Medical Imaging International September 2017

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Vol.27 No.3 8-9 /2017 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 3-21 PACS/ IT Update . . 22-24 Product News . . . . . 6-24 Industry News . . . . . . 25 International Calendar . 26

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Medical Imaging International

Focused Ultrasound Scalpel Could Destroy Liver Tumors new technique that allows an ultrasound (US) beam to be refocused in synchronization with breathing could help treat liver tumors more effectively, while sparing surrounding healthy tissue.

The technique, developed by the Fraunhofer Institute for Medical Image Computing (MEVIS; Bremen, Germany; www.mevis.fraunhofer.de) and SINTEF (Trodheim, Norway; www.sintef.no) as part of the clinical translation of patient-specific planning and conducting of FUS treatment in moving organs (TRANS-FUSIMO) project, is based on real-time, predictive software that establishes liver position by magnetic resonance imaging (MRI) every tenth of a second, and calculates movement.

The data is then sent to an US transducer equipped with more than 1,000 small transmitters that sits on the patient’s stomach.

The transducer focuses the individual US transmission beams so that their waves converge precisely at a point as small as a grain of rice, resulting in a destructive effect at the focal point; the transmitters that face the ribs remain inactivated throughout the process. The MRI scanner controls the entire process, measuring the temperature in the liver and ensuring that the correct foci are sufficiently heated. The therapy is completely non-invasive and can be performed without anesthesia, and there are no wounds. A study describing preliminary results was presented at the annual European Radiology Congress (ECR), held during March 2017 in Vienna (Austria).

“Generating an image of the liver’s position every tenth of a second is not fast enough to reliably direct the ultrasound beam. This is why we developed software that can see into the immediate future and calculate the next position of the treated region,” said mathematician Sabrina Haase, project manager at MEVIS. “The program determines the path for the focused ultrasound waves to reach the liver tumor even when the patient moves while breathing.

Developing the software was quite challenging: it must run both highly reliably and in real time.”

“Patients with abdominal tumors must undergo multiple invasive interventions; MR-guided focused ultrasound can offer a genuine alternative to such interventions,” said radiologist Professor Mario Bezzi, MD, of La Sapienza University (Rome, Italy; www.uniroma1.it), who will participate in the clinical part of the TRANS-FUSIMO project. “The new therapy control system developed in the TRANSFUSIMO project will be extraordinarily helpful in the clinical routine by allowing tumors to be destroyed very precisely and to guide the entire procedure effectively.”

High-intensity focused ultrasound (HIFU) technology is based on nonlinear mathematical optimization methods to analyze and simulate the propagation of sound in material. The information is then used to enhance the shape of an acoustic lens so that that US pressure is focused precisely on the location of the tissue to be ablated, while the surrounding tissue retains as little damage as possible.

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Medical Imaging International August-September/2017

Image: Focused ultrasound could treat tumors in moving organs, such as the liver (Photo courtesy of Fraunhofer MEVIS).

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Medical Imaging International

3T MRI Scanner Promises Improved Performance and Fewer Rescans eaturing advanced system architecture and a more powerful magnet, a newly-introduced 3T Magnetic Resonance Imaging (MRI) scanner can help clinicians personalize imaging scans and reduce the number of rescans, while improving scheduling and consistency.

The MAGNETOM Vida scanner was developed by Siemens Healthineers (Erlangen, Germany; www.health care.siemens.com), and features Siemens’ BioMatrix, GO, Select&GO, and true 3T productivity technologies, and free-breathing, high-resolution cardiac MRI with compressed sensing cardiac cine.

Siemens’ GO technologies enable a faster exam workflow, and higher throughput by facilitating workflow optimization. The front of the scanner has BioMatrix Select&GO touch interfaces that enable one-touch patient positioning for multiple regions, as well as an intelligent body model that saves repositioning time, and speeds up adjustments.

The Siemens’ Dot workflow helps ensure consistent, high-quality imaging using automation features such as AutoAlign, AutoCoverage and AutoFoV. Inline image reconstructions are automated and use the Recon&GO functionality that allows automatic

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reconstructions to be carried out in the background.

The MAGNETOM Vida also features a new viewing and reading solution called MR View&GO, that enables rapid quality checks and results distribution, following image acquisition and image reconstruction.

Image: The MAGNETOM Vida MRI Scanner (Photo courtesy of Siemens Healthineers).

PET Radiotracer Identifies Atherosclerotic Inflammation new study describes a novel positron emission tomography (PET) radiotracer that can quickly and non-invasively identify life-threatening atherosclerotic plaques.

Developed by researchers at the Munich Technical University (TUM; Germany; www.tum.de) and Klinikum rechts der Isar (Munich, Germany; www.mri.tum.de), gallium-68 (Ga-68)-pentixafor binds with nanomolar affinity to the CXC chemokine receptor type 4 (CXCR4, also known as fusin), which is present on the surface of inflammatory cells in atherosclerotic plaques. For the study, the researchers imaged seven atherosclerotic rabbits and five controls in vivo on a PET-MRI system after injection of 15 MBq/kg of 68Ga-pentixafor.

One hour later, strong signals were detected with PET-MRI in atherosclerotic plaques of the abdominal aorta and right carotid artery, as compared to normal control arteries. The uptake in the vessel wall on radiographies was located in the macrophage-rich regions of atherosclerotic plaques, and correlated with the intensity of CXCR4 expression.

The researchers also confirmed (with a small number of human patients) that the radiotracer detect-

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ed atherosclerotic plaques located in their carotid arteries. The study was published in the March 2017 issue of The Journal of Nuclear Medicine.

“Ga-68-pentixafor binds more specifically to inflammatory cells than F-18-fluorodeoxyglucose and does not require the patient to fast for six hours before imaging,” said lead author Fabien Hyafil, MD, PhD, of Klinikum Rechts der Isar.

“This new radiotracer will strongly facilitate the imaging of inflammation in atherosclerotic plaques with PET, and hopefully support the early detection and treatment of atherosclerosis, thus preventing heart attack or stroke.”

Atherosclerotic plaques fall into two broad categories – stable and unstable. While stable atherosclerotic plaques, which tend to be asymptomatic, are rich in extracellular matrix (ECM) and smooth muscle cells, unstable plaques are rich in macrophages and foam cells, and the ECM separating the lesion from the arterial lumen is usually weak and prone to rupture, causing thromboembolism. In the extreme, the emboli can cause myocardial infarction (MI) when lodged in cardiac arteries, or a stroke when reaching the brain.

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ISSN 1068-1779 Vol.27 No.3. Published, under license, by Globetech Media, LLC. Copyright © 2017. All rights reserved. Reproduction in any form is forbidden without express permission.

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Medical Imaging International

Microbubble Ultrasound Technique Can Detect Tumors without Biopsies esearchers have demonstrated a new technique, in a small, preliminary human clinical trial, that can diagnose human cancer without the need for a biopsy. The safety trial included 24 women suffering from ovarian tumors, and another 21 women with breast tumors.

The women received intravenous injections of phospholipid microbubbles, filled with harmless perfluorobutane and nitrogen gas, which bound to and could identify the malignant tumors.

The researchers from the Stanford University School of Medicine (Stanford, CA, USA; http://med.stanford.edu) published the results of the trial in the March 14, 2017, online issue of the Journal of Clinical Oncology.

For about half an hour after the injection of the medical microbubbles, clinicians used standard ultrasound to image the tumors, and found that the bubbles were clustered in the blood vessels of the malignant tumors, but in the benign ones. The researchers confirmed the accuracy of the tumor identifications by performing biopsies and pathology studies.

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Superconductive MRI Offers Silent Scanning Technology new 1.5T magnetic resonance imaging (MRI) system combines high quality imaging with a patientfriendly examination environment.

The Hitachi (Tokyo, Japan; www. hitachi.com) ECHELON Smart was designed to reduce the loud acoustic noise that accompanies an MRI scan by reducing the sound pressure, all without affecting examination time, contrast, image signal to noise ratio (SNR), and spatial resolution. The silent scanning technologies, together with a host of other functions, create a comfortable examination environment for both the operator and the patient, resulting in an enhanced workflow and minimal examination time, without affecting image quality.

Applications include AutoPose scan plane setting, intended to reduce the operator’s workload for brain scans and repeat examinations by reducing image deterioration caused by body movement, also known motion artifact; and RADial Acquisition Regime (RADAR), which is intended to reduce motion artifact in cerebral and abdominal examinations, which are affected by involuntary movements such as blood flow and breath. RADAR is also compatible with silent scanning technology, which improves the examination environment for patients with an aversion to MRI examinations.

The ECHELON Smart is preinstalled with an optimum image synthesizer and a high sensitivity 16-channel radio frequency (RF) receiver system powered by a highspeed analog-to-digital converter (ADC), which digitalizes the RF signal and subsequently applies noise suppression to obtain high quality images. Other features include a low energy consumption function that reduces running costs significantly when compared to conventional systems, which must be continuously cooled to cryogenic temperatures during operation in order to prevent the liquid helium from evaporating.

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Image: Medical microbubbles used to flag malignant cancer in women with ovarian or breast tumors (Photo courtesy of Stanford University School of Medicine).

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The MyLab Eight Platform incorporates the eMPowered Engine to allow images to be captured at greater body depth for difficult-to-scan patients.

Key features include an ergonomic design, 21inch monitor, and wired and wireless connectivity for easy networking and patient management.

The G-scan Brio offers increased diagnostic accuracy and confidence for musculoskeletal applications adding weight to diagnosis. The open/tilting design allows the study of joints and spine, either in supine or weight-bearing position, because the magnet and patient can rotate from 0-90 degrees.

The P50 offers improved signal transmission and reception processors, which leads to higher sensitivity and more accurate echo detection. The system is equipped with a wide range of transducers which adopt innovative technologies and provide a confident diagnostic experience.

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Enhanced Ultrasound Platform Improves Musculoskeletal Imaging powerful ultrasound platform expands musculoskeletal (MSK) imaging with enhanced resolution and penetration, by way of innovative tools designed to streamline clinical workflow.

The Toshiba Medical (Tokyo, Japan; www. toshiba-medical.co.jp) Aplio i-series is a scalable ultrasound solution comprised of the Aplio i700, Aplio i800, and Aplio i900 systems, which include a new beam-forming optimization technology called iBeam that increases ultrasound penetration for shoulder and deep muscle imaging, while maintaining high spatial and contrast resolution, and at the same time reducing artifacts and clutter. Another feature is shear wave technology, which provides a quantitative measure and realtime display of tissue elasticity in a variety of clinical settings.

The premium Aplio i-series also feature Smart Fusion, which is used to merge live ultrasound imaging with pre-acquired magnetic resonance imaging (MRI) data, thus making it easier to locate anomalies in complex anatomy. For comprehensive evaluation, Smart Fusion can work in multiple im-

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aging modes, including color Doppler and contrastenhanced ultrasound (CEUS). A concise quad display shows the live ultrasound image in sync with multiple views of the pre-loaded data.

