSIONALS UK Edition // No. 8 // November 2023

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Delivering Health Equality Through Wellness 10 // THE CANON MEDICAL ARENA

Locally-Led Healthcare for Local People

Renewed Support for Young People in Sheffield

Solving the Colonoscopy Conundrum

18 // MULTIMODALITY

24 // ENVIRONMENTAL,

27 // HEALTHCARE

SOCIAL & GOVERNANCE

INFORMATION TECHNOLOGY

Innovation has the potential to transform healthcare, putting it on a more sustainable footing. Through forward thinking initiatives, advanced technologies, or new ways of working; to innovate is to improve, and better the outcomes for people.

This VISIONS magazine is a publication of Canon Medical Systems Ltd and is offered free of charge to medical and health professionals. The magazine is published two to three times a year. Access to full, previously published, digital editions can be done via the web site: https://uk.medical.canon/ visions-magazine/. Register for the digital or physical edition of VISIONS UK by scanning here: For Canon Medical Systems UK's privacy policy go to https://uk.medical.canon/ technical-information/ privacy-policy.

The VISIONS magazine covers Canon Medical across the UK's regions and, as such, reflects products, technologies and services for this particular area. The mentioned products may not be available in other geographic regions.

Please consult your Canon Medical representative sales office in case of any questions.

No part of this publication may be reproduced in whole or in part, stored in an automated storage and retrieval system or transmitted in any manner whatsoever without written permission of the publisher. The opinions expressed in this publication are solely those of the authors and not necessarily those of Canon Medical.

Canon Medical does not guarantee the accuracy or reliability of the information provided herein.

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// EDITORIAL Welcome to VISIONS UK, Autumn 2023

Innovation is at the heart of this latest issue of VISIONS UK, with focus on the brand new Canon Medical Arena and some of the biggest advancements driving clinical best practice. These range from the arena’s state-of-the-art sporting facilities and fully integrated Medical Diagnostic Centre, to the tools that have been developed to transform ways of working and alleviate pressure on our health service. To innovate is to improve, and both look to change the landscape of healthcare.

Sheffield is the only city in the world with a legacy park born out of the Olympic Games. A catalyst for regeneration throughout the surrounding area, Canon Medical Arena serves as a potential blueprint for healthcare delivery in the future, positively impacting millions by providing an accessible location for diverse communities. Epicentre for improving health, wellbeing, research and innovation; this edition of VISIONS UK explores how the arena will impact the people of Sheffield. Through outreach initiatives such as RESPECT and RESPECT TOO programmes, in association with Sheffield Sharks, and a state-of-the art Medical Diagnostic Centre, we are bringing healthcare services closer to the community.

of an internationally renowned virtual colonoscopy clinical practice and research programme, gives his views on how health IT solutions can help. Dr Burling gives his experience of using the Vitrea® Advanced Visualisation CT Colon Analysis package to speed up the detection and diagnosis of colorectal cancer is shared along with suggestions of how it can play a part in evolving the role of radiographers and radiologists in the cancer care continuum.

Finally, and by no means least, we also applaud the ongoing success of Community Diagnostic Centres (CDCs) in helping to increase the number of diagnostic imaging tests and scans accessible to patients this year and beyond. The role of imaging systems has played a key part in this momentum, along with new ideas about the evolution of healthcare facilities getting closer to the patient. This includes mobile and transportable scanners, bespoke built CDCs to large-scale community-centric centres and arenas.

The transformation of healthcare never slows, and neither will we.

Wishing you our ongoing support,

To showcase innovation in the clinical field, we include best-inbreed case examples of how our systems are being used across the UK. At The Christie NHS Foundation Trust in Manchester, we highlight how ceiling-mounted Interventional Radiology has helped to protocolise same-day Prostate Artery Embolisation. This has freed-up hospital beds and enabled patients to get back to their normal daily lives quicker.

MARK HITCHMAN Managing Director Canon Medical Systems UK

We also champion innovation in partnership with training and development. One of the UK’s leading specialists in bowel cancer and inflammatory bowel disease imaging, and leader

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// CONTENTS

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UK's First Carbon-Neutral Built Community Arena Officially Named as Canon Medical Arena NEWS

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Editorial

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UK’s First Carbon-Neutral Built Community Arena Officially Named as Canon Medical Arena NEWS

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Spotlight on the Canon Medical Arena in Sheffield

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ENVIRONMENTAL, SOCIAL & GOVERNANCE

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Locally-Led Healthcare for Local People MULTIMODALITY

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Renewed support for Sports-Led Community Outreach Programme in Sheffield ENVIRONMENTAL, SOCIAL & GOVERNANCE

Renewed Support for Sports-Led Community Outreach Programme in Sheffield ENVIRONMENTAL, SOCIAL & GOVERNANCE

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Solving the Colonoscopy Conundrum HEALTHCARE INFORMATION TECHNOLOGY

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AI Automated MRI Planning Solution Launched to Beat Waiting-List Backlogs MAGNETIC RESONANCE IMAGING

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How AI can Help Save Time and Brain MULTIMODALITY

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Never Let a Crisis go to Waste - From Iodine Contrast Shortage to Environmental Sustainability MULTIMODALITY

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Our Premises Across the UK

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Advanced CT Scanners for New £6.8 Million Imaging Suite in Northern Ireland COMPUTED TOMOGRAPHY

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Understanding the Mystery of the Athlete's Heart ULTRASOUND

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How Ceiling Mounted IR Helped Protocolise Same-Day Prostate Artery Embolisation INTERVENTIONAL X-RAY

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Advanced CT Scanners for New £6.8 Million Imaging Suite in Northern Ireland COMPUTED TOMOGRAPHY

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More Automation and Real-Time Analysis Gain Momentum in 2023 MAGNETIC RESONANCE

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Understand the Mystery of the Athlete's Heart ULTRASOUND

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How Ceiling-Mounted IR Helped Protocolise Same-Day Prostate Artery Embolisation INTERVENTIONAL X-RAY

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Birmingham Women's Hospital Praises Image Quality and Usability of Ultimax-i DIAGNOSTIC X-RAY

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CDC Success at Victoria Infirmary, Northwich COMPUTED TOMOGRAPHY

CDC Success at Victoria Infirmary, Northwich COMPUTED TOMOGRAPHY

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Remaining Education Calendar 2023 EVENTS

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// NEWS UK’s first carbon-neutral built community arena with multi-purpose sports facility & integrated Medical Diagnostic Centre in Sheffield named as Canon Medical Arena.

UK’s First Carbon-Neutral Built Community Arena with Multi-Purpose Sports Facility & Integrated Medical Diagnostic Centre Named as Canon Medical Arena Opened Autumn 2023

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he construction of a unique multi-purpose sports facility with an integrated Medical Diagnostic Centre in Sheffield, South Yorkshire, has been officially named Canon Medical Arena.

Canon Medical Arena, formerly known as the ‘Park Community Arena’, will create new jobs, relieve diagnostic imaging back-logs on local hospitals, provide closer-to-home health appointments for patients plus expand community access to affordable sports and entertainment.

It will join a growing portfolio of health, well-being, sport, education and research institutions at Sheffield Olympic Legacy Park with the collective aim of improving physical and mental health, plus power research and innovation to deliver positive change for the UK population.

The almost 5000 m2 Canon Medical Arena will include a state-of-the art Medical Diagnostic Centre, operated by The LivingCare Group, featuring advanced Artificial Intelligence (Altivity) assisted CT and MRI scanners, ultrasound, digital X-ray, fluoroscopy, plus consulting rooms, and a minor surgery operating theatre. It will also provide a sporting arena with multi-sports courts, a seated capacity for 2500 spectators, a fitness studio, meeting or education function rooms and a café. Canon Medical Arena will be the home of the Sheffield Sharks and Sheffield Hatters professional basketball teams.

Mark Hitchman, Managing Director of Canon Medical Systems UK, states, “Canon Medical Arena is an exciting and unique investment in South Yorkshire to bring new positivity for residents, sporting organisations and businesses

Canon Medical Arena will create new jobs, relieve diagnostic imaging back-logs on local hospitals and provide closer-to-home health appointments for patients.

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"Canon Medical Arena is an exciting and unique investment in South Yorkshire to buoy new positivity for residents" Mark Hitchman, Managing Director of Canon Medical Systems UK.

by fostering a fresh sense of community engagement. It will provide all the facilities to improve physical exercise, enhance social or business networking and diagnose health concerns earlier, thus boosting community well-being into the future.”

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INTERVIEW // ENVIRONMENTAL, SOCIAL & GOVERNANCE // Canon Medical Arena

Spotlight on the Canon Medical Arena in Sheffield Mark Hitchman, Managing Director of Canon Medical Systems UK, discusses the creation of the UK’s first carbon-neutral built community sports and event arena with an integrated Medical Diagnostic Centre. He explains why this unique fusion of sport and wellbeing will be a catalyst for positive regional health plus highlights how its creation will advance medical technology innovation, build trust in health data and accelerate disease prevention.

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related initiatives that aim to improve ‘wellbeing’ and narrow gaps in healthy life expectancy between the areas where it is lowest and highest.

Progress is being made with the government’s Levelling-Up strategy funding projects up and down the country to close the gap between the wealthier and poorer parts of the nation. This includes many health-

At the same time, the NHS England roll out of Community Diagnostic Centres (CDCs) has gathered pace.

This is increasing the numbers of diagnostic imaging tests and MRI, CT or Ultrasound scans accessible to patients to help address some of the challenges and delays associated with the Covid-era while also looking to the

here we live shouldn’t determine how long we live.

Yet across the UK there are areas of inequality where wellness can still be determined by socio-economic groupings or postcodes. This is a huge challenge for modern healthcare.

Progress is being made with the government’s Levelling-Up strategy funding projects up and down the country future by increasing frontline diagnostic capacity. A total of 160 new CDCs has been promised by March 2025 and latest figures suggest that the initiative has delivered an additional three million checks since the programme started in mid-20211.

Creating health equality through wellness

Mark Hitchman, Managing Director of Canon Medical Systems UK.

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With the above in mind, a decision was made to develop a unique community sports and event arena with an integrated Medical Diagnostic Centre. The project’s construction is now complete on Sheffield Olympic Legacy Park, a regenerated life sciences and recreation area alongside other key organisations focused on health, wellbeing, sport, education and research. It is located next to a residential area housing some of the UK’s poorest and ethnically diverse communities.

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LivingCare using an ultrasound Aplio i-series inside Canon Medical Arena’s Medical Diagnostic Centre.

First of a kind initiative

This blueprint initiative is built on a belief that the way to improve people’s overall wellbeing is through proactive health, sport, social engagement and education; creating a cycle of future health prosperity that boosts a longer quality of life. With Canon’s long links to charitable causes, academic partnerships, health research and development organisations in South Yorkshire, the city of Sheffield is an obvious choice to build this first-of-a kind catalyst for societal change.

When it comes to health inequality, Sheffield continues to lag behind the England average on most outcomes including life expectancy, healthy life expectancy, educational attainment, unemployment and housing. Bleakest of all is the inequality in healthy life expectancy in Sheffield – 20 years between the most and least deprived men; 25 years for women2. It is further estimated that 20% of deaths per annum in Sheffield could be prevented by removing the direct cause factors of obesity, physical inactivity and environmental pollution.

So, in a bid to encourage greater accessibility to affordable sporting facilities, the Arena will aim to help people partake in exercise to reduce weight and create healthier lifestyles, at the same time as providing a onestop-shop for symptomatic healthcare.

The way to improve people’s overall wellbeing is through proactive health, sport, social engagement and education It encompasses a flexible multisporting facility, featuring three full-size basketball courts, and is designed to hold 2500 spectators.

It is the new home for the Sheffield Sharks and the Sheffield Hatters (women) professional basketball teams, and is also available to wider sporting, education and community organisations. Run by PCA Ltd, it also features a café and function/ meeting rooms including a Study Support Centre that will work with disadvantaged children from the area.

