Medical Imaging International April 2016 by Globetech

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Vol.26 No.2 3-4 /2016 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 2-26 PACS/ IT Update . . 28-32 Product News . . . . . 8-32 Industry News . . . . . . 33 International Calendar . 34

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Study: Radiation Risk from Digital Screening Mammography Can Be Reduced Further he risk of radiation-induced breast cancer for women undergoing digital screening mammography can be reduced even more for most women by employing simple changes in screening guidelines. The findings were published in the January 2016 issue of the Annals of Internal Medicine. The research was part of a comprehensive modeling study, undertaken by the UC Davis School of Medicine (Sacramento, CA, USA; www.ucdmc. ucdavis.edu/medschool) that found minimal risk of radiation-induced breast cancer for most women from digital mammography breast cancer screening. Women with large breasts or those with breast implants, often receive extra screening, and have increased radiation exposure. Larger detectors and

other new technologies can help mitigate the risk for these women. The researchers modeled the risk of women developing radiation-induced breast cancer during their lifetime from digital screening mammography, and as a result dying from the disease. The researchers compared this to the number of breast cancer deaths that were prevented by early detection and found that screening 100,000 women aged between 50 and 74, every two years, prevented 627 deaths. The radiation from such exams, and subsequent additional diagnostics, could cause 27 cases of breast cancer, and four deaths. When women aged 40 to 74 were screened every year, an additional 100 radiation-

induced breast cancers occurred, and 12 breast cancer deaths, compared to women aged 50 to 74, who were screened every two years. The results of the study showed screening mammograms taken every two years, instead of yearly, and starting from age 50, not 40 or 45, would be safer for all women. Image: Researchers used simulation models for breast cancer risk from radiation exposure to estimate how many women could get radiation-induced breast cancer from a variety of screening approaches - including mammography (Photo courtesy of Getty Images).

Quantitative Ultrasound Helps Stage Fatty Liver new study suggests that computer-aided ultrasound could be used to stage hepatic steatosis, with a high correlation to magnetic resonance imaging (MRI) spectroscopy. Researchers at Radboud University Medical Centre (Nijmegen, the Netherlands; www.umcn. nl) conducted a pilot study in 14 patients on longterm home parenteral nutrition using a phased array ultrasound transducer connected to a calibrated ultrasound machine, with the radio frequency (RF) data converted into conventional B-mode images with the aid of computer software. All patients were also subjected to proton MRI spectroscopy measurement of liver fat content for reference. The results showed that computer-aided ultrasound parameters, similar to those in a previous validation study in cows, demonstrated significant correlation with fat content as measured by MRI spectroscopy, with the most significant parameters being residual attenuation coefficient and lateral speckle size. According to the researchers, the method shows promise as a noninvasive, easy, and inexpensive alternative to invasive biopsies or expensive MRI spectroscopy techniques. The study was published in the March 2016 issue of Ultrasound in Medicine & Biology. Steatosis in the liver, when it is not due to excessive alcohol use, is most often related to insulin resistance and to metabolic syndrome, and as a result may respond to treatments originally developed for other insulin-resistant states, such as diabetes mellitus type 2. Steatosis is also the most common liver disease of high-yielding dairy cattle during early lactation, making it a suitable animal model for studying liver fat accumulation.

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New PET/CT System Addresses Clinical Indications in Oncology, Neurology, and Cardiology new Positron Emission Tomography/Computed Tomography (PET/ CT) system enables clinicians to serve a wide range of patients and move into new service areas using commercially available PET tracers. The new system automates previously manual tasks enabling users to address more indications in oncology, neurology and cardiology. The system uses 4-mm Lutetium Oxyorthosilicate (LSO) crystals to provide rapid scintillation with a high light output, and the lowest possible achievable dose to visualize small lesions. The Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com) Biograph Horizon system has features that help automate tasks, streamline workflow, and increase productivity and can perform a scan in less than five minutes. Image reconstruction occurs in parallel to acquisition and is ready 30 seconds after the scan. The QuantiQC feature runs overnight calibration and quality control procedures. The Biograph Horizon also features the syngo.via Molecular Imaging Workplace image processing solution for measurements and reporting. Other features include automated tools to visualize diagnostic information in real time, automate prefetching, preprocessing, and display comparison of previous findings. The system also features Siemens ALPHA technology for automatic registration, and EQ/PET that can calculate precise changes in tumor uptake.

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Steve Holmes, Sales Director, Siemens Healthcare, said, “At a time when there is a demand to drive down cost while enhancing productivity, Siemens is well placed to support with technology capable of improving care pathways and maximizing investments. The Biograph Horizon provides a cost-effective PET/CT imaging solution that does not compromise on quality. As our smallest PET/CT system, it offers low power requirements and a small footprint to ensure reduced operating and maintenance costs, with the flexibility to meet expanding clinical needs.” Image: The versatile Biograph Horizon PET/CT system offers premium performance at cost-effective ownership (Photo courtesy of Siemens Healthcare).

Brain Imaging Technology Could Help Study Parkinson’s Disease portable imaging device has identified differences in brain activation patterns associated with postural stability in people with Parkinsonian syndromes, according to a new study. Researchers at Drexel University (Philadelphia, PA, USA; www.drexel.edu) and Yeshiva University (YU; New York, NY, USA; www.yu.edu) used a portable functional near infrared spectroscopy (fNIRs) device as a direct online cortical probe to compare neural activation patterns in the prefrontal cortex, postural stability, and their respective interactions, in 269 older adults (mean 76 years, 56% women) without dementia. Of these, 26 patients had Parkinsonian syndromes; 117 had mild Parkinsonian signs; and 127 were healthy older adults who served as controls. The participants were asked to stand upright and count silently for ten seconds while changes in oxygenated hemoglobin levels over prefrontal cortex were measured using fNIRs. The researchers simultaneously evaluated postural stability with center of pressure velocity data recorded on an instrumented walkway. The results showed that when compared to healthy controls and patients with mild Parkinsonian signs, the patients with Parkinsonian syndromes demonstrated significantly higher prefrontal

oxygenation levels to maintain postural stability. The study was published in the November 6, 2015, issue of Brain Research. “Postural instability is a major risk factor for older adults. This initial study allowed us to measure brain activity in real time, in a realistic setting. It shows that there are indeed differences in the prefrontal cortex of healthy and Parkinsonian syndrome patients,” said study coauthor biomedical engineer Meltem Izzetoglu, PhD, of Drexel University. “If we can monitor the cognitive component of staying balanced, then this could eventually lead to better treatment options for people with Parkinsonian syndromes or even Parkinson’s disease.” The prefrontal cortex is the brain region considered to be in charge of the orchestration of thoughts and actions in accordance with internal goals, and is responsible for higher-level processing, such as memory, attention, problem solving, and decision-making. When a person is learning a new skill, for instance, neural activity is greater in this region. Increasing evidence shows that in Parkinson‘s disease, profound dopamine depletion not only occurs in the striatum of the brain, but also in the prefrontal cortex, and this may be associated with cognitive and motor deficits.

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Medical Imaging International March-April/2016

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Radiation Therapy Noncompliance Impairs Tumor Control new study concludes that the interruption of sequential external beam radiation therapy (RT) appointments may impair tumor control, particularly for head and neck cancers. Researchers at the Montefiore Einstein Center for Cancer Care (MECCC; New York, NY, USA; www.montefiore.org/cancer) and Albert Einstein College of Medicine (New York, NY, USA; www. einstein.yu.edu) conducted a study that evaluated 1,227 patients between 2007 and 2012 who were scheduled for courses of external beam RT for cancers of the head and neck, breast, lung, cervix uterus, or rectum. In all, 21.7% of the patients were noncompliant, missing two or more scheduled therapy appointments, but all patients eventually completed the radiation therapy course planned for them. The results showed that at median follow-up of 50.9 months, 108 recurrences (8.8%) and 228 deaths (18.6%) occurred. Despite the average one-

week delay in noncompliant patient RT completion, 16% of the noncompliant patients experienced a recurrence, versus only a 7% recurrence rate in compliant patients. According to the researchers, noncompliance to scheduled treatments may represent a new behavioral biomarker for identifying high-risk patients who require additional interventions to achieve optimal care outcomes. The study was published in January 2016 issue of the International Journal of Radiation Oncology Biology Physics. “This study shows that the health of our patients can improve only when a course of treatment is completed in the prescribed period of time,” said senior author Prof. Madhur Garg, MD, clinical director of the department of Radiation Oncology at MECCC. “These findings should serve as a wakeup call to physicians, patients and their caregivers about the critical need to adhere to a recommend-

ed treatment schedule.” “We previously conducted a study that demonstrated a statistically significant relationship between lower socioeconomic status and non-compliance,” said lead author Nitin Ohri, MD, assistant professor of radiation oncology at Albert Einstein College of Medicine. “As an outcome result of this study, management of mood disorders, patient navigator programs, and increasing assistance with transportation are being evaluated at Montefiore as interventions that might improve patient care outcomes and close disparities among vulnerable populations.” Prolonging radiation therapy for head and neck cancer or cervical cancer can impact tumor control and overall survival at a rate of one percent per day, which is attributed to tumor repopulation. The repopulation can even accelerate after treatment initiation.

3D DBT Mammography Screening Improves Cancer Detection recent study has shown that using 3D mammography/DBT for initial and subsequent breast cancer screening improves cancer detection, and reduces the need to call back patients for additional imaging for a period of up to three years. The researchers analyzed 44,468 mammography exams of 23,958 women screened with no history of breast cancer. The women initially underwent only Digital Mammography (DM). In the following consecutive three years all women underwent DBT exams of two-view DM, and two-view Digital Breast Tomosynthesis (DBT) of each breast. The research was carried out by scientists at the Perelman School of Medicine (PENN Medicine; Philadelphia, PA, USA; www.upenn.edu), at the University of Pennsylvania, and was published online on February, 18, 2016, in the journal JAMA Oncology. During their analysis of the data, the researchers compared differences in screening results between every year a DBT mammography screening was carried out and the DM baseline year, and between women that had a history of only one, two, or three DBT screenings. The study was the first to provide longitudinal evidence that for women with a healthy negative reading the benefits of initial DBT screening can be maintained, and improved with consecutive DBT screenings. Senior author of the study, Emily F. Conant, MD, chief of Breast Imaging, department of Radiology, PENN Medicine, said, “These findings reaffirm that 3D mammography is a better mammogram for breast cancer screening. These results are an important step toward informing policies so that all women can receive 3D mammography for screening.”

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Toshiba Launches Entry-Level CT System oshiba (Tokyo, Japan; www.toshiba.com) is reducing the cost of computed tomography (CT) with the launch of a premiumcomponent, entry-level system that provides an economic advantage for healthcare providers looking to maximize their equipment investment. The Aquilion Lightning CT system is a 16-detector row system with a small footprint that allows providers to save on both space and cost. The system utilizes PUREViSION CT Detector technology and includes fourth generation adaptive iterative dose reduction (AIDR) 3D Enhanced to help reduce radiation dose. A wide gantry opening of 78 cm ensures that even the largest patients can be easily positioned and will remain at ease during scanning. Another feature, variable helical pitch allows change of scan speed during one continuous acquisition. In addition, adaptive diagnostic solutions, such as single energy metal artifact reduction (SEMAR) help to simplify complex scans with more consistent imaging by utilizing a sophisticated iterative re-

construction technique to virtually eliminate metallic artifacts, thus improving visualization of implants, supporting bone, and the adjacent soft tissues for a clearer and more confident diagnosis. Additionally, SURESubtraction technology with pixel perfect registration and a thin 0.5 mm slice provide accurate visualization of vessels and contrast-enhanced tissue structures. By redesigning the system components, including the 5 MHU HeliCool tube, the Aquilion Lightning also has the smallest footprint in its segment, at just 9.8 m2, ensuring that it can be installed in even the smallest room, while still offering a pleasant working environment. For added patient comfort, the couch-top can be lowered to a minimum height of 312 mm from the floor, facilitating transfer of the patient from a wheel-chair or gurney. “The Aquilion Lightning embodies Toshiba’s promise to provide customers with the industry’s best solutions on every scanner,” said Satrajit Misra, vice president of marketing at Toshiba. “This

system ensures customers don’t need to compromise quality to meet their business goals, by reducing their total cost of ownership. As our CT business continues to grow, we are proud to give our partners the best in value, reliability and technology no matter the price point.” Image: The Aquilion Lightning CT system (Photo courtesy of Toshiba Medical Systems).

Rugged, Portable Ultrasound System Receives Regulatory Approval

Technique Developed to Help Clinicians Treat Early Brain Glioma Tumors

new portable ultrasound system with improved transducer signal penetration, and contrast resolution has been released following US and EU regulatory approval. The portable system, designed for the acute-care environment, features transducers wrapped in a metal housing to prevent accidental damage, increased penetration and contrast resolution, a new wide-angle display with a 33% higher viewing angles, armored cables, and a water-resistant control panel. The Edge II, which uses DirectClear techology, was developed by FujiFilm SonoSite (Bothell, WA, USA; www.sonosite.com). The system received was approved for use in the US and in Europe after receiving US Food and Drug Administration (FDA; Silver Spring, MD USA; www.fda.gov) 510(k) clearance, and the CE marking. FujiFilm SonoSite is a world leader in bedside and point-of-care ultrasound as well as in ultra-high frequency micro-ultrasound technology. Diku Mandavia, MD, FACEP, FRCPC, chief medical officer, senior vice president, FujiFilm SonoSite and FujiFilm Medical Systems USA, said, “Since SonoSite introduced the first portable ultrasound system in 1999, it has continued to build solutions that anticipate the bedside provider’s needs. The Edge II ultrasound system stays true to the SonoSite legacy of durability, reliability, and ease of use. However, we also incorporated enhancements to accelerate the time to image acquisition, enabling clinicians to make more confident decisions and focus on what matters most, the patient.”

new technique for detecting and treating deadly brain tumors earlier using a nanotechnology Magnetic Resonance Imaging (MRI) contrast agent has been developed. The agent can pass through the blood-brain barrier and provides opportunities to treat normally fatal gliomas. Patients with cancerous gliomas have a median survival rate of 14 months after they are diagnosed. The new approach was developed by researchers at the Department of Neurosurgery of Penn State College of Medicine (Hershey, PA, USA; www.pennstatehershey.org/web/college), and was published in the Journal of Neuro-Oncology. Current treatment options for patients with malignant glioma are surgery, chemotherapy, radiation therapy but the cancer often returns, surviving initial treatments, and follow-up MRI scans often are unable to catch the tumors in time. Existing MRI contrast agents can only find tumors after they are large enough to damage the blood-brain barrier. The Penn State research team found a way to created “smart fat cells” or liposomes that are able to pass the blood-brain barrier in mice, and find cancerous gliomas earlier. James Connor, distinguished professor of neurosurgery, said, “Patients typically don’t die from the tumor they initially presented with. Rather, they die from new tumors that come back in other parts of the brain. The goal is to be able to get down to detecting single cancer cells. Ultrasound, with all of its good qualities, is disruptive to the blood-brain barrier, whereas we can get an agent to cross it without causing disruption.”

Optical Ultrasound Probes with Detailed Real-Time Imaging to Guide Surgical Tools esearchers have developed a novel technique that can help guide surgical procedures more precisely and efficiently. The minimally invasive real-time technique uses optical ultrasound probes that send and receive ultrasound waves using light, to provide detailed images and guide surgical tools. The new optical ultrasound probes are designed to be integrated into needles, catheters, and other devices, and provide detailed images from inside the body. The probes are being developed by Dr. Adrien Desjardins of University College London (London, UK; www.ucl.ac.uk), a recipient of the EPSRC

Healthcare Technologies Challenge Awards, together with a team of nine researchers. The awards are designed to encourage research for improved diagnosis and treatment, and to help speed up the clinical adoption of the new technologies. The technique uses optical fibers coated in a thin micron-scale layer carbon-polymer nanocomposites, or another optically absorbing material. Laser pulses are targeted at the coating, which heats up, and generate ultrasound waves. The ultrasound wave moves through the body and is reflected from inside human tissue. The waves are then received by very sensitive optical elements called Fabry-Pérot cavities, which

reflect light between two mirrored surfaces. Dr. Desjardins, said, “Ultrasound imaging can provide exquisite visualization of tissue from within the body to guide minimally invasive medical procedures. Currently, though, ultrasound imaging is performed with electronic transducers, which have costs that are often prohibitive for single-use medical devices, and they are too bulky for many procedures. By varying the location in the tissue in which the ultrasound wave is generated, signals can be acquired and processed to produce high-resolution pulse-echo ultrasound images in real time from within the body.” Medical Imaging International March-April/2016

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Novel Intracardiac Echocardiography System Receives FDA Clearance novel catheter-based ultrasound system that provides ultrasound images of cardiac anatomy around the tip of the catheter has received US Food and Drug Administration (FDA) 510(k) clearance. The system is intended for use in intracardiac and intraluminal ultrasound imaging of the anatomy of the heart and associated great vessel anatomy. The system is the first catheter-based ultrasound system that can provide both 2D and 3D images of cardiac anatomy around the catheter’s tip. The Foresight Intracardiac Echocardiography (ICE) system is produced by Conavi Medical, formerly Colibri Technologies (Toronto, Canada; http://colibritech.com), and includes Conavi’s dual-display Hummingbird imaging console as well as the Foresight ICE catheter. The system supports minimally invasive cardiovascular procedures, for example ablations, which may require access to targeted areas of the heart.