All systems provide an image-guided user interface, which visually guides the clinician through the exam to simplify system operation and help improve efficiency. To make ultrasound exams faster, the systems feature touch control screens and realtime Quick Scan, which makes automatic image adjustments without pushing a button. The i800 also offers an ultra-high frequency transducer at 24 MHz that makes it easier for clinicians to image superficial MSK structures, and also expand the utility of diagnostic ultrasound in a variety of clinical situations.

“With the Aplio i-series, our customers have access to the high-quality imaging they rely on for confident diagnoses without sacrificing clinical efficiency or patient safety,” said Dan Skyba, director of the ultrasound business unit at Toshiba America Medical Systems. “By combining excellent image quality with brand new controls and ergonomic fea-

tures in a real-time workflow, the Aplio i-series systems make ultrasound the go-to solution for musculoskeletal imaging, as well as for a wider array of imaging needs.”

Image: The Aplio i700, Aplio i800, and Aplio i900 systems (Photo courtesy of Toshiba Medical Systems).

New Technology Improves Ultrasonic Tumor Ablation novel high-intensity focused ultrasound (HIFU) ultrasound transducer can be used to generate a steady, standing-wave field with a subwavelength-scale focal region and extremely high intensity.

To achieve subwavelength focusing, researchers at Nanjing University (NJU; China; www.nju. edu.cn) the Chinese Academy of Medical Sciences (CATCM; Beijing; www.catcm.ac.cn) and Chongqing Medical University (CQMU; China; www. cqmu.edu.cn) developed a semi-enclosed, ultrasonic spherical cavity resonator (USCR) with two open ends. The size of the focal region generated by the USCR is 50-70% of the millimeter-scale wavelength, with a pressure amplitude gain over three orders of magnitude, rapidly raising the tempera-

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ture in focal region to above 65 °C. In contrast, the size of the focal region generated by a traditional concave spherical transducer is about 10 times the wavelength, and the pressure amplitude gain is generally lower than 200. The researchers suggest that the level of intensity channeled through the tighter focal region of the new transducer may be a significant improvement in HIFU for targeted cancer treatments. The researchers are now planning to build a multiphase lattice Boltzmann method (LBM) model to study bubble dynamics, cavitation, and collapse jetting using the USCR. The study was published in the March 2017 issue of Journal of Applied Physics.

“The size of the focal region generated by conventional spherical concave transducers is restrict-

ed by acoustic diffraction to usually the order of the ultrasound wavelength, but this does not meet the needs of more sophisticated treatments,” said Dong Zhang, PhD, of the NJU Institute of Acoustics. “Because it is crucial to reduce the size of the focal region while supplying sufficient ultrasonic energy, we were prompted to design a new kind of ultrasonic transducer.”

HIFU technology is based on nonlinear acoustic mathematical optimization methods to analyze and simulate the propagation of sound in material. The information is then used to enhance the shape of an acoustic lens so that that ultrasound pressure is focused precisely on the location of the tissue to be ablated, while the surrounding tissue retains as little damage as possible.

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The E1 is a new hand-carried B/W ultrasound model equipped with comprehensive basic functions, which enhances its competitiveness as an entry-level ultrasound model. It not only provides satisfying diagnostics and image quality, but also offers a smooth workflow experience to users.

The PDC measures DAP, DAP-rate, Dose and Dose rate of installed DAP systems, and solves problems relating to variation of DAP, Patient Dose system and AEC calibration. It allows a full check of installed DAP meter calibration over a range of field sizes, shapes and beam qualities.

The Lumify allows clinicians to download the cloud-enabled Lumify Android ultrasound app on a compatible device, connect the USB transducer, and start scanning. It allows clinicians to store, review and share patient exams and high-quality images and clips right from their device.

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Ultrasound/MRI Fusion Scanner Advances Prostate Imaging new micro-ultrasound/MRI fusion application offers advances in prostate imaging and biopsy guidance.

The application allows urologists to import radiological reports from Magnetic Resonance Imaging (MRI) scans, or annotated MR images with MRI-identified lesions, co-aligned with the live real-time micro-ultrasound scan. The urologist can also use the MRI-identified lesions during the total biopsy procedure.

The FusionVu application was developed by Exact Imaging (Markham, ON, Canada; www.exactimaging.com) and runs on the company’s ExactVu platform.

According to Exact Imaging this provides the urologist with a total urological solution that can be upgraded, and scaled up.

The system is based on standard urological workflows, and does not need any additional hardware or radiological software to run. FusionVu is intended for patients with exclusive anterior lesions, or those

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with previous negative biopsies.

Exact Imaging’s ExactVu micro-ultrasound platform works at 29 MHz, and has received the European Union (CE Mark), US FDA 510(k) approval, and the Health Canada license. The system can be used for systematic biopsy protocols, and can visualize areas of interest in the prostate and target biopsies in those areas.

President and CEO of Exact Imaging, Randy AuCoin, said, “At least 70% of prostate cancer is located in the peripheral zone, which is exquisitely visualized and targetable with the 70 micron resolution of the ExactVu micro-ultrasound system. Our evidence-based PRI-MUS protocol is easily applied to help urologists identify and characterize regions and then to target those suspicious regions.”

Image: The micro-ultrasound platform enables urologists to perform targeted biopsies using standard urological workflows (Photo courtesy of Exact Imaging).

PET Imaging Agent Identifies Recurrent Prostate Cancer diagnostic agent for positron emission tomography (PET) imaging can help identify suspected sites of prostate cancer recurrence. Axumin (fluciclovine) is a synthetic L-leucine analogue radiolabeled with fluorine 18 (18F), which enters cells via amino acid transporters. Since tumor cells exhibit enhanced amino acid transport in order to help them access the materials they need to grow and spread, they take up Axumin more than healthy tissues, providing physicians with a better tool for locating recurrent prostate cancer sites, based on a detected rise in the levels of prostate specific antigen (PSA) following initial therapy.

Axumin has a short synthesis time and a long half-life, which eliminate the need for an onsite cy-

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clotron during the PET scan. The distribution of Axumin in the body also differs from other tracers, with a low native brain uptake compared to Fludeoxyglucose (FDG). Axumin is a product of Blue Earth Diagnostics (London, United Kingdom; www.bluearthdx.com), and has been approved by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA).

“An imaging agent with sufficient diagnostic performance to adequately detect and localize recurrent prostate cancer can provide referring physicians with actionable information to guide biopsy, and inform management decisions for their patients,” said David Schuster, MD, director of the division of nuclear medicine and molecular imaging

at Emory University (Atlanta, GA, USA). “The product will be convenient for patients and imaging facilities, as it can be made widely available and the entire imaging procedure can typically be completed in less than 30 minutes.”

A variety of imaging techniques and tests are currently used to diagnose and monitor prostate cancer, including PSA blood tests, magnetic resonance imaging (MRI), PET, SPECT, and CT scans.

Each method has strengths and weaknesses, but there is no single method that is able to successfully identify and monitor primary tumors, metastatic lymph nodes, and bone lesions, which can cause the patient to undergo unnecessary treatments or painful biopsies.

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Medical Imaging International

Patent Issued for 3D Skeletal Ultrasound Visualization Technology newly-approved patent for 3D ultrasound skeletal imaging can improve the detection of skeletal irregularities in unborn babies. By way of enabling clinicians to obtain more accurate views of the skeleton of unborn babies during pregnancy, the technology can help them find spontaneous fractures and skeletal malformations in the fetus, as well as measure bone structures.

The new feature called SkeletalView, is part of ContextVision’s (Stockholm, Sweden; www.contextvision.com) 3D rendering product called REALiCE, and features a volume enhancement and rendering package for 3D and 4D fetal volume visualization that includes GOPiCE volume enhancement, 3D scan conversion, and trueto-data rendering.

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ContextVision specializes in developing image analysis and artificial intelligence technologies and intends to help clinicians interpret medical images more accurately, and help them improve diagnosis and treatment. The company’s products include innovative image enhancement software for 2D/3D/4D ultrasound, Magnetic Resonance Imaging (MRI), X-Ray and mammography, and are used by large medical equipment manufacturers around the world.

VP of ContextVision, Fredrik Palm, said “Our visualization product, REALiCE, has received significant industry attention since its launch. SkeletalView adds further diagnostic value, and we expect that the product will be even more attractive to manufacturers of medical imaging equipment go- Image: A collection of images obtained using REALiCE (Photo courtesy of ContextVision). ing forward.”

System Enhances Remote Monitoring for Digital Radiography

Radiotherapy Hub Idle Despite Soaring Cancer Rates in Continent

cloud-based remote monitoring system for Digital Radiography (DR) is able to detect and report critical issues in real-time and provide ongoing performance metrics and detailed reports for wireless flat-panel detectors. The reports can be accessed and reviewed remotely for data stored on the Internet cloud.

The AeroRemote monitoring solution for AeroDR wireless flat panel detectors was launched by Konica Minolta (Tokyo, Japan; www.konicaminolta.com).

The solution provides secure, real-time information that allows the system to be used optimally, with minimal service interruptions. The monitoring solution can also evaluate the performance of the staff using the DR system, and can provide immediate notification of various critical events. The system reports are built monthly, and including the system name, the name of the user, details of usage and productivity data.

AeroRemote uses predictive analytics to enable support personnel to assess hardware status, and plan maintenance in case of unexpected issues.

This can reduce downtime by enabling scheduling servicing, before a breakdown occurs. Monitoring of AeroDR system parameters, and events includes drop detection and component performance, and encourages correct handling by users. If a DR panel is dropped or accidentally damaged AeroRemote diagnostic information on panel performance can be used to assess any damage.

modern oncology clinic in Tanzania, donated by the Indian government, is currently lying idle due to a lack of funds, and staff.

The oncology wing was intended as a regional hub for cancer treatment, and also includes a number of bunkers for the safe storage of radioactive material. The leading cause of cancer-related deaths in Tanzania is cervical cancer and currently most women are diagnosed only at an advanced stage leading to a mortality rate as high as 44%.

Equipment at the clinic that is part of the Bugando tertiary care and teaching hospital (Mwanza, Tanzania, www.bugandomedicalcentre.go.tz) includes a cobalt-60 radiotherapy radiotherapy device, linear accelerators, and a cryotherapy machine. According to local doctors and health workers, the acute rise in cancer cases may be related to environmental changes, high HIV rates, poor health education, improved diagnostics and the increased lifespan of the population.

Dr. Nestory Masalu, a medical oncologist who helped set up the oncology wing in 2009, intends to extend the cancer treatment program when it is up and running, construct a 120-bed cancer ward, and train additional oncology staff.

CEO of the Pink Ribbon Red Ribbon, a US-based non-profit, Celina Schocken, commenting about the incidence of cervical cancer in Tanzania, said, “This disease is killing more women than die in childbirth. It has an incredibly high disease burden and gets very little donor funding.”

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CT Platform Improves Operational Cost-Efficency new computerized tomography (CT) platform focuses on improving the operating cost-efficiency and profitability of imaging service providers. The Somatom go. platform, introduced by Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com), offers two scanner variants: the 32-slice Somatom go.Now, which is intended for radiology providers who want to establish a new CT department, and the Somatom go.Up, which is equipped with a wider detector that can provide up to 64 CT slices. The scanners can be controlled via a handheld tablet, allowing medical staff to stay with patients while preparing the scan. In addition, the computer hardware previously housed in the external control room is now directly integrated into the scan-

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Medical Imaging International August-September/2017

ner gantry, obviating the need for a separate control room.