A medical diagnostic centre in the heart of the community

To the north end of the Arena we have opened a state-of-the-art Medical Diagnostic Centre featuring Canon Medical’s advanced imaging systems including AI-assisted CT and MRI, diagnostic ultrasound, and digital X-ray.

Also available is fluoroscopy, consulting rooms and a minor surgery operating theatre. The centre is operated and staffed by The LivingCare Group is available to the community in conjunction with local Integrated Care Systems, NHS providers and health insurance companies.

Canon Medical Arena also provides the South Yorkshire region with its first specialist sports diagnostic imaging facility that will translate elite-level health, injury and rehabilitation learnings to routine clinical practice. This enables early detection, prevention and faster rehabilitation for sports injury and illness, as well as provide pre-season medicals and sports injury services to professional, elite, semi-professional and committed athletes.

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Despite the introduction of new systems and strategies to catch up on the growing waiting lists, new community-based diagnostic centres cannot operate without people power Alleviating health workforce pressures by introducing hybrid staffing models Pressure on healthcare resourcing has long been predicted due to the retirement rates in specialities such as radiology coupled with the replacement delays from long training timeframes for new recruits. Covid has added to this workforce crisis with well-documented burnouts of NHS staff who had to just keep going through the darkest days. Despite the introduction of new systems and strategies to catch up on the growing waiting lists, new community-based diagnostic centres cannot operate without people power.

Canon Medical recognise this and that the evolution of modern healthcare goes further than just increasing capacity and volume of imaging systems. It also requires strategic consideration of how to innovate the deployment of human resources in healthcare facilities. This has been factored into the development of the Canon Medical Arena. By working in collaboration with specialist partners, new ideas on staffing models - to work alongside the arrival of new CT and MRI scanners - are happening. This approach is about working to support the NHS to improve productivity by creating a rich and shared talent pool, and building back resilience in existing people by creating flexible roles and training new people for the future. future.

Winning workflows that help to see more patients each day

Installation of the very latest medical imaging systems into the Medical

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Diagnostic Centre will also help drive operational productivity benefits to see more patients during the working day and battle through waiting lists.

This will include the introduction of the latest generation of imaging systems with built-in AI and automation features. These help radiographers or sonographers with patient positioning, procedural consideration and accurate image acquisition first time to improve workflow efficiency.

Installation of the very latest medical imaging systems will help drive operational productivity and reduce waiting lists For example, a new MRI scanning planning tool, Auto Scan Assist, will form part of the new imaging innovations. This utilises Deep Learning and Machine Learning to enhance diagnostic imaging of a wide range of anatomical examinations from Musculoskeletal (MSK), breast, cardiac, knee, liver, prostate, to whole spine to achieve greater efficiencies.

Early data3 indicates that this can not only reduce the workload burden by up to 80% on MRI radiographers, but also improve overall workflow and the potential number of MR examinations and procedures to be carried out throughout the working day. A 75% reduction in operating time and workflow also reduces the overall examination times for patients, improving their comfort and experience.

Advancing preventative health & screening programmes

The advent of Community Diagnostic Centres (CDCs) can be applauded for the success of increasing the number of diagnostic imaging tests and scans accessible to patients. Yet one of the downsides widely reported is that the conceptional aim of preventative health closer to the community still has some way to go.

Early diagnosis is far better for the longterm health economy. Identifying some conditions or disease early can enable the prescription of lifestyle shifts, such as diet and exercise, before invasive, complicated and costly hospital interventions are required. So, imagine the potential if healthcare professionals could detect health population problems even earlier before symptoms present.

Early diagnosis

Screening programmes are hugely beneficial - 10,000 lives a year are saved through prevention and early diagnosis4.

The potential quality of life that could be saved if more people were seen and targeted by understanding disease prevalence in more detail following data analysis by postcode or patient profile is certainly worth pursuing.

This is another bold and ambitious aim with the Canon Medical Arena and works in synergy with the government’s Medical Technology Strategy5 and its priority actions of early diagnosis and industry engagement. The Canon Medical Arena has been designated to undertake research and development of health screening and disease prevention and as a regional location for a health diversity project to accelerate AI for early disease detection.

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Keeping carbon zero as a health objective

Another important element of the Canon Medical Arena is its close observation of sustainability agendas such as ‘Delivering a Net Zero NHS’, ‘Greener NHS’ and Sheffield’s own ambitions to be a net-zero carbon city by 2030.

The Canon Medical Arena is a carbon-neutral build plus providing closer-to-home diagnostic imaging.

This reduces the need for lengthy travel and promotes the use of shared public transport that is already in place on Sheffield Olympic Legacy Park.

This contributes to reducing carbon emissions associated with healthcare appointments.

Furthermore, the lifetime carbon footprint of the imaging equipment inside the Medical Diagnostic Centre will be offset through Canon Medical’s unique and decade-long carbon offsetting scheme.This calculates

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The Canon Medical Arena will be a carbon-neutral build plus provide closerto-home diagnostic imaging for patients the total carbon emissions from the manufacture, packaging, shipping and average energy usage for the whole lifetime of the diagnostic imaging system, and then offsets it to a highimpact project that reduces CO2 from damaging the natural environment and contributing to climate change.

Healthcare beyond the walls of the traditional health estate

Strengthening the spirit of community and encouraging healthy, active lives is an essential philosophy for long-term modern healthcare.

The walls of the traditional hospital environment as we know it have expanded, and serving patient communities means developing ideas

and new processes of how we build, adapt, service and maintain new community-based healthcare facilities.

It’s exciting and it’s most certainly essential. //

References 1 One-stop-shops for testing deliver over 3 million potentially lifesaving checks, tests and scans, 13/02/23, https://www.gov.uk/government/news/ one-stop-shops-for-testing-deliver-over-3-millionpotentially-lifesaving-checks-tests-and-scans 2 NHS Sheffield Annual Report 20/21, https:// www.sheffieldccg.nhs.uk/Downloads/ About%20US/Documents%20Policies%20 and%20Publications/2020%2021%20Annual%20 Report%20including%20Annual%20Accounts%20 without%20front%20page.pdf 3 Canon Medical Systems internal data results of image selection, plan setting and time savings, https://eu.medical.canon/products/ magnetic-resonance/auto-scan-assist 4 Review of national cancer screening programmes in England, 2019, https://www.england.nhs.uk/ publication/terms-of-reference-review-national-cancer-screening-programmes-england/ 5 Department of Health & Social Care, Medical Technology Strategy, Feb 2023, https://www.gov.uk/government/publications/medical-technology-strategy/ medical-technology-strategy

Our MR solutions are built with intelligent, cutting-edge workflow and image-processing technologies for a faster and more confident diagnosis.

Canon Medical’s vision and commitment to improving life for all lies at the heart of everything we do. By partnering to focus on what matters, together we can deliver intelligent, high quality solutions.

With Canon Medical, meaningful innovation is made possible. uk.medical.canon

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INTERVIEW // MULTIMODALITY // Canon Medical Arena

Locally-Led Healthcare for Local People How the Canon Medical Arena, developed by Canon Medical Systems, will be serving local communities of Sheffield.

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ncreasing the capacity of community healthcare to drive down waiting times and power up the time to treatment is gaining momentum. The growing success of the NHS’ Community Diagnostic Centre strategy is well publicised, giving patients access to planned diagnostic care nearer to home without needing to attend traditional, acute hospital locations. This is helping to shorten waiting lists, reduce the risk of cancellations when urgent hospital cases take priority and ultimately get patients into treatment pathways sooner.

Solutions to support UK health challenges

Independent and industry providers are also ramping-up with solutions to support UK healthcare challenges.

Built by Canon Medical Systems UK and installed with state-of-the-art imaging modality equipment, the Medical Diagnostic Centre at the Canon Medical Arena will be operated

by The LivingCare Group, a regulated and proven provider of quality healthcare.

The Medical Diagnostic Centre will be run by The LivingCare Group, a proven provider of quality healthcare

Established for 20 years, LivingCare has been delivering locally-led and patient-centric healthcare in Leeds and is expanding its services into Sheffield.

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LivingCare operating X-ray equipment inside Canon Medical Arena’s Medical Diagnostic Centre.

“It is our overriding aim to align our flexibility to the needs of the area, and to provide support for the NHS." Jayne Pears, Head of Imaging at LivingCare

The latest diagnostic equipment The Canon Medical Arena will include a leading-edge Medical Diagnostic Centre featuring advanced Artificial Intelligence assisted (Altivity) CT and MRI scanners, ultrasound, digital X-ray, fluoroscopy, consulting rooms, and a minor surgery operating theatre. The Medical Diagnostic Centre will be staffed and operated by LivingCare, providing additional scanning facilities beyond the NHS and for private healthcare providers, for the people of Sheffield.

“We can deliver a wide range of diagnostic services in the community,” states Helen White, Managing Director at The LivingCare Group. “This is anything that doesn’t require a stay in a hospital bed or a surgical intervention.

This includes all types of diagnostic imaging scanning, through to specialist services such as pain clinics, and Ear, Nose & Throat (ENT).”

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Community patient care

LivingCare will support a wide range of patient cohorts. This includes sporting organisations such as football, boxing, and basketball clubs.

Community patient care doesn’t stop there, with the Medical Diagnostic Centre supporting injured sporting individuals referred through private healthcare, and of course, NHS patient referrals.

Helping to reduce the NHS waiting lists

Jayne continues, “We are committed to helping to reduce the waiting lists and bottlenecks from capacity pressures in the NHS by opening our doors in Sheffield. The entire team is looking forward to working with the innovative diagnostic equipment, which will help deliver a higher quality image for clinical confidence and enable us to spend more quality time with the patients.”

"We can deliver a wide range of diagnostic services in the community."

Helen White, Managing Director The LivingCare Group

Vanessa Ellis, MRI Modality Manager at Canon Medical UK concludes, “Introducing the latest imaging technologies into diagnostic departments or centres has a huge positive impact on staff morale.

Protocols and usability are improved and the burden on operators is relieved; cascading onto the time and quality of patient care. Our range of AI-assisted MRI systems has been designed to meet the needs of departments and patients, providing the people of Sheffield and LivingCare the very best in diagnostic imaging.”

Eliminating ‘no shows’ by offering a friendly, community focused centre A growing area of concern in healthcare is the number of ‘no shows’ or ‘did not attend’ hospital appointments. This is estimated to be hundreds of thousands per month1 in the UK, further adding to capacity issues. The causes are under examination but are likely to be due to transport issues, difficulty in taking time off work, arranging childcare, or due to hospital-related anxiety.

Community based healthcare and diagnostic centres have the advantage of providing better transport infrastructure by being located close to shopping or residential areas with the arena being served by a frequent tram service and live travel information screens in reception areas. Opening hours are also sometimes longer to give appointment flexibility.

This in turn, makes the travel to appointments less costly and timeconsuming, meaning less time off work or time away from family. Furthermore, one-stop-shop clinics and diagnostic centres can have fewer negative associations than a hospital.

carefully patient diversity and medical conditions. For example, we can accommodate patients with dementia and have dimmable lighting in place for autistic patients and where necessary we can put aside a room for prayer.”

Reducing patient anxiety

“White coat syndrome is a real thing.

We’ve already experienced the benefits of reducing patients’ anxiety by attending a clinic rather than a hospital environment in Leeds. We have found that some people prefer the more relaxed environment of a clinic without theatre lights and gowns despite it still being a sterile environment.

Getting the patient pathway and the mood of the clinical environment right is essential to reach all patients,” comments Jayne Pears.

Jayne continues, “The design of the Medical Diagnostic Centre considers

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Marko Backovic, Head of Community, with young people on the RESEPCT programme.