“FDA clearance of the Foresight ICE System represents a major milestone for Conavi’s team and our customers in the US healthcare system,” says Brian Courtney, CEO of Conavi Medical Inc. “We look forward to working with physicians in the United States by providing them with new visualization tools to support existing and emerging minimally invasive procedures for patients with a broad range of cardiac conditions. The Foresight ICE system represents Conavi’s lead product in its commercialization pipeline. The advanced technology in this system provides us with a remarkable platform from which we will be able to expand in the future to help physicians, healthcare systems, and industry partners better address a large number of clinical needs.” Image: The catheter-based Foresight ICE ultrasound system (Photo courtesy of Conavi Medical).

Study Reveals Radiologic Procedure Outcomes May Be Affected by Patient Mood ew research shows that patients who experienced a high degree of negative feelings such as distress, fear, or hostility before a radiology procedure have significantly more negative side effects than other patients. The researchers analyzed data from 230 patients that underwent image-guided interventional radiology procedures and found that those patients that reported a high degree of negative feelings experienced blood pressure and heart rate changes, post-operative bleeding, or other adverse events during or immediately after the procedure that could affect the outcomes of the exam. The patients included 120 women and 110 men with a mean age of 55 years. The procedures investigated were minimally invasive ones such as catheterization. The patients were asked to complete a Positive Affect Negative Affect Schedule (PANAS) survey when they arrived for their procedure. The survey was intended to assess their mood, and used a five-point rating scale to determine whether the patients experienced positive or negative feelings. The researchers grouped the patients based on their high and low scores for positive and negative effects, and correlated the data with the occurrence of adverse effects such as low or high blood pressure, post-operative bleeding, prolonged lack of oxygen, or an abnormally slow heart rate. The results showed that 22% of the 104 patients with high negative affect (23 patients) had an adverse event, compared to only 15 (12%) of the 126 patients with low negative affect. Patients undergoing such procedures are often conscious but sedated and able to converse with the team of clinicians treating them. The researchers suggested training healthcare teams in resilience and techniques to improve their own positive emotional states, and that of the patients prior to the procedure.

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Metasurface Grid Boosts Sensitivity of MRI Machines new study claims that ultrathin metasurface resonators could reduce magnetic resonance imaging (MRI) scanning times by more than 50%. Researchers at ITMO University (St. Petersburg, Russia; www.ifmo.ru), Australian National University (ANU; Canberra; www.anu.edu.au), and other institutions demonstrated that when a specially designed metasurface (formed by an array of metallic wires) is placed under an object inside a MRI scanner, a substantial enhancement of the radiofrequency (RF) magnetic field is achieved by means of subwavelength manipulation with the metasurface, increasing the signal-to-noise ratio in the scanned area. The result of this increase is that either a higher resolution image can be obtained over the same time slot, or that a faster examination can be performed with the same resolution as in an ordinary MRI scanner. In addition, the metasurface suppresses the electric field responsible for tissue heating, a phenomenon has recently become even more relevant with the arrival of high-field and ultra-high-field

MRI scanners that provide better image resolution, but also cause an increase in RF energy absorption. The study describing the technology was published on January 11, 2016, in Advanced Materials. “In the future we see even more potential in the concept of special smart clothing for MRI scanning; stripes of our metamaterial can be sewn in the clothes,” said lead author Alexey Slobozhanyuk, a PhD student from ITMO University at ANU. “The examination of patients, wearing such clothes, would lead to higher resolution MRI images, while the special design will enable a homogeneous enhancement of the signal-tonoise ratio, which does not pose any risk to the patients’ health.” The metasurface solution does not require any intervention in the hardware of the MRI scanner, but rather represents an inexpensive functional addon device that can be used with any existing MRI scanner. The patent-pending technology is currently being co-developed by MediWise (London, United Kingdom; www.mediwise.co.uk), a company that

specializes in commercializing metamaterials for medical applications. “Metamaterials have been proven to add value through their ability to process electromagnetic and sound waves in ways that no natural material can do,” said George Palikaras, Founder and CEO of Mediwise. “The technology has the potential to extend the life of MRI imaging machines but more importantly, it will make the scan quicker, more accurate and safer to patients. We are honored to work alongside world leading academic partners, and to help advance this important innovation from the laboratory to the marketplace.” Image: An artist’s view of a biological object placed on a metasurface resonator (Photo courtesy of Advanced Materials).

MR Techniques Find Link Between NAFLD and Heart Failure in Obese People he results of a new study published online in the journal Radiology, has found that fatty liver is independently associated with subclinical heart failure in people who are obese. Non-Alcoholic Fatty Liver Disease (NAFLD) occurs when large droplets of fat are deposited in the liver (hepatic steatosis). The disease is related to insulin resistance, and includes risk factors such as obesity and diabetes. The disease is common in children in the United States and the Western World and can lead to hepatitis, cirrhosis, scars in liver tissue, and liver cancer. Up to 30% of the general population in the US suffer from NAFLD. The prevalence of NAFLD in obese people or people suffering from type 2 diabetes is between 70% to 90%. NAFLD is a manifestation of risk factors such as high blood pressure, unhealthy

cholesterol levels, and excess abdominal fat that increase the risk of strokes, heart attacks, and diseases. The researchers from the Leiden University Medical Center (LUMC; Leiden, The Netherlands; www.lumc.nl) studied 714 men and women aged between 45 and 65 years, 47% of which were classified as overweight, and 13% as obese. The researchers used proton Magnetic Resonance Spectroscopy (MRS) to measure hepatic triglyceride content, noninvasively, and cardiac Magnetic Resonance Imaging (MRI) to assess left ventricular diastolic function. Lead author of the study, Ralph L. Widya, MD, said, “One of the unique aspects of our study is that we took all of the individual components of the metabolic syndrome into account as possible confounders in this association, as the metabolic syndrome is asso-

ciated with NAFLD and with cardiovascular disease. Our results may be of importance in cardiovascular risk stratification in obesity, because there is a large variation in the degree of hepatic steatosis in obesity. Also, more emphasis should be put on dietary interventions to reduce or prevent hepatic steatosis. The reasons for the link between fatty liver and heart function are unknown, but could be related to several factors, including the presence of infection-fighting white bloods cells called macrophages or increased expression in the liver of small proteins known as cytokines. Future research is required to study the effect of NAFLD on cardiovascular events, and further study is needed to investigate to what extent the association exists and differs among normal weight, overweight and obese persons.” Medical Imaging International March-April/2016

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Collaboration Provides New Tools for Liver Cancer Treatment nterventional radiologists and oncologists have for the first time treated a liver cancer patient using a new procedure that aims to block blood flow and achieve tumor necrosis. The procedure is the result of collaboration between two specialist healthcare manufacturers, and uses live image-guidance to visualize embolic beads during treatment of liver cancer. Liver cancer is difficult to treat, and is a leading cause of death from cancer worldwide. The procedure can help those patients with liver cancer tumors that cannot be removed using surgery. BTG (London, UK; www.btg-im.com) and Royal Philips (Amsterdam, the Netherlands; www.philips.com) developed the intervention, which used BTG’s LC Bead LUMI radiopaque embolic bead, and Philips’ 2-D X-Ray and 3-D Cone-Beam Computed Tomography (CBCT) image guidance. The procedure enables interventional radiologists and oncologists to see whether tumor treatment is complete, by providing live enhanced visualization.

Image: Treating a liver cancer patient using live image-guidance and radiopaque embolic beads (Photo courtesy of Philips Healthcare).

Digital Radiography Upgrades Announced leading imaging vendor has announced enhancements and upgrades to its software solutions and Digital Radiography (DR) systems. The upgrades include a single clinical portal that features a patient-centric overview of patient information from inside and outside a hospital, and a unified Enterprise Imaging for Radiology platform including a Picture Archiving and Communication System (PACS), and new features such as support for teaching files, a taskbased workflow for residents and supervisors, and multidisciplinary team meetings. The updates are being showcased by Agfa HealthCare (Mortsel, Belgium; www.agfahealthcare.com) at the 2016 European Congress of Radiology (ECR; Vienna Austria). Agfa will also show the multidetector DR 600 X-Ray room, and DX-D 100+ fully-mobile Digital Radiography (DR) system, and upgrades for the MUSICA CR/DR image processing platform. The DR 600 system features auto-positioning with Agfa ZeroForce Technology, auto-tracking; and wireless, tethered, or fixed Cesium Iodide (CsI) or Gadolinium Oxy-Sulphide (GOS) detectors, with potential for dose reduction using the CsI detectors. The DX-D 100+ uses Agfa FreeView maneuverability, full mobility, and improved navigation, MUSICA image processing, and a collapsible telescopic arm. Hans Vandewyngaerde, president EMEA, Agfa HealthCare, said, “Looking forward to visualize the future of imaging, Agfa HealthCare is building on the firm foundation of its past: 100+ years of experience. We are using that experience to find new, innovative ways to answer the evolving challenges faced by healthcare providers, both with solutions for creating images and the IT systems that allow them to collaborate, exchange, and manage those images, to achieve integrated care.”

Medical Imaging International March-April/2016

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The Lumason contrast agent is designed to be used for focal liver lesions in both adult and pediatric patients, with phase II and II clinical trials supporting its use. The agent was known previously in the U.S. as SonoVue, and is still offered under that brand outside of the United States.

The DRX-Excel offers capabilities for both general radiography and fluoroscopy exams in a single system at a cost-effective price. The system is available in a choice of two models, a conventional configuration and a dRF configuration, to match a range of specific needs and workflow.

The RadiForce RX850 is a multi-modality monitor capable of displaying various color and monochrome imaging modalities on one screen. The 8MP monitor is capable of displaying MRI, CT, and ultrasound images, as well as digital mammography images where high performance is essential.

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PET Scans Track Progressive Stages of Alzheimer’s new study reveals how positron emission tomography (PET) scans of Tau deposition can help track the progressive stages of Alzheimer’s disease (AD) in the brains of aging cognitively normal adults. Researchers at the University of California Berkeley (USA; www.berkeley.edu) and Lawrence Berkeley National Laboratory (LBL; Berkeley, CA, USA; www.lbl.gov) conducted a study to examine Tau deposition and retention patterns in 53 adults. Of these, 5 were young adults (20–26), 33 were cognitively healthy adults (64–90), and 15 were patients aged 53–77 who had been diagnosed with dementia resulting from probable AD. Tau deposition was measured using the PET agent (18)F-AV1451, in a method established by German researchers through post-mortem analysis of the brains of suspected AD patients. The results confirmed that with advancing age, tau protein accumulates in the medial temporal lobe, which hosts the hippocampus and the mem-

ory center of the brain, and that higher levels of tau in the medial temporal lobe was associated with greater declines in episodic memory. PET detection of tau in other isocortical regions, such as the neocortex, required the presence of β-amyloid, and was associated with a decline in global cognitive function. The study also confirmed that the patterns of tracer retention corresponded well with Braak staging of neurofibrillary tau pathology. The study was published on March 2, 2016, in Neuron. “Braak staging was developed through data obtained from autopsies, but our study is the first to show the staging in people who are not only alive, but who have no signs of cognitive impairment,” said lead author Prof. William Jagust, PhD, of UC Berkeley and LBL. “Amyloid may somehow facilitate the spread of tau, or tau may initiate the deposition of amyloid. All I can say is that when amyloid starts to show up, we start to see tau in other parts of the brain, and that is when real problems begin.

We think that may be the beginning of symptomatic Alzheimer’s disease.” Tau is a microtubule protein important in maintaining the structure of neurons. They are abundant in neurons of the central nervous system (CNS) and are less common elsewhere, but are also expressed at very low levels in astrocytes and oligodendrocytes. Pathologies such as AD and Parkinson’s disease are associated with tau protein oligomers that have become misfolded and defective, and no longer stabilize microtubules properly. β-amyloid are peptides that are the main component of the amyloid plaques found in the brains of AD patients. It is believed that certain misfolded oligomers can induce other β-amyloid molecules to also take the misfolded oligomeric form, in a process similar to that of the tau protein, leading to a chain reaction akin to a prion infection that is toxic to nerve cells. There is some evidence that misfolded β-amyloid can also induce tau to misfold.

3D Mammography for Earlier Detection of Breast Cancer new study concludes that screening with digital breast tomosynthesis (DBT) combined with digital mammography (DM) increases breast cancer detection rates. Researchers at the University of Pennsylvania (Philadelphia, USA; www.upenn.edu) conducted a retrospective, four-year study of screening mammography metrics to determine if the improved outcomes observed after initial implementation of DBT screening are sustainable over time, and to evaluate the effect of more than one DBT screening at the individual level. In all, 44,468 screening events were performed on 23,958 unique women. The researchers then assessed the differences in outcomes between each DBT year and the DM year. The researchers evaluated the results between groups of women with only 1, 2, or 3 DBT screenings, and also calculated the odds of recall adjusted for age, race and ethnicity, breast densi-

ty, and prior mammograms. The results showed that the yearly rate of women called back for additional imaging decreased with the number of years they received three-dimensional (3D) DBT mammography exams. Per 1,000 women, 130 were recalled in the first year of 3D mammography exams, 78 after two years, and only 59 after three years. The analysis also showed that the yearly rate of women called back for additional imaging with 3D DBT mammography was consistently lower than the rate with standard 2D mammography. Concomitantly, the cancer detection rate per 1,000 women increased from 4.6 with 2D mammography to 5.5 in year one of 3D DBT mammography screenings, 5.8 in year two, and 6.1 in year three. Interval cancer rates decreased from 0.7% with the use of DM to 0.5% with the use of DBT. The study was published on February 18, 2016, in JAMA Oncology.

“We found that reduction in recall was sustainable at a population level, with additional reduction in recall as women returned for a second and third DBT examination,” concluded senior author Emily Conant, MD, and colleagues of the department of radiology and the computational breast imaging group. “These findings reaffirm that 3D mammography is a better mammogram for breast cancer screening […] and are an important step toward informing policies so that all women can receive 3D mammography for screening.” DBT mammograms use low dose X-rays to create a 3D image of the breast, which can then be viewed in narrow slices, similarly to CT scan images. While in conventional 2D mammography overlapping tissues can mask suspicious areas, 3D images eliminate the overlap, making abnormalities easier to recognize. Experts estimate that 3D mammography will replace conventional mammography within ten years. Medical Imaging International March-April/2016

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Medical Imaging International

Surge in CT Scans for Patients with Minor Injuries in the USA new study reveals that almost twice as many patients with non-serious injuries in the USA are undergoing computerized tomography (CT) scans in the emergency department (ED) compared to a decade ago. Researchers at the University of California, San Francisco (UCSF; USA; www.ucsf.edu) and Stanford University (CA, USA; www.stanford.edu) conducted a retrospective analysis of the California Office of Statewide Health Planning and Development (Sacramento, USA; www.oshpd.ca.gov) emergency department and ambulatory surgery data from 2005 to 2013. A total of 8,535,831 adult patients were identified with an injury severity score lower than 9 who were discharged home. The primary outcome measure was prevalence of CT imaging for each year, and clinical and hospital-level factors related to CT use. The results showed that 5.9% of the study population received at least one CT study during their ED visit, with the proportion of patients with at least one CT scan increasing from 3.51% in 2005 to 7.17% in 2013. Predictors for CT administration included age (18-24 years, or older than 45 years), Medicare and self-pay patients, fall injuries, motor vehicle collision injuries, and patients seen at level I/II trauma centers (39%), compared with 3% at low-level centers. The study was

published on January 19, 2016, in the Journal of Surgical Research. “The reasons for this increase are multifactorial,” said senior author Renee Hsia, MD, a professor of emergency medicine and health policy at UCSF. “They range from defensive medicine practices, the superior diagnostic accuracy of CT scans compared with X-rays, to their increased availability and convenience in emergency departments, and the demand to expedite discharge of patients.” “The message for both patients and physicians is that there are long-term risks associated with radiation exposure and there may be situations where imaging is not definitively warranted or beneficial,” concluded Dr. Hsia. “We can’t conclusively say which cases should not involve imaging, since every patient and every circumstance is different, but given that it is getting easier and easier to get CT scans, we need to be cautious in weighing their risks and benefits.”

