Page 1

April, 2014

Rs. 100

Ultrasound Updates:

Wordsworth: Carlos Faustmann

Exploration. Innovation. Expansion!

Esaote’s Chief Global Marketing and Domestic Sales Officer elaborates on the company’s future plans

Vol 3, Issue 4, Pages 44


India's First Complete Medical Imaging Magazine




April, 2014

Rs. 100

Ultrasound Updates:

Wordsworth: Carlos Faustmann

Exploration. Innovation. Expansion!

Esaote’s Chief Global Marketing and Domestic Sales Officer elaborates on the company’s future plans

Vol 3, Issue 4, Pages 44

India's First Complete Medical Imaging Magazine

Exploration for innovations that leads to technologies which provide more clinical confidence results in the expansion of ultrasound market in India COLOR DOPPLER | APRIL, 2014


Inside Scan Under the Scanner – COLOR DOPPLER | APRIL, 2014 Volume 3 | Issue 4 KERENG/2012/41766 editor-in-chief Joby Joseph publisher Niranjan Kumar K R M design editor Gireesh

Exploration. Innovation. Expansion!

RidiExploration for innovation which leads to technologies that provide more clinical confidence results in the expansion of ultrasound market in India

page 16

chief coordinator Saraswathy M

Wordsworth –

Expansion Time

chief correspondent Jumana Engineer

As Esaote begins its journey to the new heights of technological innovations with the launch of CrystaLine at ECR 2014, Carlos Faustmann, Chief Global Marketing and Domestic Sales Officer, Esaote speaks on company’s future plans, marketing strategy and more

co-ordinating editor Rini Baby Thottil copy writers Ria Lakshman V Purnima Sah senior designer Sohan V K assistant designers Linda Daisy Paul Sooraj K designer, new media Amit Sudhans manager-product & HR Kishore Kumar P S assistant manager, IT Swetha G manager, accounts Hariharan V V assistant, accounts Shahana P

COLOR DOPPLER #2/1775-B, Florican Road, P O Civil Station, Calicut, Kerala - 673020, India Phone : +91 495 2378808/ 09 Email : Vision and opinions expressed in this magazine are not necessarily those of Color Doppler, its publisher and/or editors. Color Doppler does its best to verify the information provided but will not take any responsibility for the business moves taken by any reader on the basis of any article published in this magazine. No part of Color Doppler can be reproduced without the prior written permission of the publisher, Niranjan Kumar K.R.M. The rights to reproduce any information published in this magazine are vested with Color Doppler. The magazine is sold on the condition that the jurisdiction for all disputes will be courts/ forums/tribunals at Kozhikode, Kerala. Printed, published and owned by Niranjan Kumar K R M, 3/1614 C, Sridevi Niranjan, Near 6th Rly Gate, Nadakkave Post, Calicut-673011 and Printed at Anaswara offset Private limited, 48/2123-c Perandoor Junction, Elamakkara, Cochin 682026 and Published at 34/1347-A, Florican Road, Malaparamba, Calicut-673009. Editor: Joby Joseph.


page 12 Talking Point –

Autism: Dispelling Myths Noted researcher on neuro imaging, Dr Rajesh Kumar Kana speaks to Color Doppler in detail about the new findings on neuro developmental disorders and briefs on the research activities that might unravel at least a part of the mysteries that lie behind the causes of autism

page 27 Industry Experts

‘Demand for Technology Driving the Market’ With the rising need for more innovative features in elastography, OB/GYN, cardiology and oncology, the market will continue to grow, says R Sridharan, Senior Director, Ultrasound, Philips Healthcare

page 20 Expert Opinion

‘Portability Revolution’

Dr N Khandelwal, MD Radiology, MD Radiodiagnosis, Professor and HOD, Radiology, PGI, Chandigarh, certifies that the portable machines have transformed the ultrasound practice in the hospitals

page 24 ECR Recap

Plenty Twenty

The 20th Annual Meeting of the European Society of Radiology held in Vienna has provided a perfect platform to learn and debate about the latest advances in imaging techniques and their clinical applications

page 35 COLOR DOPPLER | APRIL, 2014

[ news scan ]

AIMS, Kochi Becomes the First Hospital to Install GE’s Silent MRI


ulfilling the mission of Healthier India, GE Healthcare joined hands with Amrita Institute of Medical Sciences, Kochi to make available the Silent MRI – a compassionate MRI scanning technology. AIMS, thus became the first hospital in India to acquire Silent MRI. Silent MRI is a blessing to millions of patients who find scanning loud and distressing. While a conventional MRI scanner produces a noise level of 110 dBA, GE’s exclusive Silent Scan technology reduces the MR scanner noise to near ambient sound levels. “Acoustic noise is one of the biggest complaints of patients – especially elderly and children, who undergo MRI scanning. Combine that with the small bore sizes of conventional MRIs that make patients

claustrophobic and we have a very fidgety patient in our hand. Every small movement the patient makes affect the quality of outcomes and yet time needs us to re-scan the patient. If we can make the patient more comfortable and relaxed, we can get the outcomes best, first time. We found this silent technology to be very compassionate, to the patient – just as the care we strive to provide to our patients. With this, we will have very few re-scans. Our Silent MRI will be

fully operational from 3rd week of March 2014,” said Dr Prem Nair, Medical Director, AIMS. GE’s Silent Scan technology is a new type of 3D MR acquisition methodology, a combination of proprietary high-fidelity gradient and RF system electronics, by which the noise is not merely dampened, but is virtually eliminated at the source. The Silent Scan technology is co-developed in India by GE. Silent Scan is available on new as well as existing Discovery MR750w with GEM and Optima MR450w with GEM systems. Dr Karthik Kuppusamy, Senior Director, MRI Imaging, GE Healthcare, South Asia sees this as a silent revolution in India. “This technology is co-developed in India and is making a silent revolution! India is one of the fastest adopter of this compassionate technology,” he concluded.

Esaote launches CrystaLine at ECR 2014


saote, one of the world’s leading manufacturers of medical diagnostic systems launched CrystaLine, a novel technology in ultrasound that delivers new levels of versatility, value, quality and accuracy at the 20th European Congress of Radiology (ECR) recently held in Vienna. With superior hardware and software features build on the advanced eHD ultrasound technology, which Esaote introduced in the previous year, CrystaLine enables clinicians to confidently use ultrasound in borderline examinations and interventional ultrasound procedures. “Ultrasound is highly valued for its safe, non-invasive nature, and continues to evolve and prove its value. One of the challenges has been capturing high


quality images in those technically difficult patients. CrystaLine changes all that”, explained Carlos Faustmann, Esaote’s Chief Global Marketing and Domestic Sales Officer. Major technical improvements provided by CrystaLine include Combined Pulse Imaging Technology, which effectively increases depth-of-field, improving the imaging of structures deeper in the body. Combined with the new XView+ specklenoise reduction system, fully adjustable by the operator, helps to produce an optimal personalized image. Esaote systems with CrystaLine are also able to synchronize in real-time with therapeutic applications such as Echolaser to guide laser ablation and other procedures. CrystaLine is available across Esaote’s MyLab Twice, Seven and Alpha ultrasound systems.


[ news scan ]

GE Healthcare, Cancer Treatment Services International Announce Strategic Partnership


Healthcare and Cancer Treatment Services International (CTSI) announced today a strategic partnership to develop 25 world-class centres across India to improve access to cancer care. The network will be built at an investment of US $ 120 Million (INR 720 Crores) over a period of five years. The centers will offer latest technology for diagnosing and treating cancer and will follow the same standards of care found at the world’s top cancer hospitals delivered at affordable price points. “At GE, we envision a day when cancer is no longer a deadly disease. Scaling up of

affordable access to cancer care requires disruptive solutions and willing partners. We believe a partnership like this one, which presents a great opportunity to confront India’s cancer challenge head on,” stated John Dineen, President and CEO, GE Healthcare. He added, “Combining GE Healthcare’s innovative technology platforms with CTSI’s proven expertise in operating cancer centers affords a fantastic means to tackling cancer early in India.” The incidence of cancer is sharply rising in India with a prevalence of 3 million cases and an addition of 1.23 million new cases every year. The mortality rates are very high due to late detection, access and

Winners of GE Healthcare 2013 Cell Imaging Competition Announced


Healthcare Life Sciences announced Vanessa Auld from Canada, Martin Barr from Ireland and Graham Wright from Singapore as the winners of the GE Healthcare 2013 Cell Imaging Competition. The winners were chosen on the basis of judgment from an expert scientific panel as well as votes from general public. The six judges shortlisted the entries into finalists, ahead of opening for vote from over 23,000 voters. The winning pictures will light up Times Square, New York at a special event happening from April 25-27, 2014. GE Healthcare has been organizing this competition for past seven years. This year’s competition attracted over 100 entries from scientists who are using either high-content analysis or high-end super resolution microscopy to investigate at the cellular level a wide variety of diseases such as cancer, muscle disease and the effects of parasitic infections. Voting started on November 14, 2013 and continued online until January 7, 2014. Alongside the online voting, attendees


at two conferences (ASCB, December 14-18, USA and MBSJ, December 3-6, Japan) were also invited to vote for their favourite. The votes were combined to select up to a possible maximum of four winners: one main High-Content Analysis winner, one main Microscopy winner, plus a regional winner from any region not represented by the winners of these two categories. The three regions mentioned are North America; Europe, Middle East and Africa; Asia and the rest of the world (including Australia and New Zealand).

The Stars: Microscopy category Vanessa Auld, University of British Columbia, Vancouver, Canada High-Content Analysis category Martin Barr, St James’s Hospital and Trinity College Dublin, Dublin, Ireland Microscopy category (Regional) Graham Wright, Institute of Medical Biology, A*STAR, Singapore

affordability to care. Estimates suggest every two minutes three patients succumb to this deadly disease. “CTSI has built a proven healthcare delivery model tailored to making the highest quality cancer care accessible and affordable. When we launched our international operations, India was a natural place to start. It offers existing medical infrastructure, a pool of talented doctors and a population with the desire to embrace top-notch standards of care. Our partnership with GE accelerates realization of our goal to build out a network in India and ultimately apply our model in similar markets worldwide,” added Joe Nicholas, President and CEO, CTSI.

market scan China and India Markets to Witness the Most Impressive Growth through 2019 According to a research elaborated by GlobalData, Chinese and Indian diagnostic ultrasound markets are set to witness the most impressive growth through 2019. The data predicts to see just over 7 percent and 9.5 percent CAGRs through 2019, which will drive the ultrasound revenues of China and India to USD 1.3 billion and USD 192 million respectively by the end of the forecast period. The growing demand for high-quality healthcare and increase in the household incomes are the major reasons attributed for such a massive growth. The report also says that the price wars created between the domestic manufacturers and multinationals in Indian ultrasound market will continue to remain the same.



Superior Quality Medical Image Printing Paper

OLYMPUS110HG synthetic Thermal Papers for printing Ultrasonic Video Images. OLYMPUS110HG Video Papers have become very popular worldwide, replacing Sony and Mitsubishi papers with Lower Cost and Consistent Quality. OLYMPUS110HG is successfully exporting high image contrast thermal papers to world markets for medical recording and industrial applications.