"As we celebrate the 75th year of the NHS, it is our commitment to support and help transform the way healthcare services are delivered, particularly in diagnostic imaging."

Mark Hitchman, Managing Director of Canon Medical Systems UK

Educating young people early to value their health

Beyond its core aim of increasing capacity for diagnostic imaging and tests in the local Sheffield area, the numerous collaborative partnerships at Canon Medical Arena will also support the wider community.

Already there are strong and lengthy links between Canon Medical Systems UK and Sheffield Sharks Basketball Club’s RESPECT community outreach initiatives, connecting with hardto-reach young people to guide and support with citizenship, wellbeing and sport curriculums. Furthermore, Sheffield Hatters Women’s Basketball Club and LivingCare are committed to school outreach programmes with a philosophy of health prevention is better than cure.

“We undertake several school visits to promote healthy living with a focus on

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well young-man and well youngwomen messages,” adds Jayne Pears, Head of Imaging at LivingCare. “If young people can be educated early about dental health, nutrition and their body, then we can aim to prevent some long-term conditions developing in our community such as the need for dental fillings, obesity, and diabetes.

This not only helps the individual, but also saves our UK healthcare system costs into the long-term.”

Futureproofing access to healthcare with passion

Balancing the needs of today in response to Covid-related waiting lists and backlogs, plus putting diagnostic imaging strategies in place to improve the equality and accessibility of healthcare will deliver improved standards of healthcare for those that need it most. At the same time, innovating the provision of healthcare closer to the community will move

towards preventative aims to screen, detect and diagnose earlier which will improve life opportunities for many more people.

Mark Hitchman, Managing Director of Canon Medical Systems UK concludes, “As we celebrate the 75th year of the NHS, it is our commitment to support and help transform the way healthcare services are delivered, particularly in diagnostic imaging. Accessibility and convenience to appointments, innovative medical technology to drive diagnosis and partnership to broaden reach, will help improve patient outcomes now and in the future.” //

Reference NHS drive to reduce ‘no shows’ to help tackle long waits for care, https://www.england.nhs.uk/2023/01/ nhs-drive-to-reduce-no-shows-to-help-tackle-longwaits-for-care/ 1

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CASE STUDY // ENVIRONMENTAL, SOCIAL & GOVERNANCE // Sheffield Sharks, Sheffield Hatters

Sheffield Sharks professional basketball player, training at the Canon Medical Arena.

Renewed Support for Sports-Led Community Outreach Programme for Young People in Sheffield.

Sheffield based basketball-led initiative for young people will further focus on the health benefits of increased physical activity on body and mind.

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mid soaring rates of mental health issues in under 18year-olds, Canon Medical Systems UK has renewed its links to unique community outreach initiatives for young people in disadvantaged areas of Sheffield.

In association with the professional basketball team Sheffield Sharks, the RESPECT programme will receive renewed funding for three years to support its citizenship workshops and sports sessions designed to lift young people out of a cycle of negative behaviours and attitudes. Sheffield Hatters, a semi-professional female basketball team run by volunteers,

has also had a three-year funding extension from Canon Medical Systems UK to support its role-modelling initiative for local young women.

Both teams have moved into a new permanent home at the Canon Medical Arena, at Sheffield Olympic Legacy Park which opened in October.

Mental health

“It is well known that physical health problems increase the risk of poor mental health and vice versa,” states Mark Hitchman, Managing Director of Canon Medical Systems UK. “With mental health care referrals in young people increasing by 39% in the last year, putting even more pressure onto

"If we can make a difference to young people and give them belief that they can achieve more in life, it is worth doing."

Mark Hitchman, Managing Director of Canon Medical Systems UK

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our finite healthcare services, it is our responsibility as an NHS supplier to keep putting something extra back into the community. This year we have seen a new chapter in Sheffield with the opening of the Canon Medical Arena, a multi-purpose sports facility and integrated Medical Diagnostic Centre under one roof. It is also the basketball home for Sheffield Hatters, Sheffield Sharks and the RESPECT initiative.

It provides dedicated classrooms and on-site basketball courts to really take the aims of the outreach projects to the next level. If we can make a difference to young people and give them belief that they can achieve more in life, it is worth doing.

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The long-term relationship between Sheffield Sharks RESPECT Initiative and Canon Medical has grown in success in reaching increasing numbers of primary and secondary school children

Sport, exercise and wellbeing

Marko Backovic, Head of Community at the B. Braun Sheffield Sharks Basketball Club states, “Greater investment in RESPECT means that we will have extra time and resources to expand the scheme to more young people over the next three years. This is really important as the next cohort of 9–11-year-olds are the Covid-lockdown generation who had their development and routine when starting primary school interrupted by the Covid pandemic. We’re already seeing a difference in the social interactions of younger children from when we first start with the initiative and coax them out of their shells. Having our first permanent home for the initiative at the Canon Medical Arena in Attercliffe, an economically deprived area of Sheffield where many of our school families live, will also breathe new life into the community. A modern and tech-heavy Arena on the doorstep will

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help catapult aspiration in the area and really give local people something they can be proud of.”

Helping young people to get involved

Marko Backovic adds, “Many of the schools we support with the RESPECT programme are only able to provide the minimum 1-2 hours mandatory PE lessons per week. We can add to this with our basketball play workshops and amplify how sport and exercise can create feelings of wellbeing to improve mental health. For example, in our anger management sessions for young people we discuss feelings before and after sport to highlight that physical exercise can release hormones such as endorphins to lower stress and improve mood. This helps many more young people get more involved in playing sport to avoid hanging out on the streets and increase activity for positive physical and mental health.”

The long-term relationship between Sheffield Sharks RESPECT initiative and Canon Medical Systems UK began in 2018 and has grown in success in reaching increasing numbers of primary and secondary school children.

The courses are designed to support education and life skills such as physical activity and exercise through basketball, anger management, smoking or vaping health education and online safety.

Pioneers in sport

Sheffield Hatters Basketball Club has been a pioneer in women’s sport since its inception as the first female basketball team over 60 years ago. It is the most successful basketball team in the UK with over 65 titles with both players and coaches going on to represent Great Britain and England on the international stage. Canon Medical Systems UK has supported the club’s community programme for girls and women aged 6 to 60 since 2022. //

INTERVIEW // HEALTHCARE INFORMATION TECHNOLOGY // Vitrea® Advanced Visualisation

Solving the Colonoscopy Conundrum How CT Colon analysis tools and expanded radiology training programs can alleviate shortages

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magine a future where hospital waiting lists, backlogs, and healthcare workforce shortages are a thing of the past. This doesn't have to be a medical technology dream; it can become a reality. The key to achieving this lies in the innovative use of diagnostic imaging technology and comprehensive people development programs.

Dr. Burling, a Consultant Gastrointestinal Radiologist and Co-Director of the National CT Colonography Training and Accreditation Programme (NCTCTAP), sheds light on the magnitude of the issue: "Bowel cancer is the second leading cause of cancer death in the UK, affecting both men and women from all communities. It is also the most common cause of cancer death among non-smokers. Early diagnosis and prevention are crucial, and we are just scratching the surface in this regard."

“The gap is starting to close through increased understanding of how to access investigation and expedite early diagnosis. Efforts in the NHS and the independent sector focus on early cancer detection through diagnostic and screening programs. Increasing awareness among individuals, GPs, and colleagues outside the colorectal cancer specialty has led to more people being involved in early diagnosis techniques, such as referrals for colonoscopy or CT colonography.”

CT colonography, also known as virtual colonoscopy, offers numerous advantages over traditional endoscopic colonoscopy. It is more cost-effective, accessible, and provides a wealth of information. For example, it can detect cancers outside the colon, highlighting concerns in the abdomen and pelvis.

Moreover, CT colonography is less invasive, more comfortable, and safer for patients.

Improving Detection and Diagnosis

Radiologists, and in some cases specially trained radiographers, utilise analysis packages for the interpretation and reporting of CT colonography. These packages provide optimised layouts for 2D and 3D examination of the colon, along with tools for quantitative analysis of suspected polyps.

Advanced Visulisation

“The Vitrea® Advanced Visualisation CT Colon Analysis package is my colon software of choice,” explains Dr Burling. “It is a smooth scrolling visualisation software, enabling controllability as an extension of my interpretation and perception skills to identify an abnormality. It allows me to focus on important areas on the screen display without any distractions.”

"Bowel cancer is the second leading cause of cancer death in the UK, affecting both men and women from all communities."

Dr David Burling, Gastrointestinal Radiologist

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Pedunculated 8mm polyp - 3D Supine

Pedunculated 15mm polyp - 2D Supine axial

Semi-pedunculated 16mm polyp 2D Supine axial

“It also helps with characterisation.

This relies on the flagging of polyp or cancer candidates and the yellow arrow system on the Vitrea® CT Colon analysis tool is efficient and easy to master.

Empowering Radiographers in Clinical Reporting

“The National CT Colonography Training and Accreditation Programme (NCTCTAP) is at the forefront of progress in this area. By bringing together CTC experts from across the UK, the program aims to narrow the gap in CT colonography performance variations and improve quality. The associated PERFECTS2 study examines the performance effects of empowering radiographers through training. Similar to the extension of nurses' roles, empowering radiographers in CT colonography reporting could bring significant efficiency benefits to the NHS. Radiographers are cost-effective, dedicated to specific specialties, and capable of providing interpretation services multiple days a week.”

Secondly, the steps required to characterise a polyp candidate as to whether it is a true abnormality or one that can be dismissed and rejected as faeces or a normal anatomical structure. These steps require manipulation of 2D and 3D images to look at differences in shape, density and polyp matching. The ease of achieving this is the hallmark of CT colonography software and I have found this very intuitive over the years. I use Vitrea myself and to teach others,” he adds.

The shortages of radiographers and radiologists have been long documented. Even before the Covid pandemic amplified waiting times for diagnostics, the challenge of succession planning for retiring radiologists, and reducing radiographer burnout was making headlines. The opportunity for alleviating growing reporting workload could be to bring specially trained radiographers into the role supported by specialist visualisation and reporting software.

“Evolving the role of radiographers in CT colonography reporting to support radiologists and the cancer care continuum is vital,” states Dr Burling.

CT colonography, also known as virtual colonoscopy, offers numerous advantages over traditional endoscopic colonoscopy, it is more cost-effective, accessible, and provides a wealth of information

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Pedunculated 8mm polyp - 2D Supine axial

Semi-pedunculated 16mm polyp - 3D Supine

Pedunculated 15mm polyp - 3D Supine

"By embracing innovative technology and empowering radiographers, the healthcare system can enhance efficiency" Dr David Burling, Gastrointestinal Radiologist “The potential extension of the role of radiographers could have huge efficiency benefits to the NHS in the short to medium term. Radiographers are more cost-effective compared to radiologists and they are dedicated to specific specialities. For example, if you can successfully train a radiographer on CT colonography reporting, you could be getting 2-3 days of interpretation a week from that person compared to 0.5 days a week from a radiologist. This has enormous potential for speeding up healthcare,” he explains.

Harnessing Healthcare IT Innovations

Healthcare IT innovations, like the Vitrea® suite of Advanced Visualization

tools, facilitate quick and easy diagnostic reporting and visualization.

When combined with comprehensive people development programs, this partnership between Canon Medical UK and NCTCTAP has the potential to expedite referral-to-treatment rates and address radiology resource gaps.

“The colonoscopy conundrum can be solved through the use of CT colon analysis tools and expanded radiology training programs. By embracing innovative technology and empowering radiographers, the healthcare system can enhance efficiency,” concludes Dr Burling. //

Images

Dr. David Burling is a ConsultantGastrointestinal Radiologist and expert in bowel cancer imaging at St Marks Hospital. He founded the daily St Mark’s CT colonography service in 2007, the National CT Colonography Training and Accreditation Programme (NCTCTAP) and helped develop the first UK CTC ‘Train the Trainers’ course. Dr Burling has authored over 100 publications and has a distinction MD thesis in Virtual Colonoscopy.