FDA Approves Breakthrough Barium-Based Agent For Contrast Radiography he US Food and Drug Administration (FDA) has approved a Barium Sulfate oral contrast agent for double-contrast radiographic exams of the esophagus, stomach, and duodenum, for patients who are 12 years and older. The agent, which is used to visualize the gastrointestinal tract, is the first barium-based contrast agent to received regulatory approval in the US. The FDA approval indicates that the agent is safe and effective, that the manufacturing processes are reliable, and that the agent can be sold in the US. The E-Z-HD agent was developed by Bracco Imaging (Monroe Township, NJ, USA; http://imaging.bracco.com/us-en), part of the Bracco Group (Milan, Italy; www.braccoimaging.com). Bracco is a global diagnostic imaging concern that develops, manufactures, and markets diagnostic imaging agents and other medical solutions. Alberto Spinazzi, MD, senior vice president, Global Medical and Regulatory Affairs, of the Bracco Group, said, “Barium sulfate contrast agents are critically important and routinely used in medical imaging centers nationwide to help diagnose gastrointestinal tract diseases. We are proud to be the first company working collaboratively with the FDA to pave a new regulatory path for this class of products. FDA review is critical to ensuring the quality, safety and efficacy of a medicinal product. E-Z-HD is the first in a series of new drug approvals that Bracco is pursuing for its entire line of barium sulfate contrast agents.”

Medical Imaging International March-April/2016

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The Revolution CT ES features 8 cm of detector coverage and 0.28-second rotation, with an 80-cm bore. It is optimal for performing oncology, pediatric, and neurology studies, and users can upgrade for high-end cardiac exams. The scanner is expected to be available by the end of 2016.

The Arietta V70 is designed for noninvasive assessment of liver fibrosis. The system supports the comprehensive diagnosis of diffuse liver disease by measuring both liver fibrosis index and SWM to reflect the degree of fibrosis, inflammation, congestion, and jaundice.

The Affirm system allows radiologists to better target lesions found during 3D mammography screening, as well as other screening modalities with exceptional imaging. Capable of 2D and 3D imaging-guided biopsies, the Affirm offers improved workflow and 360-degree breast access.

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Combination of Imaging Methods Reveals Tumor Motion hybrid imaging approach that fuses magnetic resonance imaging (MRI) temporal information with computerized tomography (CT) can reveal lung and lung tumor motion. Researchers at the Agency for Science, Technology and Research (ASTAR; Singapore; www.research. a-star.edu.sg), Nanyang Technological University (Singapore; www.ntu.edu.sg), and other institutions have developed a novel hybrid imaging approach that is based on deformable image registration (DIR) and finite element method simulation to fuse a static three dimension (3D)-CT volume, acquired while the patient held his breath, and 3D motion information extracted from a four dimension (4D)-MRI dataset, thus creating a synthetic 4D-CT dataset. The result is images of the lungs that exhibit high spatial resolution, while at the same time accounting for lung movement due to breathing. When the researchers compared the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, the average error was less

than two mm. The hybrid approach also achieved a 40% error reduction over using only DIR techniques. The study describing the new hybrid imaging technique was published in the August 2015 issue of Medical Physics. “The method is expected to greatly assist clinicians when they target tumors in the lungs during radiotherapy,” said study author Soo Kng Teo, PhD, of ASTAR. “Encouragingly, some clinicians are thinking of applying our method to other organs, such as the liver, which also moves significantly with breathing. Also our computational method can combine information from different imaging methods to produce more comprehensive data sets.” Cancerous tumors in the lungs are often treated by irradiating them with high-energy X-rays, but this therapy is complicated by the fact that tumors are moving targets, due to the expansion and contraction of the lungs as the patient breathes. Currently, 3D-CT provides static high-resolution images, but at the cost of high radiation; in contrast, 4D-MRI does not employ

ionizing radiation and allows continuous tracking of lung motion, but its low spatial resolution yields blurred images. Image: A depiction of lungs obtained using the hybrid approach with motion denoted by the colored arrows (Photo courtesy of ASTAR).

Healthcare IT Manufacturer and Teleradiology Interoperability Expert Introduce New FHIR System new interoperability system that was launched at the 2015 Radiological Society of North America (RSNA) annual meeting in Chicago, USA, in November 2015, is now being introduced into the market. The system enables seamless integration of third party enterprise imaging systems using the latest Fast Healthcare Interoperability Resources (FHIR) standards, and translates image data to and from FHIR to Digital Imaging and Communications in Medicine (DICOM), Health Level 7 (HL7), or any simple system event. The new system, named FireBridge, was developed by Dicom Systems (Campbell, CA, USA; www.dcmsys.com), an integrated digital imaging workflow provider and Teleradiology interoperabil-

ity expert. FireBridge can make any interface FHIR-ready and enabled for DICOMweb, and together with DICOMweb, also enables third party applications to upload standard data to the Dicom Systems Enterprise Imaging Suite and Vendor Neutral Archive (VNA). FireBridge can also be deployed an FHIR proxy for Radiology, Oncology, Cardiology, Ophthalmology, Dermatology, and other subspecialties that are connected to the Enterprise Imaging network. In addition, FireBridge can connect all third party applications to the Dicom Systems VNA securely, without Virtual Private Networks (VPNs). FireBridge extends the useful life current systems by upgrading them to the latest interoperability standards.

Dmitriy Tochilnik, Dicom Systems’ president and CTO, said, “As healthcare organizations strive for greater interoperability, the introduction of HL7’s next generation standard, Fast Healthcare Interoperability Resources (FHIR) has garnered a lot of attention in the industry. FHIR facilitates interoperability by providing an implementation framework, combining Web technologies with existing HL7 capabilities. We created FireBridge to aid in the implementation of FHIR, which makes any interface FHIR ready. Those entities that embrace FHIR will ultimately be able to communicate up-tothe minute data across disparate systems, increasing health care quality, increasing patient access and use of health information and improving outcomes.” Medical Imaging International March-April/2016

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Medical Imaging International

Cancer Imaging Evolves from Grayscale to Full Color he first commercially available preclinical Spectral CT system, a new technology that creates color CT images, is being used as part of a collaboration project between a university in the US and an imaging vendor. Spectral CT uses up to eight X-ray energy channels at the same time, with different colors assigned to specific molecular signatures. This enables clinicians to more readily identify tumors and other abnormalities. The MBI pre-clinical spectral CT system was installed in the Notre Dame Integrated Imaging Facility (NDIIF; Notre Dame, IN, USA; http://ndiif.nd.edu) at the University of Notre Dame, and was developed in collaboration with MARS Bioimaging (Christchurch, New Zealand; www.marsbioimaging.com/mars). The scanner uses the Medipix3 detector chip developed at CERN (European Organization for Nuclear Research), in conjunction with nanoparticle contrast agents developed by the research team. The system can detect specific molecular sig-

natures of diseases such as cancer, with different colors for each contrast agent and tissue type. The researchers plan to use the technology to develop better methods to detect cancer in women with dense breast tissue but also for ovarian, colorectal, lung cancers, and metastatic disease. David P. Hofstra, administrative director, Diagnostic Imaging and Therapy, Saint Joseph Health System (Mishawaka, IN, USA), said, “Spectral computed tomography (CT) scanning is really the next great enhancement of clinical CT quality. It takes us beyond comparing the number of ‘slices’ to a discussion about fundamentally better and more clinically valuable imaging. Already, spectral CT scanning is playing important roles in clinical practice by reducing metal artifacts and also by reducing the amount of radiation that is administered to patients. In the very near future, spectral CT promises to allow clinicians better means to characterize the material makeup of visualized items (like kidney stones, plaques, uric acid crystals, etc.). Also

in the near future, iodinated contrast that is administered may be able to be reduced. Someday, spectral CT technology may allow altogether different types of contrast materials other than iodine, which we use currently. Different or targeted contrast agents

may show important clinical findings that we can only begin to imagine currently.” Image: The MBI pre-clinical spectral CT system (Photo courtesy of MARS Bioimaging).

MRI-Based Technology Identifies Stroke Recurrence Risk uantitative magnetic resonance angiography (QMRA) can be used to identify vertebrobasilar (VB) stroke patients who are at greater risk of having another stroke, according to a new study. Researchers at the University of Illinois in Chicago (UIC, USA; www.uic.edu), the University of Toronto (Canada; www.utoronto.ca), and other institutions conducted a prospective, blinded, longitudinal cohort study involving 72 patients with recent VB transient ischemic attack (TIA) or stroke, and 50% or more atherosclerotic stenosis or occlusion in VB arteries. The patients underwent large-vessel flow measurement using QMRA, and were also followed for two years at five academic medical centers as they continued receiving standard care from their neurologists, who were blinded to QMRA flow status. The results showed that distal flow status was low in 25% of the patients and was significantly associated with risk for a subsequent VB stroke; 12- and 24-month event-free survival rates of 78% and 70%, respectively, were found in the low-flow group, compared to 96% and 87%, respec-

Medical Imaging International March-April/2016

tively, in the normal-flow group. Distal flow status remained significantly associated with risk even when controlling for the degree of stenosis and location. Medical risk factor management at 6-month intervals, however, was similar between patients with low and normal distal flow. The study was published in on December 21, 2015, in JAMA Neurology. “At one year, the risk for patients with low blood flow was about five times as high as risk for patients without low flow in the back of the brain. For these patients, the benefits of angioplasty probably outweigh the risks,” said senior author professor of neurological surgery Sepideh AminHanjani, MD. “About three-quarters of patients didn’t have low blood flow in the vertebrobasilar region. These patients would not benefit from treatments aimed at opening the vessels, such as angioplasty; in fact, the procedure would put these patients at unnecessary risk.” The QMRA data was analyzed using noninvasive optimal vessel analysis (NOVA), a software program that can quantify the volume, velocity, and direction of blood flowing through any major vessel in the brain

using standard MRI equipment. NOVA is a product of Vassol (River Forest, IL, USA; www.vassolinc.com), and was developed at UIC by head of neurological surgery Professor Fady

Charbel, MD, who is also a coauthor of the new study. Image: An MRI scan using NOVA technology (Photo courtesy of UIC).

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The Claris CBCT features spatial resolution of .075mm, improved signal to noise ratio, short scan times and greater accuracy through a powerful xray source. It also offers tremendous flexibility with seven selectable FOVs, each with four resolution protocols.

The Micra TPS is about the size of a large vitamin and attaches to the heart with small tines that deliver electrical impulses and pace the heart through an electrode at the end of the device. It’s the only transcatheter pacing system approved for both 1.5 and 3 T full-body MR exams.

The ScanWise Implant is for selecting the best scanning sequence for patients with MRI-conditional implants. Users enter the type of implant a patient has along with other data, and the most appropriate scan sequence is selected. ScanWise is initially available on Philips 1.5T scanners.

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New Software Simplifies Cardiac MRI Workflow n advanced application that captures seven dimensions of data (three in space, one in time, and three in vectorial) could greatly simplify cardiac magnetic resonance imaging (MRI). The GE Healthcare ViosWorks software was designed to simultaneously provide key elements of a cardiac MRI exam, including anatomy, function and flow, thus helping to solve several cardiac MRI challenges at once. The delivery of three-dimensional (3D) spatial- and velocity-encoded dataset at every time point during the cardiac cycle allows the software to yield high resolution, time-resolved images of the beating heart, thus supplying a measure of the speed and direction of blood flow at each location. The exam is simplified for the patient by using a free-breathing scan that can be acquired in less than 10 minutes, compared to a conventional cardiac MRI that takes over an hour to complete, helping to reduce the error-prone and time-consuming aspect of slice positioning. This is achieved due to the fact that co-registered anatomic images can be used to assess cardiac functioning and contextualize flow abnormalities. ViosWorks is a product of GE Healthcare (GE; Little Chalfont, United Kingdom; www. gehealthcare.com), and is designed for use on the Signa Pioneer 3.0T, Signa Explorer, and Signa Creator 1.5T MRI scanners. A key element of ViosWorks is the Arterys (San

Francisco, CA, USA; www.arterys.com) cloud-based medical imaging, machinelearning platform that is designed to deliver ultra-fast visualization and quantification with automatic analysis. Arterys uses software as a service (SaaS) analytics powered by powerful algorithms that allow the large datasets to be evaluated in real time, via cloud-based software that significantly reduces the time spent on data processing, and helps promote new visualization routines. “We are excited to collaborate with Arterys and introduce this innovative cardiac MR solution that can capture seven-dimensional viewing capabilities of the heart,” said Ioannis Panagiotelis, chief marketing officer of Global MR at GE Healthcare. “With cardiovascular disease as the leading cause of death in the world, we believe that this cloud-enabled technology will help us to provide value not only for clinicians by delivering advanced visualization and quantification of cardiovascular function, but also help simplify cardiovascular examinations and address significant patient needs in cardiovascular disease.” “We are extremely pleased to announce our partnership with GE Healthcare in conjunction with the launch of our first cardiac care solution, the first selflearning system of its kind to visualize and quantify

blood flow leveraging a standard MRI machine,” said Fabien Beckers, PhD, founder and CEO of Arterys. “This pivotal milestone for the company is directly in line with our vision to transform medical imaging by bringing automatic quantitative data and deep learning to healthcare applications through a GPU smart cloud platform that can be applied to many areas of medical imaging including neurology and oncology.” GE Healthcare hopes that the new, simplified process will help it gain ground in the US market, where it currently only makes up about one percent of MRI exams, due to the time and complexity needed. Image: The ViosWorks color representation of direction and velocity of cardiac blood flow (Photo courtesy of GE Healthcare).

HIFU Ultrasound Approved by US FDA for Prostate Cancer Treatment he US Food and Drug Administration (FDA) have fully approved High Intensity Focused Ultrasound Therapy (HIFU) therapy after more than 10 years of clinical trials for the treatment of localized prostate cancer. The procedure is also approved by Health Canada, and consists of one treatment for men with stage T-1 or T-2 organ-confined prostate cancer. The HIFU therapy is used on patients who failed treatment with radiation therapy, and can be repeated if neces-

sary. Prostate cancer is the main cancer affecting men in North America, according to the American Cancer Society, affecting 200,000 men in 2015, with more than 25,000 fatalities. HIFU treatments are already approved in Europe and more than 40,000 patients have been treated around the world. Maple Leaf HIFU (Ancaster, ON, Canada; www. hifu.ca) has the most experience in treating prostate cancer patients with Ablatherm HIFU integrated imaging device in North America. The device has a com-

puter-controlled rectal probe that is used to target the tumor and destroy the prostate tissue using ultrasound waves, without damaging surrounding organs. The treatment option has minimal side effects. Dr. William Orovan, lead urological surgeon, said, “Ablatherm HIFU has the best patient safety outcomes by far and cure rates are excellent. Side effects of HIFU, including incontinence and erectile dysfunction, are much less than traditional surgery or radiation.” Medical Imaging International March-April/2016

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Medical Imaging International

fMRI Can Identify New Painkillers easuring the brain’s neural response to pain using functional magnetic resonance imaging (fMRI) may be a viable tool for evaluating the effectiveness of new pain medications, according to a new study. Researchers at John Radcliffe Hospital (Oxford, United Kingdom; www. ouh.nhs.uk/hospitals/jr) and Oxford University (United Kingdom; www.oxford.ac.uk) conducted a double blind, randomized study in 24 healthy volunteers on three separate occasions to assess the use of fMRI in obtaining objective outcome measures of drug differentiation. To induce pain, the researchers used capsaicin cream, a topical irritant often used to produce similar characteristics of neuropathic pain on subjects’ skin. Prior to capsaicin cream application, the subjects either received a single dose of gabapentin, which is considered effective and a first line treatment for neuropathic pain; ibuprofen, which is generally not considered an effective treatment for the condition; or a placebo. The researchers then assessed the effect the drugs or placebo had on the brain’s neural response to pain using fMRI, in addition to patient-reported pain relief. The results showed that neural activity was significantly reduced in the subjects who received gabapentin, even with extremely low subject numbers, highlighting the potential for fMRI to make a drug’s effect clear in small cohorts, such as during the early stages of human drug development. This ability could provide a much-needed objective method to collect data that could prevent premature discarding of potentially beneficial therapies. The study was published in the January 2106 issue of Anesthesiology. “Chronic pain is a very common condition. Even NE DES W the most effective pain medications currently available IGN only provide adequate pain relief, defined as a 50% reduction in pain, in one out of four patients, while some drugs, such as opioids, have significant side effects, including dependence and overuse,” said lead author Vishvarani Wanigasekera, MD, of the UniversiWORLD’S MEDICAL PRODUCT MARKETPLACE ty of Oxford. “We believe that neuroimaging techniques, such as fMRI, can provide objective evidence that can be used as outcome measures in early drug development to enhance the efficiency of the drug deSIGN UP velopment process.” FOR FREE! Patient-reported pain relief is the primary outcome measure used in current drug development studies to assess whether medication is effective or not. However, due to their subjective and context-dependent nature, self-reported pain perception and relief are subject to many influences. Due to the low subject population, researchers can also easily miss effective compounds that might work well in the population at large.