1. Grades High Glossy Grade – OLYMPUS110HG—110mm * 18Mtr NORMAL DENSITY – OLYMPUS110S--- 110mm * 20Mtr 2. Applications Printing Black & White Video Images on Medical Diagnostic Equipment, such as Ultrasound Systems Precision Printing Suitable for Thermal Sensitive Printing Methods 3. Compatibility Fitting perfectly to most Sony and Mitsubishi Printers Compatible Sony Printers UP-850, UP-880, UP-870MD UP-890MD, UP-895MD Compatible Mitsubishi Printers P-70, P-90 , P-91, P-93

Thermal Paper


Thermal Printer

A-3, NEW RAJINDER NAGAR,A-3, NEW NEW DELHIRAJINDER - 110060, INDIA NAGAR,NEW DELHI- 110060,INDIA TELE / FAX : +91-11-28741437, 28742510,:+91-11-28741437, M. +91-9810270997 TELE/FAX 28742510, M.+91-9810270997 e-mail :, website :

e-mail:, website:



[ news scan ]

Toshiba showcases Smart Fusion Ultrasound Technology at SIR 2014


t the Annual Meeting of Society of Interventional Radiology (SIR), which was held from March 22-27, 2014 at San Diego, California, Toshiba showcased its latest ultrasound technology Smart Fusion. Smart Fusion provides the physicians an enhanced viewing experience to focus on what exactly matters. Smart Fusion syncs previously acquired CT and MR images with live ultrasound side-by-side on a single screen, enabling the physicians to locate lesions and aiding in ultrasoundguided procedures. “Smart Fusion has allowed us to save patients from getting open surgical biopsies and increased our confidence in identifying the right lesion accurately, safely and quickly,” said Dr Van Young, interventional radiologist, St Elizabeth Healthcare. Dr Van Young certifies that this has considerably reduced the procedure time from 30 minutes to 15 minutes. Another signifi-

cant benefit of Smart Fusion is reducing dose to patients and physicians by lowering the number of CT-guided biopsies. Toshiba’s Smart Fusion is easy to use, with the most intuitive user setup available. The technology is available on Toshiba’s premier ultrasound system, Aplio 500.

event scan ULTRAFEST 2014

Date: April 18-20, 2014 Venue: The Renaissance, Powai, Mumbai For Details:

GAMET 2014

Date: April 24-27, 2014 Venue: Global Health City, Chennai For Details:


Date: May 2-4, 2014 Venue: Hotel Taj Mahal Palace For Details:

ISPR 2014

Date: September 12-13, 2014 Venue: Christian Medical College, Vellore For Details:

book scan


Brain Imaging Handbook: 1st Edition

Author: J Douglas Bremner, M.D Pages: 224 pages Price: $42.50


With quick and illustrated references to latest imaging technologies, Bremner’s Brain Imaging Handbook offers a clear understanding of the brain imaging. Being a perfect beginner for medical students and emerging physicians, the book talks about various aspects of brain imaging including changes in brain function, structure with brain development and aging. The book provides special emphasis on how brain imaging applies to certain areas like schizophrenia, mood and anxiety disorders, substance abuse and more. The inclusion of detailed coverage on neurological disorders, makes the book a perfect read for all clinicians who deal with mental health, neuroscience and neuroimaging.

Date: October 31 - November 2, 2014 Venue: JW Marriott, Aerocity, New Delhi For Details:

EMCON 2014

Date: November 6-9, 2014 Venue: Renaissance Mumbai Convention Centre Hotel, Powai, Mumbai For Details: emcon2014mumbai. com


[ new product scan ]

SOMATOM Scope X-rays

conventional detector material

UFC detector material light ouput

light ouput

Quality Matters SOMATOM Scope’s 24-row adaptive detector array collects 16 slices of data simultaneously, with sub-millimeter isotropic accuracy. Its high X-ray absorption features the industry-leading Ultra Fast Ceramics (UFC) detector material delivering bright and crisp images.

syngo 3D Bone Removal CARE Bolus CT

CARE Dose4D (TM)

syngo VRT IRIS

WorkStream4D (TM) SureView (TM)

Regularity Matters


ocus on the essence Vs. Compromise on what matters – Second best is not an option. Siemens’s SOMATOM Scope delivers high-quality and affordable care by focusing on the essence of CT. Its cost-efficient scanner delivers outstanding image quality maintaining the

right dose. SOMATOM Scope is highly reliable and easy to use. It saves time and effort throughout daily routine. A flexible service model of SOMATOM Scope helps keep overheads under control, safeguarding the facility long-term competitiveness.

SOMATOM Scope scanners comprise of syngo Scope, one console that combines powerful hardware with an absolute clinical application suite.

B enefits

Clinical Excellence

SOMATOM Scope supports daily routine while helping the clinicians to strike the perfect balance between right dose and image quality, with noise reduction of up to 25 percent.

Quantity Matters

SOMATOM Scope gives a complete package of Combined Applications to Reduce Exposure, making sure the right dose for patients imaging requirements.


Cost Efficiency

SOMATOM Scope keeps costs in check; with innovative service benefits, a small footprint for optimum use of space and features that helps lower TCO by up to 35 percent.

Low Operating Cost Matters

SOMATOM Scope adds tangible value with the unique eCockpit suite which is designed to support highly economic scanner usage and reduce overhead costs.

Small Footprint Matters SOMATOM Scope has a small footprint of just 8m2 which is very mobile to fit into almost every room. It is a lightweight scanner, needs no additional support, low power requirements and makes quick and easy installation process.


[ new product scan ]


Philips IQon Spectral CT

hilips’s IQon Spectral CT is a breakthrough spectral detector that allows the usage of color to identify the composition of what appears on the screen. This quantitative approach adds spectral resolution to image quality. This feature of IQon Spectral CT not only helps to get the anatomical information that is

used with CT, but it also uncovers the characterization of structures based on the material content. Philips IQon Spectral CT is designed from the ground up for spectral imaging. It comes with spectral resolution without any complexity and at low dose.

Ensuring Economic Value IQon Spectral CT ensures the economic value of the system by reviewing prospective and retrospective spectral data analysis with traditional workflow. This feature adds into the clinical reputation and differentiates the services. It is very easy and quick to implement.

Driving Clinical Performance IQon Spectral CT drives clinical performance by adding spectral resolution to image quality with IMR and iPatient.


IQon Spectral CT

Philips IQon Spectral CT is first-of-itskind invention that allows the usage of color within CT images to identify the composition of what is displayed on the screen. This significant feature adds spectral resolution to image quality, providing anatomical information to improve patient care.

Routine Spectral CT Workflow The Spectral CT makes a custom workflow, offering the experience of


spectral CT with no need of special protocols.

On-Demand Analysis

Philips IQon Spectral CT gives nostalgic spectral analysis that makes the product easy to use and allows routine spectral usage. iPatient gives the ability to prospectively plan the results and automatically generate spectrally separated results. This feature also gives direct integration in radiology reading workflow, on-demand review of spectral information and spectral analysis.

Enhancing Patient Experience Philips IQon Spectral CT improves better patient experience by providing dose management. The same time it works on improving image quality.


[ new product scan ]


Toshiba’s Xario 200

oshiba’s Xario 200 stands on all the clinical demands with its outstanding versatility features. Xario 200 offers high image quality and excellent performance in a stylish and compact system at affordable price. Its outstanding mobility, excellent image quality for visualizing small lesions and unique

user-friendly design supports an accurate diagnosis. Xario 200 gives ensured routine exam. Its mobility makes it very comfortable to operate in operating rooms, emergency departments, interventional suites and angiography rooms.

Powerful Revolutionary High Density Architecture forms the foundation of the superb imaging capabilities in Xario 200.

Smart Xario 200’s fully customisable console and mode-sensitive touch screen suit the clinical needs and personal preferences.

Adaptable B enefits

Volume Imaging Suite


Xario 200 gives a full-fledged solution featuring a comprehensive set of imaging modes including surface rendering, MultiView and MPR .

Panoramic View

Real-time Elastography

Stress Echo

It assists in localizing and assessing palpable masses with high accuracy, sensitivity and reproducibility.

Contrast-Enhanced Ultrasound

It allows assessing and quantifying perfusion dynamics in a wide range of clinical settings including specialized


Premium quality screen with articulating arm and convenient monitor is easily moved into position.

This helps visualize widespread areas and anatomical relationships by creating wideview images of a region of interest. The fast and accurate cardiac assessment supports standard and user-defined protocols for exercise and pharmacological studies.

Auto IMT

An easy-to-use, automated tool to determine the thickness of the intimamedia layers of the carotid walls.

Productivity With Xario 200, clinicians can review, analyze report and archive their clinical data anytime with no loss of functionality.


[ wordsworth ]

Expansion Time As Esaote begins its journey to the new heights of technological innovations with the launch of CrystaLine at ECR 2014, Carlos Faustmann, Chief Global Marketing and Domestic Sales Officer, Esaote speaks on company’s future plans, marketing strategy and more

Carlos Faustmann


Rini Baby Thottil l cd news

We expect to grow our ultrasound business in two ways, by International geographical expansion and by ultrasound product portfolio optimization 12

saote has etched its name as an inventor, innovator and implementer in the minds of healthcare audience. The company brings to India the stateof-the-art technology that seamlessly adds value to the Indian healthcare sector through a blend of multiple high-end technologies. Headquartered in Genoa, Italy, Esaote’s expertise is in color Doppler ultrasound market suitable for different medical specialties such as cardiology, radiology, vascular, obstetrics and gynecology. With an impressive customer base and increasing customer demand, the company walks ahead making new milestones in the ultrasound market. On its new milestone of launching CrystaLine at the European Congress of Radiology (ECR) 2014, Carlos Faustmann, Chief Global Marketing and Domestic Sales Officer who is responsible for Domestic Italy Sales and Global Marketing of Ultrasound, dedicated MRI, interventional solutions, veterinary, technical service and healthcare IT, speaks to Color Doppler about the company’s new ventures, marketing plans and more. Mr Faustmann has over 30 years of experience in the diagnostic imaging industry, having held international management and board positions at multinational imaging companies such as Aloka, Siemens and Acuson. He holds a Bachelor of Science Degree in Electronics Engineering from the University of Santo Thomas, Philippines - and Management of High Technology Companies Program of the American Electronics Association at Stanford University Executive Institute of California, USA. With three decades of perfecting the art of knowing the pulse of healthcare industry, Carlos speaks with determination and vision to succeed.




[ wordsworth ] Excerpts from an interview: As a leading player in ultrasound segment, how do you perceive the future? We expect to grow our ultrasound business in two ways, by international geographical expansion and by ultrasound product portfolio optimization. Our ultrasound products will be focused on continuing to provide innovative clinical ultrasound solutions where ultrasound imaging leads patient care, such as prevention, diagnosis, guiding interventional procedures, treatment and follow-up. As a latest, cutting-edge ultrasound technology, how is CrystaLine going to enhance the productivity, efficiency and value of ultrasound? CrystaLine represents a flexible tool for multiple ultrasound applications. It improves the imaging of deep structures in difficult-to scan individuals, incorporating innovative solutions that allow clinicians to confidently use ultrasound. It possesses automatic process functions for imaging, doppler, post-processing, measurements, archiving and connectivity. By improving the diagnostic image quality, ease-of-use and compatibility on both portable and cart based systems, our customers will be able to increase productivity, efficiency and value. Please elaborate on the technical capabilities of CrystaLine. Two key technical capabilities of CrystaLine are our new XView+ speckle-noise reduction adaptive technology and CPI Combined Pulse Imaging. The XView+ offers improved image homogeneity, better edge definition, high-definition of fine details, improved signal to noise ratio especially in the hypo-echoic areas, high resolution image enhancement and no reduction in Frame Rate. CrystaLine CPI technology is obtained with a proper selection of increased penetration frequencies properly combined in order to completely exploit the energy delivered. With CPI, we can offer a solution to the challenges of imaging technically difficult-to-scan patients. Detailed images of obese patients can also be acquired. What are the hardware and software features incorporated in CrystaLine? CrystaLine incorporates specific hardware and software features that build on the advanced eHD ultrasound technology Esa-


The best results of CrystaLine and eHD technology are achieved with our iQ Probes single crystal technology incorporating a new acoustic lens design with high Signal to Noise ratio, durability, lower friction and increased impedance coupling ote introduced last year. The best results of CrystaLine and eHD technology are achieved with our iQ Probes single crystal technology incorporating a new acoustic lens design with high Signal to Noise ratio, durability, lower friction and increased impedance coupling. How is CrystaLine going to help the clinicians in providing an optimal personalized diagnostic experience to each patient? The XView+ speckle noise reduction adaptive technology of CrystaLine provides a new balance control setting function, which the clinician can use to adjust the algorithm’s behaviour to meet their preference for each patient. What are the initiatives taken by Esaote to ensure that the cost does not influence the overall cost of treatment for the patients? Esaote has been developing ultrasound systems for over 30 years including ultrasound probes. Our solutions now cover a full range of ultrasound systems in both cart-based and portable that are capable of providing cost-effective multidisciplinary applications in general imaging, cardiovascular, women’s health and point-ofcare applications. Over time, we have been able to deliver premium performance capabilities to our high, mid and low tier systems. How does Esaote keep track of unmet consumer needs when it comes to new ultrasound products and technologies? Esaote’s R&D team have extensive experience in probe design, system design and software development. We have close ties with leading universities and clinicians. Examples of our technology and innova-

tions are Virtual Navigation Fusion Imaging, Advanced Contrast Agent Imaging, and probe innovations like a new special 0-degree biopsy probe were developed in close cooperation with leading expert users. The need to resolve the challenge of scanning technically difficult or obese patients is another example of our CrystaLine technology, which we expect will help meet this need. How can the end users be made well aware of the latest technology and its potential applications? One of our priorities in our marketing communications is focused on our large installed base of end users in various clinical specialties with tailored relevant information. This helps create stronger awareness of our latest technologies and applications within user’s networks. Our partnerships with educational institutions have been designed to provide practical courses with live scanning sessions by expert users in specific applications. These courses have been very effective. How do you look at the evolution of ultrasound technology and where do you think this technology is heading? We can see the role of ultrasound technology to continue to develop new solutions outside the traditional applications in addressing the needs for application specific imaging in new areas of point of care and in real-time image guided interventional procedures. Esaote systems with CrystaLine enable clinicians to synchronize in real-time ultrasound with other imaging modalities like CT, MRI, PET/CT for therapeutic and interventional applications such as Echolaser to guide laser ablation and other procedures. This image fusion and virtual navigation technology together with the introduction of the 0-degrees biopsy-interventional dedicated probe is an example of innovative ultrasound solutions from Esaote in direct therapeutic applications. What innovations do you have in the pipeline for the near future? Esaote is strongly committed to the innovative concept aiming at making ultrasound able to deliver imaging for prevention, diagnosis, therapy, interventional and follow-up with innovative solutions: this brand new approach has become our focus, which leads our R&D labs.