Standardized procedures enable users to run the required scan with just a few inputs; automated post-processing facilitates scanner operation, enabling staff with less training to perform examinations, such as in night shift emergencies.

The standardization also helps radiologists to avoid errors, the need for repeat scans, and unnecessary wait times. The software also adds additional assurance with regard to the diagnostic quality of the images, as well as offering faster scanning, which is especially important for lung imaging.

“Siemens Healthineers held interviews and workshops with over 500 radiologists, radiology as-

sistants, CFOs, patients, and referring physicians from various countries to collaboratively identify key characteristics of an ideal CT scanner,” said André Hartung, head of CT at Siemens Healthineers.

“The result is a platform that offers high quality standards and responds to current needs for efficient workflows and to clinical and financial requirements.”

The Somatom go. CT platform is available with the integrated Siemens Healthineers Connect Plan, a multi-year service concept that provides low operating costs and innovative technologies that help providers to budget reliably, with lower running costs overall, thus helping to improve efficiency and patient care with corresponding high financial reliability.

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The Senographe Pristina allows technologists to position patients while facing them, as well as move the tube head to a parked position away from their head. The contrast can be modified to accommodate user preferences, and the console and gantry are ready for use within minutes.

The ACUSON P500 FROSK edition offers new high-end imaging technology in a compact notebook format. Weighing less than seven kilograms, it can be easily carried and positioned in almost any clinical environment, helping clinicians make quick decisions in difficult scanning conditions.

The CARMEX features a microprocessor-controlled X-ray generator operating at high frequency. It can be equipped with either stationary or rotating anode X-ray tubes and is ideal for various applications including orthopedics, urology, cardiology, interventional radiology and ERs.

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PET-MRI Hybrid Enables New Approaches for Neuro-Imaging Scans ybrid imaging techniques that combine Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) make use of the detailed images of human anatomy that MRI can provide, together with assessments of tissue function characteristics provided by PET imaging.

The new PET-MRI technique and other advanced neuro-imaging modalities, intended for the early diagnosis of conditions such as dementia and stroke are being displayed at the RadiologyAsia 2017 conference (Singapore; www.radiology asia.com). The conference will host advanced medical imaging experts, and is taking place on May 19-20, 2017. The conference theme is “Bringing state-ofthe-art imaging into clinical practice.”

The occurrence of dementia among an aging population is on the rise, and as the disease progresses it can result in ever increasing neuro-degenerative problems for patients. For this reason, early diagnosis is critical for improved patient outcomes. The new PET-MRI technology provides both volumetric imaging information, as well as metabolic data for the diagnosis of early dementia.

PET-MRI and the other new imaging techniques are already enabling clinical researchers to evaluate new drug therapies in clinical trials, and treat dementia and other conditions early, before they result in significant morbidity.

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Image: Innovations in PET-MRI imaging techniques are proving useful for noninvasive diagnosis of medical conditions such as early dementia (Photo courtesy of Getty Images).

Echotherapy Option Addresses Breast Fibroadenomas n innovative system uses high intensity focused ultrasound (HIFU) for the non-invasive treatment of breast fibroadenomas.

The Theraclion (Paris, France; www.theraclion.fr) EchoPulse device is based on ultrasound both for the image-guided targeting system and for the delivery of HIFU for tissue necrosis. The system includes an ultrasonic transducer, an amplifier, a visualization and treatment unit (VTU), and an interchangeable cooling system (TH-Kit), which ensures both cooling and coupling functions. The EchoPulse is designed to provide optimal image quality, a milimetric range accuracy of wave shots, and step-by-step procedure control via a touch screen monitor.

The VTU head includes an ultrasound transducer for real-time monitoring of the target area, an HIFU emission device used for treatment, an articulated arm for easy positioning on the treatment area, and a motorized head which is can perform

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not only sagittal and transverse slices, but also micro-movements. Other advantages offered by the system are non-invasive, scarless treatment and conscious sedation for the patient; fast, efficient, and harmless procedures for practitioners; and lower costs of hospitalization for medical centers.

“HIFU technology is exciting because it has the potential to provide patients with an alternative to surgery, avoiding a scar, with minimal interruption in their normal daily activity,” said David Brenin, MD, chief of breast surgery at the University of Virginia, and principal investigator of the U.S. trial for the Echopulse. “An ultrasound transducer generates the energy over a broad surface area and focuses it underneath the skin. At the focus point of the energy, the tissue is heated up to about 60 degrees celsius, and there’s also a physical disruption that occurs from the sound energy itself.”

“We believe that patients are searching for alter-

natives to invasive surgery that are outpatient, of short duration, generate minimal or no post-treatment pain, and no scarring,” said David Caumartin, CEO of Theraclion. “There are approximately 400 thousand surgeries to remove breast fibroadenomas in the United States each year. This clinical trial is a significant step toward bringing our Echopulse echotherapy to U.S. patients.”

Fibroadenoma is the most widely spread breast benign tumor, with as much as 10% of women at risk of developing it in their lifetime; it also represents more than half of breast biopsies. It affects women of all ages, but is a lot more frequent with women under 30. The pathology is often found during a medical examination or by self-palpation, and radiologic images using mammography and ultrasound are used to confirm the diagnosis. In some cases, a micro biopsy is necessary to confirm its benign nature.

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RADIATION PROTECTION SYSTEM

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The DR Tablet Solution features wi-fi capability that allows end-users to communicate wirelessly with both the CXDI detector and the DICOM network. This offers the ability to acquire images from the CXDI detector and send the previous images simultaneously to PACS.

The Xpress CR REGIUS Model 210 can process up to 100 plates per hour for maximum performance. It provides the flexibility to separate the location of the consoles and the readers to allow for the same fast and thorough image checking as with conventional systems.

The Portegra2 is a ceiling-suspended system for the protection of the head, eyes, thyroid gland, upper arms and extremities from scattered radiation.

Featuring an optimized design, maximum safety and high flexibility, it is suitable for use in both hospitals and radiological practices.

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Medical Isotope Production in the U.S. to Begin Within a Year nce operational, the University of Missouri Research Reactor (MURR; Columbia, USA; www.murr.missouri.edu) will be capable of supporting nearly half of U.S. demand for molybdenum-99 (Mo-99), which currently must be imported from outside North America.

MURR and its partners Nordion (Ottawa, Canada; www.nordion.com) and General Atomics (GA; San Diego, CA, USA; www.ga.com) have announced that MURR’s license amendment request (LAR) has been submitted to the U.S. Nuclear Regulatory Commission, a critical step towards implementing domestic U.S. production of Mo-99. Once approved, MURR will begin producing Mo-99 using selective gaseous extraction (SGE), a proprietary technology developed by GA to extract the isotope from low enriched uranium targets.

The patented approach will produce Mo-99 of high specific activity, while avoiding the production of liquid uranium waste, a significant problem with existing technologies that require highly enriched uranium (HEU). The extracted Mo-99 will be sent to Nordion for final purification and distribution to radiopharmaceutical manufacturers, after which it

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will be distributed to hospitals and medical facilities around the world. Nordion will continue to maintain its conventional Mo99 processing capacity through March 31, 2018, in the event of a significant global shortage of Mo-99.

“This LAR submission shows the Nuclear Regulatory Commission that we will have all of the technology, expertise, and safety measures needed to begin producing Mo-99 in place and ready to go once approval has been received,” said Ralph Butler, executive director of MURR. “As a public research institution, we are proud to play a partnership role with GA and Nordion in helping America secure a new, domestic source of Mo-99.”

The most important medical isotope, technetium-99m (Tc-99m), is obtained from the decay of its parent Mo-99, and is used in more than 80%

of all nuclear medicine procedures. Mo-99 is packed into source containment vessels and distributed to hospitals, where nuclear medicine specialists can draw off the Tc-99m as needed for about a week. Because of its unstable nature, Mo-99 does not occur naturally and is traditionally produced using HEU in research reactors in Canada, the Netherlands, Belgium, France, Australia, and South Africa.

Image: The University of Missouri Research Reactor (Photo courtesy of MURR).

PET Technique Predicts Early Immunotherapy Response esearchers have demonstrated a new PET imaging technique, which can find tumors that respond to immune checkpoint inhibitors, by measuring the activity of an immune cell protein.

The new technique can measure the protein granzyme B that immune cells release when they kill cancer cells, enabling the researchers to find those tumors that responded to immune checkpoint inhibitors in the early stages of treatment. Immunotherapies treatments do not work in most patients, and could instead be treated using other therapies, and be spared the increased risk of side effects.

The research was published online on April 30,

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2017, in the journal Cancer Research by researchers from the Harvard Medical School (HMS; Boston, MA, USA; http://hms.harvard.edu), and the Massachusetts General Hospital (MGH; Boston, MA, USA; www.massgeneral.org).

The researchers first designed a probe that binds to granzyme B, and attached it to a radioactive atom.

They then imaged the entire body using Positron Emission Tomography (PET) scanning to find where immune cells were actively releasing granzyme B. The results showed that a high PET signal correlated with a positive response to therapy, and tumors that subsequently regressed.

Research author, professor of radiology Umar

Mahmood, MD, PhD at Harvard Medical School, said, “The ability to differentiate early in the course of treatment patients who are likely to benefit from immunotherapy from those who will not, can greatly improve individual patient care and help accelerate the development of new therapies. In our study, we found a marker that was highly predictive of response to immunotherapy at a very early time after starting treatment, and we were able to design an imaging probe to detect this marker and accurately predict response noninvasively. Further, therapeutics that achieve high levels of granzyme B release can be advanced faster and those leading to low granzyme B release can be altered or eliminated.”

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Medical Imaging International

MRI Scans Help Spot Persistent HIV in Brain new study suggests that diffuse white matter signal abnormalities (DWMSAs) in HIVinfected individuals with neurological problems should raise suspicion of possible cerebrospinal fluid (CSF) discordance.

Researchers at University College London (UCL, United Kingdom; www.ucl.ac.uk) and Central and North West London NHS Foundation Trust (United Kingdom; www.cnwl.nhs.uk) conducted a retrospective study involving 46 HIV patients (median age 45 years) who were investigated for cognitive problems between 2011 and 2015, and who underwent a concomitant diagnostic lumbar puncture (LP). Clinical and neuroimaging variables – associated with CSF discordance and/or escape – were identified using multivariate logistic regression.

The results showed that 24 (14.7%) LPs in 22 patients showed CSF discordance, of which 10 LPs in nine patients represented CSF escape, with both CSF discordance and escape associated with DWM-

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SAs on cranial MRI. Patients with definite signs of DWMSAs were also 10 times more likely to have HIV in the brain than those with normal white matter appearances. All seven patients with CSF escape had been diagnosed with HIV over seven years prior to the LP. The study was published on March 13, 2017, in Clinical Infectious Diseases.