All scans taken by Dr David Burling, Gastrointestinal Radiologist, using the Vitrea® Advanced Visualisation CT Colon Analysis package.

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PRODUCT // MAGNETIC RESONANCE IMAGING // Auto Scan Assist

Auto Scan Assist, a new Artificial Intelligence (AI) innovation to help speed up MRI scanning planning time and alleviate pressure on radiology services has been launched into the UK

by Canon Medical Systems.

AI-Automated MRI Planning Solution Launched to Beat Waiting-List Backlogs and Increase Efficiency Canon Medical Systems’ new Auto Scan Assist to reduce burden on radiographer operators by 80% and power 75% reduction in procedure time to improve patient services.

A

new Artificial Intelligence (AI) innovation to help speed up MRI scanning planning time and alleviate pressure on radiology services has been launched into the UK by Canon Medical Systems. Auto Scan Assist utilises Deep Learning and Machine Learning to enhance diagnostic imaging of liver, prostate, and whole-spine examinations to achieve greater efficiencies in delivering patient services.

The specialist software has been designed to help NHS and independent healthcare providers speed up MRI scanning appointments by automating slice alignment for a growing range of anatomical examinations. Early data* indicates that Auto Scan Assist can not only reduce the workload burden on MRI radiographers by up to 80%, but also improve overall workflow and the potential number of MR examinations and procedures to be carried out throughout the working day. A 75%

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reduction in operating time and workflow enhancements also aims to improve patient comfort by reducing overall examination times.

"the productivity gains of advanced AI innovation in healthcare technology is vital."

Vanessa Ellis, MRI Modality Manager at Canon Medical Systems Vanessa Ellis, MRI Modality Manager at Canon Medical Systems UK states, “With UK diagnostic strategies aiming for community-based hubs and centres to catch up on waiting-list backlogs and provide additional capacity for a growing need for front-line imaging procedures, the productivity gains of advanced AI innovation in healthcare technology is vital. This is not about conceptual theory or early research, but real and ready applications that can

rapidly help UK healthcare with its greatest challenges. Patients need prompter access to diagnostic services and NHS staff need support to power through their busy working days.”

Frédéric Martin, Referring MRI Technician at Gie Var Ouest, an early adopter of Auto Scan Assist in Ollioules, France, using a Canon Medical Vantage Orian MRI scanner states, “After two or three days of adaption, the team has utmost confidence in the AI automation positioning techniques, which allow them to concentrate on other, more rewarding tasks, such as post-processing tasks. Exam time is optimised and no time is wasted.

Today, 85% of knee exams are performed using this technique.”

Practical applications

The practical applications of Auto Scan Assist include: ProstateLine+ for the automatic slice orientation and positioning for Axial, Sagittal and

Coronal planes based upon Pi-Rad Standards, plus details and exact slice orientation and positioning parallel and /or perpendicular to urethra for prostate examinations; LiverLine+ and SUREVOI Liver for automatic slice orientation and positioning for 2D RMC Probe, Visual Prep, MRCP and Liver examinations; and W-SpineLine+ enabling the planning of spine studies quickly and easily, and to set up double-oblique slices to enhance the reproducibility of follow-up exams.

A 75% reduction in operating time and workflow enhancements aims to improve patient comfort by reducing overall examination times

The enhancement of the Auto Scan Assist packages builds on the previously named ‘EasyTech’ applications for MRI that include automatic planning for spine, knee, and cardiac. // Reference * Canon Medical Systems internal data results of image selection, plan setting and time savings eu.medical.canon/products/magnetic-resonance/ auto-scan-assist

Auto Scan Assist, a new Artificial Intelligence (AI) innovation to help speed up MRI scan planning time.

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INTERVIEW // MULTIMODALITY // AI

How AI can Help Save Time and Brain Mark Hitchman, Managing Director of Canon Medical Systems UK explains why innovations in artificial intelligence for healthcare will deliver time efficiencies and better standards of care for patients.

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trokes occur once every five minutes in the UK and are the fourth single leading cause of death. Great results have been achieved in bringing these figures down over the years due to expanding research, medical innovations and awareness campaigns, but the saying ‘time is brain’ is still incredibly important.

The quicker clinicians can identify and treat a patient with stroke, the better the outcome from death or long-term neurological damage. Swift diagnosis of stroke also has numerous health, economic and management benefits for the entire stroke healthcare continuum, including shortened hospital stays and lower levels of rehabilitation, such as physio, occupational, speech and language therapy.

AI-assisted MRI produces images that are detailed and low in noise.

This reduces scan times and produces valuable diagnostic images first time.

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AI can provide an effective decision support tool to help triage reporting cases and speed up decision making AI Powering efficiencies inside the hospital

Artificial intelligence (AI) in diagnostic imaging is about solving many of the problems in the modern healthcare environment. This includes providing the tools to help clinicians make confident decisions faster when faced with growing patient lists and backlogs. It can help to simplify workflows that can optimise staffing and equipment resource deployment, plus help reduce the daily stress and pressure on health professionals. Replacing radiologists or other clinicians with AI is not the motivator, the human element is needed more than ever, but AI can provide an effective decision support tool to help triage reporting cases and speed up decision making.

This has begun with Deep Learning Reconstruction AI algorithms built into the frontline medical imaging systems, such as AI-assisted CT or MRI scanners. This innovation helps to differentiate ‘noise’ from true signal, reducing distortions, preserving edges and maintaining details in image outputs at the same time as achieving lower doses than ever before in routine CT imaging. This gives super clear images for radiologists to report on and lowers the number of repeat scans needed to improve image quality – another tick in the time-saving box. The low dose is also much healthier for patients, many of whom will have multiple scans over the course of their lives, adding to their cumulative dose, given that CT is now a ‘routine’ diagnostic pathway.

AI-assisted imaging is now being used by dozens of hospitals across the UK, bringing benefits to patients. Mid Cheshire Hospitals NHS Foundation Trust was a pioneer in this area.

Its Consultant Radiologist commented, “Advanced Deep Learning Reconstruction of clinical images heralds a new era in CT. It enables phenomenal patient dose reduction, up to 90% below the National Diagnostic Reference Levels, at the same time as providing extremely high-quality clinical images and all in a rapid timeframe suitable for everyday clinical use. The images generated are much more natural and acceptable in appearance to radiologists reporting on cases. Previously, the images looked as if they had been painted with watercolours. This is a great improvement – once you see them, you’ll never look back. As a department we have always been very proactive when it comes to keeping patient dose down and our experiences of using the system every day for in inpatients and outpatients has exceeded our expectations. It is a game changer for radiology.”

But AI can go much further. Automated AI applications for imaging that drill into specific disease conditions are now rolling out.

Prioritising patient cases with AI-assisted stroke diagnosis

For example, AI can now analyse and categorise diagnostic brain images automatically following a CT scan, with zero user clicks, to detect signs of ischemic and haemorrhagic stroke faster than manual reporting. This can help a radiological team prioritise urgent patient cases, refocus valuable human resources and speed up diagnostic reporting. This, in turn, has the potential to reduce the time taken to make a clinical decision on incoming query stroke cases and administer life-saving treatment faster.

Image 1: Non-contrast CT Intracranial Hemorrhage (CINA® ICH) helps you quickly locate multiple variations of intracranial hemorrhage when time is of the essence.

Image 2: Non-contrast CT ASPECTS (CINA® ASPECTS) delivers scoring of early ischemic stroke signs, which are routinely challenging to detect.

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MRI 1.5T Axial FLAIR imaging with and without AiCE (see through the noise)

Advanced Deep Learning Reconstruction of clinical images heralds a new era in CT Streamlining stroke-related workflow by automatically consolidating results into a single summary and flagging up abnormalities or a clinician to view is exciting. It will save time and empower clinicians.

AI is much talked about today. But it can be perceived as complicated, confusing and time-consuming to learn how to use. Layering and automating it into mainstream medical technology that clinicians already use daily, will help remove these barriers to acceptance. This will amplify and simplify its important roll out into mainstream healthcare. //

Image 3: CT Large Vessel Occlusion (CINA® LVO) can help you locate occlusions in cerebral infarction patients.

Image 4: CT Perfusion maps (CT Brain Perfusion) created using validated Bayesian CTP+ algorithms can help indicate potential regions of penumbra and infarct core.

Register online for VISIONS VISIONS magazine is Canon Medical's customer magazine about innovative technologies and applications in medical imaging.

Read all about our clinical solutions in the fields of CT, MRI, diagnostic X-Ray, interventional radiology, ultrasound, heathcare IT, mobile imaging solutions and stay up-to-date with the latest innovations.

Visit our webpage uk.medical.canon/ visions-magazine/ to read the latest published VISIONS UK edition and to read full, previously published editions of the VISIONS UK magazine.

Do you want to receive a digital or paper copy of VISIONS magazine free of charge, twice a year?

You can register online via eu.medical.canon/ visions-magazine/registration or scan the code.

Do you have any questions, problems with access or do you want to share your own clinical experiences by writing an article? Contact VISIONS directly via visions.UK@eu.medical.canon

VISIONS 08 // 35

TECHNOLOGY // MULTIMODALITY // Contrast reduction, AICE, ESG

Never Let a Crisis go to Waste - From Iodine Contrast Shortage to Environmental Sustainability Joanne D. Schuijf, PhD

During the summer of 2022 many imaging centers in the USA and elsewhere faced a shortage of iodinated contrast, which is crucial for contrast-enhanced CT. Due to the COVID-19 lockdown, a key manufacturing facility was forced to temporarily shut down, causing an almost immediate global shortage of iodinated contrast. Hospitals responded rapidly with various mitigation strategies to maintain care as much as possible.

Production has meanwhile resumed, but local shortages are expected to last for weeks to come. Moreover, the contrast agent shortage and rapid implementation of strategies to reduce the administration and waste of contrast materials highlight the need to critically review our approach to contrast utilisation in radiology. We need to become less vulnerable to shortages in the short-term and strive for sustainability in the long run.

I

n this article, I'll discuss the benefits of contrast reduction from a patient, financial and enviromental perspective. In addition, I'll list several ways technological advancements can help you reduce the amount of contrast administered.

Contrast reduction: How can patients benefit?

For many imaging procedures, contrast agents - such as iodinated contrast for CT and gadolinium-based contrast agents for MRI - play a crucial role in improving the detection and characterisation of abnormalities.

Although the administration of contrast agents is generally safe, allergic responses can occur. Caution is also required in case of renal impairment. Thus, for each patient the potential negative effects of using contrast are weighed against the benefits of the diagnostic or therapeutic procedure and, ideally, the administration of contrast agents is restricted as much as possible. As the population ages, the number of patients with relative contraindications to contrast is expected to increase since renal function declines with age.

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Recently, concerns have also been raised due to the observation of gadolinium retention, particularly in the setting of repeated imaging. Thus, strategies to reduce patientexposure are warranted. Such considerations of patient safety are fueling the development of imaging approaches to either reduce the amount of contrast or even providing contrast-free alternatives to limit contrast related complications.

Contrast reduction: How can hospital \ finance benefit?

More efficient use of contrast materials also makes sense from a financial perspective. In general, the benefits of contrast administration through improved diagnostic performance offset the financial costs of contrast agent. However, in times of increasing financial restriction, strategies to improve operational efficiency and minimise costs are mandated. Several studies have investigated the potential cost-savings when changing from singleuse vials to multi-patient injection systems.

"Reducing resource consumption is crucial to support the transition towards more environmentally sustainable healthcare."

Dr. Joanne Schuijf, Clinical Research Manager working as a member of the Global Research & Development Center in Canon Medical Systems Europe.