[ under the scanner ]


Innovation. Expansion!

Riding on the users’ demand, exploration for innovation which leads to technologies that provide more clinical confidence results in the expansion of ultrasound market as the volume of Indian ultrasound equipment market has soared to the highest of 2,096 units in the fourth quarter of 2013

ccording to the data, the volume of Indian ultrasound equipment market has soared to the highest of 2,096 units in the fourth quarter of 2013 calendar year. The global annual equipment sales is estimated at about five percent overall. This surge in the sales of ultrasound equipment showcases the increasing demand for this modality in the market. Competition is fierce with new entrants in the market, with each player making their mark by launching new innovations. This unprecedented advancements in the technology help to address the strains on overburdened hospitals and healthcare systems, which are continually challenged


to provide a high-quality and cost effective healthcare. The technologies have fast forwarded the time of diagnosis, with more consistent examinations that are easier to perform. The benefit of this scenario accounts to the public as well as the physicians, who receives novel and easy diagnosis methods that raise their comfort and confidence. Here, Color Doppler makes an attempt to count the latest innovations in the ultrasound market, which are the game changers in the industry. To begin counting, nSight from Philips was one major technological innovation that totally created a novel approach to


[ under the scanner ] imaging. nSight, when combined with Philips’ Anatomical Intelligence technology delivers a powerful combination of speed and image clarity. nSight is a beam-forming technology blended with an enhanced parallel processing capacity, offering considerable improvements in imaging performance. Highly detailed ultrasound images with extraordinary temporal resolution, ability to view new levels of tissue uniformity, exceptional penetration at higher frequencies are the benefits attributed to nSight technology. The technology is a boon, particularly while scanning obese patients in which previous ultrasound systems will often produce inconclusive results, according to Philips. The new transducers from the company can increase penetration by up to 76 percent with more uniform imaging and have been tested successfully in patients with a body mass index (BMI) of up to 80. This makes it less likely that these larger patients will have to be referred for further MR and CT examinations. Philips’ Anatomical Intelligence technology is a rich database of anatomic structural models and adaptive system technology built into an ultrasound system. This provides advanced organ modeling, image slicing, and proven quantification, making examinations easier to perform, more reproducible and deliver new levels of clinical information. Siemens has launched HELX Evolution and SieStream HD system architecture as the newest iterations of the ACUSON S Family of ultrasound imaging systems. Enhanced ultrasound elastography and tissue strain analysis, HD image quality, streamlined workflow, cost-effective sustainability and upgradability are the benefits extended by the new additions. The technologies now enable the machines to provide 50 percent greater pixel density and 20 percent greater image visibility in PACS. Siemens has further incorporated eSie Touch elasticity imaging in the sytems, offering a revolutionary way of visualizing and measuring tissue stiffness. It allows clinicians to evaluate anatomy more clearly than ever before. Needle Mate is an ultrasound function from Samsung that delineates the needle location when performing interventions


such nerve blocks, corticosteroid injections and PIC line insertions. Easy needle detection improves accuracy in biopsy procedures based on advanced technologies. This enables fast and accurate diagnosis for an optimized clinical workflow, which allows the patients with increased safety during treatment. Auto IMT is another ultrasound function from Samsung that automatically measures the intima-media thickness of the carotid artery wall. Accurate IMT measurements have the potential to identify patients with an increased risk of stroke and heart disease. Spatial Compounding Image (SCI) technology spotted in Samsung UGEO PT60 controls ultrasound beams electronically by steering. SCI compounds many scan lines to deliver a significantly improved definition in soft tissue planes, combined with a dramatic reduction in speckle and other noise. Going silent is the next trend seen in today’s ultrasound machines. Many manufacturers including Philips, GE and Samsung has launched virtually silent machines. This provides an operational peacefulness in the clinical environment. Less power consumption is another countable feature that produces less heat in the clinical condition. Besides these technological advancements in ultrasound machines, novel applications have been developed in the treatment methods as well. One such is described below:

High-intensity Focused Ultrasound (HIFU) HIFU, sometimes known as Focused Ultrasound is a highly precise medical procedure that applies high-intensity ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. Under this procedure, the sound waves are absorbed, the mechanical energy of the pressure wave is converted into thermal energy. At a greater intensities, the tissue becomes warmer. By ensuring the location of sound waves at a specific location, multiple transmitters are used at once. Clinical HIFU is performed in assistance with an imaging procedure to enable treatment planning and targeting before applying ultrasound energy. According to the imaging procedure used for assistance, the technique changes. To say, when Magnectic Resonance Imaging is used for guidance, the technique is called Magnetic Resonance-guided Focused Ultrasound (MRgFUS). When diagnostic sonography is used, the technique is called Ultrasoundguided Focused Ultrasound (USgFUS). MRgFUS is the best approach for identifying and locating the abnormalities in soft tissue. It is also the only available method to non-invasively measure temperature changes in the body. The changes in temperature can affect the neighboring water molecules inside the tissue. This change of temperature is signalled in MRI reading. Temperature measurements using MR make it possible to adjust the heating effect by modifying the delivered energy,


[ under the scanner ] in the same way as a thermostat does. For the first time, MRI-guided HIFU can raise the temperature locally in the tissue and control it, automatically and noninvasively. This is important for the treatment since the physicians have to make adjustments for variable perfusion, variable absorption of ultrasound and variable thermal insulation. If the tissues are heated for a certain time, the tissue will die off once. It dies off almost immediately as a result of damage to proteins and membranes. It does sometimes happen more slowly, sometimes even several days after heating. Afterwards MR imaging can be used to monitor treatment response, or an MRI contrast agent can be used to determine whether the therapy has actually been effective. Lesions can be detected by their dark core and the high signal activity around them. The dark core shows that the contrast agent can no longer penetrate it as the tissue is no longer perfused. High signal activity around the edges of the lesion can be seen due to increased blood flow in these areas. The biggest benefit of MRI-controlled sound waves is its non-invasiveness. Pre-

cision will be also higher due to real-time MRI guidance. The modality faces some physical limitations as well. The spatial precision is highly limited by the ultrasound frequency. Hence, the ultrasound transducer should be large as possible. Ultrasound applications in the liver, kidney and pancreas are technically more difficult because of the movements caused by respiration and heartbeat, as well as by the fact that the ribs partially reflect or absorb sound waves. New techniques are being developed to provide solutions to these problems. The technique is in its infancy. Currently, several applications of MRI-guided HIFU in cancer are being tested. MRIguided HIFU has tremendous potential in the medical care. Ultrasound gaining Momentum in Breast Cancer Diagnosis Another area where ultrasound is gaining momentum is in breast cancer. The recent technological advancements in ultrasound offer numerous benefits over the traditional imaging techniques and is growing into a challenge for the long-standing domi-

nance of X-ray mammography. The global market for ultrasound systems used for breast applications is currently a tenth the size of the mature mammography market in terms of unit shipments. The mammography market shows a considerable reduction due to its limitations, mainly its less diagnostic possibility in dense breast tissue and radiation exposure. Breast ultrasound can boast significant benefits in comparison to other modalities. Flexibility, relative low cost, no radiation and increased patient comfort, all point to a modality that is better suited to widespread breast imaging. Vendors already began to realize this potential, with few companies like Siemens and GE Healthcare already having Automated Breast Ultrasound systems available. Watching this tremendous growth in technology, it is evident that ultrasound presents the most exciting prospect to date in medical imaging. The road to ultrasound as a front-line screening tool is undoubtedly established, perhaps proving a death to the other imaging modalities in future.

Leading New Standards in Ultrasound Extraordinary images. Ergonomic Design. Innovative solutions. Check a few ultrasound systems that ensure clinical confidence to end users

Siemens Acuson Freestyle Engineered to meet the unique needs of point-ofcare clinicians, Acuson Freestyle ultrasound system brings a whole new level of clinical experience by providing improved workflow and excellent image quality. Titled as the world’s first ultrasound technology with wireless, cable-free transducers, the ultrasound system provides the maximum freedom while scanning. Compact and portable, the system provides greater flexibility while positioning and requires only minimal space in the procedure room.


Esaote MyLab Seven Comprised of eHD technology and CrystaLine features, Esaote MyLab Seven delivers high-class performance and enhanced clinical experience. Compact in size, it comes with wide 16:10 LCD monitor and is suitable for cardiac, vascular, women’s healthcare and general imaging applications. The Esaote CrystaLine technology offers brightness, clarity, purity and sharpness to increase productivity and efficiency. The machine is also equipped with wireless access to provide easy data transfer.


Hot Products

[ under the scanner ]

Samsung UGEO WS80A UGEO WS80A is a revolutionary ultrasound system from Samsung that provides superior clinical performance for a variety of women’s health exams. The system has the stylish Samsung design and also features groundbreaking 5D technologies that provide exceptional image quality with maximum diagnostic confidence for physicians. The system is also equipped with technologies such as Hybrid Beamforming Engine evo, Samsung Dynamic MR evo, Advanced Feto Realistic View, MPI, ElastoScan, e-DEB, etc.

X-Porte SonoSite, the leaders in hand held and mountable ultrasound introduced a new chapter in ultrasound visualization technology by launching X-Porte, the world’s first ultrasound kiosk. The beam-forming technology of the system provides pinpoint precision and clutter free images. Through its easily customizable touch-screen interface, X-Porte puts at your fingertips leading-edge capabilities and on-board educational resources, such as step-by-step tutorials viewable simultaneously with live scans. X-Porte’s slender profile makes it easy to manoeuvre alongside beds for POC imaging. For portability during transport, its screen folds down and its stand lowers.


Philips Epiq 7

GE Healthcare, the pioneers in the industry has launched GE LOGIQ ultrasound systems capable of all imaging needs in radiology, vascular, breast, interventional, MSK and point-of-care applications. The series is an affordable range of ultrasound systems with excellent image quality. Shared service capabilities and advanced clinical features such as Elastography, Auto IMT, 3D/4D, Tissue Velocity Imaging (TVI) with Q Analysis, and B-Steer that help you to expand the applications of your ultrasound practice makes it a perfect system that fits your varied clinical needs.

Designed and developed to meet the unmet needs in the ultrasound segment, EPIQ 7 ultrasound system from Philips Healthcare ensures a premium ultrasound performance providing a higher quality of care. The system enables a quick and accurate diagnosis in less time. Backed by the family of proprietary xMATRIX transducers, Anatomical Intelligence and nSIGHT from Philips, EPIQ 7 enables faster and more consistent exams that are easier to perform. The system also provides a higher level of confidence.