Image: MRI scans. Scientists used data from functional magnetic resonance imaging to compare the effects of compounds on brain responses (Photo courtesy of Shutterstock).

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The TULSA-PRO combines real-time MRI with transurethral robot-driven ultrasound and closedloop thermal feedback control for a treatment tailored to patient anatomy and pathology. It has demonstrated accurate and precise ablation of prostate tissue, both malignant and benign.

The Delta4 Discover in-vivo dose monitoring system is designed to verify patient radiation doses simultaneously during treatment. The new system is expected to greatly increase the quality and overall safety of radiation treatment methods for cancer patients.

The S50 is configured with powerful single crystal technology, remarkable 4-D functions and an intelligent workflow. With a top of the line platform and advanced technology, the S50 meets any medical imaging need in any clinical situation.

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Pilot Study Results of Novel Breast Imaging System Released novel optoacoustic breast imaging system has the potential to prevent unnecessary biopsies, and follow-up examinations, and to improve down-classification of suspicious breast masses. The company that developed the pioneering imaging device announced the results of the pilot study at the annual Radiological Society of North America (RSNA 2015) meeting in Chicago USA. The pilot study compared the device to traditional ultrasound, and showed that the device had the potential to improve the ability of clinicians to classify benign breast masses accurately. Seno Medical Instruments (San Antonio, TX, USA; www.senomedical.com) developed the Imagio breast imaging device, and is a pioneer in Optoacoustic (OA) tool for diagnosing breast cancer. The device can identify the presence of abnormal blood vessels and the relative reduced levels of oxygen in the blood of cancerous tissue compared to benign masses, or healthy normal tissue. OA imaging is noninvasive, does not use contrast agents, ionizing radiation, or radio-isotopes, as do other modalities such as Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET). The pilot study that included 100 subjects was

part of the US-based multicenter PIONEER pivotal study with more than 2,000 subjects. In the pilot study seven independent breast radiologist readers and an expert radiologist trainer were asked to blindly assess 102 masses using only OA images made by the Imagio device. Immediately before the OA exam the researchers also made conventional grey-scale ultrasound exams, as internal ultrasound controls, and the independent readers also assigned a Breast Imaging-Reporting and Data System (BIRADS) score to these images. In addition, a total of 39 benign and 36 malignant masses were biopsied. The results of the pilot study showed that the device can be used to help clinicians identify women who do not have breast cancer, and spare them the agony of undergoing invasive biopsy procedures and/or follow-up exams over a two year period. Erin Neuschler, MD, Northwestern Medicine radiologist, co-principal investigator of the PIONEER study, said, â&#x20AC;&#x153;Downgrading benign masses classified as BR 4b (moderate suspicion), 4a (low suspicion) and 3 without missing cancers is an unmet need that the Imagio OA breast imaging system can potentially help address. If these pilot findings are verified after the completion of the multicenter PIONEER Study, we will have confirmation that the

Imagio OA breast imaging system could help women not only avoid biopsy procedures but also multiple short interval follow-up ultrasound exams over two years.â&#x20AC;? Image: The Imagio breast imaging device (Photo courtesy of Seno Medical Instruments).

Anti-Scarring Topical Paste Reduces Radiation Fibrosis new study suggests that topical application of an A2A receptor (A2AR) antagonist prevents radiation dermatitis, and may be useful in the reduction of fibrotic changes in the skin. Radiation dermatitis is a cutaneous lesion induced by ionizing radiation, which ranges from a mild rash to severe ulceration, with approximately 85% of all patients treated with radiation therapy (RT) experiencing a moderate-to-severe skin reaction. Once considered to be a major risk of conventional RT, it has become less common and less severe since the 1970s, with the development of

high- and medium-energy accelerators. Researchers at NYU Langone Medical Center (New York, NY, USA; www.med.nyu.edu) conducted a study in mice to test if blocking the A2AR site could prevent radiation-induced fibrosis, a side effect experienced by as many as 95% of patients undergoing initial radiation treatment. To do so, they exposed mice to a single dose of 40 Gy, an amount of radiation similar to a five-week radiation therapy treatment protocol. Some of the irradiated animals were normal; some were genetically engineered to lack A2AR, while others were treated with the

A2AR antagonist ZM241385. The results showed that in irradiated normal mice treated with the A2AR antagonist there was a marked reduction in collagen content, myofibroblast cells, angiogenesis, and density of collagen fibrils. Epidermal thickness due to an increasing the number of proliferating keratinocytes was also prevented by ZM241385. Similar changes were seen in the A2AR genetically modified mice. The study was published in the January 2016 edition of the Journal of the Federation of American Societies for Experimental Biology (FASEB). Medical Imaging International March-April/2016

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Medical Imaging International

Study Reveals Value of CT Colonography In Determining Growth of Polyps olumetric measurements of the evolution of medium-sized polyps may better inform clinicians in the management of the polyps than linear measurements. The volumetric measurements were helpful in determining whether a patient needed a colonoscopy, or whether surveillance using Computed Tomography Colonography (CTC) was sufficient. The research was carried out at the University of Amsterdam (Amsterdam, The Netherlands; www. uva.nl/en/home) and presented at the annual Radiological Society of North America (RSNA 2015) meeting in Chicago (IL, USA). The study had 70 participants, each with one or two 6–9 mm polyps, identified during primary CTC screening CTC. The patients underwent an additional CTC screening three years later. Patients with 6 mm or larger lesions had the opportunity to undergo colonoscopy and polypectomy. During the CTC screening exams semi-automated volumetric measurements were performed, and mean volume calculated for prone and supine volume measure-

ments. Polyps whose volume increased more than 30% were classified as progressing, while those that decreased more than 30% were classed as regressing. Polyps between those parameters were classed as stable. The researchers then correlated Polyp growth to histopathological findings. Thirty-five percent out of a total of 95 polyps found in the initial CTC were found to have progressed. A total of 38% of the polyps remained stable, 27% regressed, and 14% were completely resolved. During the surveillance interval none of the polyps were found to have progressed to colorectal cancers or adenomas with high-grade dysplasia. The presenter of the study, Charlotte Tutein Nolthenius, MD, Department of Radiology, Academic Medical Center, University of Amsterdam,

said, “Previous literature showed a 3–6.6% chance of harboring advanced histology for medium-sized (6–9 mm) polyps, but little is known about their natural course. CTC is probably the best method for determining longitudinal growth of these polyps, because we leave them in place allowing a reproducible localization and measurement. Image: Computed Tomography Colonography (CTC) of a progressing advanced adenoma polyp in the ascending colon on 3D images (Photo courtesy of University of Amsterdam / RSNA).

MRI Dye Technique Could Detect HIV Dementia

Gamma Knife and RapidArc Radiosurgery Equally Effective

new magnetic resonant imaging (MRI) contrast dye could be used to target specific white blood cells (WBCs) believed to play a key role in the development of HIV-associated neurocognitive disorders (HAND). Researchers at the University of Hawaii (Honolulu, USA; www.hawaii.edu) are conducting studies to examine the use of ferumoxytol – an ultra-small iron oxide MRI contrast agent – to identify and quantitate monocyte/macrophage (M/MΦ)-mediated inflammation in the brain of HIV-infected people. M/MΦs are believed to play a critical role in the pathogenesis of HAND, but neuroimaging HIV research has not as yet focused on assessing M/MΦ-mediated inflammation in the brain, since no modality exists that can define inflammation extent as a diagnostic tool, or assist in defining objective improvement in clinical trials addressing HAND. The researchers hypothesized that imaging based on ferumoxytol, which is avidly taken up by circulating M/MΦs, could identify ongoing inflammation resulting from the perivascular M/MΦ, a key pathologic correlate of HAND. The neurocognitive disorders in HIV continue to be prevalent, despite effective combination antiretroviral therapy (cART), and are responsible for a significant impact on morbidity and quality of life. The researchers believe that once M/MΦs have switched on to battle HIV, an unintended consequence is the production of toxic chemicals in the brain that cause uncontrolled inflammation and ultimately cognitive impairment.

new study comparing Gamma Knife and RapidArc radiosurgery found that while each system offers a different strength, they are equally effective at eradicating cancer in the brain. Researchers at Thomas Jefferson University (TJU; Philadelphia, PA, USA; www.jefferson.edu) conducted a study involving six patients with three or four small brain metastases that varied from 0.1–10.5 cm3 in size. Stereotactic radiosurgery (SRS) modalities for multiple brain metastases were made using both the Gamma Knife (GK) Perfexion system and a single-isocenter, multiple noncoplanar RapidArc device, as determined according to the size of the target. The results showed that the Gamma Knife system was slightly more effective than RapidArc at focusing the beam of radiation at a very low-dose (<3 Gy), thus limiting spread to normal tissue. On the other hand, the RapidArc system offered much quicker treatment; compared to GK treatment, which typically takes 60–100 minutes, RapidArc was about 3-5 times faster. The study was published on January 25, 2016, in Frontiers in Oncology. “Understanding the benefits of advanced radiosurgery technology is essential because there has been, and will continue to be, an increase in cases of brain metastases,” said study coauthor Adam Dicker, MD, PhD, of the TJU Sidney Kimmel Medical College. “Chemotherapies and targeted agents can’t reach the brain and the central nervous system because of the blood-brain barrier. The results are that a number of different cancers are now showing up in the brain.”

DARPA Grant for Advanced Focused Ultrasound Research he US Defense Advanced Research Projects Agency (DARPA) has set up a new program to advance research into focused ultrasound and improve physical and mental health using targeted stimulation of peripheral nerves. DARPA selected seven teams to work on the Electrical Prescriptions (ElectRx) program funded by a USD 3.3 million grant. The research team includes Columbia University’s School of Engineering and Applied Science (New York, NY, USA; www. engineering.columbia.edu) and plans to develop new techniques to use focused ultrasound for stimulating peripheral nerves. This could eventually be used to control organ function.

Medical Imaging International March-April/2016

The human peripheral nervous system modulates the function of the heart, stomach, intestines, bladder, and other organs. The researchers intend to map the neural circuits governing these systems, and develop minimally invasive neural and bio-interface technologies. The team intends to optimize the ultrasound parameters, and develop devices that can be worn. These devices would be used to stimulate the saphenous nerve in the thigh, and the team plans to evaluate how ultrasound can induce such effects. Elisa Konofagou, professor of biomedical engineering, at Columbia University’s School of Engineering and Applied Science, said, “What we’re working on is a very exciting application for ultra-

sound. We could, for the first time, provide a noninvasive approach to nerve and organ stimulation while at the same time advance our understanding of the coupling between the mechanical and electrical activity at the cellular, multicellular, and organ levels. We think targeted ultrasound could be a good option for managing conditions such as chronic pain and neuropathy. We know that, as ultrasound propagates through biological tissue. It exerts mechanical pressure on that tissue, which stimulates specific mechano-sensitive channels in neurons and causes them to ‘turn on.’ So we think that this is a way we can use ultrasound to turn specific nerves ‘on’ or ‘off’ depending on what the treatment calls for.”

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ULTRASOUND

PULMONARY IMAGING SEQUENCE

Agfa HealthCare

Mindray

Toshiba Medical Systems

The DR 600 is designed to provide high-quality images, while maximizing productivity and versatility. Key features of the fully automated system include a pre-programmed MUSICA workstation exam tree, automated MUSICA image processing, and seamless integration with RIS and PACS.

The Resona 7 enhances ultrasound image quality by zone acquisition and channel data processing. The gesture-based, multi-touch system improves clinical research with V Flow for vascular hemodynamic evaluation, and an intelligent plane acquisition from 3D dataset for fetal CNS diagnosis.

The Ultrashort Echo Time (UTE) allows clinicians to capture images in tissues that generally disappear too quickly for accurate MR imaging. The UTE is available on the Vantage Titan 3T MR system, and enables reliable imaging of anatomy such as the lungs.

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Novel Biopsy Robot Could Improve Disease Diagnosis n innovative biopsy robot under development combines features of both magnetic resonance imaging (MRI) and ultrasound (US), aiming to improve the identification of breast cancer and muscle diseases. Researchers at the University of Twente (Enschede, The Netherlands; www.utwente.nl), Siemens (Munich, Germany; www.siemens.com), KUKA (Augsburg, Germany; www.kuka.com), and other companies and institutions participating in the MRI and Ultrasound Robotic Assisted Biopsy (MURAB) project joined to build a robot that combines the best aspects of an MRI scan with cheaper technologies, such as an US sensor and a pressure sensor, with the potential to drastically improve the clinical workflow by precise targeting of small lesions visible under MRI, but not under US. The system will be based on a robotically steered US transducer with acoustically transparent force sensing, which will be autonomously moved to optimally acquire volumetric and elastographic data. Thanks to an innovative technique, the system will first optimally register the acquired volume to the MRI scan. Once completed, the radiologist can then select the target lesion on the MRI; the robot will then steer the instrument to the exact desired location by adapting the insertion angle on the basis of real time US measurements; tissue deformations will be predicted based on the acquired elastographic measurements. “Patients need to spend just 15 to 20 minutes in the MRI scanner; this produces an offline MRI image that you can combine, during the biopsy, with online images from the ultrasound sensor,” said UT researcher and PhD candidate

Foad Sojoodi Farimani, MSc. “One of the biggest challenges in this project is to use the precise MRI image to locate suspicious tissue in the much more indistinct ultrasound image.” The technologies developed within MURAB will also have the potential to improve other clinical procedures, such as breast cancer diagnostics and muscle disease diagnostics. Image: An artist’s representation of the MURAB biopsy robot (Photo courtesy of the University of Twente).

Functional Imaging Technique Measures Brain Resting State new study suggests that functional magnetic resonance imaging (fMRI) could be a cost-effective alternative for estimating relative levels of activity in a cerebral metabolic map. Researchers at Western University (WU; London, Canada; www.uwo.ca) and the University Hospital of Liège (Belgium; www.chuliege.be) conducted a study to gauge the possibility of using fMRI instead of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for generating the metabolic maps that are used to asses changes in brain activity in clinical applications, such as during the study of severe brain injury and disorders of consciousness. To do so, the researchers first extracted resting state fMRI functional connectivity maps using independent component analysis, and combined only

components of neuronal origin. They then compared the generated maps with the FDG-PET maps in 16 healthy controls, 11 vegetative state/unresponsive wakefulness syndrome patients, and in four locked-in patients. The results showed a significant similarity for healthy controls and for vegetative state/unresponsive wakefulness syndrome patients between the FDG-PET and the fMRI based maps, with conjunction analysis showing decreased frontoparietal and medial regions in vegetative patients with respect to controls. Subsequent analysis in locked-in syndrome patients, which are known to be conscious, also produced consistent neuronal maps with healthy controls. The study was published on December 29, 2015, in Brain and Behavior. “Many hospitals in developing countries have

access to functional MRI technology or FDG-PET, but not both. By developing new fMRI techniques, hospitals that already have the expensive scanning equipment or wish to purchase a unit effectively get ‘more bang for their buck’,” said lead author Andrea Soddu, PhD, of the WU department of physics and astronomy. “If no metabolic absolute measures can be extracted, our approach may still be of clinical use in centers without access to FDG-PET.” PET scans are widely used to diagnose and track a variety of diseases, including cancer, because they show how organs and tissues function in the body, in contrast to MRI or CT scans, which mostly show anatomy. Using radioactive tracers that produce a signal from within the body, PET scanners produce a 3D image that is constructed by computers using sophisticated mathematical techniques. Medical Imaging International March-April/2016

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Medical Imaging International

Elastographic Ultrasound System Reduces Unnecessary Liver Biopsies premium-grade ultrasound system offers unique solutions, such as acoustic radiation force impulse (ARFI) elastography imaging, multi-modality review, and contrast-enhanced ultrasound. The Acuson S3000 Ultrasound System, HELX Evolution with Touch Control is powered by an intuitive, user-centric interface on a 12.1-inch high-resolution display with instant response technology that allows for precise key selections, promoting streamlined exam workflow efficiencies. This new usability concept also helps to eliminate unnecessary keystrokes and repetitive hand movements. The interface features context-sensitive body markers, intuitive pictograms, transducer markers, and supportive, color-coded guidance annotations that suggest logical replacement text specific to the exam being performed. A unique signal-processing algorithm optimizes integration between the transducer and the display by

doubling the standard pixel density, resulting in high definition (HD) images that provide diagnostic confidence. Multimodality imaging, which combines the 3D topography of computerized tomography (CT) and magnetic resonance (MR) with real-time ultrasound, provides a range of clinical and spatial information for interventional procedures and complex ultrasound analysis. Smart initialization and auto-alignment help reduce examination time and effort. With the aid of ARFI imaging, proprietary Virtual Touch (VT) technologies provide a new dimension of ultrasound information to evaluate tissue stiffness with shear wave elastography (SWE). Another advanced feature is in-depth anatomy imaging using contrast enhanced ultrasound (CEUS), which allows for the visualization of lesions in organs based upon vascularity and contrast harmonic imaging (CHI) for detail, and contrast pulse sequencing (CPS) for penetrating clarity.