“Before we had effective treatments for HIV, AIDS often led to dementia and other problems in the brain. Thankfully this is less common now that we can treat HIV, but up to half of HIV patients still report cognitive problems,” said senior author Professor Ravi Gupta, MD, of UCL, and colleagues. “At the moment we have to perform a lumbar puncture to confirm this; this is quite an invasive procedure that requires patients to stay in hospital for several hours.”

“HIV treatments have come a long way, but patients whose HIV is suppressed by drugs can still have cognitive problems due to HIV-related inflam-

mation,” concluded Professor Gupta. “MRI scans can help to diagnose these patients, whether showing an elevated risk of HIV-related problems or finding a different cause that can then be treated.

Where HIV has spread to the brain, we can change the treatment regime to add drugs that cross the blood-brain barrier more effectively to control the infection.”

Human immunodeficiency virus (HIV) can continue to replicate in disparate compartments during suppressive antiretroviral therapy, with up to 10% of individuals who are peripherally suppressed showing detectable HIV RNA in CSF, which can cause neurological problems. Reasons for this include intermittent adherence and treatment interruption leading to viral rebound. There are also data on inadequate control in CSF due to regimens of suboptimal potency, for example, protease inhibitor (PI) monotherapy, or triple therapy with drug resistance, but in many cases the cause is unclear.

NE DES W IGN

Researchers Develop PET Probe to Assist Pulmonary Fibrosis Patients

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esearchers have developed a Positron Emission Tomography (PET) imaging probe that can help diagnose and stage pulmonary fi-

brosis.

Pulmonary fibrosis is a lung disease that may in part be caused by exposure of patients to pollutants, or from other diseases, and causes the buildup of scar tissue. This stiffens the lung tissue and restricts oxygen absorption and breathing. The condition can lead to death in patients between three and five years.

The researchers from the Massachusetts General Hospital (MGH; Boston, MA, USA; www.mgh.harvard. edu) published their results in the April 2017 issue of the journal Science Translational Medicine.

The collagen-targeting probe, called 68Ga-CBP8, was able to bind to the lung scar tissue of animal models indicating the extent of fibrosis. The researchers also showed how fibrosis could be reduced in animals using an anti-fibrotic drug. The researchers also used human lung tissue, and found that the probe could differentiate between stable pulmonary fibrosis and progressive fibrosis.

Experiments using another model showed that there was increased uptake of the probe in areas where there was more extensive fibrosis. This model was also able to track disease progression over time.

Co-corresponding author of the paper, Michael Lanuti, MD, from the MGH Division of Thoracic Surgery, said, “The ability of molecular PET imaging with this probe to detect early-stage fibrosis would allow us to begin treatment when it would be most effective. This probe may also be able to distinguish new, active fibrosis from stable disease, which would allow clinicians to better tailor therapy to individual patients. And since response to therapy is difficult to ascertain with high-resolution CT scanning, PET molecular imaging may be a more sensitive way to detect changes in active fibrosis.”

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The iXRS iDR features a radiographic stand with four motorized joints and pre-programmed data for automatic positioning. It provides high-quality digital radiographic images with reduced dose, and has been specially developed for moderate budgets and small spaces.

The Selenia Dimensions uses breast tomosynthesis technology for a rapid four-second scan time and low patient dose. It is the world’s first and only tomosynthesis-guided biopsy and delivers exceptionally sharp images, as well as seamless transition between imaging modes.

The ATRAD M Series is a mobile radiography system that is compact and flexible enough to cover radiographic examinations at the patient’s bed.

The system is particularly designed for small space management in clinics and hospitals.

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Brain Abnormalities Discovered in Bipolar Patients he results of a new global MRI study show thinning of gray matter in patients with bipolar disorder. The researchers used the Magnetic Resonance Imaging (MRI) data from their study to build a roadmap of bipolar disorder, and the affects this condition has on the brain. The brain regions most affected by the disorder are used for inhibition, and emotions.

The research was part of the international consortium ENIGMA (Enhancing Neuro Imaging Genetics Through Meta Analysis), and was led by the University of Southern California Keck School of Medicine (USC; Los Angeles, CA, USA; http://keck.usc.edu) Stevens Neuroimaging and Informatics Institute. The research findings were published in the May 2, 2017, issue of the journal Molecular Psychiatry. For their study, the researchers used MRI scans of 2,447 adults suffering from bipolar disorder, as well as scans from 4,056 healthy control subjects.

The results of the study showed thinning of brain gray matter in patients with the disorder, compared to the healthy control subjects. The researchers found that the greatest deficits were in the frontal and temporal regions of the brain controlling inhibition and motivation.

According to the researchers, the clear and consistent changes in key brain regions provide insight into the underlying mechanisms of the disorder, and could enable future research into new medications and treatments.

Senior author of the study, Ole A. Andreassen, professor, Norwegian Centre for Mental Disorders Research, University of Oslo (Oslo, Norway; www. med.uio.no/norment/english), said, “We created the first global map of bipolar disorder and how it affects the brain, resolving years of uncertainty on how people’s brains differ when they have this severe illness.”

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Image: Research shows bipolar patients tend to have gray matter reductions in frontal brain regions involved in self-control (orange colors), while sensory and visual regions are normal (gray colors) (Photo courtesy of the ENIGMA Bipolar Consortium/Derrek Hibar et al.).

Surgical Navigation System Facilitates Neurosurgery Procedures n advanced navigation solution offers neurosurgeons enhanced workflows and more comprehensive data integration.

The StealthStation S8 surgical navigation system, the latest iteration of the Medtronic (Dublin, Ireland; www.medtronic.com) StealthStation image guidance platform, combines hardware, software, tracking algorithms, various image data, and specialized surgical instruments to help neurosurgeons plan their procedures. Intuitive software workflows provide new tools for advanced visualization that allow the surgeon to also use the data intraoperatively, with interfaces to iMRI, iCT, C-arms, and the Medtronic O-arm surgical imaging system that helps orient surgeons to the patient’s anatomy.

Improvements in patient registration allow the

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surgeon even more flexibility in data integration, such as touch and trace techniques within the same registration process, while providing quantitative feedback. The combined patient data and segment structures are translated into three-dimensional (3D) images displayed on two high-definition 27” touch screen monitors. An intuitive user interface support multi-touch gestures like pinch-and-zoom and drag-and-drop, allowing user to create, store, and simulate progression along one or more surgical trajectories.

StealthStation offers both optical and electromagnetic surgical instrument tracking, integration with external devices such as microscopes and ultrasound, a broad array of instrument offerings, and core software applications for cranial neurosurgery

procedures, including biopsy, resection, and deep brain stimulation lead placement. Both single and dual cart configurations are available for greater flexibility, and wireless connectivity to hospital and medical devices allows the import and export of exams from anywhere within the hospital network.

“The StealthStation S8 demonstrates Medtronic’s continued commitment to innovation, helping surgeons make critical decisions and enhancing the OR environment for all surgical staff,” said Brett Wall, senior vice president and president of Medtronic’s Brain Therapies division. “We look forward to seeing how this next generation of the Stealth system will contribute to the continued transformation of how neurosurgeons treat brain and spine disorders around the world.”

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Massive Imaging Database Created to Aid Research large healthcare system in the U.S. has announced the creation of a massive, anonymous imaging database that will integrate clinical imaging and electronic health records using data from more than 1 million patients.

The goal of the project is to dramatically improve clinical care and translational research, and enable clinicians to investigate patterns and traits of specific diseases or conditions. The project will help clinicians

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find common features among large groups of patients, and identify genetic or other similarities that could lead to new diagnostic techniques and treatments.

The Imaging Research Warehouse (IRW) was developed by the Mount Sinai Translational and Molecular Imaging Institute (TMII) of the Mount Sinai Health System (New York, NY, USA; www.mountsinai.org).

The IRW is intended to advance research in mammography, prostate

cancer, genomics, spine injuries, neuro-degenerative diseases, and bowel disease, and has the potential to change the way radiologists read and collect data. Together with the help of machine learning algorithms, radiologists could use the system to better evaluate known abnormalities in imaging scans. Other possible outcomes include new and more accurate Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) imaging protocols and techniques.

Medical Imaging International

Vice Chair, Radiology, Mount Sinai Health System, David Mendelson, MD, professor at the Icahn School of Medicine at Mount Sinai, said, “The Imaging Research Warehouse is a unique resource that will provide large volumes of de-identified images to the research community. This model fills a gap in the new world of healthcare ‘big data.’ The data contained within patients’ radiological images is hard to make use of, and this warehouse is the solution to expose this information for analysis.”

Image-Guided Platform Provides Integrated Cardiac Therapy Solutions next generation cardiac care image-guided therapy platform features optimized system integration and improved performance for enhanced stenting procedures.

The platform is intended to facilitate improved and more personalized interventional cardiology procedures and improve patient care cost-effectively.

The Royal Philips (Amsterdam, Netherlands; www.philips.com) Azurion image-guided therapy platform is the center of an integrated solutions portfolio and supports a wide range of configurations for routine high-volume and advanced image-guided therapy procedures. Azurion integrates data from patient health records, imaging systems, interventional devices, and navigation tools. Philips has also unveiled the iFR Roadmap technology for

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interventional labs that enables realtime navigation through vessels and coronary arteries and facilitates the treatment of coronary artery disease.

Ronald Tabaksblat, business leader Image Guided Therapy Systems at Philips, said, “As we celebrate 40 years of innovation in angioplasty, it’s incredible to see how far we’ve come. From guiding the first balloon angioplasty catheters to aiding stateof-the-art interventions of today, and tomorrow, with the introduction of Philips Azurion, our next-generation image guided therapy platform. We are dedicated to dramatically transforming our technologies to better address physician and patient needs. At EuroPCR, we’re demonstrating this commitment with our integrated solutions that seamlessly connect people, technologies, and care protocols across the health continuum.”

Image: Functional Magnetic Resonance Imaging (fMRI) brain scans intended to identify biomarkers for autism (Photo courtesy of SpectrumNews).

Siemens in MR Workflow Alliance in the U.S. iemens has entered into agreement with a U.S.-based firm to cooperatively sell the newest version of an innovative cloud-based CMR workflow solution.

The browser-based Cardiovascular Magnetic Resonance (CMR) software solution combines viewing and an analysis of medical images, and reporting in one cloud-based platform.

Under the agreement between Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) and HeartIT (Durham, NC, USA; http://heartit.com) both companies will sell the latest version of the Precession zero-footprint CMR solution.

The Precession has both US FDA clearance and the CE Mark (Conformité Européenne) approval, and fea-

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Medical Imaging International August-September/2017

tures WebPAX technologies, and multi-user collaboration and accelerated image post-processing over the Internet cloud. Precession also includes post-processing tools for quantifying cardiac ejection fraction, blood flow velocities, auto-calculation of LV and RV volumes, 3D multi-planar reconstruction, and T1/T2 relaxation times. The solution also provides realtime cloud-based sharing of diagnostic-quality CMR and CCT scans, and single-mouse-click de-identification of patient data.

Precession supports detailed structured reporting in both English and German, and is intended to improve the efficiency of reading CMR imaging procedures. Clinicians can use all fields in the reports for data mining.