Industry Experts


[ under the scanner ]

‘Demand for Technology Driving the Market’

With the rising need for more innovative features in elastography, OB/GYN, cardiology and oncology, the market will continue to grow, says R Sridharan, Senior Director, Ultrasound, Philips Healthcare

eaping high as an innovator in image-guided technology, Philips Healthcare has turned into the most widely whispered name among the customers. The unparalleled innovations in the field, combined with a peoplecentric approach grants the company this unresolved acceptance among all. Their commitment to deliver new healthcare technologies, relevant to the consumer needs is evident in their product portfolio that cater the needs of different medical specialties. Of these successful sagas, there lies behind sheer hard work, ingenious planning with sensitivity and thorough knowledge of the industry. R Sridharan, Senior Director, Ultrasound, Philips Healthcare shares Color Doppler his insights on ultrasound industry, its future and how Philips Healthcare successfully create the next generation technology that help people live healthy and happy. Excerpts from an interview: How do you think the Indian ultrasound industry has transformed over the last five years and where do you think the market is heading towards? Technology and functionality in ultrasound has progressed multifold in last few years. When it comes to high quality imaging the focus is on better contrast ultrasound imaging for easy clinical diagnosis. Rampant adoption of 3D and 4D facility in radiology, cardiology and imaging, functionalities like whole body elastography used in liver, breast, gynecology applications and innovative features like Anatomical intelligence, which simplifies exams are a few of the factors. Also increased awareness on medical advancements has fueled the demand for quality healthcare services and treatment.


R Sridharan What are the unique market drivers in India that boom the ultrasound segment? Rampant expansion of ultrasound utility in rural, tier I and II cities, eagerness to adopt a high-end technology and desire for having emerging differentiated functionalities in ultrasound, which helps more area of diagnosis are key drivers. With the rising need for more innovative features in elastography, OB/GYN, cardiology and oncology the market will continue to grow. The initiatives of the government and private players in reducing mortality in cancer and cardiac diseases and improving morbidity rates during pregnancy will also pay a key role. Being radiation-free, noninvasive, effectively meeting emergency care standards - it has a huge impact on patients who values quality healthcare and clinicians choosing this over other imaging modalities. Growth in OB/GYN and POC applications and taking note of India’s huge middle and upper-middle class population, value and mid-end will continue to be largest growth segments. There is a soaring rise in competition in the ultrasound market, with new entrants heading into the segment. What are the unique marketing strategies Philips healthcare adopt in order to stand unique from others?

Our collaborative and customer centric approach ensure that we closely work with the leading clinicians from the time of product inception to the final product introduction, ensuring that all our innovations meet their needs and aspirations. Our marketing initiatives focus on partnering with clinicians to drive clinical education and training ensure that they extract the best out of our systems and optimize efficiency and bring forth clinical excellence. Through our customer marketing initiatives we ensure their success, when they partner with Philips. Patient activation initiatives by Philips ensures patients get proactively involved in the decision making process involving their health and well-being. Philips’ Anatomical Intelligence is a recent technological innovation from Philips Healthcare. How this technology revolutionizes the diagnostic ultrasound? Anatomical Intelligence to put simply is turning images into answers. For the first time an ultrasound system incorporates a rich database of anatomic structural models and utilizes adaptive system intelligence to deliver results. Real answers that excel in the face of greater case volume, diagnostic complexity, and demand for certainty that ultrasound must deliver. Anatomical Intelligence applies adaptive system intelligence, and a rich database of 3D models of anatomical structures to a patient’s ultrasound data, with the aim of simplifying investigations and providing more reproducible results. With advanced imaging technology of organs, image slicing and proven quantification, exams are easier to perform, more reproducible and deliver new levels of clinical information and ensure workflow efficiency. There are a plenty of technological advancements happening in ultrasound segment. How does Philips ensure that the end-users are made aware of the


Industry Experts

[ under the scanner ]

its potentials?

safety and quality IEC 60601 addition 3.

We are aggressively driving clinical education programs and training in India that focus on these advanced technologies. We have training programs with our consulting partner sites in Chennai, Delhi and Coimbatore to drive personalised handson ultrasound training. In addition, Philips drives special niche programs on lung ultrasound, which is unique to Philips technology solution. By sharing best practices and clinical outcomes of national and global luminaries with clinicians, we ensure they use the advance system features and capabilities and deliver clinical excellence. We also partner with medical associations and build a platform of sharing and learning.

Regulations in the ultrasound market in India has always been under discussion. What is your insight on the same?

‘Going Green’ is the motto of most of the healthcare manufacturing device companies. How environment friendly are the products from Philips Healthcare? We comply with the Ministry of Environment on E-waste Management. We ensure collection of end-of-life equipment back as a process and get the units cannibalized through authorized companies by the ministries. We also extend service support till the end-of-shelf life. All our products comply to global electrical standards of

The industry is consistently working towards increasing the scope of ultrasound to larger disease management and diagnosis. It also brings down the infant mortality rate. Simultaneously, technology revolution has added a several dimensions to reduce the size of the equipment, thereby giving opportunity for mobility and effective point-of-care and emergency usage of ultrasound. The regulators and industry should converge to optimize the full benefits of the advancing technology. We comply with the regulations and support them so that technology is not used by vested interest for ill practices. Please brief us on the R&D activities of Philips, especially your imaging segment. The Philips Innovation Campus (PIC) in Bangalore is one of our global development centers that leverages local talent and the surrounding eco-system. Products are designed by local experts for both local and global markets. Products developed at PIC such as ClearVue ultrasound machine and Allura Centron cath lab have had great success overseas as well.

We collaborate with clinicians to understand challenges in today's rapidly changing healthcare environment and deliver meaningful solutions to address their needs. Many of our users in India are actively involved in the development of our future innovations. After-sales service is an important factor that determines the value of the company. How does Philips ensure best services to its customers? We have a state-of-the-art customer care solution centre that houses very experienced service specialists who resolve customer issues over the phone and offer remote support. Remote support services are offered in our systems that have very high functionality. This helps in proactively identifying system issues and having them corrected and ensures that the system downtime is very minimal. We also have established flying squad teams in India who are available at short notice to identify and fix customer issues that has reduced the turnaround time to solve problems. Our parts TAT is one of the best in industry. This results in very high uptime of our systems. Our strong and wide spread customer service team has ensured that we are number one in customer delight and customer satisfaction.

Thanks to R&D, Mindray Makes Global Mark Mindray began its modest journey into Medical Devices Market in 1991 and our first Ultrasound system was developed in the year 2001, since then there is no looking back. Mindray expanded rapidly both on product lines and geographically. With strong investment in Research and Development, today Mindray products are used globally, establishing Mindray as a reputed Healthcare company. Mindray did many notable Ashwani Raina mergers and acquisitions Deputy Director, UIS Mindray India during this period. 2013 witnessed an important milestone when we acquired ZONARE, a California based Ultrasound Company which further strengthened our


product line and technology. As Globally, Mindray ‘s Journey in India too has been amazing; from being perceived as a low cost B & W ultrasound company to what we are today is by virtue of the trust and faith our customers had on us. Today in many regions, our color Doppler systems are the first choice of customers, because of the performance and ease of use and we do aim to achieve this across India. Frost and Sullivan award in 2012 is a proof of our achievement and depicts our growth story of ultrasound business in India. Our ultrasound product portfolio has been expanding and the latest DC8 premium color Doppler system has won accolades from across the board and has found its place in some of the finest centers across the country. A big thank you to all our customers and well-wishers who helped us in taking Mindray to the next level and helping us achieve our dreams. I assure we will remain humble, committed and provide the best services to our steamed users.




Riding on demand for new imaging technologies, the values of Indian diagnostic ultrasound market is predicted to witness over 9.5% CAGRs through 2019, driving the country’s ultrasound revenues to $192 million, by the end of the forecast period


2096 units

The Indian Ultrasound Equipment’s market in terms of volume as of Calendar Year Q4 2013


The number of vendors shipped ultrasound equipment



850.5 crores Estimated ultrasound market in 2013-14

5645 systems Estimated market in 2013, in volume terms

31% - Combined market

14% - Combined mar-

46% - Market share

41% - Market share of

ket share of premium and high-end models

share of premium and high-end systems

mid-end systems

of mid-end ultrasound systems

28% - Entry level

23% - Market share of

segment share

the entry level and portable system.

17% - Share of

portable system






Market Leaders


1 2 3


Market Drivers

Key Highlights

Rising government spend in the Indian healthcare system Increasing need to enhance the standard and access of healthcare services Diagnostic success rates Decreasing price trend

There is a rise in demand for ultrasound machines designed for specialties such as cardiology and radiology.

Increasing awareness on screening for breast cancer has driven the number of ultrasound procedures.

Improved handling of the devices The use of ultrasound as a primary screening method for breast cancer

The penetration of portable and color Doppler ultrasound systems into the market.



Advanced technology such as echocardiography has evolved into a non-invasive method for imaging, driving further growth.

color Doppler is gaining popularity and is a major contributor to the ultrasound market.

The availability of low-end color Doppler at affordable prices has led to the decline of black-andwhite (B&W) ultrasound equipment market.

Development of new imaging technologies An increased number of applications for ultrasound systems



The Future Impressive Growth Ahead! 9.5% CAGRs* through 2019 = Revenue of USD 192 million

Market Drivers Increase in household incomes Growing demands for higher-quality healthcare Growing number of radiologists and physicians Investment opportunities for ultrasound manufacturers in future. The availability of high-end, user-friendly machines

Key Challenges The price wars created between domestic manufacturers and multinationals The absence of proper relevant laws and regulations makes it hard for newcomers to enter the market.

*CAGR - Compound Annual Growth Rate



Expert Opinion

[ under the scanner ]

Portability Revolution Dr N Khandelwal, MD Radiology, MD Radiodiagnosis, Professor and HOD, Radiology, PGI, Chandigarh, certifies that the portable machines have transformed the ultrasound practice in the hospitals


he diagnostic accuracy of the physical examination is problematic, even when performed by the experts. Between this arrives the hassles of large ultrasound scanning machines making it extremely difficult for the physicians to examine the injured, old and bed-ridden patients. Here comes the benefit of portable or hand-carried ultrasound scanning machines. The benefit of portability is being hassle free. The portable machines have the asset of less weight and handiness, enabling the physicians to use it with ease near critical, bed-ridden patients. The handheld ultrasound scanning machines thus extends the physician’s diagnosis capabilities beyond the limits of physical examination. Dr N Khandelwal, MD Radiology, MD Radiodiagnosis, Professor and HOD, Radiology, PGI Chandigarh, India, who has been using portable ultrasound systems since 2000 certifies that the machines has transformed the ultrasound practice in the hospitals. He founds it safe, non-invasive and nonfrightening to the patients. Excerpts from an interview: When did you start using the ultrasound systems? It was in 1985, when the first ultrasound system was installed in our institution. But it was a stationary and heavy machine. In 2000, we got the first portable ultrasound system installed and today, we have six portable ultrasound systems in our department. What kind of problems did you face with the original ultrasound machines?


probes. Ultrasound guidance has brought care to the point of patient, enabling practitioners to provide comprehensive care. This has also increased patient safety. In fact, our hospital is one of the major HCU users with six units of SonoSite MicroMaxx in the radiology department. We use these systems for emergency, image guidance, reviewing cases in intervention radiology and in our mobile outreach programme for community radiology.

Dr N Khandelwal Well, the major drawback with those systems was the patients had to be shifted to the said department for scanning purposes. It was very inconvenient especially for critically sick patients or those admitted in the ICU. How has the use of Hand-carried Ultrasound (HCU) system changed the way you practice? HCU systems have, in fact, transformed the ultrasound practice in our hospital. These lightweight systems are so safe and non-invasive, that they can easily be handcarried, much to the advantage of patients in the ICU or other critical departments. Patients who are injured, old and bed-ridden or an incubator-bound premature baby can now all be examined at their bedside. Does the compact size of the HCU system affect the quality of ultrasound scan of a patient? Over the years, there has been a transformational change in the role of ultrasound scan due to enhanced image resolution and easy-to-use characteristics. The concept of one probe with black and white or grayscale has now changed to variation in

How is the ultrasound technology better than other scanning modalities for pediatric patients? Ultrasound is radiation-less unlike radiography, CT scans, and nuclear medicine imaging techniques. The non-frightening appearance of the HCU system, combined with the advantages of rapid scanning and lack of concern about ionizing radiation, makes it a perfect diagnostic tool for many pediatric applications. We have a dedicated POC machine in the neonatology section. Are there any benefits of using system in the neuro segment? Currently, we are using these systems only in TCDs, but can definitely expand our services. If a physician has already done neuro-intervention or carotic-stenting, it can be good modality to do follow-up and check status. With the kind of performance of HCU systems that we are experiencing, it can make a marked difference in neonatology. Do you think HCU system has emerged as a life-saving tool? Where seconds count, we require equipment that responds as quickly as to help in making life-saving decisions. SonoSite HCU boot up in few seconds, providing ultrasound technology on real-time at patients’ bedside. This is crucial particularly when vital information is needed quickly to decide on further course of treatment.