The Acuson S3000 Ultrasound System, HELX Evolution with Touch Control is a product of Siemens Healthcare (Erlangen, Germany; www.siemens.com/healthcare). SWE relies on the lateral displacement of tissues induced by the force of a focused ultrasound beam or by external pressure that creates shear waves that are perpendicular to the direction of the generating force, travel slowly, and are rapidly attenuated

by tissue; the propagation velocity of the shear waves correlates with the elasticity of tissue. The combination CEUS and SWE enhance the comparison of blood flow in the microcirculation with the mechanical and structural properties of tissue, giving even more diagnostic information. Image: The Acuson S3000 ultrasound system (Photo courtesy of Siemens Healthcare).

Radiation Detector Plate Improves Cancer Radiotherapy prototype detector plate placed in the radiation path (before the X-ray beam hits the patient) records a real-time map of the intensity of the radiotherapy (RT) beams. Developed by researchers at the University of Wollongong (UOW; Australia; www.uow.edu.au), the MagicPlate-512 (MP512) detector consists of a silicon monolithic diode array sandwiched between plastic sheets less than 1-mm thick, which measures the radiation dose during treatment with millisecond-by-millisecond precision. A proprietary algorithm determines the actual dose reaching the patient, based on the measured intensity of the X-ray distribution in the beam. This can then be compared to the planned dose; if a mismatch exists, the RT could be automatically and immediately stopped. The MP512 detector is wire bonded on a printed circuit board 0.5 mm thick and covered by a thin layer of resin to preserve it from moisture and chemical contamination, and to protect the bonding wires. The array contains 512 0.5×0.5 mm2 pixels with a pitch of 2 mm. It has been tested and validated in a simulated

Medical Imaging International March-April/2016

environment using different X-ray beam energies that are commonly used to treat cancer patients. The researchers found the plate did not interfere with the quality of RT and accurately recorded in real-time the transmission of the radiation beam. “Current procedures typically involve a test on a plastic dummy before the patient is treated, to verify the equipment is delivering the dose according to the oncologist’s treatment plan calculations,” said Ziyad Alrowaili, MSc, who developed the plate as part of his PhD thesis. “A single patient treatment plan may contain thousands of parameters defining the variables involved, and this complexity makes it imperative that processes are in place to check and verify the X-ray equipment delivers the dose accurately,” added Martin Carolan, MD, director of radiation oncology medical physics at Illawarra Shoalhaven Local Health District (ISLHD; Australia; www.islhd.health.nsw. gov.au). “There are many layers of safeguards already in place to reduce the risk to the patient, but the concept of measuring the radiation dose distribution every day as it is delivered to the patient is elegant and appealing.” LINKXPRESS COM

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PET/CT SYSTEM

RESPIRATORY IMAGING SYSTEM

FujiFilm SonoSite

Neusoft Medical Systems

PneumaCare

The SonoSite Edge II is designed with emergency medicine and critical care applications in mind, and features a design intended to enhance infection control management and efficient use of common controls. It offers a wide-angle display with a 33 percent increase in viewing angles.

The NeuSight PET/CT combines anatomic and functional imaging with qualified design and technology for tumor, brain and heart scanning. Key features include a large port and dual pillar bed to improve patient comfort, along with improved scan speed and accuracy for analysis.

The Thora-3DI is designed to show respiratory function in real time and divide that performance data into various regional assessments for comparison. The NIV system does not require any direct interaction with the patient, allowing them to be sitting, lying, conscious or unconscious.

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New Angiography System Requires Less Contrast Media new angiography system that supports minimally invasive treatments, improved 3D and enhanced therapeutic support applications, and trace-mapping functionality has been released. The system supports Percutaneous Coronary Intervention (PCI) applications. The Trinias MiX (Minimally invasive eXperience) package, an extension of the Trinias angiography system, was developed by Shimadzu (Kyoto, Japan; www.shimadzu.com) and uses proprietary image processing technology. The enhancements result in shorter treatment times, and a reduction in the amount of contrast media required for the procedure. The Trinias MiX uses the SCORE PRO Advance image-processing engine, which reduces the X-Ray dose by approximately 50%. The trace-mapping feature extracts and displays the vessel-wall outline automatically, and provides mapping that facilitates device guidance. Other new features include a 3D application which links the angiography system to existing Computed Tomography (CT) images, and PCI support that enables the real-time display of stents in a fixed position. The imported pre-procedure CT images are

displayed on the system’s workstation, and are overlaid with fluoroscopy images. The new system can also configure the Region Of Interest (ROI) from the preceding fluoroscopy image.

Image: The Trinias F12 MiX floor-mounted C-Arm features shorter treatment times and a reduction in the amount of contrast media required (Photo courtesy of Shimadzu Medical).

Low-Dose Radiography Effective for Limb Measurement ow-dose biplanar radiography may perform as well as conventional computed tomography (CT) scans in assessing limb length, according to a new study. Researchers at the Hospital for Special Surgery (HSS; New York, NY, USA; www.hss.edu) conducted a study to determine the accuracy and reliability of the EOS Imaging System as compared with a CT scanogram for the measurement of leg length. To do so, 0.8 mm diameter Tantalum beads were inserted into the cortex on both the medial and lateral sides of 10 skeletally immature lamb femurs. CT scanogram and EOS imaging were then obtained, and measurements of total length and distance between bead pairs were recorded on both anteroposterior and lateral views. The results revealed that the biplanar EOS meas-

urements, as evaluated by two orthopedic surgeons, showed near-perfect correlation to those of CT scanogram, and intrarater and interrater reliability were excellent for all measurements with both EOS and CT scanogram. According to the researchers, the combination of EOS imaging and tantalum bead implantation may be an effective way to evaluate physeal growth following procedures such as epiphysiodesis and physeal bar resection. The study was published in the January 2016 issue of the Journal of Pediatric Orthopaedics. “CT or conventional scanograms are the current gold standard for measuring limb-length discrepancy. However, the use of low-dose EOS is being used more frequently in pediatric orthopedics,” said senior author Emily Dodwell, MD, MPH. “The greatest benefit of using these tantalum

markers with EOS may be in monitoring growth following injury or surgery to the growth plate. Further investigations are necessary to determine whether this measurement technique will be of significant clinical utility.” The EOS Imaging System, a product of EOS Imaging (Paris, France; www.eos-imaging.com) is a low-dose, system that provides three-dimensional (3D) images of patients in natural standing positions using perpendicular X-ray beams collimated in two very thin, horizontal, fan-shaped beams. Two variable gain detectors provide an extremely high contrast digital radiograph using a significantly lower radiation dose than a general radiography X-ray, thus enabling clinicians to make a more informed diagnosis and create individualized treatment plans for children with musculoskeletal disorders. Medical Imaging International March-April/2016

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Medical Imaging International

No Proof That X-ray Radiation Causes Cancer he widespread belief that radiation from X-rays can cause cancer is based on an invalid paradigm for estimating lowdose radiation exposure risk, according to a new study. According to researchers at Loyola University Medical Center (Maywood, IL, USA; www.loyolamedicine. org), the linear no-threshold (LNT) model, which is constantly used today to provide risk estimates for cancer resulting from any exposure to low-dose ionizing radiation, is unsound. They claim the paradigm, which is used for X-Rays and computerized tomography (CT) imaging, among others, is only theoretical, and has never been conclusively demonstrated by any empirical evidence. The also reappraised the original studies, which date back more than 70 years, which concluded that the well-established cancer-causing effects of high doses of radiation are extended downward in a straight line down to zero dose level. They concluded that these risk estimates, defined by of the LNT model, are erro-

neous, as the original studies in fruit flies, which concluded there is no safe level of radiation, had not been done at truly low doses. In fact, a study that actually exposed fruit flies to low-dose radiation wasn’t conducted until 2009, and that study did not support the LNT model. Studies of atomic bomb survivors and epidemiological studies of human populations have also never conclusively demonstrated that lowdose radiation exposure can cause cancer. The new study refuting the LNT model and calling for its decisive abandonment was published in February 2016 issue of the American Journal of Clinical Oncology. “The LNT model dissuades many physicians from using appropriate imaging techniques and discourages many in the public from getting proper and needed imaging, all in the name of avoiding any radiation exposure,” concluded corresponding author Prof. James Welsh, MD, and colleagues. “Any claim that low-dose radiation from medical imaging procedures is known to cause cancer

should be vigorously challenged, because it serves to alarm and perhaps harm, rather than educate.” Low-dose radiation exposure due to natural background radiation bathes every single person on Earth, at levels that vary annually from a few mGy to 260 mGy, depending upon where one lives on the planet. Irrespective of the level of background exposure to a given population, no associated health effects have been documented to date anywhere in the world. In fact, people are living

longer today than ever before, likely due to improving levels of medical care, which include radiation exposure from diagnostic medical radiation, which are well within the background dose range across the globe. Image: According to a recent article, studies purporting to show that radiation from X-rays, CT scans and other medical imaging causes cancer have serious flaws, including their reliance on an unproven statistical model (Photo courtesy of Loyola University Medical Center).

Digital PET/CT Technology to Provide Improved Image Quality new generation of PET/CT scanners could lead to improved patient care according to a study. The new systems Positron Emission Tomography/Computed Tomography (PET/CT) technology uses solid-state components, and all-digital data, and provides a dramatic reduction in the tracer dose for clinical PET imaging. Other advantages of the new technology include improved accuracy and visual/quantitative quality, and improved reproducibility of measurements for PET imaging in clinical oncology. In the Phase 1 study, blinded readers compared images made using current generation photomultiplier tubes with images scanned using Royal Philips Healthcare (Amsterdam, The Netherlands; www.philips.com) Vereos 64 TF scanners in which the tubes were replaced by a solid-state digital photon counting chip. The new end-to-end digital solidstate scanners dramatically improve image reconstruction capabilities compared to existing scanners, and temporal resolution is improved from

Medical Imaging International March-April/2016

500 picoseconds to 325 picoseconds. Very high-resolution reconstruction is possible with new scanners, without compromising image quality, and a slice thickness as thin as 1–2 mm. Dr. Knopp, director, Wright Center for Innovation and Biomedical Imaging, Ohio State University commented, “The system and the technology have performed remarkably well. It allows us to visualize with a higher definition and higher reconstruction maintenance, which can translate into better lesion detectability and quantitative accuracy. Also, confidence of lesion detectability was rated significantly higher on the digital PET when evaluating lesions of less than 15 mm. This research demonstrates that the new generation of PET scanners can be used as a better clinical tool or biomarker, especially for today’s targeted therapeutics. The images look crisper and more precise and provide a truer metabolic coefficient ratio. This technology can redefine our clinical work, especially with some of the exciting new tracer doses on the horizon.” LINKXPRESS COM

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PRODUCT NEWS X-RAY SYSTEM UPGRADES

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MRI SCANNER

X-RAY ACQUISITION CART

Shimadzu Medical Systems

Siemens Healthcare

Canon

The MobileDaRt Evolution upgrades include a vibration-resistant solid-state drive, and a new energy-saving collimator with a bright irradiation field. Other upgrades include an LCD monitor with a wide viewing angle, and a 17 x 17-inch flat-panel display that boosts internal processing speed.

The MAGNETOM Amira 1.5T offers the potential to shorten many exams and enable many patients to undergo scans in routine applications. It features DotGO MRI exam software to simplify protocol management and offer the right operating sequence for each scan to suit requirements.

The RadPro Delinia 200 digital X-ray acquisition cart comes equipped with a computer, access point, touchscreen monitor, and detector holder. The user-friendly cart also offers users a choice of Canon CXDI-801C, CXDI-701C, or CXDI-401C wireless flat-panel DR detectors.

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CBCT Systems Assess Injuries Of American Football Players hysicians treating football players at the 2016 US National Football League Scouting Combine are using Cone Beam Computed Tomography (CBCT) systems to assess players’ injuries. CBCT systems can be used to capture weight-bearing images of injuries to the knees, legs, feet, arms, hands, and other extremities. The system can improve visualization of bone, and soft tissue, and uses less radiation than existing Computed Tomography (CT) systems. CBCT systems are intended for use in orthopedic practices for sports medicine, and other imaging and treatment facilities. Physicians at the 2016 NFL Combine are using the new Carestream DRX Plus 3543 detector together with existing Carestream’s Digital X-ray systems, and can capture diagnostic images within several seconds. Carestream Health (Rochester, NY, USA; www.carestream.com) provides dental and

medical imaging systems, and IT solutions. Carestream has also designed a new 3D extremity imaging system that can detect injuries of athletes. The OnSight 3D Extremity System (presently not marketed - available for investigational use only) uses CBCT technology and can capture images of extremities, including weight-bearing exams The system is currently undergoing trials and research studies by UBMD Orthopaedics & Sports Medicine (Williamsville, NY, USA; www.ubortho.com) and the US Erie County Medical Center (ECMC; Buffalo, NY, USA; www.ecmc.edu). Jianqing Bennett, president of Carestream Digital Medical Solutions, said, “We are working closely with leading orthopedic specialists, sports medicine physicians and athletic trainers to develop compact, portable imaging systems based on CBCT technology that are designed for use in treating orthopedic conditions, including traumatic injuries, joint replacements, arthritis and osteoporosis.”

Image: The DRX Plus 3543 detector can provide X-ray images within seconds (Photo courtesy of Carestream Health).

Chemoradiation May Help Increase Cancer Survival Rates he addition of chemotherapy to radiation therapy (RT) improves survival rates among a subset of septuagenarian head and neck cancer patients, according to a new study. Researchers at the University of Colorado (Anschutz; Aurora, USA; www.ucdenver.edu/anschutz) queried the US National Cancer Data Base (NCDB) for records of patients older than 70 years who were treated for non-metastatic head and neck squamous cell carcinoma (HNSCC) cancers between 1998 and 2011. The patients were then divided into two groups, based on whether or not patients received chemotherapy concurrent with RT (CRT), defined as beginning a course of chemotherapy within 14 days of RT. The results showed that 68% of the patients re-

ceived RT alone, and 32% received CRT. When compared to RT alone, CRT demonstrated a survival benefit among septuagenarians that was similar to that of younger HNSCC patients with limited comorbidity and later-stage disease. Specifically, CRT was beneficial for patients 71–79 years of age with low comorbidity scores and advanced disease stage. The study was presented at the annual Multidisciplinary Head and Neck Cancer Symposium, held during February 2016 in Scottsdale (AZ, USA). “Because the toxicity of concurrent chemoradiation is greater than radiation alone for definitive HNSCC treatment, many clinicians have reservations about offering CRT for elderly head and neck cancer patients,” said senior author and study presenter Sana Karam, MD, PhD, assistant professor of

radiation oncology at Anschutz. “However, in the era of improved radiation techniques, improved systemic therapy and better supportive care, we find that CRT does, in fact, improve survival for a large segment of this population.” HNSCC develops in the mucous membranes of the mouth, nose, and throat, and is classified by its location: the oral cavity, the oropharynx, the nasal cavity and paranasal sinuses, the nasopharynx, the larynx, and the hypopharynx. The can also be grouped into wider oropharyngeal, laryngeal, and hypopharyngeal cancers. Depending on the location, the cancer can cause ulcerations, unusual bleeding or pain, sinus congestions, pain when swallowing or difficulty swallowing, a hoarse voice, difficulty breathing, or enlarged lymph nodes. Medical Imaging International March-April/2016

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Medical Imaging International

Portable 3D Ultrasound Quantifies Bladder Volume new portable three-dimensional (3D) ultrasound instrument helps reduce catheter-associated urinary tract infections (CAUTI) by reducing the use of catheters. The Verathon BladderScan Prime is a noninvasive bladder volume measurement tool that acquires multiple scan planes inside the body, produces 3D quantification of the bladder, and then automatically calculates and displays urinary bladder volume. To boost reading accuracy among users of varying skill levels, the device provides simple and advanced aiming modes; immediate feedback for off-center scans and pubic bone interference; and onboard help and tutorial assistance accessible at any point during the exam. Features of the system include a touch-screen interface, live B-mode scanning, and onboard self-diagnostics; for example, in the event of a drop, the ultrasound probe has an internal mechanical diagnostic to confirm it is still functioning properly. Benefits of the system include reduc-

ing unnecessary catheterizations; management of Foley catheter use and incontinence issues; and reducing costs and nursing staff time. The Verathon BladderScan Prime is a product of Verathon (Bothell, WA, USA; www.verathon.com). “Prime is built to be a workhorse device in any healthcare environment. It is designed to reduce downtime, which in turn raises quality of care,” said David Garner, global director of marketing for imaging & scanning solutions at Verathon. “Prime is designed to help reduce catheter associated urinary tract infections, one of the leading causes of infection in hospitals today, and despite years of efforts, those infection rates aren’t improving. We’re hoping to change that.” Bladder volume measurement is a well-established metric used in the diagnosis and treatment of a wide range of medical conditions. It is a critical component of a comprehensive catheter-associated urinary tract infections (CAUTI) prevention program, an area of intense focus for hos-

Image: The BladderScan Prime in use (Photo courtesy of Verathon).

pitals as a result of Medicare penalties for hospitals with high rates. These include reducing payments by one

percent for hospitals with a high number of hospital-acquired conditions (HACs).