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The AirDRc Gadox provides integrated AED (Automatic Exposure Detection) to allow for seamless integration into new or existing X-ray rooms. The detector has an active area of 17 inches x 17 inches, which eliminates the need for rotation and offers a more efficient workflow and throughput.

The Nucline TH is a digital, high resolution, sfov gamma camera for thyroid, heart, mammo and small organ imaging. It comes with a lightweight motorized detector stand and a wide range of easily exchangeable collimators, along with an integrated ECG triggering device.

The Ingenuity TF offers a variety of patient-specific methods and tools to facilitate optimal management of both image quality and radiation dose. It offers capabilities to reconstruct a PET image in as fast as 30 seconds per bed, and can acquire data for typical procedures within five minutes.

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SPECT/CT Could Prevent Unnecessary Surgery for Kidney Tumors esearchers have shown that a non-invasive imaging exam, 99mTc-sestamibi SPECT/CT, together with a regular CT or MRI scan, can prevent unnecessary surgery for many patients with benign kidney tumors.

The 99mTc-sestamibi Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) scan provides additional diagnostic data, when used with conventional CT and Magnetic Resonance Imaging (MRI) scans, and helps clinicians distinguish between malignant and benign kidney tumors.

The results of the study were published in the April 2017 issue of the journal Clinical Nuclear Medicine. The study included 48 patients diagnosed with a kidney tumor using regular CT or MRI. The patients underwent an additional sestamibi SPECT/CT scan at Johns Hopkins University School of Medicine (Baltimore, MD; www.hopkinsmedicine.org) before surgery. Radiologists graded the tumors in both the conventional and the sestamibi SPECT/CT images as benign or malignant using a 5-point scale.

The researchers found that adding the sestamibi SPECT/CT scan helped identify seven out of nine benign tumors. The research also suggests that the sestamibi SPECT/CT test is a faster, and less expensive option than surgery. In the US alone, surgeons surgically remove benign kidney tumors in 5,600 patients every year.

One of the developers of the new approach, Steven P. Rowe, MD, PhD, at Johns Hopkins, said, “As radiologists, we have struggled to find noninvasive ways to better classify patients and spare unnecessary surgery, but this has not been easy. Sestamibi SPECT/CT offers an inexpensive and widely available means of better characterizing kidney tumors, and the identical test is now being performed as part of a large trial in Sweden, for which the first results have just recently been published and appear to confirm our conclusions.”

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Image: A new study found the use of a non-invasive 99mTc-sestamibi SPECT/CT imaging exam together with conventional CT or MRI could prevent thousands of patients undergoing unnecessary surgery for benign kidney tumors (Photo courtesy of iStock).

HD Tomosynthesis Provides Heightened Sensitivity ew technology applies iterative and machine learning algorithms to provide a clearer, more concise three-dimensional (3D) breast reconstruction during digital breast tomosynthesis (DBT).

Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) High Definition (HD) DBT technology incorporates enhanced multiple parameter iterative reconstruction (EMPIRE) software, which builds on the company’s established DBT platform, offering a wide sweep of 50 degrees and a total of 25 projections. The wide range provides a perspective required for optimal

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depth resolution, which cannot be achieved with smaller angles. The state-of-the-art panel detector also offers readout at full resolution without the need for pixel binning.

EMPIRE technology also upgrades image quality by reduction of noise and artifacts, enhanced detection and display of micro-calcification morphologies, and improvements in subcutaneous tissue and skin line visualization. EMPIRE also includes Insight synthetic software, which visualizes tomosynthesis volumes in 2D and 3D as obtained from the EMPIRE 3D image set, providing surgeons with a functional navigational support tool that does not

subject the patients to an additional radiation dose.

“The 50-degree angle and 25 projections provide better image quality,” said Ana Maria Rocha Garcia, MD, of Povisa (Spain). “3D imaging gives you more information and a wider angle reduces the effect of overlapping tissue, which is the main problem of 2D mammography. This allows for a better diagnosis.”

EMPIRE is available with the Mammomat Inspiration mammography system, a highly flexible platform that offers a tailored tomosynthesis solution that optimizes clinical outcomes by supporting screening, diagnostics, stereotactic biopsy, and DBT. Medical Imaging International August-September/2017

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Medical Imaging International

Innovative Angiography System Supports Interventional Radiography n innovative robot-supported angiography system advances minimally invasive surgery, interventional radiology, and interventional cardiology in the hybrid operating room (OR).

The Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) Artis pheno angiography system is based on a the zen40HDR flat panel detector and the Gigalix X-ray tube, which provide the system with 2k imaging technology that offers a fourfold increase in resolution for 2D imaging, with up to 15% faster scan times in the body area.

This increase is made possible by syngo DynaCT 3D imaging, which uses less contrast agent during the imaging process; if the patient is sensitive to contrast agents, Artis pheno can also support CO2 imaging of the extremities.

The C-arm has a free inner diameter of 95.5 centimeters, which offers more space for handling adipose and moribund patients, while the system’s multi-tilt table can accommodate patients weighing up to 280 kilograms. The robotic construction provides a flexible isocenter that allows the C-arm to follow all table positions and provide the best possible imaging support for the patient’s treatment, presenting the target area of the body from virtually any angle. The end of the table can also be tilted in order to stabilize the patient’s blood pressure or to make breathing easier.

Optional application packages are available to suit complex cases. For example, up to ten vertebrae can be represented in 3D using syngo DynaCT

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Large Volume, giving surgeons a larger overview during spinal fusion procedures.

Another application, syngo DynaCT 360, can generate arge-volume images of the lung or the liver, including the anatomy of the tumor and the vessels leading to it, providing effective support for tumor transarterial chemoembolization (TACE), which involves supplying embolic particles coated with a chemotherapeutic drug via a catheter directly into the arteries leading to the tumor.

Another application, Syngo Needle Guidance, makes it possible to plan extensive procedures using orthopedic screws or surgical needles. Screw paths can be planned with precision, with an automatic path alignment function that automatically aligns the C-arm to follow them. A laser integrated in the image detector shows the surgeon the planned path, which helps improve both accuracy and speed in the OR and minimizes the rate of screw positioning errors in the spine.

Another new feature called StructureScout can adapt and optimize imaging parameters to best suit the material structure of the area being X-rayed, which enables even less radiation to be used, and also increases CO2 visibility when the table is tilted.

The system also supports effective hygiene management in the hospital environment thanks to an antimicrobial coating, CleanGuide technology, and large sealed surfaces with fewer spaces, which helps customers with system cleaning.

“We see a high number of multi-morbid patients with impaired kidney function in the angio suite,” said Professor Frank Wacker, MD, director of the Institute for Diagnostic and Interventional Radiology at Hanover Medical School (Germany; www. mh-hannover.de). “Shorter scan times help reduce the amount of iodinated contrast agent during 3D angiography in the thorax and abdomen by up to 15 percent.”

Image: The Artis pheno angiography system and tilt table (Photo courtesy of Siemens Healthineers).

CT May Replace Colonoscopy for Diagnosing Colitis Infections new study affirms that computerized tomography (CT) scans are a fast, reliable, and noninvasive mode of diagnosing immune-related colitis.

Researchers at Dana-Farber Cancer Institute (Boston, MA, USA; www.dana-farber.org), Boston University (BU; MA, USA; www.bu.edu), and other institutions conducted a retrospective study in 303 patients with advanced melanoma who received the monoclonal antibody agent ipilimumab between 2008 and 2015 and suffered gastrointestinal (GI) problems. In all, 33% of patients developed diarrhea during therapy, and 15% received corticosteroids for colitis. Among the patients with diarrhea, 48% underwent a colonoscopy and 46% underwent both a colonoscopy and a CT. The researchers then evaluated the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the CT scans, compared with the gold standard of colonoscopy with biopsy. The results showed that biopsy results validated the CT findings with a positive predictive value of 96%. In patients who had GI symptoms and a CT evaluation, CT was also highly predictive of the need for steroids to reach resolution of symptoms, with a positive predictive value 92%. The study was published on April 3, 2017, in Cancer Immunology Research.

“Differentiating between patients with mild symptoms and those who will progress to severe

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Medical Imaging International August-September/2017

and life-threatening colitis is difficult, especially because presentation can be subtle and easily confused with an infectious etiology,” concluded senior author oncologist Patrick Ott, PhD, of Dana-Farber Cancer Institute. “We conclude that CT is a fast, reliable, and noninvasive mode of diagnosing colitis, whereas colonoscopy and biopsy may not be needed to establish that diagnosis.”

Colitis can be life-threatening for patients treated with immune checkpoint blockade antibodies such as ipilimumab, which inhibits the programmed cell death protein 1 (PD1) mechanism in

T lymphocytes, allowing them to destroy cancer cells. Patients treated with these antibodies can develop GI symptoms, especially diarrhea, at any time during or after treatment. About one-third of patients develop mild symptoms, while 5-8% experience moderate to severe symptoms that can become serious. Currently, a colonoscopy with biopsy of the colonic mucosa is the only validated tool to confirm immune-related colitis.

Image: Research shows CT imaging could help detect immune-related colitis (Photo courtesy of Alamy).

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The Black Piranha identifies the probes and selects the optimum settings for measurements. It uses a tablet/laptop as an interactive display during the measurements, and performs instant realtime analysis to prepare a report on the go, with results stored inside the tablet/laptop.

The UP-DF550 features a dual film tray, which accommodates four film sizes, making it suitable for a variety of diagnostic modality printing tasks. It is equipped with two film supply trays, along with an output tray to sort out film prints of various sizes.

The Biograph mCT Flow enables continuous motion of the patient table, allowing for increased image quality, patient comfort and better performance. A large bore and large-capacity table support the exams of heavier patients, and offers space for additional therapy accessories.

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New Radiation Dosimeter Enhances Real-Time Features new dosimetry solution helps clinicians and hospital staff track their X-Ray exposure, in real time, on a monitor, with the help of bar graphs, and adapt their behavior accordingly to minimize unnecessary radiation exposure. The new device is designed for wearability, increased measurement accuracy, and a longer life cycle, and can be used for low-dose procedures, and even in hybrid Operating Room (OR) environments.

Unfors RaySafe (Billdal, Sweden; www.raysafe.com), a Fluke Biomedical company (Everett, WA, USA; www.flukebiomedical.com) developed the new RaySafe i3 device. RaySafe has developed and produced X-Ray quality assurance solutions since 2012. The devices are used to track and visualize radiation exposure and promote radiation safety.

Regulatory bodies are keen to reduce the radiation doses medical staff and patients are exposed to, and promote the As Low As Reasonably Achievable (ALARA) standard for this purpose. Clinicians undergo radiation safety training, but the dynamic nature of the working environment may lead to higher than necessary radiation exposure. The RaySafe devices provide medical staff with real-time insight into their personal exposure, and empower them to use the existing radiation reduction solutions they already have access to.

Personal dosimetry business area manager at RaySafe, Bart Leclou, said, “RaySafe i3 helps keep the medical staff in-the-know, at all times, about the level of radiation exposure, for themselves and their colleagues, in realtime. The decision to implement the RaySafe i3 shows a commitment and dedication by a department to keep their staff safe from excessive radiation exposure.”