Tech View

[ under the scanner ]

Philips Anatomical Intelligence With a database of anatomic structural models and adaptive system technology, the ultrasound’s computer can automatically identify the anatomy based images without human interface


natomical Intelligence applies adaptive system intelligence, and a rich database of 3D models of anatomical structures to a patient’s ultrasound data, with the aim of simplifying investigations and providing more reproducible results. It helps clinicians perform typical and advanced tasks, such as alignment, segmenting, visualizing and quantifying. Today, even with familiarity and practice, these tasks can take significant time during ultrasound exams, as well as during procedures. In today’s cardiology practice, assessment of LV function is no longer limited to evaluation of ejection fraction. Speckle strain echocardiography is a novel technique for use in imaging myocardial deformation (strain). For cardiologists to incorporate strain results into their clinical decision-making,

currently, the most important practical limitations of routine clinical incorporation of strain imaging include its impact on workflow efficiency, observer variability, and inter-vendor inconsistency, driven by the fact that different manufacturers may use different tracking algorithms. As with many other technologies, automation is the key to achieve workflow efficiency and measurement reproducibility of strain echocardiography in a busy clinical practice. Conventional ways to initiate GLS measurement requires manual tracing of the endocardial border or at least manual location of anatomic landmarks such as the mitral annulus and LV apex. This inevitably slows down the workflow and introduces human error and observer variability, hence limiting practical use of strain imaging.

With the aCMQ Anatomical Intelligence tool of Philips EPIQ, GLS can be obtained with ZeroClick technology within a few seconds after acquisition of 2D images from three routine apical views (4-chamber, 2-chamber and long-axis).

Automated 2D QuantificationA.I. (a2DQA.I.) is an ideal tool for every echo lab. Its ZeroClick technology uses Anatomical Intelligence for rapid access to proven 2D EF and volumes for adult and pediatric patients. Your 2D EF measurements are one click on every patient – no manual tracing. AutoEF is available during the study and so fits in with an everyday echo protocol.


Mitral Valve NavigatorA.I. (MVNA.I.) takes a Live 3D volume of the mitral valve and turns it into an easyto-interpret model in eight guided steps, providing access to a comprehensive list of MV measurements and calculations. Compared to previously available tools, MVNA.I. models and measures with 87 percent fewer clicks, saving steps at each part of the process. MVNA.I. guides the entire process using simple commands and clear graphics, making this a very easy tool to use. This helps a surgeon to look into the valve before a procedure and to decide whether to go for repair or replacement.




Autism: Dispelling Myths Noted researcher on neuroimaging, Dr Rajesh Kumar Kana speaks to Color Doppler in detail about the new findings in the field of neurodevelopmental disorders and briefs on the research activities that might unravel at least a part of the mysteries that lie behind the causes of autism

A Purnima Sah l CD News

utism is a developmental disorder that affects multiple areas of development such as, a toddler’s ability to develop speech like a normal child, verbal and non-verbal communication and socialize with people around them, and these result in many behavioural peculiarities such as repetitive conduct. The root cause of autism is yet to be unravelled, for which a number of research studies are being carried out across the globe. A group of researchers from University of Alabama at Birmingham (UAB) Department of Psychology are trying to unfold the mysteries of how human brain functions. Dr Rajesh Kumar Kana is leading this group’s research projects. He uses neuroimaging methods, especially functional magnetic resonance imaging (fMRI) and diffusion tensor


imaging (DTI) to understand the brain in typical population as well as in individuals with neurodevelopmental disorders. Dr Kana earned his PhD from Indian Institute of Technology (IIT), Delhi, India. Before joining the University of Alabama at Birmingham as an Assistant Professor in 2007, he was trained in neuroimaging and Autism at UCLA and at Carnegie Mellon University. He is an expert in the area of fMRI research on children and adults with autism spectrum disorders. Dr Kana, now a tenured Associate Professor at UAB, is here with us, explaining parts of his research activities that might unravel at least a part of the mysteries that lie behind the causes of autism. Excerpts from an interview: You have an experience of conducting researches for more than a decade in the field of autism spectrum disorders. What are the root causes of autism, according to you? The exact cause of autism is not yet known. However, several factors at different levels, such as genetics, neurobiology and development may work in concert to create the underlying pathology of autism. It should be noted that, even in the first

scientific paper on autism by Leo Kanner in 1943 (Kanner, 1943), a biological origin was proposed as the basic cause of autism. Research in the last few decades has unravelled multiple genes as well as multiple neurological abnormalities that may underlie autism spectrum disorders. It is not very surprising that there is no single cause of autism identified yet, considering the complexity and magnitude of the symptomatology of autism. How effective is neuroimaging in diagnosing autism spectrum disorders in the initial stages? In the last few years, neuroimaging research has made significant advances in helping us understand the mechanisms behind typical and atypical brain functioning and autism is no exception. Several recent studies, including one of our own, have used neuroimaging data to successfully classify participants to autism and control groups, suggesting the diagnostic utility of neuroimaging based inferences. While all these attempts and findings are signs of significant progress, I do not think neuroimaging is ready yet to be used for exclusive autism diagnosis. This is primarily because neuroimaging based


inferences are derived from a combination of different factors, starting with the fact that brain activity is an indirect measure of blood flow changes. I think neuroimaging, with all the advances in technology, may help in the next five to ten years, to supplement behaviour-based diagnosis of autism, but perhaps not replace it. What are the recent advancements in brain imaging, which can bring revolutionary changes in the field of neuroscience? Multimodal neuroimaging is an important new approach in understanding disorders, especially complex neurodevelopmental disorders like autism. This approach combines evidence from multiple neuroimaging techniques. Such an approach provides probing the brain at functional, anatomical, connectional and neurochemical levels in order to derive a comprehensive understanding of the neurobiology of autism spectrum disorders. Another avenue is to understand the relationship between genetic mechanisms and brain development. Few centres have started examining the autism risk gene and its impact on brain organization and connectivity, which can provide valuable information about the interface between genotype and phenotype. Yet another promising direction is scanning infants and infant siblings to understand brain developmental patterns as early in life as possible. And finally, intervention-based neuroimaging studies have started to provide preliminary evidence of the impact of different cognitive and behavioural interventions on brain activity and brain connectivity in autism. This approach is translational in that it integrates and applies basic neuroscience findings to fine tune clinical intervention strategies. Please elaborate on how brain scans help in detecting the signs of autism. The way brain scans can help detect autism is by identifying reliable, consistent, and common patterns of brain organization, brain function or brain connectivity. Pattern classification studies using


machine learning techniques, in the field of neuroscience, have a significant role in identifying such biomarkers or neural signatures if any. Disruption in brain connectivity has been a relatively consistent neural signature of autism. Nevertheless, the main questions to think about in this context are about the accuracy, specificity and sensitivity of such markers in distinguishing autism from typical individuals and from individuals with other disorders. What measures can be taken to make the world understand what Autism exactly is? Creating awareness among public is perhaps the most important factor in dispelling the myths about autism. Of late, due to several factors including media coverage, autism awareness among general public has been significantly increased. In addition to the public knowledge of autism, it is also equally important to provide doctors, especially paediatricians, with basic training and knowledge of autism, particularly in developing countries. A scientific study (Daley and Sigman, 2002) done several years ago in India found huge disparity in the way professionals including doctors understood and conceptualized the diagnosis of autism spectrum disorders. It is also the responsibility of scientists working in the field of autism spectrum disorders to communicate their findings with the public in timely and convincing ways. Is autism a kind of seizure disorder? I do think autism can be called a seizure disorder. However, the prevalence of seizures in autism is much higher than that in typical population. Some estimates indicate about 5-38 percent of individuals with autism have some form of seizures. Brain abnormalities, such as an imbalance between excitatory and inhibitory neural activity in autism may underlie seizures. How can Autism be treated? There are lots of treatments available for autism. However, we have to be careful and clear about what we mean by “treatment�. Intervention of autism involves

cognitive and behavioural therapy, treatment with medicines etc. Many of these interventions and medicines are targeting to build a specific skill (eg, social behaviour) or to alleviate some difficulties (eg, deficits in attention). The intervention will have to be individualized as there is significant heterogeneity in the manifestation of autism. Intervention practices need also to be structured, intense and consistent. Please share us one of your most interesting researches in detecting autism spectrum disorders. One of our recent neuroimaging studies (Deshpande et al., 2013) examined how the brains of high-functioning adults with autism respond to a task involving reading the thoughts and feelings of other people (theory-of-mind). We collected behavioural, functional MRI and diffusion tensor imaging (DTI) data from a group of participants. The study found differences at several levels including functional connectivity (synchronization of brain activity across regions), effective connectivity (causal influence of one brain area on another) and white matter fibre integrity. When we submitted all these different indices to a classification analysis, we and found that the pattern of effective connectivity among posterior to anterior brain areas predicted the group membership of a given subject with about 95 percent accuracy. This is an important step in the direction of finding a neuroimaging-based marker for autism. What are your ongoing researches on neuroimaging? One of the projects involves multimodal neuroimaging with high-functioning adults with autism. This project examines cortical thickness, volume, surface area, white matter connectivity and the concentration of neurochemicals like n-acetyl aspartate in the brains of individuals with autism. The goal is to understand the structural, connectional and neurochemical abnormalities, and their relationship in mediating the brain functioning in autism. Another project is more translational in COLOR DOPPLER | APRIL, 2014

nature and examines the impact of an intense language intervention on changing brain connectivity in children with autism. Preliminary findings from this study show significant improvements in language circuitry in the brain of children with autism after going through intense individualized intervention. Yet another project examines the structural and functional integrity of reward circuitry in adults with autism. All these projects are aimed at finding the neural mechanisms underlying autism. There is a notion that autism can only be treated by occupational therapy and speech and behaviour training. How valid is this? Occupational therapy and speech and behaviour training are all important in improving the daily functioning of a child or an adult with autism. For me, every therapy is important as long as it is relevant and effective in improving the behaviour or function we are targeting. Speech therapy is extremely critical in many children with autism who may have atypical language or delayed milestones in

language development. One of your articles with UAB News which was published in the middle of October, 2013 you have talked about fMRI study of Theory-of-Mind (ToM) on high functioning adolescents and adults with autism. Please brief for our readers. As I have mentioned earlier, this study examined Theory-of-Mind (ToM) using a causal attribution paradigm involving intentional causal attribution (folk psychology) and physical causal attribution (folk physics). We found the participants with autism made more errors, relative to controls, in understanding intentional causality, but not in understanding physical causality. In addition, we found significantly weaker coordination (weaker functional connectivity), and poor posterior to anterior information transfer (effective connectivity) among brain areas in participants with autism during intentional causal attribution. This study also found white matter alterations along with connectivity patterns predicting group membership of

a given participant, as mentioned earlier. This study is vital, as Theory-of-Mind is such an important skill that is at the centre of our successful social interactions. Alterations in ToM circuitry in the brain in autism can have a significant impact on their social life. How fast the field of neuroimaging growing? What will be the breakthrough in near future? The field of neuroimaging is growing at a significant pace. With advanced and sophisticated computational techniques, the precision, promise, and possibilities of neuroimaging have improved. Specifically, advancements in neuroimaging methods have resulted in the development of faster data acquisition sequences, higher magnetic fields, better image quality, and reduction in artifacts. All these advances are helping not only basic research, but also promising breakthrough in clinical and translational research. I think the contribution of neuroimaging to understanding and treating disease states will be the biggest breakthrough in near future.

index to advertisers Advertiser




Sonosite India Pvt Ltd

0124 2881100


Noesis Technologies



Nature’s Global Service






USCON 2014

+91 9811540891




KS Biomed



0124 4632488



32 42 43 44


Energise growth now


[ world autism awareness day special ]

Brain Scans Sheds Rays of Hope in Autism Diagnosis In association with World Autism Awareness Day on April 2, Dr Y T Patel offers an overview of the disease, with emphasize on its symptoms, diagnosis and imaging


utism is a common disorder of childhood and it is a life long condition. It is a neuronrelated disorder caused by the abnormalities in the development of brain. The pattern of nerve connections – the wiring of nerves within brain is altered, resulting in autism. Males predominate in the occurrence of autism. Autism to a lesser or greater extent lack the ability to grasp and interpret the meanings of gestures, body movements, tone of voice and facial expressions. The speech, language, verbal and non-verbal communications are altered as compared to normal individuals. Symptoms •They are often mentally retarded, having low IQ and have seizures - epilepsy. •Often associated with Tuberous Sclerosis (TSC) and less often with Fragile X (FraX) syndrome. •Pervasive developmental disorders include: Marked impairment in social interaction, impairment in using multiple non-verbal behaviors. Examples: eye-to-eye gaze, facial expressions, body postures and gestures to regulate social interaction. •They prefer loneliness and do not mix with their correspondents. •They feel shy, sometimes depressed and sit with expressionless face. •They usually fail to establish relationships appropriate to development levels. •Lack of emotional and social reciprocity •Lack of spontaneous seeking to share enjoyment, interests or achievements with other people.