Routhier et al.1 showed for three major CT indications (pulmonary embolism, head and neck, abdomen and pelvis) that such an approach could reduce the average amount of contrast agent used and translate to annual cost savings of $31,000 (corresponding to approx. £24,800). Likewise, Struik et al.2 pointed to increased operational efficiency and lower costs for MRI.

Contrast reduction: How can the environment benefit?

Reducing resource consumption is crucial to support the transition towards more environmentally sustainable healthcare. In this context, the negative consequences of medical pharmaceuticals on the environment are a growing problem that calls for awareness and action worldwide. With rising levels of care, human pharmaceuticals are increasingly found in our waterways, posing a risk to the natural environment and our health.

Contrast materials are no different. As contrast agents are excreted from the body via urine, they also enter the aquatic environment through our sewage systems.

Contrast media and their byproducts are now commonly detected in our rivers, lakes and drinking water supply systems 4-6. Indeed, during the past decades, concentrations have been found to increase in direct relation to growth in imaging utilisation and as such are expected to rise further 4-6.

It is important to realise that while contrast media themselves are relatively safe with low toxicity, their byproducts may not have the same risk profile.

Moreover, contrast agents and their byproducts are difficult to completely remove from water during purification processes. Such observations provide another important argument to invest in strategies to reduce contrast media use and waste.

With rising levels of care, human pharmaceuticals are increasingly found in our waterways

VISIONS 08 // 37

During the past decades, engineers from Canon Medical Systems have been actively pursuing strategies to limit the need for contrast materials

Contrast reduction: How can technical innovations contribute?

Multi-patient dosage systems and saline flush techniques can minimise the amount of wasted contrast material, while urine collection bags have been shown to reduce entry into the sewage system6. However, from a patient perspective, it is preferable to optimise the amount of contrast administered.

In this regard, weight-based dosing is an important first step.

The contrast shortage also created awareness that protocols for certain indications could safely be shifted to non-contrast CT protocols. Nonetheless, for those indications that do require enhancement with contrast agents, technological advancements may provide important opportunities to further reduce contrast dose.

During the past decades, engineers from Canon Medical Systems have been actively pursuing strategies to limit the need for contrast materials. More recently, developments in artificial intelligence have been added to technologies available for this purpose. As shown in the clinical examples for CT, combining Deep Learning Reconstruction algorithms, such as with Advanced intelligent Clear-IQ Engine (AiCE), with low kVp (Figure 1) or spectral techniques (Figure 2) allows to maintain or increase arterial enhancement while using less contrast.

Other approaches to contrast media optimisation are also available from Canon Medical. In CT, the virtual contrast boost technique uses a sophisticated 3D algorithm to boost the contrast-enhanced signal (figure 3).

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High technical efficiency with substantially lower contrast use was recently demonstrated in the interventional setting using a state-of-the-art Angio CT system for liver ablations7.

In MRI, pioneering work is taking contrast reduction even further by eliminating its use entirely in angiographic applications8,9. Continuous improvement and further expansion to other indications remain areas of active research and development8,10.

Key takeaways

Contrast agents remain crucial for imaging diagnostics and interventions. While reducing contrast may not always seem worth the effort or a priority, it is our responsibility as healthcare providers to reduce patient and environmental exposure to contrast agents as much as possible.

Reduction of contrast media use has important benefits: l For patients by reducing complications l For hospitals by reducing costs l For the planet by reducing environmental pollution Reduction can be achieved in several ways, including: l Reduction of contrast waste l Reduction of contrast volume per examination l Development of contrast-free alternatives Medical imaging companies play an important role in reducing contrast use through technological innovation and Canon Medical is committed to continuing its efforts in this area. //

need for contrast materials. More recently, developments in artificial intelligence have been added to technologies available for this purpose. As shown in the clinical examples below for CT, combining Deep Learning Reconstruction algorithms, such as with Advanced intelligent Clear-IQ Engine (AiCE),

Example 1

•

Development of contrast-free alternatives

Medical imaging companies play an important role in reducing contrast use through technological innovation and Canon Medical is committed to continuing its efforts in this area. //

Example 1

Usually 80 kVp is limited to smaller

patients due to higher noise and Usually 80 kVp is limited to smaller patients due to higher reduced image quality. However, noise and reduced image quality. However, Advanced Advanced intelligent Clear -IQ Engine intelligent Clear -IQ Engine (AiCE) Deep (AiCE) Deeplearning learning Reconstruction makes it possible to use 80 kVp Reconstruction makes it possible to use 80 kVp even for even for average-sized to moderately overaverage-sized to moderately overweight patients by weight patients by reducing noise reducing noise and improving overall imageoverall quality. and improving image quality.

In this clinical example, contrast

In this clinical example, contrast saving is clearly saving is clearly demonstrated demonstrated when combining when lowercombining kVp with AiCE lower kVp with AiCE DLR compared to higher kVp DLR compared to higher kVp without DLR. without DLR. Example 2

Figure 1. 1.

Figure

Deep Learning Spectral makes Example it possible to2fully benefit from Deep Learning Spectralatmakes Example 2 the iodine conspicuity low //itVISIONS 40 to fully benefit from possible keV range (35-60 keV)benefit by providDeep Learning Spectral makes it possible to fully the conspicuity low ing iodine excellent low noiseat virtual from the iodine conspicuity at low keV (35-60 keV) keV rangerange (35-60images keV) byacross providmonochromatic the excellent low noise virtual by providing excellent low noise ing virtual entire keVmonochromatic spectrum. monochromatic images across the images across the entire keV spectrum. entire spectrum.

In thiskeV clinical example, iodine contrast load is reduced by 46%

In thisusing clinical example, iodine by In this clinical example, iodine contrast load isLearning reduced when Deep contrast load is reduced bystan46% Spectral, compared to the 46% when using Deep Learning Spectral, compared to the when using Deep Learning dard site protocol. standard site protocol.

Spectral, compared to the standard site protocol.

Figure 2.

Figure 2. 2.

Figure

Example 3

Example 3

Subtraction CT (SCT) Virtual Contrast Subtraction CT (SCT) Virtual Contrast Boost Example 3 is a 3D deformable Boost is a sophisticated sophisticated 3D deformable registration Subtraction CT (SCT) Virtual registration algorithm algorithm whichContrast ensures Boost is a sophisticated 3Diodine deformable accurate extraction of the sigwhich ensures accurate extraction of the iodine signal. registration algorithm which ensures nal. Recombining the extracted iodine Recombining the extracted iodine signal into the accurate extraction of the iodine sigsignal into the CTA data set increases CTA data set increases the HU density of iodine. nal.

Recombining the extracted iodine the HU density of iodine. signal into the CTA data set increases the HUclinical densityexample, of iodine.

In this iodine signal is

In this clinical example, iodine signal is increased by 45% increased by 45% and 112% respectively, thisSCT clinical example, iodine signal and 112% respectively, using SCTIn Virtual Contrast Boost 11 andis using Virtual Contrast Boost increased by 45% and 112% respectively, Contrast Boost 2. This SCT and Contrast Boost 2. This SCT technology, unique totechnology, using VirtualMedical, Contrastmakes Boost 1itand uniqueSCT to Canon Canon Medical, makes it possibleContrast to fully benefit from this Boost This SCT technology, possible to fully2.benefit from this unique to Canon Medical, makes it for significant increase in iodine signal for contrast significant increase inmedia iodine signal possible to fullyoptimization. benefit from this contrast media optimisation. significant increase in iodine signal for contrast media optimization.

Dr. Joanne Schuijf Clinical Research Manager working as a member of the Global Research & Development Center in Canon Medical Systems Europe. She is an expert on cardiovascular imaging, with over 15 years’ experience.

Figure 3. 3.

Figure Figure 3.

References 1 Justin Routhier et al. | Contrast and cost savings by implementation of a multidose bulk IV contrast delivery system | J am Coll Radiol. 2011 References 2 References 1 F Struik et al. | Performance of single-use syringe versus multi-use MR contrast injectors: a prospective Justin Routhier et al. | Contrast and cost savings by implementation of a multidose bulk IV contrast delivery 1 comparative study | Sci Rep 2020 Justin Routhier et al. | Contrast andsystem cost savings implementation of a multidose bulk IV contrast delivery | J am Coll by Radiol.

2011 3 Medical Systems Corporation. CSR Report 2021. https://global.medical.canon/about/csr/ Struik et al. | Performance of single-use syringe versus multi-use MR contrast injectors: a prospective system | J am Coll Radiol. 2011 2 FCanon csr2021_csr-policy comparative study | Sci Rep 2020 2 4 F Struik et al. | Performance of single-use syringe versus multi-use MR contrast injectors: a prospective 3 Vanessa Hatje et al. | Increases in Anthropogenic Gadolinium Anomalies and Rare Earth Element Canon Medical Systems Corporation. CSR Report 2021. https://global.medical.canon/about/csr/ Concentrations in San Francisco Bay over a 20 Year Record | Environ Sci Technol. 2016 comparative study | Sci Rep 2020 csr2021_csr-policy 5 Kazumasa Inoue et al. | Impactin onAnthropogenic gadolinium anomaly in river waters in and Tokyo related the increased 4 3 Vanessa et al. | Increases Gadolinium Anomalies Rare EarthtoElement Canon Medical Systems Corporation.

CSR Hatje Report 2021. https://global.medical.canon/about/csr/csr2021_csr-policy number of MRI devices in use | Mar 2020Record | Environ Sci Technol. 2016 Concentrations in San Francisco BayPollut over aBull.

20 Year 4 6 Vanessa Hatje et al. | Increases in5Anthropogenic Anomalies and Rare ofEarth Element Helena M Dekker etGadolinium al.||Impact Tackling increasinganomaly contamination the water supply by iodinated contrast Kazumasa Inoue et al. onthe gadolinium in river waters in Tokyo related to the increased Dr. Joanne Schuijf media | Insights Imaging.

2022 Concentrations Francisco Bay over 20devices Year Record | Environ Sci Technol. 2016 number ofaMRI in use | Mar Pollut Bull.

2020 Clinical Research Manager workingin as San a member 7 6 Qian Yu et al. | Real-time arteriography-directed percutaneous microwave ablation for small or poorly 5 M Dekkeranomaly et al. | Tackling the increasing of the water supply by iodinated contrast of Global Research & Development in Kazumasa Inoue etCenter al. | Impact on Helena gadolinium inusing river waters contamination in Tokyo related to the increased Dr.the Joanne Schuijf characterized hepatic lesions hybrid Angio-CT | Abdom Radiol (NY) 2022 media | Insights Canon Medical Systems Europe.

Shedevices is an expert 8 Clinical Research Manager as a member number ofworking MRI in use | Mar Pollut Bull.Imaging.

2020 2022 7 Yoko Kato et al. | Non-contrast coronary magnetic resonance angiography: current frontiers and future Qian Yu et al. | Real-time arteriography-directed percutaneous microwave ablation for small or poorly on cardiovascular imaging having over 15 years’ of the Global6Research &M Development in horizons | MAGMA. 2020 Helena Dekker etCenter al. | Tackling the increasing contamination of the water| Abdom supply by iodinated characterized hepatic lesions using hybrid Angio-CT Radiol (NY) 2022 contrast experience in the field. Europe.