MR Tomography Can Determine Breast Density n automated user-independent breast density (BD) measurement system based on magnetic resonance tomography (MRT) could provide diagnosis and risk assessment. Researchers at the Medical University of Vienna (Austria; www. meduniwien.ac.at) investigated the use of an automated user-independent quantitative volumetric (AUQV) MRT measurement system to compare it with qualitative and quantitative mammographic BD measurements. The study involved 43 women with normal mammogram results who were subjected to BD assessment with MRT using the Dixon technique; to test reproducibility, a second MRT after patient repositioning was performed. The system automatically calculated BD percentage. Qualitative and quantitative BD was estimated semi-automatically using a thresholding technique, and statistical tests were used to assess the agreement between the two AUQV MRT measurements and compare them with qualitative and quantitative MG BD estimations. The results showed a nearly perfect agreement of

Medical Imaging International March-April/2016

AUQV MR BD measurements between the 2 MRT examinations, which were significantly lower than quantitative and qualitative MG BD assessment. “It works practically at the touch of a button and only takes a few minutes. There is also no need to provide contrast material,” said lead author and study presenter Georg Wengert, MD, of the department of radiology and nuclear medicine at the Medical University of Vienna. “For the first time worldwide, an objective measurement of breast density with fully automatic software and higher precision and reproducibility has been detected with this method, and a prototype currently exists.” Breast density is divided into four categories according to the guidelines of the American College of Radiology (ACR). Ranging from A to D, the risk of getting breast cancer is considered to be four to six times higher for a higher BD (C/heterogeneous and D/extremely dense). The density cannot be precisely measured using mammography and an ultrasound scan, and additionally a high breast density makes diagnosis more difficult. LINKXPRESS COM

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Reduced CT Dose Effective in Joint Fracture Detection new study claims that computerized tomography (CT) scans for joint fractures can be performed with one-fourteenth the amount of radiation, without compromising image quality. Researchers at NYU Langone Medical Center (New York, NY, USA; www.med.nyu.edu) and Jamaica Hospital Medical Center (JHMC; NY, USA; https://jamaicahospital.org) used the reduced computed tomography in orthopedic injury (REDUCTION) protocol to determine the lowest dose necessary for detecting traumatic joint fractures. To do so, 50 fracture patients with clinical symptoms received ultra-low dose (0.03 msV) radiation CT scans, which were compared to a sample of age-matched, similar fracture injuries where patients were evaluated with a standard CT scan dose (0.43 msV). The results showed 98% sensitivity and 89% specificity with the ultra-low dose CT scans, a detection rate, which is comparable to conventional CT-scans (98% sensitivity and 85% specificity), when occult fractures were removed from the equation. Image quality was rated moderate to near perfect by orthopedic surgeons. The study was presented at the American Academy of Orthopedic Surgeons (AAOS) specialty day, held during March 2016 in Orlando (FL, USA). “We have taken a frequently used and necessary imaging test and made it safer,” said lead author and study presenter assistant professor of orthopedic surgery Sanjit Konda, MD, of NYU Lan-

gone, and director of orthopedic trauma at JHMC. “Providing patients with a CT scan with 14-times less radiation could have significant implications from a public health and safety standpoint.” “The ability to perform ultra-low dose radiation CT scans without compromising image quality demonstrates the comprehensive capabilities of this protocol,” said senior author Professor Kenneth Egol, MD, chief of the division of orthopedic trauma surgery at NYU Langone. “Patients who undergo a traumatic injury or suspected fracture have enough to worry about. Our research makes radiation exposure among the least of their concerns.”

CT scans help diagnose medical conditions including broken bones, cancers, internal bleeding, or signs of heart disease. Yet, despite its prevalent use, medical societies and federal agencies have been increasingly trying to reduce the number of unnecessary scans due to radiation’s link to an increased risk for cancer. While the overall risk is considered low, there is particular concern in performing CT scans on children. Image: Ultra-low dose radiation CT scan of a fracture of the tibial plateau compared to a conventional dose CT scan (Photo courtesy of NYU Langone Medical Center).

Image Analytics to Offer Faster and Cheaper Guidance for Breast Cancer Treatment new technique has been developed that can analyze Magnetic Resonance Image (MRI) data of women with the most common type of breast cancer and reliably differentiate between women who require chemotherapy and those for whom hormonal treatment is sufficient. The technique is faster, and cheaper than currently used genomic testing that differentiates between aggressive and non-aggressive Estrogen Positive-Receptor (ER-positive) cancer in women. The genomic test requires tissue biopsy and analysis, and assigns a risk score to guide treatment. In the past most women underwent chemotherapy, often with harsh side effects. The research was carried out by researchers at

Case Western Reserve University (CWRU; Cleveland, OH, USA; www.case.edu) and was published in the February 18, 2016, issue of the journal Nature Scientific Reports. The researchers used data mining to search Dynamic Contrast Enhanced MRI image data from 96 ER-positive cancer patients for useful signals to discern aggressive ER-positive from non-aggressive cancer. Dynamic Contrast Enhanced MRI images tissues as they take up a contrast agent. The women also underwent the genomic test. The researchers found that in 85% of the cases, the conclusions from the data mining matched those of the genomic test. The new technique would cost significantly less than the USD 4,000 genomic test, and would requires an MRI scan, instead of a biopsy.

Research leader Anant Madabhushi, biomedical engineering professor, Case Western Reserve, said, “In the United States, nearly 70 percent of all breast cancer patients are diagnosed with ER-positive, but the majority don’t need chemotherapy. We think the dynamic texture data is robust and reliable. It allows us to compare apples to apples. With cloud computing and data warehousing, we can analyze images coming in from anywhere in the world. It breaks down geographic boundaries because everything is electronically transmitted. Even if the MRI test proves to make accurate predictions only for patients at extremely low or extremely high need for chemotherapy, the analysis would still serve 30 to 40 percent of patients.”

MRI of the Cervix More Accurate Than Ultrasound at Predicting Preterm Birth he results of a new study have shown that MRI of the cervix is more accurate at predicting preterm birth, for some women, than ultrasound. The study, published in the March, 2016, online edition of Radiology, investigated early dilation of the cervix, during pregnancy, which can lead to premature delivery. Women with a cervix measuring 15 mm or less, as measured using an ultrasound exam in the second trimester of pregnancy, are considered to have an increased risk of preterm birth. The researchers used Diffusion-Weighted Imaging Magnetic Resonance Imaging (DWI-MRI) to ex-

amine pregnant women with suspected fetal or placental abnormality. The thirty pregnant women that took part in the study all had a short cervix, and underwent a positive fetal fibronectin test between the 23rd and 28th weeks of gestation. Eight of the women delivered within one week of the MRI examination, and the other 22 delivered 55 days later on average. The researchers compared ADC values, using MRI data, between the inner, sub-glandular zone and the outer, stromal area of the cervix and found that the sub-glandular ADC was higher in patients with impending delivery. This suggested increased

mobility of water molecules in that area, consistent with cervical ripening. Lead author of the study, Gabriele Masselli, MD, Radiology Department, Sapienza University (Rome, Italy; http://en.uniroma1.it), said, “Our results indicate that a high ADC value recorded at the level of the subglandular area of the cervix is associated with the imminent delivery of asymptomatic patients with a short cervix. In detail, the subglandular ADC was inversely correlated to the time interval between MRI and delivery and therefore emerged as a powerful imaging biomarker in evaluating patients with impending delivery.” Medical Imaging International March-April/2016

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Medical Imaging International

Image Analysis Technique Provides Enhanced Treatment Assessment for Liver Cancer study presented at the annual Radiological Society of North America (RSNA 2015) meeting in Chicago USA has shown that a novel MRI analysis technique can significantly speed up the assessment of the effectiveness of liver cancer treatment compared to existing methods. Hepatocellular Carcinoma (HCC) is the second most deadly cancer worldwide and treatment consists of an image-guided procedure called Transarterial Chemoembolization (TACE). During the procedure chemotherapeutic drugs are delivered to the tumor while at the same time the blood supply to the tumor is blocked. If a patient does not respond to TACE treatment the clinician needs treat them again, or change their therapy, as rapidly as possible. Infiltrative HCC is very difficult to treat after TACE with traditional methods because of the large number of lesions and their ill-defined borders. The researchers used a new approach developed together with Philips Research North America (Cambridge, MA, USA; www.research.philips.com/ locations/briarcliff.html), called the quantitative European Association for the Study of the Liver (qEASL)

technique. The new 3D technology provides whole liver volumetric enhancement quantification on Magnetic Resonance Imaging (MRI) and enables a radiologist to segment and delineate an entire tumor in 15–20 seconds in a semi-automated process. The researchers assessed 68 liver cancer patients with infiltrative HCC, using the qEASL technique, before their first TACE procedure, and again one month after the procedure. The researchers measured treatment response, and predicted survival, and segmented the entire liver of the patients while identifying tumors. The researchers found that responders had an overall survival rate of around 21 months and a mean 57.8% decrease in enhancing volume. Non-responders had a survival rate of 6.8 months and a 19.1% increase enhancing volume on average. Coauthor of the study, Julius Chapiro, MD, Yale University School of Medicine, said, “In clinical oncology, it is very challenging to assess tumor response to treatment. Up until now, we could measure the extent of tumor diameter or uptake with manual tools like the caliper on the screen, which are highly unreliable due to reader bias. The radiol-

ogist can segment the entire tumor with the assistance of the computer. It’s a work-flow efficient, semi-automated process that takes 15 to 20 seconds to segment and allows you to delineate the tumor in 3D. The findings show that quantitative tumor enhancement is possible with 3-D qEASL and can predict survival after TACE for infiltrative and multifocal HCC. qEASL is not a diagnostic tool but rather a means of comparing differences before and after treatment to identify non-responders. The earlier the non-responders are identified and treated, the better their outcomes.” Image: Liver images from before and after treatment. The bottom right image shows that less cancer is visible after treatment (Photo courtesy of RSNA).

Mobile System Combines OCT Imaging with Angiography new diagnostic system couples state-ofthe-art optical coherence tomography (OCT) and angiography co-registration into one portable system for hospitals with multiple catheterization labs. The OPTIS Mobile System uses the combination technology to help physicians make improved stenting decisions based on high-resolution and three-dimensional (3D) OCT views of coronary anatomy, while simultaneously mapping their exact location via an angiogram. By using OCT technology, the system provides anatomical images of disease morphology and automated measurements that help physicians to visualize and measure important vessel characteristics that are otherwise not visible or difficult to assess with older imaging technology. As a result, the automated, highly accurate measurements can guide stent selection, deployment, and placement ensuring successful procedures, and helping to minimize repeat revascularizations. The system also integrates proprietary fractional flow reserve (FFR) technology to offer detailed coronary hemodynamic circulatory information during percutaneous coronary intervention (PCI). The OPTIS Mobile System is a product of St. Jude Medical (SJM; St. Paul, MN, USA; www.sjm.com), and has been approved for sale in Europe and Japan. “The OPTIS Mobile System represents the ongoing commitment of St. Jude Medical to develop products that provide physicians with more options for improved OCT and angiography co-registration guidance in their daily practice,” said Eric Fain, MD, Group President of St. Jude Medical. FFR is a physiological index used to determine

Medical Imaging International March-April/2016

the hemodynamic severity of atherosclerotic narrowing of the coronary arteries, and is measured using proprietary SJM PressureWire Aeris and Certus systems. FFR specifically identifies which coronary narrowing is responsible for the ischemic obstruction of the flow of blood to a patient’s heart muscle and helps guide the interventional cardiologist in determining which lesions warrant stenting, resulting in improved patient outcomes and reduced health care costs.

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Image: The OPTIS mobile imaging system (Photo courtesy of St. Jude Medical)

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Mathematical Tool Helps Predict Migraines in Concussion Patients esearchers have developed a mathematical tool to help find which concussion patients are most likely to suffer migraines. The study results were published online in the journal Radiology. Patients with concussion injuries commonly suffer from post-traumatic migraine headaches. To investigate the relationship between headaches and concussion-related damage to the brain, researchers normally use a Magnetic Resonance Imaging (MRI) technique called Diffusion Tensor Imaging (DTI). Researchers create histograms of the whole brain, and then a mean Fractional Anistropy (FA). There are shortcomings with the FA technique however. Instead of using the FA technique, the researchers analyzed the MRI scan results using Shannon entropy, an information theory model that that reveals areas of entropy, in the brain. The researchers then assessed the performance of Shannon entropy for use as a diagnostic tool for concussion patients with and without post-traumatic migraines. The study included 74 concussion patients – 57 with post-traumatic migraines and 17 without, 22 healthy control patients, and 20 control patients with migraine headaches. Mean FA and Shannon entropy results were calculated from the total brain FA histograms and compared between concussion patients and the control patients, and between those patients with, and those without post-traumatic migraine.

The results showed that using Shannon entropy analysis of FA histograms was more successful than mean FA as a diagnostic test to differentiate between concussion patients and controls. In addition, Shannon entropy was better in determining which concussion patients would develop posttraumatic migraines. The results also suggested that Shannon entropy could provide a reproducible biomarker that can be calculated automatically and can help triage patients after initial injury, and predict which patients are more likely to have severe symptoms. Study author Lea M. Alhilali, MD, from the University of Pittsburgh Medical Center (UPMC; Pittsburgh, PA, USA; www. upmc.com), said, “Mean FA represents an average. If someone has a higher FA to begin with and they lose white matter integrity from trauma, they still might average out to have a normal mean FA. A healthy brain has high entropy, but people with injuries to the white matter from trauma may lose some of that complexity and have less entropy. This approach requires just one histogram for the entire brain. If it continues to show promise, then it could

be added to the regular brain MRI as part of the study. Additional research is needed to study other potential applications of Shannon entropy, such as predicting future cognitive performance in concussion patients.” Image: MRIs of brains damaged in concussions. Shannon entropy, an information theory model that looks at areas of entropy in a complex system like the brain, has advantages over mean FA in the analysis of brain histograms (Photo courtesy of the University of Pittsburgh Medical Center).

Hybrid PET/MRI System Enhances Breast Cancer Imaging novel imaging technique is being developed that can improve breast cancer detection and characterization, and help clinicians evaluate the response of the cancer to treatment. The 4-year project, named Digital Hybrid Breast PET/MRI for Enhanced Diagnosis of Breast Cancer (HYPMED), began on January 1, 2016, and is being developed under a new cross-European project coordinated by the European Institute for Biomedical Imaging Research (EIBIR; Vienna, Austria; www.eibir.org). Other HYPMED project partners include the University Hospital Aachen (UKA; Aachen, Germany; www.ukaachen.de/en), and four other research institutes in Germany and The Netherlands. Four industry partners in Germany, France, and The Netherlands, including Royal

Philips (Amsterdam, The Netherlands; www. philips.com) are also taking part. Breast cancer is still the most common female cancer, and a major cause of cancer death in women. The stage at which breast cancer is detected is at the moment the most important factor indicating survival of the patient, and there is a pressing need to improve early diagnosis of the disease. The HYPMED project will develop a hybrid Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) imaging system intended to improve diagnosis of breast cancer, and provide personalized control of therapy results. The consortium intends to develop a Radio Frequency (RF) coil that can used in any standard clinical MR scanner, transforming the scanner into a high-resolution hybrid

PET/MRI system that can identify extremely small breast cancer foci, better characterize the cancer, and improve treatment response. The radiation dose of the new system is expected to be minimal, comparable to a regular digital mammogram. The consortium also plans to use the HYPMED approach in the future for prostate cancer detection, hybrid cardiac imaging, and other diseases. Scientific Coordinator of the project, Professor Christiane Kuhl, University Hospital Aachen, said, “The HYPMED project combines visionary clinical expertise with excellence in physical and engineering sciences and the developed technology will greatly help us to choose an appropriate treatment that is exactly right for a given cancer in a given woman.”