•Dissociation between simple and complex processing reported in language, memory, reading, mathematics and executive function.

Dr Y T Patel MD Radiology, FICR, FICMU Professor of Radiology GMERS Medical College and Hospital, Dharpur- Patan, North Gujarat Dean, Indian College of Medical Ultrasound (ICMU) President, Indian Radiological and Imaging Association, Gujarat State Branch

•Delayed milestones: delay or lack of development of spoken language •Hearing loss can co-exist with autism (conductive, sensorineural or mixed type) Diagnosis •Comprehensive team work of multidisciplinary approach involving psychologist, speech - language pathologist and audiologist, pediatrician, pediatric neurologist, child psychiatrist, occupational therapist and physical therapist is necessary to make the early diagnosis. •Intensive surveillance and screening along with appropriate counseling and education is indeed needed. •Increased head circumference without evident neuropathology. •Considerable deficits in speech, language and verbal and non-verbal communication. •Sensory-motor deficits: Hypotnia causing impairment of gross and fine motor functions. •Low IQ score, under response or paradoxical response to environment and sensory stimuli.

Imaging of Brain in Autism In the era before 2000, neuroimaging, CT- PET/SPECT and MRI, fMRI revealed no definite-concrete supportive role in the clinical diagnosis of autism. Autistic individuals screened to exclude other associated disorders. In the present era, autism can be diagnosed with brain scan. Brain scans detect early signs of autism. Eventually, the researchers and developers hope that brain scans might also be a useful diagnostic tool. While further tests may be required, any tool which could help diagnose autism far at earlier age, have great deal of potential to improve or to offer good quality of life by offering right support at right time. Autistic individuals are certainly having differences in brain anatomy. Some regions are bigger and some are smaller or they have difference in shape. Usually, the following changes are spotted: • Accentuated head circumference without apparent neuropathology. • Significant differences in the thickness of tissue of grey matter in the areas of frontal and parietal lobes which are responsible for functions like behavior and language. • The amount of structural difference is probably directly proportional to the severity of the autism. • Some brains are located quite far away from ‘control’ brain, while some are like the ‘controls’ in this case autism is not too severe. Brain imaging analysis revealed differences in both grey and white matter (relatively more in grey matter) between children with autism and without autism. Temporal pole abnormalities in a child


[ world autism awareness day special ] with autism are as follows: • Subcortical hyper intensities on T2 coronal images localized in the temporal lobes observed in children with autism. • Dilated Virshow - Robbin spaces•Dilated, fluid containing perivascular spaces surrounding penetrating arteries. • Abnormally increased total brain volume, juvenile and adults with ASD have reduced corpus callosum volume, and increased amygdala volume. • Increased cortical thickness in parietal lobes. • Abnormal growth trajectories in frontal and parietal lobes.

Early diagnosis of autism and earliest intervention is rewarding as the symptoms of autism: problems with understanding and interpreting the language and communication, social interaction and behavior, can be very well improved. With a better understanding of the exact etiology as to what causes autism, there may be eventually better and more effective ways, not only for its treatment, but also for its prevention. It is important to understand thoroughly the anxious, frustrated, depressed, and many a times suicidal autistic individuals and to support, and help them at every

single stage of their life for their better quality life. Autistic individuals need to have education, employment, mental reassurance, cooperation and coordination of family members, friendship and fellowship and social rehabilitation. A dedicated, devoted, hard and sincere efforts to help out, not only autistic individuals, but all those who need support can bring good changes. A committed and sincere efforts for a better society, thereby better world, where one understands the other and supports at level best is all what is needed to make this earth a heaven.

Color Doppler at Your Fingertips Download Color Doppler from the 'Magzter' store to read India's first complete medical imaging magazine anywhere, anytime COLOR DOPPLER | APRIL, 2014


Now, You Can Graduate In Ultrasound!

Introducing India’s first Ultrasound course for bio-medical engineers and students

INDIAULTRASOUND SALES ‘N’ SERVICE Mobile:+91 9847 069684 Application:



[ featured company ]

Nature’s Global Service: Born to Make a Difference


he sheer number of medical imaging devices available today could overwhelm any customer. A number of recent launches have made us baffled and we concentrate mainly on the major streams of devices such as X-ray systems and ultrasound machines. But, equally are significant, those accessories and supporting solutions that enable the clinicians to have a safe and enhanced working environment. Here, we introduce Nature’s Global Service, pioneers in X-ray radiation protection apparels, X-ray dark room accessories, X-ray machine spares, CT scan tubes et cetera. Established in 1980, by Tarun Bhateja, a young and dynamic entrepreneur, Nature’s Global Service has been growing ever since the medical equipment industry. Currently, the company is a world leader in providing a wide array of medical equipment. Being the Chief Executive Officer of the company, Mr Bhateja has constantly introduced the latest state-of-the-art technological innovation at significantly lower prices and thus, created a niche for himself and the company. The company is one of the most affordable medical equipment sellers in the country. Imaging, the Prime Focus Being a person who has known the pulse of radiology industry for long, Mr Bhateja has focused in the radiology specialty of the RADIATION SAFETY. A highly reputed ISO 9001:2008, ISO 13485 certified manufacturer, Nature’s Global Services concentrates on the import and export of X-ray radiation protection apparels which are lead/lead free, protection screens, X-ray protection lead glass, lead acrylic mobile shields; X-ray dark room accessories such as X-ray cassettes, X-ray slim illuminator, chest stand, cassette pass box, drying cabinets, protection screen, safe light and film drying rack; X-ray spares such as GPI grids, lead glass, bucky, collimetre, hand switches, high tension cables etc. This wide range of product range exhibits the company’s reach to all spheres


printer technology that combines the cost effectiveness and high-quality output of an LED printer with embedded DICOM software. This allows the physicians to print directly from the medical equipment without the use of any software or external print services. The DICOM printers are not only perfect for printing medical imaging, but also for standard office printing. This makes it an all-in-one printing machine for the organizational needs. Bringing Cost Effectiveness Tarun Bhateja

of radiology. The Brand X-Shield Nature’s Global Service sells the lead/ lead free aprons under the brand name ‘X-Shield’. There are mainly two types – frontal apron and double-sided aprons. The frontal type apron comprises of X-Lite and Pb-Free models. As the name indicates, X-Lite is an ultralight multivinyl apparels that weigh 20 to 30 percent lighter than the lead rubber apparels. Pb-Free is nothing but the lead free models that weighs the lightest 0.50mmpb equivalent apron without any weight of lead. This makes it the lightest apparel in the world with the most stylish designs. Both the above models are available in the form of surgical and coat type apron. A similar lead/lead free light weight models are also available for the category of double-sided apron. The full front and half back aprons are perfect for those who look for full front and half back protection. Double side aprons have further divisions like optimum series and maximus series that has features such as wide adjustable elastic belt, side slit fastner etc. X-Shield brands are also used for products like jacket, shirts, gonad and overy shield, goggles, table mounted shield, lead glass etc. First in Medical Imaging and Printing As said earlier, Nature’s Global Service is a pioneer in introducing innovations. The DICOM printers introduced by Nature’s Global Service is a first in digital

In the field of Digital Radiography, Nature’s Global Service has introduced DR-Retrofit Kit system. This enable the hospitals to upgrade the existing analog X-ray machines of any make via wireless technology for instant imaging. The technology boasts of several benefits over the use of CR system. The Kit consists of DR cassette of 17X17 inches, control box, DICOM application software and a DICOM compatible mono/ color printer. The print on A3/A4 papers is as good as an X-ray film image, which is a huge cost-cutting factor for any hospital. Other Services Nature’s Global Service further extends its services to dealership for various products including Varian CT scan machines for all major companies including GE, Philips, etc. The company is also an established dealer for Mitsubishi thermal paper and printer, Orion gold X-ray film, Sony thermal paper and printer, X-ray tubes, Olympus110s Normal Density and High Gloss Thermal Paper, and more. The network of Nature’s Global Service lies worldwide with the company exporting its products to countries like China, Taiwan, Europe, USA, Africa and Middle East. With advanced infrastructure and quality assurance in compliance with the international standards, Nature’s Global Service wins the trust and confidence of the customers. For more details about the company, contact: Tarun Bhateja, A-3, New Rajinder Nagar; New Delhi, India;; Phone: +91-11-28741437; +91-9810270997; or visit:


[ eventful ]

Organized to provide cutting-edge skills in advanced OBGYN ultrasound techniques, INSUOG 2014, which is to be held from May 2-4, 2014 at Hotel Taj Mahal Palace, Mumbai, is all set to raise the curtain

Towards a Better Tomorrow


Ria Lakshman V l CD News t is an interesting era in healthcare industry. A number of innovations are relished, plenty of studies are made and revolutions are happening in the way patient care has been done. The hullabaloos happening at the sector make it hard for every physician to cope with the way he/she looks at his profession. Staying updated is the only solution to this and here comes INSUOG 2014 that delivers high-quality learning to medical imaging practitioners through its education programs organized at various places. The event happens at Mumbai from May 2-4, 2014. The ADVANCED COURSE in OBGYN ULTRASOUND, happening at Hotel Taj Mahal Palace, one of the posh hotels in Mumbai, will cater to the radiologists, sonologists, OBGYN specialists and Fetal medicine specialists who are interested in obtaining cutting-edge skills in basic and advanced OBGYN ultrasound techniques. The course is conducted with an aim to empower the clinicians to a higher standard of international excellence in practicing OBGYN ultrasound. Under the Guidance of Veterans of Ultrasound The ADVANCED COURSE in OBGYN


ULTRASOUND will be conducted by the current national and international faculty of OBGYN ultrasound. The line of international faculty includes scholars such as Prof Dario Paladini, Prof Jon Hyett, Prof Nicholas Raine-Fenning and Prof Rabih Chaoui. Prof Dario Paladini, a major face in the field of diagnostic ultrasound has taught over 200 national and international ultrasound courses and seminars. He was also the Chair of Education Committee who co-ordinates the ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) activities worldwide. Prof Jon Hyett is the Head of High Risk Obstetrics and a Staff Specialist in Obstetrics and Maternal and Fetal Medicine at the Royal Prince Alfred Hospital, Sydney. Predictive modelling of adverse pregnancy outcome, first trimester prenatal diagnosis and the management of twin pregnancies are his areas of research. Prof Nicholas Raine-Fenning is an academician at University of Nottingham, who doubles as a Consultant Gynecologist at the Nottingham University Hospitals NHS Trust. His area of interest lies in gynecological pathology and is an experienced endoscopic surgeon. Prof Rabih Chaoui has marked his achievements in ultrasound through the study of the fetal coronary and pulmonary circulation, suggestion of specific planes in fetal echo, evaluation of the

fetal thymus, application of 3D in prenatal diagnosis, and assessment of first trimester brain. Content of the Course The course intends to provide latest information on various topics including first trimester and second trimester screening for congenital anomalies, Fetal Echocardiography, Fetal Neurology, Fetal Infection screen, Obstetric color Doppler, Fetal growth restriction, Fetal interventions, Infertility, Gyanaec malignancies, Elastography, Contrast imaging and more. Besides lectures on the topics, there will be live demonstrations, interactive sessions and presentation of new diagnostic hints. Three best papers will be awarded prizes and the participants can also submit e-papers or posters. A Joint Effort The major coordinators of the event are the three popular faces in ultrasound segment - Dr Chander Lulla, Dr Nitin Chaubal and Dr P K Shah. Dr Chander Lulla is the Scientific Secretariat of the course and he is all set to make new marks at the event. The other committee members are the pioneers who are also the faculty members of the course. Dr Mandakini Megh is the PCPNDT Coordinator for the course. With the clichéd note ‘Knowledge is Wealth’, Color Doppler wishes the INSUOG 2014 team a very best to shine and rise. For details: COLOR DOPPLER | APRIL, 2014

[ ecr recap ]