9 Canon Medical Systems She is an expert 8 Canon Medical Systems Corporation. Non-Contrast Imaging. https://global.medical.canon/products/ Yoko Kato et al. | Non-contrast coronary magnetic resonance angiography: current frontiers and future media | Insights Imaging. on cardiovascular imaging having over 15 years’ 2022 magnetic-resonance/non_contrast horizons | MAGMA. 2020 7 10 experience in the field.Yu et al. | Real-time arteriography-directed Qian percutaneous microwave ablation for small or poorly 9 Joanne D Schuijf et al. | Cardiovascular ultrashort echo time to map fibrosis-promises and challenges | Canon Medical Systems Corporation. Non-Contrast Imaging. https://global.medical.canon/products/ Brhybrid J Radiol.Angio-CT 2019 characterized hepatic lesions usingmagnetic-resonance/non_contrast | Abdom Radiol (NY) 2022

10 Joanne D Schuijf et al.resonance | Cardiovascular ultrashort echo time to map fibrosis-promises and challenges | Yoko Kato et al. | Non-contrast coronary magnetic angiography: current frontiers and future Br J Radiol. 2019 horizons | MAGMA. 2020 9 Canon Medical Systems Corporation. Non-Contrast Imaging. https://global.medical.canon/products/ magnetic-resonance/non_contrast © 2023 CANON VISIONS 40 // 10 MEDICAL SYSTEMS // MMEU2312 Joanne D Schuijf et al. | Cardiovascular ultrashort echo time to map fibrosis-promises and challenges | Br J Raiol. 2019

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© 2023 CANON MEDICAL SYSTEMS // MMEU2312

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Our Premises Across the UK 1

Headquarters Canon Medical Systems Ltd Boundary Court, Gatwick Road, Crawley, West Sussex, RH10 9AX 01293 653700

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Stirling Branch Canon Medical Systems Ltd 2A Hillside House, Laurelhill Business Park, Stirling, Scotland, FK7 9JQ

3

Northern Ireland Branch Canon Medical Systems Ltd. C/o Antrim & Newtownabbey Borough Council, LG Floor, Carnmoney Road North, Newtownabbey, Co.Antrim, BT36 5QA

4

Midlands Training & Distribution Centre Training facility and storage 1, Redwood Court, Campbell Way, Dinnington, Sheffield, S25 3NQ

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Stevenage Training & Distribution Centre 4 & 5 Eastman Way, Pin Green, Stevenage, SG1 4SZ

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PRODUCT // COMPUTED TOMOGRAPHY // The Aquilion ONE / PRISM Edition

Two top-of-the-range AI-assisted, spectral, wide-detector CT scanners from Canon Medical Systems UK have been ordered by Craigavon Area Hospital, part of Southern Health and Social Care Trust in Northern Ireland, for a £6.8 million ‘twin’ CT suite development.

Advanced CT Scanners for New £6.8 Million Imaging Suite in Northern Ireland Deep intelligence technologies to modernise cardiac, stroke and cancer services for patients.

T

wo top-of-the-range artificial intelligence (AI) assisted, spectral, wide-detector CT scanners will be supplied by Canon Medical Systems UK to Craigavon Area Hospital, part of Southern Health and Social Care Trust in Northern Ireland, for a £6.8 million ‘twin’ CT suite development. The new diagnostic imaging systems will help to improve the standard of care delivered to patients by cutting waiting times, expanding the range of local imaging services and providing enhanced image quality outputs for more certain, first-time clinical interpretations.

The advanced scanning protocols on the new spectral Canon Medical CT scanners will aim to improve stroke, cancer and cardiac imaging services offered to all Southern Health and Social Care Trust’s local catchment area. Presently, due to limited scanning capabilities, advanced scans like cardiac CT are outsourced and patients have to travel longer distances to obtain the scan. Providing advanced scanning onsite will not only improve service capacity but will also improve patient accessibility to diagnostic services closer to home.

Providing advanced scanning onsite will not only improve service capacity but will also improve patient accessibility to diagnostic services closer to home VISIONS 08 // 43

The Aquilion ONE / PRISM Edition combines our Advanced Intelligent Clear-IQ Engine (AiCE) with Deep Learning Spectral Reconstruction.

"We are looking forward to playing a central role in delivering the CT technology and see it fulfil many clinical and efficiency benefits for the radiology team and patients served."

Billy Erwin, Account Manager at Canon Medical Systems UK.

AI technologies

The Aquilion ONE / PRISM Edition CT scanners will be capable of rapid and accurate detection of stroke via brain perfusion and AI technologies.

Spectral CT scanning will reduce the requirement for follow-up appointments by allowing earlier characterisation of abnormalities which will also help in providing highly efficient cancer work-up. Advanced cardiac CT capabilities along with AI will also improve patient comfort and satisfaction by reducing requirement for invasive cardiac catheterisation procedures.

with joint control room at Craigavon Area Hospital has been six years in the making. We have been part of the project management team for the new CT facility build, guiding the room design, supporting safety features, and planning delivery access. This has aimed to reduce the stress on hospital clinical teams by ensuring smooth equipment planning and commissioning logistics. We are looking forward to playing a central role in delivering the CT technology and see it fulfil many clinical and efficiency benefits for the radiology team and patients served.”

Billy Erwin, Account Manager at Canon Medical Systems UK states, “The development of the new twin CT suite

The chosen Aquilion ONE / PRISM Edition CT scanners from Canon Medical UK are powered by

44 // VISIONS 08

technologies from the ‘Altivity’ suite of deep intelligence innovations for diagnostic imaging. This includes intelligent Clear-IQ Engine (AiCE), a reconstruction technology delivering sharp, clear, and distinct images at high speed and low dose; and Deep Learning Spectral Reconstruction delivering energy separation and low-noise properties integrated into end-to-end workflow for routine protocols. This automatically reconstructs monochromatic images, material specific reconstructions, and iodine maps to provide the clinical images needed direct to the Canon Medical Vitrea™ visualisation applications. //

Find out more about Canon Medical's Aquilion ONE PRISM Edition.

Canon is supporting Rugby World Cup 2023

SportsMed solutions.

“Transferring elite-level health, injury, and rehabilitation learnings to routine clinical practice.”

Leveraging this knowledge, in combination with the use of readily available imaging technology, clinical skills and experience, Canon Medical Systems and our partners develop knowledge and techniques allowing healthcare professionals to support sport enthusiasts to maximise their sporting enjoyment, whether amateur or professional, young or mature.

https://eu.medical.canon

©Canon Medical Systems Corporation 2023. All rights reserved.

VISIONS 08 // 45

46 // VISIONS 06 08

INTERVIEW // MAGNETIC RESONANCE // Vantage Fortian, Vantage Orian, Vantage Galan, Vantage Elan

VISIONS spoke with Thierry Munier, European Director of MRI at Canon Medical Systems Europe, about what customers can expect in terms of novelty at the dawn of a new year.

More Automation and Real-Time Analysis Gain Momentum in 2023 Activity resumed in 2022 and automation is becoming the standard, according to Thierry Munier, European Director of MRI at Canon Medical Systems Europe, who told VISIONS what customers can expect in terms of novelty in 2023.

"We’re back to an almost traditional operation level inside the organisation and with users or future customers, whom we’ve been able to meet again in product presentations or conferences such as the ECR, JFR or SIRM," he said. "We were able to restart site visits and take potential customers on tour."

The COVID-19 pandemic put MRI sales on hold in 2020 and early 2021,

but activity has resumed, with a stark increase in new installations and replacements.

"There’s a strong demand because patients who had abandoned their care journey have now returned," he explained. "There’s a long waiting list and we have to respond as soon as possible. We can’t lose time in intermediate operations that don’t contribute to diagnosis."

"The pandemic has put a strain on already tight resources, and there is a very strong interest in improving workflow with automation."

Thierry Munier, European Director of MRI, Canon Medical Systems Europe.

VISIONS 08 // 47

Current market trends

The pandemic has put a strain on already tight resources, and there is a very strong interest in improving workflow with automation.

Healthcare systems are bled dry, both financially and in terms of human resources. There are difficulties in recruiting skilled personnel, and there are fewer and fewer radiographers and technicians. Physicians have more and more tasks to manage and there’s a lot of burnout. Systems must be made easier to use. Workflow must be increasingly simple and fast.

Automation is becoming the standard, but there are a few obstacles that remain to be tackled, according to Thierry. "While many companies provide software that enables ease of

workflow, these solutions are usually focused on specific applications.

And unlike CT, which is increasingly specialised, an MRI scanner traditionally serves all purposes inside a hospital. We need either a more generalised post-treatment solution or a lot of small bricks that correspond to all the needs," he suggested.

Imaging equipment vendors do not have the means to develop solutions for every application, so the market is likely to move towards a market place style and forge partnerships with AI companies, he predicted.

"There are so many diverse and varied requests that one type of software can’t answer all the clinical specificities, especially in MRI, where image types vary a lot depending on the anatomy."

The challenge will be to meet the different customers’ needs and accompany them in performing automated post-processing tasks.

2022 has been a milestone for Canon Medical with the launch of the new Vantage Fortian 1.5T MRI system, now installed in Japan, Spain and France, and further installations in the pipeline."It’s been a marketing and sales success. We’ve sold 14 scanners since the system was launched in July and feedback is very positive from the installed equipment."

The Vantage Fortian was launched together with new features that bring many improvements, and which have also been added to other equipment in the portfolio, such as the Orian 1.5T and the Galan 3T systems.

"The reliability and reproducibibily of MR images contine to be improved, and we're very proud to show that we can develop solutions that meet the needs of our clients."

Thierry Munier, European Director of MRI, Canon Medical Systems Europe.

Vantage Galan 3T MRI

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Vantage Orian

“MRI is an exciting modality with innovation for decades. Our “Made For Life” philosophy is anchored in our R&D strategy to provide fast, reliable and efficient MR diagnosis solutions.”

Thierry Munier, European Director of MRI, Canon Medical Systems Europe.

"The reliability and reproducibility of MR images continue to be improved, and we’re very proud to show that we develop solutions that meet the needs of our users and improve their diagnostic efficiency," Thierry said.

"Part of my team’s role is to understand the users’ needs and communicate them to Japan, where engineers can develop products that will make a difference."

Horizon 2023 and beyond

A lot of exciting things are happening this year, with the introduction of features such as Auto Consult Brain, a fully automated procedure that covers all steps of an examination from patient positioning to image analysis and reporting, with live automation during the acquisition.

"The choice of sequences automatically takes into account the patient’s history," he explained. "The software automatically recovers the previous protocol through the PACS or RIS, and reprograms the same type of examination with the same positioning of the slices, which is great for reproducibility."

At the end of the basic protocol, the data is sent to the automatic analysis software, while the patient is still on

the examination table, and the system compares two types of images (FLAIR and diffusion) to see if there is any inconsistency between the two.

Depending on the results, the system either informs that no additional information is needed or sends an instruction to complete the examination using sequences with or without contrast. The protocol is guided by the results of the automation platform in real time.

"Automation systems and real-time analysis will become widespread in the next 20 years," Thierry said. "The competence is not necessarily there.

Teleradiology is developing more and more, so there may be a medical supervisor on site, who might not have skills in medical imaging. Real-time automation will have an impact on the way imaging services are organised."

Auto Consult Brain will first target stroke, to enable earlier diagnosis and treatment onset. Other applications will follow, such as oncology, multiple sclerosis, prostate or MSK imaging.

Another exciting release in 2023 will be the introduction of PIQE, an AI-fed tool already used in CT scans to improve image resolution. In MRI, the

software will enable high resolution on standard acquisitions with small size matrices, by applying the algorithm to raw data. The solution will be applicable everywhere.

"In MRI we want to go for resolution of fine anatomies like the knee, the polygon of Willis, or small ones like the pituitary gland and the inner ear," he said. "We also continue to develop a technique of motion correction using AI." The challenges for MRI remain to expedite examination times and improve image quality to boost diagnostic efficiency, either with finer images or new acquisition techniques, all the while trying to reduce motion artifacts.

There is no doubt that future equipment will help overcome these limitations, Thierry believes.

"I’m blessed to be working in a modality that is still evolving. I started 35 years ago and I learn every day. It’s always surprising to see that things we thought were impossible become so, thanks to advances made in science and technology. We manage to solve problems that we thought were unsolvable before." //

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CASE STUDY // ULTRASOUND // Cardiology

Aplio i-series is designed to deliver outstanding clinical precision and departmental productivity. Crystal-clear images with enhanced resolution and penetration, as well as an abundance of expert tools, help get diagnostic answers both quickly and reliably.