Volumetric Ultrasound Technique Could Improve Obstetrical Care in Resource-Poor Areas new study shows that a new volumetric imaging technique can increase accessibility to obstetric ultrasound, and reduce infant mortality, in resource-poor regions worldwide. Poor communities in the world lack the resources and trained personnel for obstetrical care, and this can result in undiagnosed complications during pregnancy, and increased neonatal, infant, and maternal mortality. The new technology is portable, and relatively inexpensive, and can be taught to people with no previous ultrasound experience, within several hours, and the results sent to an obstetrical expert for evaluation over

an Internet connection. Results for 91 patients examined using the new technique were compared to results from routine obstetric ultrasound exams performed on the same patients, on the same day. The researchers found that the ultrasound exams were useful in finding multiple pregnancies, and fetuses in breech positions. The researchers were also able to use the scans from more than 73% of the minimally trained people to estimate gestational age by measuring the Biparietal Diameter (BPD). The scans could also be used to evaluate for Intrauterine Growth Restriction (IUGR), and preeclampsia. According to the researchers the technology

could also be useful in imaging pediatric patients for abdominal emergencies, to find evidence of heart disease in pregnant women, evaluating breast lumps, and has a significant potential for emergency imaging following natural disasters. The author of the study, Kristen K. DeStigter, MD, University of Vermont College of Medicine (Vermont, Burlington, VT, USA; www.uvm.edu/ medicine), said, “At first we were compressing and transmitting the sweeps for quality assurance purposes, but when we saw that the images were quite good we started to wonder whether it was possible to use the sweeps for primary interpretation to identify complications early in pregnancy.” Medical Imaging International March-April/2016

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Medical Imaging International

Ultrasound-CT Fusion Guides Surgical Procedures novel clinical device that attaches to any ultrasound probe provides real-time image fusion for interventional procedures without special needles or instruments. The Scenergy Ultrasound-CT Fusion System is designed to help interventional radiologists and surgeons perform minimally invasive biopsies and other diagnostic and therapeutic procedures by combining the clarity of CT with the real-time visualization of ultrasound. First, the ultrasound probe and the device’s optical head are intelligently integrated into a fused, live image via a fully automated visual registration process based on visual markers that align the ultrasound and computerized tomography (CT) images. Following this short registration process, effortless visual navigation can be displayed on the devices touchscreen controller. Intuitive instrument navigation tracking overlays the path of standard instruments on-screen, allowing surgeons to lock in a target, then realign the probe from a different angle and find the target again. As an additional benefit, the system does not require special needles or new equipment, pre-

Healthcare Providers Increasingly Adopt Enterprise Imaging Workflow Solutions he proliferation of clinical IT systems is leading to a dramatic rise in the market for enterprise medical imaging workflow solutions for healthcare providers. Healthcare providers need to rationalize their increasingly complex imaging Internet Technology (IT) systems, and regain control and oversight of the systems. Many healthcare providers are reshaping the scope and goals of their enterprise imaging strategies. One enterprise medical imaging workflow solutions provider, Laurel Bridge Software (Newark, DE, USA; www.laurelbridge.com), has experienced dramatic growth during the past year. Part of this growth has been due to consolidation between healthcare providers, which creates larger and increasingly complex healthcare IT systems that need to be interoperable. Additional challenges include cost reduction, efficiency, and performance. Leading healthcare providers are working to build a comprehensive enterprise imaging strategy, and ease access and sharing of medical information with the aim of automating enterprise imaging workflow mechanisms, using a strategic cross-functional approach. Mark Blair, Laurel Bridge Software president, said, “We are seeing an increasing number of large health systems looking to solve numerous complex, interrelated image sharing and distribution problems that have resulted from a recent merger or acquisition. These organizations, often led by cross-functional IT teams, want easily implemented, proven IT solutions that provide flexibility and control over clinical imaging workflow challenges that typically span non-radiology clinical departments and multiple facilities. This is a dramatic shift from the radiologycentric workflow requirements of the past.”

serving the workflow and maximizing productivity of existing capital equipment. The Scenergy Ultrasound-CT Fusion System is a product of Clear Guide Medical (Baltimore, MD, USA; www. clearguidemedical.com), and has been approved by the US Food and Drug Administration (FDA). “We have pioneered solutions like our real-time CT-ultrasound fusion technology to provide all users with better image clarity and real-time CT visualization,” said Dorothee Heisenberg, CEO of Clear Guide Medical. “Scenergy is evidence of our commitment to transforming healthcare through innovations that enable best-in-class minimally-invasive procedures at an affordable price.” Fusion imaging is a technique that fuses two different imaging modalities. It has gained considerable attention since it can help conduct interven-

tional procedures with high confidence and accuracy when targeting challenging lesions. Image: The Scenergy ultrasound-CT fusion system (Photo courtesy of Clear Guide Medical).

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The Clinical Collaboration Platform uses clinical data across and outside the enterprise to break down walls between departments, sites and networks, and provide physicians with a single view of critical patient data. It allows for sharing data in ways that can reduce costs and improve care.

The IQQA-Guide provides RT 3D image guidance in the interventional suite for abdominal/thoracic biopsy, interventional procedures, and surgery. It uses a 3D map of anatomic representations from multimodality images, providing RT tracking and referencing to anatomic features of interest in 3D.

The iViewDose is designed to provide an efficient solution for the detection of radiotherapy errors. It prompts user intervention with a simple traffic light system, and increases clinical confidence by detecting dose errors during treatment, including those caused by changes in patient anatomy.

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FDA Clearance for New Oncological Imaging Analytics Software new analytics software package intended to increase radiologists’ workflow efficiencies for oncological cases, and advanced decision support has received US Food and Drug Administration (FDA) 510(k) clearance. The software package features a quantitative imaging dashboard with time-sequenced Electronic Health Record (EHR) information, image characterization, and image tracking. Another feature is the ability to track a tumor or nodule over multiple, spatially registered imaging exams to show whether the cancer is stable, shrinking, or growing. Visualizing changes in the structure of cancers is important for monitoring and/or adjusting the treatment regime of a patient. The imaging analytics package was developed by HealthMyne (Madison, WI, USA, www.healthmyne. com), a company that provides imaging informatics data mining solutions, and solutions for automating data capture, and structured reporting. EHR informa-

tion on the software dashboard is provided by Epic Systems (Verona, Wisconsin, USA; www.epic.com). The HealthMyne software can be used for automatic identification of nodule growth in lung cancer screening programs, which provides an indication of potential malignancy of a nodule, and additional follow-up treatment that may be necessary. In addition, in view of the large increase in the number of cancer treatment options available today, the HealthMyne package can be used to provide quantitative insight and improve clinical decision-making. Roger Chylla, CTO of HealthMyne, said, “By automatically delineating the boundaries of a lung nodule (or tumor), our software can make other sophisticated measurements within those boundaries - such as quantitatively describing important prop-

erties like size, shape, and texture. Physicians can examine these properties to make critical judgments about a patient’s prognosis, follow-up schedule, or how to best treat them.” Image: New image characterization and tracking features are now provided in a comprehensive, quantitative imaging dashboard, which includes time-sequenced Epic EHR information (Photo courtesy of HealthMyne).

Carestream Introduces Expanded Clinical Collaboration t this year's European Congress of Radiology (ECR), Carestream (Rochester, NY, USA; www.carestream.com) demonstrated its Clinical Collaboration Platform enabling the sharing of images in real time, aiding interactive working, and improving the efficiency of service delivery. By providing a complete enterprise imaging platform with patient-centered views of clinical imaging data across departments and sites, the Carestream Clinical Collaboration Platform offers every stakeholder a modular solution for meaningful collaboration across the continuum of care. This is delivered via the solid enterprise viewer part of the platform itself. Stefano Arata, Carestream Solution Architect for the EMEA region, explained why the development of the Clinical Collaboration Platform was pushing the boundaries of clinical information sharing into new territory. As a concept, the Clinical Collabora-

tion Platform embodies joint working between physicians, across departments and multiple sites within a healthcare region. It provides an overarching, standards-based platform to manage all imaging data, radiology, videos, photos, electrocardiograms (ECGs) and scanned documents. This is a perfect “enabler” for the electronic medical records (EMR) that is not focused on image sharing. Carestream has been a leader in radiology imaging for many years, but more recently the field of image exchange in radiology has adopted a position of increasing importance in their portfolio. “We now realize the significance of offering an enterprise imaging platform to enable physicians to collaborate across the clinical pathway across hospitals and medical professionals,” said Arata. “We want to provide access to images that might be captured in different locations enabling all relevant physicians

and patients to access these data.” Of note, the Platform is comprised of a set of modules and an enterprise repository consisting of a standard vendor neutral archive (VNA) incorporated with the ability to integrate with EMR. This is a function that is normally missing from the VNA. “We also provide the workflow because we know how important it is to acquire the images and capture them in such a way that they are properly managed,” he added. The Clinical Collaboration Platform provides all the tools needed to ensure this happens and that images are securely shared with those people who need them. Furthermore, in the near future, patients will be able to upload their own data, added Arata. He cited the example of patients being able to upload their images and make them available to the hospital before attending appointments. “There’s a high demand for this,” he said. Medical Imaging International March-April/2016

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IT/PACS Update

Enterprise Imaging Platform Ready to Go into Teaching Hospitals n advanced platform, presented by AGFA (Mortsel, Belgium; www.agfa.com) at this year’s European Congress of Radiology (ECR), enables faster and better decision-making and embraces potential challenges associated with collaborative workflow and mobile scenarios. The company’s Enterprise Imaging platform now extends further by way of features appropriate to the patient as well as the general practitioner (GP). All are available at a regional, intra-, and extramural level. “Our platform is ready for each case scenario in hospitals or across regions within countries,” explains Mr. Hans Vandewyngaerde, President Agfa HealthCare Region Europe. It is also ready to deal with a whole range of different scenarios in the radiology department.” One of the most recent developments has been a radiology specific aspect of the Enterprise Imaging platform that has been refined for academic hospitals including support for multidisciplinary team meetings, teaching files, and residence/supervisor task based workflow. Essentially, AGFA’s system comprises one platform for each and every scenario, emphasized Mr. Vandewyn-

gaerde. “It is strong in flexible thought-driven workflow, meaning it is easily-configurable, accounting for different tasks from radiology per se, regional in nature, and patient or GPoriented. It’s a workflow that is flexible and specifically task-driven.” Radiology-oriented display protocols include post-processing tools for three-dimensional (3D) ultrasound, 3D volume building colonoscopy, integration with other 3D applications that are similar and completely embedded. Furthermore, the platform has a design requirement that ensures there are collaborative tools reflecting a move towards radiology connecting with other stakeholders for example, associated radiologists, patients, GPs and other healthcare workers. Mobile tools are also front and center to the platform. “Today we clearly have a case requiring mobile sign off from radiologists with mobile reporting lists. The iPad is FDA [US Food and Drug Administration] approved for diagnostic viewing, and the platform is notable for operating on all web browsers and vendor neutral archives (VNA). These features of collaborative and mobile tools enhance the efficiency of workflow,” added Mr. Vandewyngaerde.

New Cardiovascular Image and Information Management System he newly-introduced Cardiovascular Image and Information Management System (CVIS) is intended to improve interoperability, enhance collaboration, and centralize patient data from around the hospital. The system should help streamline workflows, and improve patient care, by allowing all clinicians to view the complete patient history, treatment, and therapy, preventing delay and unnecessary repetition of tests. The Royal Philips (Amsterdam, the Netherlands; www.philips.com) webenabled IntelliSpace Cardiovascular CVIS provides tools that enable clinicians to access, analyze, and share cardiovascular images and information freely. Existing Philips’ Xcelera customers can also upgrade to the new IntelliSpace Cardiovascular CVIS, which includes clinical applications such as IntelliSpace Portal, and IntelliSpace ECG, in one workspace. Improved interoperability, and centralized patient data, will help stream-

Medical Imaging International March-April/2016

line workflows and improve care. CVIS is vendor agnostic, and can link users to advanced visualization tools, a third-party Picture Archiving and Communication System (PACS), or Electronic Medical Record (EMR). The system has a scalable design and built-in echocardiography reporting features to help cardiologists in the reporting workflow. The CVIS also includes built-in analytics tools that can compile data and provide searchable information for clinicians, researchers, and administrators. Iain Burns, CEO, Philips Canada, said, “At Philips we are committed to delivering innovations that can improve people’s lives. IntelliSpace Cardiovascular’s single integrated workspace produces a panoramic view of the patient’s care continuum across the entire cardiovascular service line enabling better care for cardiology patients. This new technology provides cardiologists with sophisticated tools for confident diagnosis and planning of patient cardiovascular care.”

Mr. Vandewyngaerde also highlighted that the move from vertical care to integrated care, which is strongly promoted by the European Commission and encourages multiagency and multidisciplinary working with a patient-centric view. “We see this happening now in the UK, and in Belgium, and in regions of Spain. It isn’t about intra-muros but an extramuros approach with a patient who is more empowered and engaged in their healthcare,” he said, asserting

that medical imaging was a classic example of how this works. With the Enterprise Imaging platform, the patient receives a notification advising the report is available with access to the image which they can share with their GP or for a second opinion elsewhere. Image: The Enterprise Imaging Platform incorporates views that are radiology and medically centric, as well as appropriate to the patient and the general practitioner (Photo courtesy of Agfa HealthCare).

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The GE Health Cloud is designed to enable medical facilities to perform data analytics and other functions more efficiently in the cloud. Four key features of the GE Health Cloud include advanced visualization, virtual meetings, case exchanges, and image access portal.

The Exa platform includes a custom workflow design engine and performance dashboards. It allows each facility to design its own preferred imaging workflow with drag-and-drop tools. The entire process can be customized quickly and easily, with no prior IT or coding experience.

The MultiSync MD211G5 21-inch display is designed for tomosynthesis applications and full field digital mammography (FFDM). The 5MP monitor is also cleared for standard mammography, and offers out-of-the-box factory DICOM calibration and uniformity control for consistent imaging.

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GE HealthCloud to Receive Radiology Protocols Tool adiology Protocols (Iowa City, IA, USA; www.radiologyprotocols.com) has announced that its protocol management tool for medical imaging devices will be added to the GE Healthcare (GE; Little Chalfont, United Kingdom; www.gehealthcare.com) HealthCloud suite of applications when the Cloud goes live in late 2016. Radiology Protocols offers an intuitive online radiology imaging management platform that provides a customizable, scalable, Health Insurance Portability and Accountability Act (HIPAA)-secure hosted solution to document, organize, and tailor imaging protocols. The protocol management tool is vendor agnostic, allowing customers to utilize the system across different equipment modalities and different platforms to allow providers to share best practices across systems instantaneously and seamlessly, thus eliminating paper-based files. The standardized imaging guidelines conform to both the local imaging practices and the regulatory environment, based on a hosted system that improves communication, saves time and money, and

improves patient care. Under the agreement, GE HealthCloud radiology department customers will be able to access and use the sophisticated protocol management platform to increase productivity and improve the quality of exams. “Radiology Protocols is pleased to take its place as one of the GE HealthCloud’s early and core applications which will enable exceptional connectivity and scalability for customers,” said Stephen Baker, founder and president of Radiology Protocols. “This will allow for standardization of imaging protocols across IDN’s resulting in better utilization, sharing of best practices and improved patient care.” “Radiology Protocols delivers much needed quality improvement tool that imaging customers around the world need; a method to define, organize and maintain imaging protocols, for all modality types, on a centralized, web-based platform,” said John Kalafut, imaging outcomes and solutions leader at GE Healthcare. “As a vendor agnostic system, it can be used to manage the protocol process

by all of our customers, which is a great advantage for everyone.” GE HealthCloud, which includes a suite of enterprise imaging applications, provides a robust platform for software vendors to deliver healthcare applications across the healthcare enterprise including large, complex integrated delivery networks (IDNs). Image: The GE HealthCloud provides a platform for software vendors to deliver healthcare applications across the healthcare enterprise (Photo courtesy of GE Healthcare).