Plenty Twenty The 20th Annual Meeting of the European Society of Radiology, held in Vienna, has provided a perfect platform to learn and debate about the latest advances in imaging techniques and their clinical applications


xtremely well organized, the European Congress of Radiology 2014 (ECR 2014), the 20th annual meeting of the European Society of Radiology, held in Vienna, has set a perfect platform to learn and debate about the latest advances in imaging techniques and their clinical applications. As every ECR, the Vienna edition has ended a unique and unforgettable event, which extends the brilliant chain of outstanding meetings, if not set a new practice of knowledge gatherings. The jubilee meeting – the 20th congress in the modern history of the event, count-


ing from the 1991 when it was completely re-designed and held in Vienna for the first time, has turned out to be a spectacular show with a wide array of sessions and new-media friendly organisation. As the belief goes, the ECR has once again proved that it is the most advanced, sophisticated, well organized and stylish radiological meeting in the world. It offered a unique opportunity to debate controversial issues, discuss important professional challenges, and review the current situation in all basic and advanced topics in modern radiology. With so many educational and scientific sessions containing vital clinical information and cuttingedge science, it was no wonder that the congress has become a global event rather than a purely European one. One new innovation especially for ECR 2014 is the Multimedia Classroom,which

was launched under the guidance of Dr Emanuele Neri and Dr Daniele Regge. The ECR had created a special auditorium with a network of workstations, which was used to present multimedia sessions,each including discussion of three selected cases, which lasted for 90 minutes. Another important feature of this congress was the full digital and web coverage. At ECR 2014, the web streaming service, ECR Live, covered the vast majority of educational and scientific sessions, and the recordings was available via the ESR website both during and after the congress. The opening ECR Vienna talk of the conference was given by Dr Oleg Atkov, a cardiologist and former cosmonaut, who pioneered medical imaging in space in the 1980s. After spending eight months on board of the Soyuz T-10, Dr Atkov studied


[ ecr recap ] the effect of zero gravity on the body through ultrasound, finding some complex changes in blood and fluid dynamics under weightlessness. He explained how radiology is still being used in space research with astronauts, in complex studies with MRI and fMRI that allow the study of subtle brain changes in space travellers. Innovation makes ECR interesting One of these innovations was the multimedia classroom. The organizers setup an auditorium with network connected workstations where multimedia sessions were presented, each including the discussion of three clinical cases that allowed the attendees to participate in the lecture and encouraged discussion. The extensive digital coverage of the conference, including a mobile app, live streaming of most of the sessions, and a ‘Social Media Wall’, made it easy for attendees to follow the development of the congress and navigate the vast amount of events going on at the same time.

MRI: Latest innovations, upgrades and enhancements For many MRI manufacturers, the ECR has set a platform for exhibiting the latest innovation in the field. MRI has opened up the human body for radiologists to explore with remarkable precision and to gather clinical information of enduring value for physician colleagues, but the liver has so far proved a real diagnostic challenge. A combination of the organ’s complex vasculature and motion effects in free-breathing patients have meant that other modalities have been chosen instead of MRI, particularly when looking for metastases in oncology cases. Thanks to the researchers and manufacturers across the globe, the situation is changing. Visitors to the commercial exhibition could inspect a new software application which improves temporal resolution in MR images along with other developments that make scans both safer and more comfortable for patients. FREEZEit from Siemens SIEMENS has unveiled a technology that says it will make contrast-enhanced liver imaging fast and robust and allow free-breathing dynamic liver imaging, giving more patients access to high quality MR-based abdominal imaging. Dr Bernd Ohnesorge, chief executive of


Siemens’ MR business unit,explained that the key software technologies underlying the company’s new Twist-Vibe and StarVibe features will be available together as a package called FREEZEit. The former is a sequence that offers high temporal and spatial resolution with full 4D coverage formulti-arterial imaging with 100 percent precise contrast-timing. Meanwhile,StarVibe is an application that delivers robust, free-breathing, and contrast-enhanced exams for noncompliant patients by resisting motion artefacts. FREEZEit will be commercially available in Europe from summer 2014 onwards in Siemens Magnetom Aera 1.5T and Magnetom Skyra 3T scanners, and this technology offers the first step in the process of making MRI a more appropriate modality for use in staging early cancers. By providing full high-resolution liver exams in two to three seconds with about 1 mm spatial resolution, it not only removes the problem of motion artefacts but also produces high-quality images, enabling the accurate detection and characterization of small lesions. Small but big At ECR 2014, TOSHIBA has introduced a reportedly compact and cost-effective new scanner that comes equipped with a number of features intended to make an MR imaging procedure a more comfortable experience for the patient. With a mere 23 sq m footprint, the 1.5Tesla Vantage Elan unit is equipped with the same advanced features available in other systems within the company’s MRI product range. They will include the M-Power clinical application software suite and the Pianissimo noise reduction technology, which aims to provide a more pleasant working environment for the technician as well as the patient. To further reduce the stress of an examination, Vantage Elan has a 63cm aperture and has been designed to facilitate feet-first imaging for all studies apart from those involving the head or upper torso. Full angio and cardio suites are available, and the body package can be extended to include the Spine Line application, offering fully automated planning of spine examinations. In addition, the inclusion of Toshiba’s advanced non-contrast MR angiography technology, which allows vascular imaging without the use of con-

trast, will reduce potential health risks for the patient and make the procedure more cost-effective, the company suggests. Silent Scan becomes more silent GE HEALTHCARE is another vendor that has been concerned about the potential distress caused by excessive noise in some older MR machines, and last year introduced its own proprietary technology, called Silent Scan. At ECR 2014, it unveiled a software upgrade that includes tools for carrying out quieter procedures in more clinical areas. The company pointed out that machine noise during a conventional scan can sometimes exceed 110 decibels, equivalent to the sound level near the stage at a rock concert. This is caused by vibration in the coils resulting from rapid changes in field strength. Silent Scan is based on a novel data acquisition method where gradients are used continuously, but are not rapidly switched on or off. Thereby, mechanical vibration is eliminated and virtually no noise is generated during the process, according to the company. The new applications are contained within the DV24.0 Continuum Pak software upgrade. They include special applications for neurological investigations and MR angiography. The new software will also enable productivity improvements of up to 30 percent compared with previous generation systems, due to workflow enhancements based on GE’s new eXpress PreScan and Workflow 2.0 features. The company says the package has also been designed to increase diagnostic confidence, by including a 3D imaging technique with real-time motion correction called Promo. It is available with the Optima MR450w and Discovery MR750w systems. In the MRI section of the PHILIPS booth, upgrades and enhancements were highlighted, such as Smart-Path to dStream, the vendor’s digital broadband MRI technology. The company was promoting the latest release of dStream, which includes applications in neurology, trauma, paediatrics, and fay liver patients, as well as routine fat saturation.

Hot Innovations in CT! In the ECR 2014 exhibition, SIEMENS demonstrated how its newest scanner, Somatom Force, can carry out contrast-


[ ecr recap ] enhanced procedures using significantly smaller volumes of iodine-based agents. This could bring significant benefits for up to 20 percent of patients showing some level of renal insufficiency. There is no practical alternative to using iodine-based agents in perfusion studies, so normally those patients considered at risk, such as diabetics, or those with identified renal problems would be bloodtested before scanning. Any patients found to have elevated creatinine levels would need special measures, such as hydration before or after the procedure, to help their kidneys to cope with the extra burden placed on them by the contrast medium. Somatom Force is the third generation in the company’s line of dual-source scanners, and it features two Vectron Xray tubes capable of carrying out routine examinations at tube voltages as low as 70 to 100 kilovolts. As the contrast-to-noise ratio rises, the amount of contrast medium needed can be lowered accordingly. The technology has been tested at partner institutions and should be commercially available from the middle of 2014. Reports from those centres suggest that the new scanner has considerable promise in the early diagnosis of oncology patients. Perfusion imaging studies in patients with suspected liver tumours would normally require a high radiation dose, typically more than 50 millisievert (mSv), but the new technology allows those studies to be performed at considerably lower dose levels. Seitz pointed out that safer imaging will encourage the use of CT in monitoring response to chemotherapy. “Making accurate 3D measurements of the blood supply to a tumour will allow more precise use of extremely expensive therapies and improve patient care by enabling early decisions on which treatments will be most effective,” he said. Fusion Magic PHILIPS is another company that is pushing back the barriers to what can be achieved using advanced imaging techniques in cancer patients, and is promoting the results achieved with its latest PET/ CT scanner called Vereos. To date, this fusion modality has been mainly used for research studies at academic centres, but Duncan Porter, head of imaging systems field marketing for the company, believes COLOR DOPPLER | APRIL, 2014

it has potential for future use as a frontline diagnostic option. Philips also exhibited a more conventional CT-based scanning technology called IQ on Spectral CT. As with previous spectral CT scanners, this builds up images based on data from two parallel sets of detectors that capture either low or high energy photons. But while normally the technician must decide in advance whether to use the spectral function or carry out a conventional imaging procedure, with IQ on both sets of readings are available automatically. This means the radiologist can examine the conventional grayscale image before consulting with

This is a unique application that dramatically lowers patient dose during coronary CT angiography exams using a helical prospective acquisition. It automatically detects and adjusts to patients with irregular heartbeats, providing quicker and more consistent exam results, according to a company statement. The vendor is also addressing one of the major challenges in CT units: that of interpreting scans from patients with metallic implants. Its SEMAR (Single Energy Metal Artefact Reduction) technology uses a sophisticated reconstruction algorithm to eliminate artefacts caused by metal, while still improving visualisa-

the color spectral CT data for additional information acquired with the same scan. “As the additional image would have no negative impact on workflow, then spectral CT can be used for all routine imaging”, Porter said. TOSHIBA staff in the exhibition hall are keen to demonstrate the additional capabilities available for its Aquilion ONE scanner. These include a full suite of applications in what the company is calling its Adaptive Diagnostics range, notably the SURE Subtraction function, which can subtract bone and calcium from data sets, allowing clinicians to better visualise tumours or arteries at risk. Another highlight is the SURE Cardio Prospective function with arrhythmia detection.

tion of the implant. SEMAR can be used in routine low-dose volume acquisitions, and when combined with another piece of Toshiba software, AIDR 3D (Adaptive Iterative Dose Reduction), it is said to provide excellent image quality. Revolution in the making Meanwhile, GE HEALTHCARE has displayed its latest CT technology as a work-in-progress. The company has filed for a US marketing authorization for the scanner, which it is calling Revolution. It reportedly provides both reduced dose imaging and wider anatomical coverage, and acquires 16 cm of data per rotation, which will usually be sufficient to cover the whole cardiac and chest area in a single cycle. Most standard CT scanners gather


[ ecr recap ] 4 cm of data per rotation and the separate images would then be merged together to form the larger picture. The company says that the new product will offer further benefits, including a fast 0.28-sec gantry rotation speed and a bore size of 80 cm to accommodate bariatrics patients. This increased scanning speed has been integrated with software technologies such as SnapShot Freeze for reducing coronary motion. Radiation dose is further reduced with technologies such as iterative reconstruction. The 256-detectorrow scanner is capable of reconstructing data at 512 slices. Compact and Versatile HITACHI is increasing the choice available for those looking for a compact and versatile 16-channel CT scanner with the launch of Supria, an open access machine with a 75 cm bore. For the technician, the product is intended to offer easy operation with an intuitive graphical user interface design and a wide (24 inch/61 cm) monitor. It is a high-speed scanner with less than 1 sec/rotation and the latest 3D reconstruction that provides rapid coverage for efficient and precise examinations. The vendor is equipping Supria with Intelli P (Advanced), the latest version of its proprietary noise reduction technology. It also offers Core Method, the company’s 3D reconstruction algorithm that can ensure high image quality with a lower risk of artefacts, even during high-pitch scanning.