Understanding the Mystery of the Athlete’s Heart Curtis Wadley MSc - PhD student at the Children's Health and Exercise Research Centre

Why the role of echocardiography when synchronising exercise and cardiac assessments is helping sports medicine researchers gather greater knowledge

R

ecent imaging advances are enabling researchers to investigate cardiac function during exercise, gaining novel insights in the athletic heart using cardiac exercise MRI and echocardiography.

WMT strain echocardiography is one of the best non-invasive measures of cardiac performance

Cardiopulmonary exercise testing (CPET) is the gold standard assessment of an individual’s cardiorespiratory fitness. It can unmask pathologies not normally seen during a resting examination such as ventilatory patterns and cardiac arrhythmias. CPET usually involves exercise by the participant running or cycling on an ergometer to maximum effort, at the same time heart rate/rhythm, blood pressure, power output, and pulmonary gases are recorded. However, a limitation is that it only provides an indirect quantification of cardiac function. This can be overcome if echocardiographic monitoring is added during the test.

WMT strain echocardiography measures how much the heart shortens/or contracts during a cardiac cycle, which makes it one of the best non-invasive measures of cardiac performance. Longitudinal and circumferential strain and strain rate can be measured from apical and parasternal short axis views of the heart respectively when the participant is on a recumbent cycle ergometer. WMT strain imaging is less load and angle independent than other techniques, which makes it the appropriate choice for imaging during exercise.

Advances in wall motion tracking (WMT) ‘strain’ echocardiography may increase sensitivity and specificity in identifying subtle changes in cardiac function, which may indicate an underlying pathology.

Pairing both CPET and innovative echocardiographic techniques, such as WMT, allows researchers or clinicians to simultaneously measure cardiac, pulmonary, metabolic, and muscular responses to exercise which can unmask early and discrete cardiac pathology.

Recent imaging advances are enabling researchers to investigate cardiac function during exercise, gaing novel insights in the athletic heart 50 // VISIONS 08

Paediatric athlete case example Subject and method

An elite 14-year-old male UK academy football player with no evidence of underlying cardiac disease received a resting scan and exercise echocardiography using a Canon Aplio i900 system, with a i6SX1 (1.8 – 5.2 MHz) transducer and UltraExtendV3.2 software.

Parasternal short axis view and apical four-chamber views were captured for strain analysis. Left ventricle (LV) global longitudinal (Sl) and circumferential (Sc) peak systolic strain were defined as the maximal deformation value of a segment during systole in the endocardial segment and is represented as a percentage (%). Global strain rate index (SRI & SRc) was defined as the rate of deformation of a segment in systole over time and is expressed in 1/s.

WMT strain imaging is less load and angle independent than other techniques, which makes it the appropriate choice for imaging during exercise against increased (50 W • 3 min−1), with the aim of getting the participant to reach maximal exhaustion in 10 to 15 minutes, and 2- & 6-minutes post exercise.

At the end of each step blood pressure and perceived exertion were recorded. The electrocardiogram and gas exchange were continuously monitored.

Echocardiography was performed at rest, during exercise at 0, 50, 100, 150 W, and two and six minutes post exercise.

The exercise protocol stage combined CPET with simultaneous echocardiography on a recumbent cycle ergometer. Every three minutes the resistance cycled

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Figure 1. Cardiopulmonary responses to exercise (the vertical dotted lines represent the start and end of the exercise).

Figure 2. Cardiac responses as a function of exercise intensity and physiological responses.

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Figure 3. Resting LV longitudinal strain analysis of the apical four chamber view using Canon Vitrea for ultrasound (V7.11) software.

Figure 4. Resting LV circumferential strain analysis of short axis base view using Vitrea for ultrasound (V7.11) software.

Results

Conclusion

All conventional echocardiography parameters and exercise test responses were considered normal.

The cardiopulmonary, blood pressure, and cardiac responses to the CPET are summarised in Fig. 1 and 2, respectively. The participant achieved a peak power output of 300 watts, a peak heart rate (HR) of 198 b·min-1, a minute ventilation (VE) of 143 L·min-1, a peak oxygen consumption (peak VO2) of 3.28 L·min-1, a relative peak VO2 to body mass of 48.7 mL·kg-1·min-1, a respiratory exchange ratio of 1.24 (Fig. 1). The participants' gas exchange threshold occurred at a VO2 of 1.95 L·min-1, which corresponds to ~60% of his peak value.

Longitudinal strain (SI) and longitudinal strain rate (SRI) had a resting value of -21.2 % and -1.11 1/s respectively and increased throughout exercise to -25.4 % and -2.24 1/s at 150 W. SI appears sensitive to exercise changes with an almost immediate increase in strain from rest to 0 W. SI and SRI return to near baseline values at two minutes and six minutes post exercise cessation. Circumferential strain (Sc) and circumferential strain rate (SRc) resting values were -31.8 % and -1.7 1/s, and remained stable until 100 W. At 150 W Sc and SRc increased to -37.7 % and -3.4 1/s and continued to increase into recovery up to a peak of -38.3 % and -3.9 1/s at two minutes post exercise.

As the exercise starts the participants SI strain preferentially increases, then at higher intensity (~100 W) Sc increases predominantly to increase global myocardial performance. Sc and SRc continue to increase after exercise and up to their peak at two minutes post exercise. It could be postulated that after exercise has ended with the subsequent fall in HR, to maintain stroke volume/cardiac output, Sc continues to increase to maintain stroke volume (and thereby cardiac output) to repay the oxygen debt accumulated by the working skeletal musculature.

Understanding intricate myocardial mechanics during exercise helps researchers decipher the workings of the athlete’s heart. WMT strain imaging may also hold the key to being able to discriminate between normal physiological adaptations to exercise training compared to early signs of myocardial disease (e.g., cardiomyopathies). //

Reference Castelletti, S., & Pieles, G. E. (2022). The athlete’s heart from Philippides to the modern marathon runners. European Heart Journal, 2538–2541.

Claessen, G., La Gerche, A., Voigt, J. U., Dymarkowski, S., Schnell, F., Petit, T., Willems, R., Claus, P., Delcroix, M., & Heidbuchel, H. (2016). Accuracy of Echocardiography to Evaluate Pulmonary Vascular and RV Function during Exercise. JACC: Cardiovascular Imaging, 9(5), 532–543.

Dorobantu, D. M., Radulescu, C. R., Riding, N., McClean, G., de la Garza, M.-S., Abuli-Lluch, M., Duarte, N., Adamuz, M. C., Ryding, D., Perry, D., McNally, S., Stuart, A. G., Sitges, M., Oxborough, D. L., Wilson, M., Williams, C. A., & Pieles, G. E. (2022).

The use of 2-D speckle tracking echocardiography in assessing adolescent athletes with left ventricular hypertrabeculation meeting the criteria for left ventricular non-compaction cardiomyopathy. International Journal of Cardiology, October.

La Gerche, A., Claessen, G., Van De Bruaene, A., Pattyn, N., Van Cleemput, J., Gewillig, M., Bogaert, J., Dymarkowski, S., Claus, P., & Heidbuchel, H. (2013). Cardiac MRI: A new gold standard for ventricular volume quantification during highintensity exercise. Circulation: Cardiovascular Imaging, 6(2), 329–338. 7 Pieles, G. E., Gowing, L., Forsey, J., Ramanujam, P., Miller, F., Stuart, A. G., & Williams, C. A. (2015). The relationship between biventricular myocardial performance and metabolic parameters during incremental exercise and recovery in healthy adolescents. American Journal of Physiology - Heart and Circulatory Physiology, 309(12), H2067–H2076.

Pieles, G. E., Gowing, L., Ryding, D., Perry, D., McNally, S. R., Stuart, A. G., & Williams, C. A. (2020). Characterisation of LV myocardial exercise function by 2-D strain deformation imaging in elite adolescent footballers. European Journal of Applied Physiology, 121(1), 239-250.

Pieles, G. E., Grosse-Wortmann, L., Hader, M., Fatah, M., Chungsomprasong, P., Slorach, C., Hui, W., Fan, C. P. S., Manlhiot, C., Mertens, L., Hamilton, R., & Friedberg, M. K. (2019). Association of echocardiographic parameters of right ventricular remodeling and myocardial performance with modified task force criteria in adolescents with arrhythmogenic right ventricular cardiomyopathy. Circulation: Cardiovascular Imaging, 12(4), 1–11.

Pieles, G. E., Szantho, G., Rodrigues, J. C. L., Lawton, C. B., Stuart, A. G., BucciarelliDucci, C., Turner, M. S., Williams, C. A., Tulloh, R. M. R., & Hamilton, M. C. K. (2014).

Adaptations of aortic and pulmonary artery flow parameters measured by phase-contrast magnetic resonance angiography during supine aerobic exercise.

European Journal of Applied Physiology, 114(5), 1013–1023.

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PRODUCT // INTERVENTIONAL X-RAY // Alphenix Sky+

The most advanced ceiling-mounted system. This C-arm offers unprecedented flexibility and full body 3D imaging capability with faster acquisition, fewer artifacts and less contrast agent.

How Ceiling-Mounted IR Helped Protocolise Same-Day Prostate Artery Embolisation The clinical operational and financial healthcare benefits unlocked by 360° ergonomic access of Sky+.

P

rostate artery embolisation (PAE), a non-surgical procedure using interventional imaging systems to shrink an enlarged prostate or Benign Prostatic Hyperplasia (BPH), is gaining momentum. Informed patients are requesting PAE due to the lower complication risk compared to alternative, invasive options, and busy NHS hospitals are seizing the opportunities of freeing up beds, lowering cost per treatment and cost per patient stay.

Traditionally, BPH patients would be referred by an urologist for a transurethral resection of the prostate (TURP), a surgical procedure that involved cutting away a section of the prostate. This would involve a general or spinal anaesthesia and a 2-3 day recovery stay in hospital. Today, hospitals such as The Christie NHS Foundation Trust in Manchester, have protocolised same day, minimally

invasive PAE using interventional radiology (IR). This is helping to free up hospital beds and enable patients to get back to their normal daily lives quicker.

A simple switch from left to right-sided patient access

“Studies have proven prostate artery embolisation, PAE, has similar outcomes to TURP. Patients now have the option of a minimally invasive alternative which would favour those who are not suitable for or prefer not to have invasive surgical treatment,” states Dr Pavan Najran, Consultant Interventional Radiologist at The Christie NHS Foundation Trust.

“An enlarged prostate (benign prostatic hypertrophy) is a common problem for men who suffer from lower urinary tract symptoms, which can be debilitating. Men now actively seek alternative treatment options, which include PAE, to help resolve such severe symptoms.”

Today hospitals, such as The Christie NHS Foundation Trust in Manchester, have protocolised same day, minimally invasive PAE using Interventional Radiology (IR) VISIONS 08 // 55

“The shift to same-day treatments was accelerated during the Covid-19 years as we had to limit the use of inpatient beds."

Dr Pavan Najran, Consultant Interventional Radiologist at The Christie NHS Foundation Trust.

Same day treatments

“The shift to same-day treatments was accelerated during the Covid years as we had to limit the use of inpatient beds. PAE was protocolised as a day case with discharge of patients the same day. This was made possible by having a ceiling-mounted interventional imaging system, giving us the ergonomic flexibility to switch to transradial access (TRA) via the patient’s wrist on the left side rather than transfemoral access (TFA) via the groin on the right. TRA is known to have fewer complications at the access site and is more comfortable for the patient, so it aided the confidence in decision making to speed up our discharge rates.”

Dr Najran continues, “It sounds like a small point when focusing on big clinical issues, image quality and low dose, but the ergonomics of an IR system are essential. You need to be

56 // VISIONS 08

able to walk 360 degrees around your patient or swing the C-arm around. Floor mounted or fixed robotic systems create physical barriers to getting to the top end of the patient to place jugular lines or orientate larger teams in a small space.”