3D Printed Models of DICOM Images Are Critical for Medical Care he use of 3D printed models of DICOM images can change the way doctors are trained, and how they communicate with their patients. The research was presented at the annual meeting of the Radiological Society of North America (RSNA 2015). The research shows that despite the challenges that still need to be overcome before 3D models printing reaches its full potential in radiology, the impact of 3D printing could become the standard. According to Frank Rybicki, MD, PhD, professor, Department of Radiology, University of Ottawa Faculty of Medicine (Ottawa, Canada; http://med. uottawa.ca/en), radiologists need to invest the time to learn 3D model printing methods. Dr. Ry-

bicki suggests that printing of medical models from Computed Tomography (CT) and Magnetic Resonance (MR) images should become part of radiology departments. Advanced imaging modalities and protocols need to be able to generate source DICOM images that can be used for 3D printing. Radiologists could use 3D printed models of DICOM images for tactile feedback, and tangible depth information of anatomic, and pathologic states. Existing obstacles to the mainstream adoption of 3-D printing include a consensus in terminology, cost, training, materials, equipment, and guidelines. Dr. Rybicki, said, “If we’re going to get reimbursement, we need a single reporting standard for

3D printing, and reimbursement will be a major hurdle. All payors know that we need 3D printing, and that it will eventually be reimbursed as the demand continues to swell. This will happen as we accumulate more data, and then develop guidelines regarding appropriate utilization. While there are many pressures to contain costs, data is beginning to show that the generation of 3D models is cost-effective for several applications, particularly when the model saves time in the operating room. 3D printing is a completely disruptive technology in general and in medicine. It will change the way that doctors do procedures. It will change the way we teach young physicians. The next natural step in the progression of technology is 3D printing.” Medical Imaging International March-April/2016

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

IT/PACS Update

Helping Optimize Workflow With Flat Panels in Surgery he year’s European Congress of Radiology (ECR) was a prime opportunity for Thales (Neuilly sur Seine, France; www. thalesgroup.com/en), the French multinational electronic systems company, to introduce its groundbreaking flat panel detectors and imaging solutions to radiology professionals gathered to learn more about state of the art technologies on offer this year. Jerome Tabourel, Marketing Director from Medical Radiology at Thales explained that at ECR, they were introducing a complete new product range for surgical applications. Hospital operations are evolving, he said, and the new emerging driver is the need for complementary products that help optimize workflow management. “Currently, the surgical market us-

es imaging intensifiers and in this respect Thales holds 50% market share. But now we are seeing a transition between imaging intensifiers and flat panel detectors,” he noted. With digital imaging and flat panel technology becoming ever more ubiquitous, the key global driver remains higher image quality with lower dose. At ECR, Thales unveiled its Pixium Surgical Imaging Suite that combines the high performance Pixium Surgical flat panel detectors with cutting-edge Image Chain Solution. The surgical market is extremely price demanding, Mr. Tabourel pointed out. “Basically we are introducing the 21 cm by 21 cm squared flat panel to replace the 9 inch tubes, and we are introducing the 30 cm by 30 cm panel to replace the 12 inch tubes.” In coming months, the company will

Radimetrics Enterprise Platform Crafted for the Smaller Institution adimetrics Enterprise Platform was again the highlight of the European Congress of Radiology (ECR), but this year it had a new twist, or in the words of Mr. Bill Cavanaugh, Head of Global Informatics Strategy at Bayer Pharma Radiology (Whippany NJ; www.radiology. bayer.com), “Radimetrics, with our new Select Package, is a simple, affordable and scalable solution to help smaller institutions prepare for regulation while improving the performance of their radiology practices.” Bill Cavanaugh continued by explaining that Bayer Pharma Radiology had introduced a new version of the platform that helps radiologists manage radiation exposure by mitigating inefficiencies and achieving reproducible quality. It is used alongside MRI to monitor contrast dose, and in CT imaging, X-ray, interventional medicine, nuclear medicine and mammography to monitor radiation dose. It comes with tools to not only monitor radiation and contrast dose from scanners and injectors, but enables the physician to manage patient dose history longitudinally. “Now we have a version of the product incorporating the specific needs of the smaller end of the market,” said Mr. Cavanaugh, explaining some of the benefits of this new version of the product. “We have brought in all of the best practices from leading healthcare institutions to

Medical Imaging International March-April/2016

transform our contrast injectors into smart connected devices within the broader hospital ecosystem, bringing efficiencies and patient-centered care to even the smallest users.” This latest version of Radimetrics also encompasses efforts to bring some of the best teaching practices from large teaching hospitals to the benefit of smaller practices. Registries are one of the latest initiatives to allow small institutions to benchmark themselves against what leading institutions. Mr. Cavanaugh cites the example of a registry being established in Germany currently. “In Germany, a new registry is under formation and we can potentially compare data from an institution in Switzerland with data from a leader in Germany, as well as connecting them with what is happening in California, for example. It’s about sharing best practices.” One of the main benefits of Radimetrics is the radiation dose management and it provides data required by the upcoming European directive. Another key feature of the product is the level of quality that customers buy into. “Quality is not a one-time event but a continuous process,” asserted Mr. Cavanaugh. “Generally, in radiology people are being forced to do more with less – more compliance, more needs, more pressure to put more patients through the scanner. This product helps with efficiency.”

launch a third product in the series of flat panel detectors. Thales also introduced a new generation of flat panel detectors for digital radiography, which currently comprises a 43 cm by 43 cm square panel called the Pixium RAD 4343 CE and G-E. He explained that this was a new generation detector for a fixed RAD room and it remains a mainstay of this segment, because of its flexibility and adaptability to any

imaging solution. However, as workflow management changes, different systems are required. As a result, the Pixium Portable EZ coupled with the ArtPix Mobile EZ2GO tablet, allows technicians to take images directly in patients’ rooms and to instantly view the clinical image. Image: The Pixium surgical imaging suite (Photo courtesy of Thales).

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The RayStation5 features carbon ion treatment planning, an advanced form of radiation therapy, and Plan Explorer, a planning tool that allows clinics to maximize delivery efficiency and plan quality for every individual patient treatment. Other key features include unlimited patient data storage.

The Simultaneous Multi-Slice (SMS) EPI is designed to acquire imaging slices simultaneously rather than sequentially to reduce 2D acquisition times. It also integrates DTI and blood oxygen level-dependent (BOLD) imaging, benefiting surgical neurology cases through mapping.

The Forward projected model-based Iterative Reconstruction SoluTion (FIRST) improves image quality with noise reduction, while reducing dose. It cuts the time needed for model-based CT image reconstruction, helping providers make diagnoses and treatment decisions more effectively.

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Advanced Visualization and Analysis Suite for Spectral CT Receives FDA Clearance n advanced clinical applications suite for spectral Computed Tomography (CT) has received US Food and Drug Administration (FDA) 510k clearance for the US. The suite of advanced visualization and analysis tools was designed to give clinicians on-demand spectral information, and clinical decision support to analyze incidental findings, without the need for additional scans and additional radiation exposure for the patient. The Spectral Diagnostic Suite (SpDS) was designed by Royal Philips (Amsterdam, the Netherlands; www.philips.com) for the Philips IQon Spectral CT scanner. The SpDS includes Spectral enhanced Comprehensive Cardiac Analysis (sCCA), Spectral enhanced Advanced Vessel Analysis (sAVA), Spectral enhanced Tumor Tracking (sTT), and enables clinicians to view and analyze spectral datasets in a reading room, on a Picture Archiving and Communication Systems (PACS), or remotely. The Philips Spectral suite also enables clinicians to perform segmentation, on different energy levels, advanced fusion, and more detailed comparison of images. Mikael Strindlund, senior vice president & general manager of CT at Philips, said, “The game-changing capabilities of the Spectral Diagnostic Suite represent our ongoing commitment to drive advanced innovation in medical imaging to improve clinical output and diagnostic confidence, leading to better care for patients at lower dose exposure. Providing clinicians with additional data to help support the right clinical decisions while improving workflow and patient experience, is at the core of everything we do.”

Image: The Spectral Diagnostic Suite is a set of advanced visualization and analysis tools designed for the IQon Spectral CT to deliver enhanced spectral viewing and advanced clinical applications capabilities (Photo courtesy of Royal Philips).

Next Generation Cranial Radiosurgery Software Combines Conformal Arcs with VMAT Therapies new approach to optimizing existing treatments using software for Stereotactic Radio-Surgery (SRS) was showcased at the annual meeting of the American Society for Therapeutic Radiation and Oncology (ASTRO; San Antonio, USA), October 18–21, 2015. The new software is a core treatment toolkit to complement existing workflows. Dynamic conformal arcs are widely used and are dosimetrically robust and easy to validate for SRS planning and delivery. The additional flexibility of Volumetrically Modulated Arc Therapy (VMAT) techniques for managing dose combined with dynamic conformal arcs, are now available for SRS users

in the new treatment. The new combined treatment, Brainlab Elements Cranial SRS, was developed by Brainlab (Munich, Germany; www.brainlab.com), which develops, manufactures, and markets softwaredriven medical technology, enabling access to advanced, less invasive patient treatments. Brainlab products include radiosurgery, information-guided surgery, precision radiation therapy, digital operating room integration, and knowledge, and information exchange. Brainlab products are used in neurosurgery, orthopedic surgery, spine surgery, trauma surgery, radiosurgery, and radiotherapy treatments.

Brainlab develops new elements for indicationinherent intelligence, with new features from clinicians’ feedback, and has created customized modules and business models, including subscriptionbased models. Stefan Vilsmeier, president and CEO of Brainlab, said, “We’ve carefully analyzed what keeps good treatments from being perfect treatments. By focusing each Element on a single clinical indication, we are able to frontload intelligence and streamline processes, re-building from scratch the premier cranial, spine, and lung software for radiotherapy. Clinicians can create a wholly personalized suite of Elements to deliver innovative stereotactic radiosurgery.” Medical Imaging International March-April/2016

Industry News

Elekta in Strategic Partnership with Australian Radiotherapy Provider lekta (Stockholm, Sweden; www.elekta.com), a company pioneering cancer and brain disorders treatment solutions, has announced a multiyear strategic partnership with GenesisCare (Alexandria, NSW, Australia; www.genesis care.com.au), the largest radiotherapy provider in Australia. The eight-year partnership is valued at more than USD 100 million and includes Elekta's Leksell Gamma Knife radiosurgery system, brachytherapy systems, Versa HD linear accelerators, software, and services for use in GenesisCare cancer treatment centers in Australia, the UK, and in new markets. The agreement also includes Elekta’s MOSAIQ enterprise licensing system, and the METRIQ software. The MOSAIQ software enables a com-

pletely optimized and automated workflow across a global enterprise, while the METRIQ software is an integrated cancer registry, including reporting, and follow-up analysis. Dan Collins, managing director of GenesisCare, said, "Elekta is a natural partner for GenesisCare. We want all cancer patients to receive rapid access to high quality care. Elekta helps us make this happen with their suite of technology solutions, global reach and commitment to innovation. The MR-linac is a game changer. We expect cancer patients, including those receiving treatment for prostate, breast and other cancers, to benefit from this innovation. Anything that improves the accuracy of treatment and provides a smoother patient experience should improve outcomes."

Cloud-Based Solutions Provider Adds Image Sharing Capabilities edidata (New York, NY, USA; www.mdsol.com), a leading global cloud-based solutions provider for clinical research has acquired Intelemage (Cincinnati, OH, USA; www. intelemage.com) a global medical image sharing and workflow management company. Medical imaging data is the fastest growing and largest source of data in the healthcare industry and cloud storage provides users with an endto-end solution for capturing, managing, and analyzing their medical imaging data.

Under the transaction Medidata will integrate Intelemage technology into the Medidata Clinical Cloud, a Software as a Service (SaaS) platform. Intelemage operates in 85 countries, and in more than 5,000 locations around the world, and provides tools for capturing medical imaging data, workflow management. The tools are used in clinical trials, hospitals, life sciences companies, research institutions, doctors, and core labs. The tools provide a single environment for managing all imaging activities, a high level of data control and access, and performance metrics.

Consolidation in Ultrasound Transducer Disinfection Field he market leader for highlevel ultrasound transducer disinfection products has been acquired by a leading manufacturer of ultrasound guidance devices and infection control products. The acquisition will consolidate a range of hardware, and consumable products for a growing market in cost-effective infection control products, and ultrasound transducer reprocessing. PCI Medical (www.pcimedical. com) was acquired by CIVCO Medical Solutions (www.civco.com) and will enable CIVCO to add storage and high-level disinfection and reprocessing of ultrasound transducers to

Medical Imaging International March-April/2016

their portfolio. PCI Medical is a leader in the market for Joint Commission and US Food and Drug Administration (FDA; Silver Spring, MD USA; www.fda.gov)-compliant infection control products for ultrasound transducer disinfection, and storage devices. CIVCO Medical Solutions' Multi-Modality Imaging (MMI) unit designs and manufactures accessories for diagnostic and therapeutic imaging, and interventional procedures, especially for the ultrasound market. CIVCO's new ASTRA family of devices received FDA 510(K) clearance in 2015, and enables CIVCO to enter the market for cardiology, women's and men's health products.

USA-Australian Alliance in Medical Image Management Solutions ach7 Technologies (Burlington, VT, USA; www.mach7t. com) and 3D Medical (3DM; Port Melbourne, VIC, Australia; www. 3DMedical.com.au) have formed a combined company poised to bring advanced medical image management solutions to customers worldwide. As a result, 3DM, a medical-specific three dimensional (3D) printing, holographic projection, and data integrations provider, is now a whollyowned subsidiary of Mach7 Technologies, with the combined company renamed Mach7 Technologies Limited. The merger is designed to expand the international market for the enterprise imaging and 3D printing capabilities of the company, which include 3D medical printing; EchoPixel holographic projection technology; and GestSure surgery image control. Mach7 Technologies provides an enterprise platform that delivers complete image management with rapid record identification, integration, synchronization and routing, advanced

clinical viewing, and optimized, vendor-neutral archiving. Under the terms of the merger, Mach7 Technologies will maintain its US headquarters for product development, professional services, sales and marketing, with the Australian 3DM offices in charge of expanding sales and marketing efforts throughout Australia, New Zealand, and Western Europe. “We will remain a nimble company focused on providing the most innovative enterprise imaging platform in the world. Access to new capital will enable us to surpass business and product roadmap goals in a shorter time frame and to better serve our customers,” said Albert Liong, CEO of Mach7 Technologies Limited. “Mach7 has enjoyed substantial growth in recent years, and we feel this will be enhanced with access to the public capital market. Australian investors appreciate world leading healthcare technology, and we look forward to this new phase as we continue to build our global presence.”

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

International Calendar Medical Imaging International P.O.Box 802214, Miami, FL 33280-2214, USA Fax: 1-954-893-0038 • E-mail: info@globetech.net www.radiologiekongress.ch

MAY 2016 ISMRM 24th Annual Meeting SMRT 25th Annual Meeting - International Society for Magnetic Resonance in Medicine Section for Magnetic Resonance Technologists. May 7-13; Singapore, Singapore; Web: www.ismrm.org/ ISFRI/IAFR Joint Congress 2016- International Society of Forensic Radiology and Imaging & International Association of Forensic Radiographers. May 12-14; Web: www.eis everywhere.com International Pediatric Radiology (IPR) 7th Conjoint meeting and exhibition. May 15-20; Chicago, IL, USA; Web: www.ipr2016.org/ CRCPD Annual Meeting 2016 - Conference of Radiation Control Program Directors. May 16-19; Lexington, KY, USA; Web: www.crcpd.org Saudi Health 2016. May 16-18; Riyadh, Saudi Arabia; Web: www. saudihealthexhibition.com ASNR 54th Annual Meeting - American Society Of Neuroradiology. May 21-26; Washington, DC; Web: www.asnr.org Swiss Congress of Radiology 2016. May 26-28; Bern, Switzerland; Web:

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International Calendar ence Of The IEEE Engineering In Medicine And Biology Society (EMBC). Aug 17-20; Orlando, FL; Web: http://embc.embs.org The 16th Asian Oceanian Congress of Radiology. Aug 19-21; Beijing, China; Web: www.theaosr.org FIME 2016 – Florida International Medical Exhibition. Aug 20-24; Miami, FL, USA; Web: www.fimeshow.com ESC 2016 – European Society of Cardiology. Aug 27-31; Rome, Italy; Web: www.escardio.org

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