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Image: The i3 device helps clinicians to track X-Ray exposure in real time, and enables them minimize unnecessary exposure (Photo courtesy of RaySafe).

Research Shows Connectivity Changes in Brains of Blind People esearchers have shown that the brains of people born blind, or those who became blind at a very early age, ‘rewire’ themselves to boost other senses and cognitive functions.

The researchers used Magnetic Resonance Imaging (MRI) multimodal diffusion-based and resting state brain imaging techniques to study 12 blind subjects, and 16 normally sighted individuals, all of whom were in the same age range.

The researchers from the Massachusetts Eye and Ear Center (Boston, MA, USA; www.masseye-

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andear.org) published the report online in the March 17, 2017, issue of the journal PLOS ONE. The researchers found structural and functional connectivity changes in the scans of the blind subjects. The changes included evidence of enhanced connections between areas of the brain that were not apparent in the control group. According to the researchers this is due to neuroplasticity, which allows our brains to adapt to experiences.

The researchers hope that the new insights will help them to develop improved rehabilitation efforts that will help the blind compensate for the

absence of visual information.

Lead author of the study, Corinna M. Bauer, PhD, Schepens Eye Research Institute at Mass.

Eye and Ear, said, “Our results demonstrate that the structural and functional neuroplastic brain changes occurring as a result of early ocular blindness may be more widespread than initially thought. We observed significant changes not only in the occipital cortex (where vision is processed), but also areas implicated in memory, language processing, and sensory motor functions.”

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Range of Ultrasound Innovations Advance Ob/Gyn Imaging range of new ultrasound tools enable simultaneous transparent, photo-realistic and 3D visualizations for Ob/Gyn ultrasound imaging.

The new tools are intended to allow clinicians to diagnose complex Obstetric (Ob) and Gynecological (Gyn) situations faster, and with more confidence.

The new TrueVue, GlassVue, and aRevealA.I. were developed by Royal Philips (Amsterdam, the Netherlands; www.philips.com), and are intended for use with the Philips EPIQ 7 and 5, and Affiniti 70 and 50 ultrasound systems.

TrueVue provides photorealistic, lifelike, 3D ultrasound images, with a

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virtual light source. The operator can move the light source anywhere in the 3D volume. GlassVue also has an internal light source, and provides an early and more transparent view than traditional ultrasound. GlassVue can also reveal internal structures in the fetus such as bone, and organs. The aReveal Anatomically Intelligent Ultrasound (AIUS) 3D fetal-face algorithm enables the user to automatically reveal or hide the fetal face in one touch.

The system enables clinicians to perform post-processing of exam parameters, and finalize images before transferring them to the Picture Archiving and Communication System (PACS). Philips also offers MaxVue for the EPIQ and Affiniti

systems that enable clinicians to view ultrasound images in 16:9 Full High Definition (FHD).

Maternal-fetal medicine specialist, Dr. Michael Ruma, Perinatal Associates (Albuquerque, NM, USA; http:// panm.com), said, “Philips’ latest technological advancement in Ob/ Gyn ultrasound is a novel tool allowing clinicians to further explore the anatomic evaluation of the fetus. A clinician’s relationship with our pa-

Medical Imaging International

tients is at its heart a personal one, especially during pregnancy. The ability to provide high-quality, lifelike images not only helps clinicians improve diagnostic confidence, but also supports the important connection between mother and fetus.”

Image: New visualization tools include TrueVue, which uses a virtual light source to provide more lifelike 3D ultrasound images (Photo courtesy of Philips Healthcare).

MRI Helps Detect pH Changes in Tumor Tissue new study demonstrates how hyperpolarized 13C-labelled zymonic acid (ZA) can be used as a magnetic resonance imaging (MRI) pH imaging sensor.

Researchers at Munich Technical University (TUM; Germany; www. tum.de) developed the pH imaging sensor using ZA marked with carbon13 in order to be visible in MRI images. In order to make pH values visible using ZA, the molecule is first hyperpolarized using microwaves at very low temperatures; a hot liquid is then used to quickly return the ZA to room temperature. The biosensor is then injected into the body, and the scan is performed immediately, as the hyperpolarization effect wears off in 60 seconds.

When inside the MRI, the magnetic field waves excite the nuclear spins of the ZA to oscillation. The reactions of the nuclei are then recorded, and the data is used to calculate frequency spectra, which in turn provide information about the chemical properties of the molecular surroundings of the nuclei. The pH value at any examined location in the tissue can be represented based on molecular changes in the ZA. The researchers have succeeded in showing that their method is sensitive enough to represent medically relevant pH value changes in the organism.

The researchers conducted studies in rat kidneys and subcutaneously inoculated tumors derived from a mammary adenocarcinoma cell line, generating in-vivo pH maps, and also

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successfully characterized ZA as a non-toxic compound predominantly present in the extracellular space.

The researchers also suggest that in contrast to current optical methods, which are limited to superficial penetration into the body due to the low transparency of tissue, there are no limitations to the depth of penetration for MRI. The study was published on May 11, 2017, in Nature Communications.

“Areas surrounding tumors and inflammations are usually slightly more acidic than areas surrounding healthy tissue, a phenomenon possibly linked to the aggressiveness of tumors,” said senior author TUM physicist Franz Schilling, PhD. “pH values are also interesting when it comes to evaluating the efficacy of tumor treatments. Even before a successfully treated tumor starts to shrink, its metabolism and thus the pH value of the surrounding area could change. An appropriate pH imaging method would indicate at a much earlier stage whether or not the right approach has been selected.”

The hyperpolarized spin state exists at very low spin temperature that are not in a thermal equilibrium with the temperature of the tissue, which leads to high magnetization of the spin ensemble, resulting in very high nuclear magnetic resonance signal intensity. The hyperpolarized spin state eventually returns to the thermal equilibrium temperature by depolarization.

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X-RAY DETECTOR

DIAGNOSTIC ULTRASOUND

TECHNIX

Teledyne DALSA

Alpinion Medical Systems

The TCA 6S enables operational flexibility and freedom of movement for the surgeon within the confines of the sterile area. Features include a large distance of the SID axis from the unit’s stand, motorized elevation reaching 500 millimeters, and wide C-arm’s insertion and span spaces.

The Remote RadEye is designed to fit into tight spaces that are too small to fit a complete imaging camera. Available in five different sensor modules, it is designed for portable NDT applications, but can also be used in fixed installations.

The E-CUBE 15 Platinum is designed to process 2D and Doppler data to improve Doppler performance while maintaining the 2D image quality. It delivers a high level of image performance with visualization features and intelligence analysis tools across a wide range of clinical applications.

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Optimal Therapy Discovered for Vocal Cord Cancer he results of a major study comparing radiotherapy treatment options for vocal cord cancer indicate new optimal radiation treatment therapies for the disease. Current treatment options for Early-Stage Glottic Cancer (ESGC) include both Conventionally-Fractionated Radiotherapy (CFX), and HypoFractionated Radiotherapy (HFX).

The study was published in the April 26, 2017, issue of the Journal of the National Cancer Institute by researchers from the Yale Cancer Center (New Haven, CT, USA; www.yalecancercenter.org). The researchers used clinical data from a large national database in the US, from the period 2004 to 2013, for the study. The study group consisted of 10,212 patients diagnosed with stage 1 or 2 glottic cancer. Most of the patients, 6,182 (60.5%) in number, were treated with CFX. The rest, 4030 patients (39.5%) were treated with HFX. The results of the study show that for patients treated with definitive radiotherapy for ESGC cancer, HFX radiotherapy treatment resulted in improved survival compared to CFX radiotherapy treatment. This was especially the case for patients with stage 2 ESGC. Lead author of the study, Assistant Professor Zain A. Husain, MD, said, “This is an important finding as the optimal fractionation for early stage glottic cancer has long been an area of controversy. These results strongly support hypofractionation as a preferred treatment approach. It is also reassuring to that our results show the utilization of hypofractionation has been increasing considerably.”

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Image: New research shows HFX radiotherapy treatment offers improved survival for patients with ESGC (Photo courtesy of Shutterstock).

MRI Reveals Spinal Atrophy Tied to MS Progression new magnetic resonance imaging (MRI) study among early stage multiple sclerosis (MS) patients reveals detectable cord gray matter atrophy in both the cervical and thoracic cord. Researchers at the University of California, San Francisco (UCSF; USA; www.ucsf.edu) and University Hospital Basel (Switzerland; www. unispital-basel.ch) enrolled 64 patients with early MS and 53 controls in an observational study. The MS patients (mean age 36.9, 26 women) had a mean duration from first symptom onset of 1.2 years, and a median expanded disability status scale (EDSS) score of 2. Among the healthy controls, the mean age was 37.4 and 38 were women.

MRI scans of the C2/C3 cervical spine among the

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early MS patients revealed a 14% reduction in gray matter area among patients diagnosed with progressive MS, compared with a 3% reduction in gray matter area among patients diagnosed with relapsing MS; the 3% decrease in gray mater area in the cervical spine was also significantly lower than in controls. Total spinal cord area matter was reduced by 10% among patients with progressive disease, but actually increased by a non-significant 2% from controls.

There was also a significant difference in white matter, reduced 9% in those with progressive disease compared with an increase of 3% among patients diagnosed with relapsing MS. The researchers did not find significant differences in the loss of gray matter in the spinal cord at the T9/T10

location among patients with or without spinal cord lesions, but there was a significant difference in spinal cord white matter. In addition, cervical and thoracic gray matter areas were not correlated with the number of spinal cord T2-lesions. The study was presented at the annual American Academy of Neurology meeting, held during April 2017 in Boston (MA, USA).

Historically in neuroscience, the vast majority of research effort has been invested in understanding and studying gray matter and neurons, while white matter has received relatively little attention, largely due to the lack of effective research tools to study white matter, even though it comprises about half the volume of the brain.

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Medical Imaging International

Digital Tomosynthesis Reduces Re-Excision in Breast Surgeries new study shows that digital breast tomosynthesis (DBT) can reduce surgical positive margins by offering a better view of lesion margins than mammography alone.

Researchers at the University of Turin (Italy; www.unito.it) conducted a study of 925 patients who had breast surgery between 2010 and 2015.

Of these, 685 were breast-conserving surgeries, while 240 were mastectomies. Prior to surgery, 537 patients were staged with digital mammography and ultrasound, and 388 were staged with digital mammography, ultrasound, and DBT. In the first group, 348 women had lesions two cm or smaller, and 189 had lesions larger than two cm; in the second group, 207 women had lesions two cm or smaller, and 181 had lesions larger than two cm.

Histology revealed that 7.9% of the patients had positive margins at histology. The re-excision rate for the first group was 10%, significantly higher than for the second group, who underwent DBT as well, which was 5%. Re-excision planning was also

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less extensive for patients in the second group, with one of 20 patients receiving a mastectomy, compared with 20 of 53 patients having mastectomies in the first group. The re-excision rate for lesions smaller than two cm was not statistically significant between the two groups, in contrast to larger lesions. The study was presented at ECR 2017, held during March 2017 in Vienna (Austria).