AI-assisted diagnostic imaging means that resulting interventions are needed at a much lower unit cost High image quality and low dose management

PAE is typically a two-hour procedure involving an interventionist and radiographer technician team. Image quality for navigation accuracy and decision certainty is vital, as is a dose management system to safeguard the

patient throughout the procedure and control cumulative dose management for clinical operators.

Dr Najran explains, “Cone Beam CT is essential for PAE as we need to confirm vessel certainty in supplying the prostate. Traditional angiography in this region isn’t conclusive as there are small vessels that you may not identify on an Anterior Posterior, AP-image.

Therefore, Cone Beam CT on the IR system can identify very small vessel branches that supply areas at the base of the penis, bladder or rectum. This insight helps with decision making to either embolise or identify an alternative embolization point.”

“Dose reduction is also essential to manage the cumulative dose for the operators working in the room. We need to conserve the dose as much as possible and it was one of the factors in our system selection,” he adds.

An imaging partnership

The Christie NHS Foundation Trust is the largest single site cancer centre in Europe, treating more than 60,000 patients a year. Based in Manchester, it serves a population of 3.2 million people across Greater Manchester and Cheshire, with a quarter more patients also referred from across the UK. “As a cancer centre we try to promote a relaxed atmosphere with a holistic philosophy to reduce the anxiety patients may potentially feel. Whilst the PAE procedures are for benign conditions, it is still our aim to provide the highest level of choice and a calm environment. Canon Medical worked closely with us at the start of our PAE journey. This helped us gain timing accuracy for contrast delivery with the Cone Beam CT, and resulted in defining a PAE protocol,” explains Dr Najran.

Delivering innovative procedures for patients is a key goal for the interventional department at Christie Hospital

Alphenix angiography systems offer integrated cardiac-optimised technologies to help deliver the best possible outcomes to patients.

Developed in collaboration with leading clinicians for neurovascular intervention, Alphenix features the world’s first high definition flat panel detector.

VISIONS 08 // 57

The Christie NHS Foundation Trust is the largest single site cancer center in Europe, treating more than 60,000 patients a year Interventional radiology is a catalyst for expanding future patient treatment

Expansion of patient services continues.

New services treating liver cancer have recently been introduced using the IR system. An example of this includes chemosaturation, a complex treatment involving cardiac bypass and the administration of high-dose chemotherapy directly into the hepatic artery with systemic circulation isolation.

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Dr Najran concludes, “Delivering innovative procedures for patients is a key goal for the interventional department at The Christie Hospital.

Ergonomic, space saving ceilingmounted interventional imaging equipment helps us deliver personnel -heavy procedures, allowing us to have up to 14 essential people in the IR suite, including interventionists, cardiac perfusionists, anaesthetists, radiographers and nurses.”

Evolving innovations

It’s exciting times for interventional imaging. Evolving innovations in image quality, dose and system ergonomics are helping to broaden the range of procedures that focus on minimal invasion. This improves the patient experience so reduces the overall cost of treatment, ticking all the boxes of improving quality of care. //

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PRODUCT // DIAGNOSTIC X-RAY // Ultimax-i

The Ultimax-i replaces a 13-year-old system at Birmingham Women’s Hospital, broadening the range of on-site fluoroscopy procedures, and enabling easy access for radiographers, nurses and clinicians.

Birmingham Women’s Hospital Praises Image Quality, and Usability of Ultimax-i Female and infant fluoroscopy procedures enhanced to deliver high-quality care.

F

emale fluoroscopy procedures including Hysterosalpingography (HSG) to assess uterine cavity and fallopian tubes, as well as video urodynamics to study pressure/flow in the lower urinary tract have been upgraded at Birmingham Women’s Hospital with the introduction of an Ultimax-i from Canon Medical Systems UK.

Service efficiencies

The Ultimax-i has the potential to deliver many service efficiencies including broadening the range of on-site fluoroscopy procedures for babies in the Neonatal Intensive Care Unit (NICU). Previously, newborns would have been transferred for these imaging procedures by ambulance to the children’s site, 10-15 minutes away, depending on traffic, and back again.

Now, patient safety, time, transport,

travel-related carbon emissions and parental anxieties have all been reduced.

Future workload

Dr Moji Balogun, Consultant Radiologist at Birmingham Women’s Hospital states, "Our HSG caseload is really high, at the last audit we were the busiest provider in the country, so with a more modern fluoroscopy system we are ready to embrace future workloads and give greater comfort to our female patients. On-site fluoroscopy capabilities for babies are also very valuable to avoid the fragile transfers. The lower dose, image quality and ease of use are key highlights, plus the small footprint of the system works well in our compact room.”plus the small footprint of the system works well in our compact room.”

The Ultimax-i replaces a 13-year-old system to modernise the hospitals' patient imaging services The Ultimax-i replaces a 13-year-old system to modernise patient imaging services and introduce easier working practices for staff. The adjustable C-arm with its large area flat panel detector works around the patient and enables easy access for radiographers, nurses and clinicians from both sides of the table during simple or complex procedures.

The table height is also easily adjustable, not only to work at an optimum level to suit all heights of users, but also to lower to just 52cm for patients to easily get on to the table without needing steps.

“Our HSG caseload is really high, at the last audit we were the busiest provider in the country, so with a more modern fluoroscopy system we are ready to embrace future workloads."

Dr Moji Balogun, Consultant Radiologist at Birmingham Women’s Hospital

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The Ultimax-i at Birmingham Women's Hospital. Modernising patient imaging services and introducing easier working practices for staff.

“We’ve worked closely with the team at Birmingham Women’s Hospital to ensure hospital staff were quickly trained on the new system and were confident about using all the features of the Ultimax-i.”

Louis Westley, Account Manager at Canon Medical Systems

Louis Westley, Account Manager at Canon Medical Systems UK states, “We’ve worked closely with the team at Birmingham Women’s Hospital to ensure hospital staff were quickly trained on the new system and were confident about using all the features of the Ultimax-i for their specific workloads. Responsiveness to all questions at the start of a new customer journey is vital and we look forward to supporting them into the future.”

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Centre of excellence

Birmingham Women’s Hospital, part of Birmingham Women’s and Children’s NHS Foundation Trust, is a centre of excellence providing specialist services to more than 50,000 women, men and their families each year. Birmingham is one of two dedicated women’s hospitals in the UK, with the busiest single site maternity unit delivering more than 8,200 babies a year. //

Birmingham Women's Hospital.

COMMUNITY DIAGNOSTIC CENTRE // COMPUTED TOMOGRAPHY // Aquilion Prime SP

External modular CT building has been fully integrated onto the existing Victoria Infirmary listed building, bringing a 'one-stop-shop' to the Cheshire community.

CDC Success at Victoria Infirmary, Northwich Modular CT building created in five months on listed hospital site creates capacity for thousands more patients to be seen via ‘one-stop-shop’ diagnostics.

T

he success of Northwich’s Victoria Infirmary (VIN) Community Diagnostic Centre (CDC) has enabled more patients to be seen in Cheshire for quick frontline diagnostic imaging, reducing waiting times and freeing up pressure on other acute hospital scanners. In less than a year, thousands more patients have attended for CT scans and other tests on the same day, improving the quality of care experience and reducing the need for multiple attendances at different hospital locations.

The modular CT building has been fully integrated onto the existing Victoria Infirmary listed building by Canon Medical Systems UK.

Turnkey project

The turnkey project took five months and involved creating the additional CT scanning facility by demolishing an old casualty building, knocking through and adding an integrated modular building containing an AI-assisted Aquilion Prime SP CT scanner.

Northwich creates an ideal model for future patient pathway reforms. In less than a year, thousands more patients have attended for CT scans and other tests on the same day 64 // VISIONS 08

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INTERVIEW // ENVIRONMENTAL, SOCIAL AND GOVERNANCE // Sheffield Hatters

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Pictured L to R: Karen Bowman, General Manager and Michael Potts, CDC Imaging Lead at Northwich’s Victoria Infirmary (VIN) part of Mid Cheshire Hospitals NHS Foundation Trust with the Canon Medical Aquilion Prime SP CT scanner.

“Two thousand outpatient, follow-up or high-risk query CT scans have been enabled in nine months due to the creation of the CDC at VIN.” Karen Bowman, General Manager, Victoria Infirmary

Karen Bowman, General Manager, Victoria Infirmary, part of Mid Cheshire Hospitals NHS Foundation Trust states, "Two thousand outpatient, follow-up or high-risk query CT scans have been enabled in nine months due to the creation of the CDC at VIN. This means more people have been seen sooner than would have been previously possible - we’re even calling people to arrange CT scans on the same day they have seen their GP. The dedicated CDC also means that the pressure burden on our acute

hospital scanners at Leighton Hospital has been relieved. That’s thousands of CT appointments removed from our front-line acute scanners giving them the dedicated focus they need for emergency or advanced imaging such as cardiac and CT colonoscopy.

CDC Success

We’re now seeing happy, grateful patients and this has had a direct impact on our radiology team, increasing morale with reduced pressure.” The future aim of outpatient diagnostics is making more tests

available and closer to patients,” continues Karen Bowman. “The CDC model has proven itself here and given us confidence. As we start to plan our new hospital, we will look to focus on provision for acutely unwell patients and those with higher-risk, elective care needs and move more diagnostics and non-hospital reliant services closer to our patients’ homes.

The success of the CDC so far has also enabled us to start conversations about enhancing other care pathways via a ‘one-stop-shop' approach such as our cancer services.”

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"We’re now seeing happy, grateful patients and this has had a direct impact on our radiology team, increasing morale with reduced pressure."

Karen Bowman, General Manager, Victoria Infirmary

Meeting expectations

Michael Potts, CDC Imaging Lead at VIN adds, “Canon Medical worked closely with us on the modular building and kept construction noise and disturbance on the hospital site to a minimum.

The Aquilion Prime SP CT scanner will be our fourth Canon Medical scanner at the Trust and it keeps meeting our expectations. It brings the renowned

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Advanced Intelligent Clear-IQ Engine (AICE) for phenomenal image quality at low dose and high speed, plus provides additional advanced applications that help with clinical procedures. This includes Single Energy Metal Artifact Reduction (SEMAR) to work around visualising elderly patients with prostheses, stents, pacemakers or tooth replacements; and SURESubtraction to enhance iodine imaging with colour mapping.”

Billy Erwin, Account Manager at Canon Medical Systems UK states, “Separating acute and outpatient care is at the heart of the CDC philosophy to create efficiencies and speed up patient diagnosis. Victoria Infirmary has achieved so much already by embracing its CDC opportunity and we look forward to supporting them to optimise future plans to streamline pathways and evolve its community service offerings.” //

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// EVENTS

Remaining Education Calendar 2023 Keep up to date with all of our latest events.

Canon Medical Systems UK offer an excellent variety of events, education roadshows and study days, both virtually and face-to-face.

For the updated information on all our active and future events, scan here.

Whether Canon Medical UK are sponsoring events or running them – there is something for everyone all year round.

November 2023

December 2023

5-7th November BSBR Location: Northern Ireland, UK Duration: 3 day event Register here: www. delegate-reg.co.uk/bsbr2023

5-7th December BMUS 2023 Location: York, UK Duration: 3 day event Register here: www.bmus.org

11th November Antenatal Ultrasound – Increasing Diagnostic Confidence Location: Birmingham, UK Duration: 1 day event Register here: medicalimagingacademy.co.uk/ courses/birmingham-2023 11th November Canon Medical Southwest Ultrasound Educational Roadshow Location: Buckfastleigh, UK Duration: 1 day event Register here: medicalimagingacademy.co.uk/ courses/exeter-2023

Please be advised, some dates are subject to change.

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