“Margin status is one of the most important predictors for local recurrence following breast cancer surgery, and accurate pre-operative staging helps to plan appropriate surgical treatment and reduce the consequences of re-excision,” said lead author and study presenter Alessia Milan, PhD. “These consequences can include emotional burden for the patient, a worse cosmetic outcome and higher costs.

Our findings suggest that DBT has a role in improving conventional imaging for preoperative breast cancer surgical treatment staging.”

DBT mammograms use low dose x-rays to create a three-dimensional (3D) image of the breast, which can then be viewed the in narrow slices, similar to computerized tomography (CT) scans. While in conventional 2D mammography overlapping tissues can mask suspicious areas, 3D images eliminate the overlap, making abnormalities easier to recognize. It is estimated that 3D DBT will replace conventional mammography within ten years.

Image: A new study shows digital breast tomosynthesis reduces cancer surgery re-excision rates (Photo courtesy of Carestream Health).

Studies Confirm Effectiveness of Stereotactic Neurosurgery

Study Compares Effectiveness of Diagnosis Rules

ew studies have confirmed the clinical effectiveness of a minimally invasive stereotactic neurosurgery system in treating brain cancer, other non-cancerous brain tumors, and neurological conditions.

The Leksell Gamma Knife developed by Elekta (Stockholm, Sweden; www. elekta.com) was featured in more than 15 scientific presentations at the annual meeting of the American Association of Neurological Surgeons (AANS) in Los Angeles, California, in the US, in April 2017. The head frame of the new Leksell Vantage Stereotactic system is made from a novel epoxy composite material designed to improve the speed, imaging quality, and patient comfort during neurosurgery procedures.

The new Leksell Vantage system is pending 510(k) clearance by US Food and Drug Administration, but received CE (Conformité Européenne) Mark clearance in March 2017, and will now be put into clinical practice in Europe for the first time in hospitals in France, the Netherlands, the UK, and Sweden.

VP of the Neuroscience portfolio at Elekta, Jesper Söderqvist, said, “Our Leksell Stereotactic System has been helping clinicians achieve outstanding patient outcomes for more than 60 years, and Vantage improves upon this gold standard platform to deliver uncompromising accuracy in stereotactic imaging and treatment. With potential for faster imaging, more efficient workflow, reduced artifacts and a better overall user experience, Leksell Vantage is a welcome advancement for physicians and their patients.”

he results of a prospective observational study of children with head injuries, in Australian and New Zealand tertiary hospitals, have compared the diagnostic accuracy of three clinical decision rules used in emergency units.

Children with head injuries often undergo Computed Tomography (CT) scans in emergency departments to rule out serious brain injury, however not all children with milder injuries need such a scan. Unnecessary radiation exposure from CT scans can increase the risk of cancer.

The results of the study were published online in the April 11, 2017, issue of the journal The Lancet. The goal of the study was to find the best clinical decision rules to help emergency medicine clinicians decide which children under 18 years of age, suffering from head injuries, needed a CT scan. The study included 20,137 children in ten Australian and New Zealand tertiary hospitals.

The researchers found that the US Pediatric Emergency Care Applied Research Network (PECARN) clinical decision rule provided the best options for identifying children with a very low risk of a traumatic brain injury. Associate Professor Franz Babl, lead investigator of the trail, Murdoch Children’s Research Institute (Victoria, Australia; www.mcri.edu.au), said, “The aim of this study was to determine which children need CT scans to detect brain injury. Most head injuries are mild and don’t require neurosurgical management. The preferred course of treatment is to avoid a CT scan in minor head injuries if it is unnecessary. In particular, there is concern about the high radiation dose associated with CT scans of the head which can lead to cancer.”

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Radiotherapy Treatment Demonstrated for Kidney Cancer Patients he results of a recent study have shown that using stereotactic ablative radiation therapy as an alternative to traditional kidney cancer patients, can achieve more than 90% percent control of metastases. Traditional treatment for metastatic renal cell carcinoma includes targeted drugs, or immunotherapy, and other system therapies, which have significant side effects.

The study was carried out by researchers at the University of Texas (UT) Southwestern Medical Center’s Kidney Cancer Program (Dallas, TX, USA; www.utsouthwestern.edu) of the Harold C. Sim-

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mons Comprehensive Cancer Center. The study was published in the May 1, 2017, issue of the journal International Journal of Radiation Oncology, Biology, and Physics.

According to the researchers, the study demonstrates that some kidney cancer patients could even be cured using stereotactic radiation therapy, or alternatively systemic therapy could be delayed saving patients from the side effects of immunotherapy drugs.

In the US, five-year survival rates for stage 1 kidney cancer are 81%, for stage 3 approximately 53%, and for patients with stage 4 cancer only 8%. On

the other hand five-year survival rates of patients with stage 4 kidney cancer treated at the UT Southwestern Kidney Cancer Program are double the US national benchmarks. Senior author of the study and co-leader of the Kidney Cancer Program, Assistant Professor of Radiation Oncology, Dr. Raquibul Hannan, said, “This study shows that stereotactic radiation provides a good non-invasive alternative to conventional treatment, and that it effectively controls the disease. It may also offer an alternative to patients who are not candidates for surgery due to the number and location of the metastases.”

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ENTERPRISE IMAGING PLATFORM

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Konica Minolta Medical Imaging

The Synapse VNA can be configured to manage the data and transactions using the same shared infrastructure for multiple sites, facilities and departments. It efficiently integrates multiple clinical IT environments and improves patient care by simplifying the sharing of all clinical content.

The CXDI Control Software NE helps optimize workflow and reduce the steps needed to complete exams. It provides quick image confirmation and timely network distribution, supports multiple study acquisition, and can be easily tailored to individual clinical preferences.

The Exa offers a diagnostic quality Zero Footprint Universal Viewer for DICOM and non-DICOM images that minimizes unwanted exposure to data.

The platform provides hospitals and imaging centers the ability to view images across departments and facilities, regardless of image source.

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Updated Cardiology Platform Supports Additional Specialties new version of a cardiology enterprise imaging platform now includes congenital echocardiology, and nuclear cardiology functionality.

The enterprise imaging platform is designed to provide efficient access to clinically relevant images, and features advanced reporting, real-time visual collaboration tools, and post-processing capabilities. The system enables access, even from a remote location, to the complete cardiology file of a patient. The system can generate reports, and distribute them, all in one session, using a task-based workflow that is aligned with the clinical workflow of an institution.

Agfa HealthCare (Mortsel, Belgium; www. agfahealthcare.com) announced the new version of its Enterprise Imaging for Cardiology platform that

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includes the new congenital echocardiology, and nuclear cardiology structured reporting modules. Enterprise Imaging for Cardiology is part of Agfa Healthcare’s Enterprise Imaging converged platform that provides a single point of access, and standards-based, task-based, care-centric workflow intended to improve interoperability.

In addition, the platform enables a patient health record across departments even between multiple facilities.

Global VP of Agfa HealthCare, James Jay, said, “Cardiology continues to be an image-intense domain, and the Enterprise Imaging for cardiology platform offers a value-based care solution providing access to clinically relevant cardiology data. By enhancing the features and functions to cover more

sub-specialties, we extend the support for patientcentric care all along the care continuum.”

Image: A clinician using the updated imaging platform, which allows access to the complete Electronic Medical Record (EMR) of a patient (Photo courtesy of Agfa HealthCare).

Imaging Alliance to Detect Intracranial Bleeding in Head Trauma s a result of a licensing agreement, IBM Watson Health (Armonk, NY, USA; www. ibm.com/watson/health) will be expanding its range of offerings to include an innovative 3D system for identifying intracranial bleeding following head trauma. The Artificial Intelligence (A.I.)based clinical decision support application was developed by MedyMatch (Andover, MA, USA; https://medymatch.com) and is intended to help imaging specialists in acute care settings such as hospital emergency rooms.

In the next phase the companies plan to develop interoperability capabilities between the MedyMatch application and IBM Watson Health Imaging products. MedyMatch Technology solutions make use of advanced cognitive analytics, and A.I. to provide realtime decision support tools for acute care settings.

The MedyMatch intracranial bleed assessment application is currently undergoing a clinical trial,

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with the aim to achieve US Food and Drug Administration (FDA) Class III Premarket Approval (PMA).

Chairman and CEO of MedyMatch, Gene Saragnese, said, “The opportunity to license our deep vision application to IBM Watson Health creates a unique value proposition in healthcare. Engaging closely with IBM allows for a near-zero footprint implementation at a customer location delivering ‘A.I. to the bedside’ where I believe the future of healthcare lies. At MedyMatch, we believe improvements in the interpretation of data will lead to better decisions, better decisions will lead to better outcomes for

patients and lower cost for healthcare. This is what drives us forward every day.”

Image: The MedyMatch intracranial bleed detection application, including 3D rendering of the location and volume of bleeding (Photo courtesy of MedyMatch).

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IT/PACS Update

IBM Debuts Watson Health Cognitive Imaging Solution BM (Armonk, NY, USA; www.ibm.com) has launched the IBM Watson Imaging Clinical Review (WICR), the first cognitive imaging offering from Watson Health that is designed to help healthcare providers identify patients that require urgent attention.

IBM Watson Imaging Clinical Review is a cognitive “peer-review” tool designed to enable reconciliation of discrepancies between a patient’s clinical diagnosis and administrative records, ultimately providing a more accurate patient record. Essentially, it uses cognitive text analytics to read both structured and unstructured information in cardiology medical reports, combines it with a variety of data from other sources, and extracts the relevant information needed to verify that key data, including the diagnosis, is accurately reflected throughout the electronic medical record (EMR).

It subsequently compares the clinical data with the EMR problem list and medical coding to empower users with accurate information. The first application introduced is designed to identify cardiovascular disease (CVD) patients suffering from aortic stenosis, a debilitating condition that causes shortness of breath, tiredness, and chest pain. IBM plans to supplement

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Study Shows How Deep Learning and AI Diagnose TB esearchers have found that they can use an artificial intelligence technique called deep learning to identify cases of tuberculosis on chest X-Ray exams with a net accuracy rate of 96%.

According to the World Health Organization (WHO) around 1.8 million people died from tuberculosis (TB) in 2016. A simple chest X-Ray exam can help radiologists identify the disease, but many TB patients live in remote areas without access to expert radiologists who can interpret the images, and diagnose the disease.

The study was carried out by researchers at the Thomas Jefferson University Hospital (TJUH; Philadelphia, PA, USA; www.jefferson.edu) who trained artificial intelligence models to identify TB on chest X-rays.

The goal of the research was to help screen and evaluate patients in TB-prevalent areas lacking access to radiologists. The study was published in the April 25, 2017, online issue of the journal Radiology.

The researchers used 1,007 X-Ray exams of patients with and without active TB for the study. The multiple TB-positive and TB-negative X-Ray datasets were used to train two different Deep Convolutional Neural Network (DCNN) models called AlexNet and GoogLeNet. The researchers found that the best performing Artificial Intelligence (AI) model was when both AlexNet and GoogLeNet were used together, resulting in a net accuracy of 96%.

Co-author of the study, Paras Lakhani, MD at TJUH, said, “There is a tremendous interest in artificial intelligence, both inside and outside the field of medicine. An artificial intelligence solution that could interpret radiographs for presence of TB in a cost-effective way could expand the reach of early identification and treatment in developing nations. The relatively high accuracy of the deep learning models is exciting. An artificial intelligence solution using chest imaging can play a big role in tackling TB.”

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the release of the initial offering with nine other cardiovascular conditions, such as myocardial infarction (MI), valve disorders, cardiomyopathy, and deep vein thrombosis (DVT).

“Apart from identifying patients who might need follow-up care, Watson will look across patient populations to figure out similar patients who could benefit from follow-up visits, even if their ultrasounds or other images weren’t analyzed by Watson,” said Anne Le Grand, vice president of imaging for Watson Health.

Watson – named after Thomas Watson, the first president of IBM – incorporates a technology called Deep Question and Answer (DeepQA) that allows it to analyze human language and quickly process huge amounts of information. The same technology can be applied to help Watson sift through the equivalent of about a million books or roughly 200 million pages of data, analyze the information, and provide an answer in less than three seconds.

Image: The Watson Imaging Clinical Review (WICR) is designed to help healthcare providers identify patients that require urgent attention (Photo courtesy of IBM).

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DATA MANAGEMENT SYSTEM

CLINICAL REVIEW MONITOR

Totoku

VISUS

Ampronix

The CCL550i2 color display allows the viewing of mammography images, pathology images or ultrasound at the same time. Its 21-inch color LCD display has a resolution of 5 MP with high brightness and contrast, to ensure capture of even the smallest amount of data.

The JiveX Medical Archive allows all medical data, documents, images, videos, and signals to be accessed anywhere in the hospital using a single viewer. It allows for communication via IHE-XDS and HIS integration at all workstations with just one interface to the HIS.

The LG 27HJ712CS-W provides enhanced brightness levels, wide viewing angles, minimal color shift and accurate images. The DICOM-compliant monitor is specifically designed to increase hospital staff efficiency by enabling streamlined work flows and multitasking capabilities.

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Clinical Trials Show Benefits Of iFR Compared to FFR esults from several studies indicate that the adoption of instant waveFree Ratio (iFR) instead of Fractional Flow Reserve (FFR) for the assessment of Coronary Artery Disease (CAD) is a more cost-effective, and faster diagnostic solution.

The two clinical trials were the largest randomized coronary physiology outcome studies that have been carried out to date, and included 4,529 patients.

The two trials also showed that iFR could nearly eliminate severe patient symptoms completely, compared to FFR. The results of the two large trials, that took place in 49 centers in Europe, Africa, Asia, and North America were announced by Royal Philips (Amsterdam, the Netherlands; www.philips.com) and were published in the New England Journal of Medicine. The iFR index was developed by Philips, to enable hyperemia-free physiological assessment of blockages in coronary arteries.

Business Leader at Philips Volcano, Christopher Barys, said, “The clinical validation of our innovations is a critical element of our strategy in image-guided therapy. The outcomes of these clinical studies underpin the value of iFR and its benefits for patient safety and effective diagnoses. It is our hope that the results

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advance the adoption of iFR to help physicians improve patient care. This is one of the largest coronary physiologic datasets ever collected and truly demonstrates the value of iFR in the physiological assessment of coronary artery disease in patients.”

Image: Clinicians using the innovative instant wave-Free Ratio (iFR) technique (Photo courtesy of Philips Healthcare).

New 3D Printing Technologies Improve Pediatric Osteotomy Planning he US Food and Drug Administration (FDA) approval of new 3D-printed patient-specific radius and ulna osteotomy guides for children aged seven years and older will help orthopedic surgeons plan, and carry out complex surgery.

The 3D-printed guides are intended for use with 3D pre-operative planning to help surgeons improve the planning processes before pediatric surgery and help them during the surgery. Until now surgeons have used 2D X-Ray imaging for pediatric osteotomy planning. The 3D-printed guides are intended to benefit children with bone injuries, and those with natural deformities.

The 3D-printed guides were developed by Materialise (Leuven, Belgium; www.materialise.com). Materialise has more than 26 years of 3D printing experience, and offers a range of end-to-end 3D printing solutions for the orthopedic industry. Each 3D-printed surgical guide is patient-specific. Materialise also works with hospitals and surgeons around the world to develop and improve 3D-printed osteotomy guides for complex bone corrections in adults. With this US FDA approval Materialise can now also provide 3D-printed guides for use with pediatric surgery.

VP and GM of Materialise North America, Bryan Crutchfield, said, “In bringing this 3D printing technology to pediatric surgery, surgeons will have access to our clinical engineers’ wealth of experience developing osteotomy guides,

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Image: Two 3D-printed patient-specific radius and ulna osteotomy “guides for surgery planning in children (Photo courtesy of Materialise).

helping them perform even the most complex bone corrections that will have a positive impact on the rest of the child’s life.”

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Industry News

TeraRecon to Buy IT Development Platform Provider eraRecon (Foster City, CA, USA; www. terarecon.com), a provider of advanced visualization and enterprise medical image viewing solutions, has announced the acquisition of machine learning company, McCoy Medical Technologies, (Chicago, IL, USA; www.mccoymed.com).

TeraRecon is an independent, vendor neutral medical image viewing solution provider with a focus on advanced image processing innovation. Its solutions advance the accessibility, performance, clinical functionality and medical imaging workflow throughout many areas of the healthcare ecosystem. The company provides advanced visualization 3D post-processing tools, as well as a spectrum of enterprise medical image viewing, diagnostic interpretation, image sharing, cloud, interoperability and collaboration solutions.

McCoy provides a developer platform and API

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interface for algorithm developers, partners and end users. It facilitates the streamlined distribution and hospital implementation of evidence-based practices and trained machine learning algorithms via a vendor neutral distribution platform. The McCoy platform allows users anywhere to access cloudbased algorithms without requiring access to the algorithm code or training data to protect PHI and developer intellectual property. It assists research institutions and emerging AI companies in the translational and commercialization processes, starting with rapid deployment via a scalable, secure, cloudbased infrastructure. McCoy also works with distribution partners, including TeraRecon, to make algorithms on the platform available to a very wide footprint of hospitals and, ultimately, to physicians.

As part of the transaction completed earlier this week, a new independent company, initially called

WIA Corporation, has been formed to provide simplified access to AI algorithms with a focus on integrations that connect the work of individual endusers, machine learning researchers, open source organizations and diagnostic imaging companies.

“This decade has seen a proliferation of extremely impressive applications leveraging machine learning, especially for computer vision. Today, there is a real need for simpler, standards-based channels to socialize, access and apply these technologies,” said Dr. Siegel, a leading imaging informatics expert and member of the McCoy Medical advisory board.

“The TeraRecon and McCoy venture holds great potential to be among the first to develop and commercialize their offerings in the form of a truly open platform community. This kind of approach is exactly what is needed for the amazing innovations in AI to achieve widespread utilization.”

Philips Acquisitions Expand Offerings in Intelligent Image Analysis Software, Brain Activity Monitoring Acquisition of Tom Tec Imaging in Germany Royal Philips (Amsterdam, the Netherlands; www.philips.com) has signed an agreement to acquire TomTec Imaging Systems GmbH (Munich, Germany www.tomtec.de), a provider of intelligent image analysis software, especially for diagnostic ultrasound.

The acquisition is expected to strengthen Philips’ position in cardiac ultrasound, and support the company’s further expansion in other clinical areas, such as obstetrics and gynecology (OB/GYN).

Philips’ ultrasound portfolio finds application across a broad range of clinical specialties including radiology, cardiology, point-of-care and OB/GYN. The company’s innovations in ultrasound solutions include real-time 3D imaging of the heart, quantification tools driven by Anatomical Intelligence, and ultra-mobile, portable ultrasound solutions.

TomTec offers multi-modality and vendor-neutral diagnostic and analysis applications in cardiology, radiology and OB/GYN, allowing clinicians to increase efficiency and diagnostic quality through automated and reproducible measurements. The company’s clinical applications, workflow solutions and R&D capabilities are expected to complement Philips’ strengths in ultrasound image quality, 3D-imaging and transducer technology.

“We are committed to providing ultrasound solutions that combine superb image quality with advanced analytics to drive efficiency and reproducibility, while reducing costs for our customers,’’ said Vitor

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Medical Imaging International August-September/2017

Rocha, Business Leader Ultrasound Business Group at Philips. “The acquisition of TOMTEC brings a strong team and new assets that are strategically valuable to Philips and will enable us to accelerate growth in our cardiac ultrasound and OB/GYN portfolios.”

Acquisition of Electrical Geodesics in Oregon, USA In a related development, Royal Philips has entered into a definitive agreement to acquire Electrical Geodesics, Inc. (Eugene, Oregon, USA; www. egi.com), a medical device company that designs, develops and commercializes non-invasive technologies used to monitor and interpret brain activity. EGI’s proprietary dense array EEG platform technology gathers brain activity data from many more electrodes than conventional EEG products to generate higher quality and precise levels of information.

EGI’s portfolio of EEG hardware, software and acquisition sensors will complement Philips’ existing portfolio of imaging technologies (e.g. MRI and PET-CT) and advanced informatics (e.g. IntelliSpace Portal) for neurological applications. The combined portfolios will enable Philips to address neurological disorders such as stroke, epilepsy, traumatic brain injury and Parkinson’s disease.

“In order to improve the treatment for some of the most complicated, life altering neurological disorders, we need more personalized and adaptive guidance tools to plan each individual patient’s therapeutic options,” said Joe Burnett, Business

Leader Neuro Diagnostics at Philips.

“This acquisition will enable Philips to provide an integrated neurology solution comprising diagnostic imaging and clinical informatics to assess brain anatomy and physiological processes, and EEG mapping tools from EGI to measure electrical brain

activity. By fusing these different tools together, we will create a more comprehensive map of the brain, and unlock new computational algorithms which will help to shorten the path to a definitive diagnosis and guide some of the most complex therapeutic strategies.”

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OCTOBER 2017 WFUMB 2017 – World Federation for Ultrasound in Medicine and Biology. Oct 13-17; Taipei, Taiwan; Web: www.wfumb.org JFR 2017 – Journées Francophones de Radiologie. Oct 14-17; Paris, France; Web: http://jfr. radiologie.fr IEEE 2017 – Nuclear Science Symposium and Medical Imaging Conference. Oct 21-28; Atlanta, GA, USA; Web: www.ieee.org EANM 2017 – Annual Congress of the European Association of Nuclear Medicine. Oct 21-25; Vienna, Austria; Web: www.eanm.org ESMRMB 2017 – Annual Scientific Meeting. Oct 19-21; Barcelona, Spain; Web: www.esmrmb-event calendar.org 6th International Conference on Radiology and Imaging. Oct 2325; Chicago, USA; Web: www.radiology.conferenceseries.com Society of Radiologists in Ultrasound (SRU) Annual Meeting.

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International Calendar IRIA 2018 – 71st Annual Conference of the Indian Radiology and Imaging Association. Jan 25-28; Mumbai, India; Web: www.iria.in AOCR 2018 – 17th Asian Oceanian Congress of Radiology. Jan 25-28; Mumbai, India. http://aocr 2018.org

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