Radiology on Cloud Nine In many countries, hospitals no longer operate as stand-alone entities, but as part of a local or regional network, as healthcare administrators respond to the pressures of increasing demand, static or shrinking budgets and an ageing population. As providers of medical services to other clinical departments, radiologists are also adapting to their changing role of providing diagnostic expertise to colleagues working in institutions tens or even hundreds or thousands of kilometres away. However, some of the technologies that will help ESR members to deal with shining demands on their time are on show in the commercial exhibition. GE HEALTHCARE aims to improve the capability of medical staff throughout the hospital to work with colleagues across medical disciplines, administrative bound-


aries and even national frontiers. The company is demonstrating its new Centricity 360 concept – a cloud computing service rather than a product – intended to provide healthcare professionals with internet access to a wide range of distributed services and the ability to share patient information both securely and in real-time. In the radiology arena, Centricity 360 is a convergence between a traditional PACS and advanced visualisation technologies. It will be launched in Europe during the first half of 2014 with a patient case transfer capability, and additional services will be added later. Eventually, the company hopes to develop the service as a ‘virtual meeting space’ for multidisciplinary team meetings. Another vendor at the forefront of efforts to advance distributed radiology services is . Assisted by funding from Vinnova, the Swedish national research agency, Sectra is working with academic partners on a project to develop the technology needed to scan, store and display digitised histopathology images. At ECR 2014, Sectra showcased the results so far, although Ekström acknowledges that there are still considerable hurdles to overcome, particularly in relation to handling the huge volume of digital data likely to be generated by a busy histopathology unit. Meanwhile, SIEMENS HEALTHCARE is working to provide radiologists with a speedier workflow and greater diagnostic precision when working on MR and CT images. The new VA30 version of its syngo via routine 3D and advanced reading software contains the General Engine package of automated and standardised applications. It features ‘anatomical range presets’, which provide a quick, precise and optimal view of key anatomical features without the need for the radiologist or technician to spend time choosing and creating projections manually, according to the firm. On the PHILIPS stand, staff unveiled the latest refinements to its Intellispace technology. Intellispace is described as a thin-client solution requiring no dedicated workstation on which to perform the advanced analysis functions that it offers. In addition, Philips has updated the service to include advanced applications for

MR and nuclear medicine examinations in a vendor neutral technology capable of processing images derived from any company’s scanner. Its ability to combine the results of CT, MR and PET imaging modalities will prove invaluable in monitoring treatment of oncology patients by providing objective and accurate data on how the size of the tumour has changed over time. Across the hall on the CARESTREAM stand, the company was showing its new generation VuePACS as a work in progress designed to integrate images with reports and enable cost-effective teleradiology capabilities. A further highlight is the Vue Vendor Neutral Archive, a portfolio of solutions that store medical information in a non-proprietary, interchange format that allows it to adapt to any enterprise or departmental information-sharing workflow and open standard. Clinicians have access to a unified view of their patients’ clinical information across disparate systems with a global or single access virtually anytime, anywhere, according to a company statement. Another work-in-progress is Carestream’s planned enhancements to the digital breast tomosynthesis module on its VueMammo workstation intended to produce DICOMcompliant 2D synthetic views calculated from the 3D dataset. AGFA was keen to impress on visitors to its stand the potential advantages of its latest Impax Agility PACS, a departmental imaging platform designed to improve productivity, reduce cost and facilitate quality outcomes. According to a statement, “This comprehensive solution redesigns capabilities typically found in a RIS, multi-departmental PACS, voice recognition reporting and connectivity into one single system. IMPAX Agility streamlines navigation with a dynamic user interface and diagnostic tools to support enhanced productivity. A powerful task-based workflow engine helps to ensure that users follow the appropriate steps for each procedure and circumstance, from ordering to result distribution. This supports the hospital in meeting regulatory obligations and workflow best practices, as well as improving clinical communication through mobile apps.”


[ ecr recap ]

Patient safety is key priority Radiology department staff will always be concerned about the radiation dose received by their patients when they undergo routine imaging procedures. Among the many innovations on show in the commercial exhibition at ECR 2014 for reducing radiation risks, there is one that effectively eliminates any iatrogenic hazard for this patient group, according to the company that developed the technology. On the TOSHIBA booth, the company demonstrated its dose-tracking system for use in fluoroscopy procedures. The device is designed to minimise problems in patients undergoing lengthy interventional examinations. Regulations from the International Electrotechnical Commission (IEC) require manufacturers to display two dose parameters on their fluoroscopy monitor: the dose area product and entrance dose. But the methodology used in this process does not give an accurate measurement of the radiation reaching the patient’s skin surface, according to Andreas Patz, clinical marketing manager for Toshiba’s x-ray business unit. It is a theoretical calculation that takes no account of either backscatter effects or the type of tissue being examined, he warned. Moreover, existing monitors only provide a retrospective assessment of the cumulative dose, whereas the new technology provides real-time values that allow the technician to modify the procedure to prevent injury. “The effects of backscatter means that


previous systems may underestimate the real skin dose by 30-40 percent and if you have a local hot spot this will significantly increase the risk of skin damage. With the dose-tracking system, the technician will receive a warning to reduce the dose or change the angulation. So this is a support tool which increases awareness of the real skin dose delivered to the patient and prevents adverse effects,” Patz explained. Meanwhile, PHILIPS presented a new version of its Mobile Diagnost wDR digital radiography system designed to offer the benefits of a small and highly manoeuvrable imaging unit for those areas of the hospital where the available space may be limited, such as the trauma ward and neonatal intensive care units. The latest addition to the company’s product range includes the new Sky Flow scatter-correction algorithm that allows the radiographer to produce high quality, high contrast chest examinations without the use of grids. “That provides a double benefit in reducing the amount of radiation used and simplifying the imaging process which will help increase the workflow of the radiographers involved,” explained Duncan Porter, heads of imaging systems fieldmarketing for Philips. “Another important feature of the system is the lightweight SkyPlate wireless detector that is available in two sizes. One is for standard imaging in adult patients, and a smaller unit will be particularly useful in paediatric and intensive care situations. This is where access to the patient may be compromised and having that smaller detector can provide

much greater flexibility.” Improving diagnostic precision was the focus of the latest equipment on display at the CARESTREAM booth. The latest version of the image acquisition software for its computed and digital radiography systems comes with a bone suppressionfeature designed to create a companion image to suppress the appearance of posterior ribs and clavicles, while enhancing the visualisation of soft tissue in the chest. At ECR 2014, AGFA HEALTHCARE is launching the CR 15-X, a versatile digital radiography system that is ideal for use in decentralised general radiography environments, private practices, small clinics, general orthopaedic and chiropractic offices. According to the vendor, “The system combines a simple and smart design with proven Agfa Healthcare technologies to create an affordable system. It can be used for a broad range of digital radiography applications, while its high speed and image quality can be adjusted to meet the customer’s unique needs. Compact and affordable, yet robust and reliable,it offers an easy workflow for the radiography environment.” SAMSUNG is looking to enhance its reputation with the new S4335-Wdigital radiology detector. It states that the unit is a high sensitivity direct deposition-type detector that will provide high quality images at low radiation doses. As a standard cassette-sized unit weighing only 3.1 kg, the detector is designed to be portable, light weight and compact to meet the procedural demands of customers and increase patient throughput. SHIMADZU exhibited the following products at ECR 2014: TheTrinias F12 crossover angiography system, Sonialvision G4 multifunctional R/F room solution, OpescopeActeno surgical C-arm, and Mobile-DaRt Evolution wireless DR system. The vendor is focusing its efforts on these core areas: tomosynthesis for general radiographic examinations, slot radiography, motion-tolerant SCORE RSM, and SCORE StentView. Improving the safety of routine mammography examinations is the goal of a new product on display at the SIEMENS stand. The company is exhibiting its Mammomat Fusion system, which incorporates a second generation caesium iodide receptor offering enhanced sensitivity at a much lower dose compared with older models.


[ eventful ]

Delivering New Realms This year, Ultrafest 2014 covers the theme ‘Emergency Ultrasound’, focusing extensively on topics required for daily practices such as Emergency ultrasound infertility, gynaecological and fetal ultrasound Ria Lakshman V l CD News Beyond the dryness of summer, April has in its store an exclusive anticipation for the ultrasound market – The Ultrafest. Organized by Maharashtra State Branch of Indian Radiological and Imaging Association (MSBIRIA), Ultrafest has established itself as the must-attend event for everyone concerned with the ultrasound industry. The event brings together veterans from the ultrasound industry and spreads the knowledge seeds across the medical fraternity. Continuing to unleash the success saga, the 6th Edition of Ultrafest is set to raise the curtain in Powai, Mumbai at The Renaissance from April 18-20, 2014. With the theme ‘Emergency Ultrasound’, the program intends to cover diverse topics required for daily practices including emergency ultrasound infertility, gynaecological and fetal ultrasound. The event goes under the leadership of Dr Jignesh Thakker, organizing chairman. He has in his team Dr Shailendra Singh and Dr Sanjeev Mani, organizing secretaries for making it a remarkable event. Among the scientific committee, well-known ultrasound practioners such as Dr Asif Momin, Dr Mohit Shah, Dr Aniruddha Kulkarni, Dr Bimal Sahani, Dr Sanjota Nair, Dr Mrudula Bapat and Dr Rajesh Kamble joined hands to choose the best of


studies for the event. Impressive Array of International Faculty The presence of international faculty is an attraction in this year’s Ultrafest. Dr Peter Doubilet, Professor of Radiology at Harvard Medical School is one among the keynote speakers. Beyond an academic lecture, Dr Doubilet intends to share the attendees his extensive clinical and academic experience in ultrasound industry. He has been a radiologist at Brigham and Women’s Hospital and Harvard Medical School since 1981. From 1986 – 1999, he worked as a Director of Ultrasound and Co-Director of High-Risk Obstetrical ultrasound at Brigham and Women’s Hospital, where he is currently the Senior Vice Chair of Radiology. His area of interest is Obstetrical ultrasound, focusing on fetal growth, complications of first trimester pregnancy and mathematical approach to medical decision making. Another keynote speaker is Dr Carol Benson, who is a specialist in ultrasound in the department of Radiology at Brigham and Women’s Hospital where she is Director of Division of ultrasound, Co-Director of High Risk Obstetrical ultrasound, and Radiology Director for the Vascular Laboratory at Brigham. Dr Benson has a wide range of research interests in areas related to use of ultrasound in clinical practice. Dr Tom Winter, who is a familiar face

among the ultrasound events is also a keynote speaker at Ultrafest 2014. Obstetric sonography, musculoskeletal sonography, ultrasound guided biopsies, tumor ablation, virtual colonoscopy and abdominal transplant organ imaging are his areas of interests. He is currently a Professor of Radiology and Obstetrics and Gynaecology at the University of Utah, Salt Lake City. Dr Nawaz Ali Khan, who possesses 34 years of experience of undergraduate training with 24 years of postgraduate training is a perfect face to train the emerging physicians in the area. He is the Honorary Professor of Radiology, Andizhan State Medical Institute, Uzbekistan since 1998 and is a visiting Professor in many universities across the world. With his interest in hepatobiliary imaging, he is one among the few who has researched in untapped specialties of imaging. Ultrafest also brings together a good array of national faculty members, who are well-known in the industry. Dr B S Ramamurthy, Dr Nitin Chaubal and Dr Asif Momin are a few among them. The sessions will begin at 9.00am in the morning and extends till 6.30pm every day. Major Ultrasound device manufacturing companies too will be present at the event, allowing the delegates to assess and compare the products of all companies at a time.


[ upcoming issue ]

Mobile Buzz and OB/GYN


s we head into one of the hottest months of the year, Color Doppler too intends to speak about the hottest topic of the medical specialty – Mobile Teleradiology. The issue will speak about its applications in Emergency Medicine and about its untapped potential in remote areas. A sum-up on the latest imaging software and apps launched in healthcare industry is another extension of mobile teleradiology that would give the readers a knowledge on the newbies of the sector. In addition, Ultrafest 2014, one of the biggest ultrasound fests in India will be featured in the issue. The glimpse will cover the real-time updates from the venue, along with the latest launches, imaging device companies and other revolutions happening in the ultrasound sector.

May issue of Color Doppler brings to you insight on Mobile Teleradiology. Issue will also cover ultrasound for OB/GYN Mobile Teleradiology as an emerging trend Its applications in Emergency Medicine Enhancing radiology practice in remote areas Latest imaging software and apps Featured Event: Ultrafest 2014

Editorial contact:, +91-9447766392 Advertisement contact:, +91-9745853808 Subscription contact:, +91-4952378808/09

SUBSCRIPTION FORM Subscribe/ Renew %Discount

Discounted Rate

Payment to be made in the name of "Color Doppler Media"


No.of Issues

Actual Rate

3 years





2 years





DDs should be payable at Calicut

1 year





6 months 3 months

6 3

550 275

25% 10%

400 250

1 month





Please mail to: Color Doppler #2/1775-B Florican Road, Civil Station P O, Calicut, Kerala, INDIA-673020 Phone: +91 495 2378808 / 09

Name ............................................................................................................................................................. Mailing Address.............................................................................................................................................


....................................................................................................................................................................... City .................................................. State ........................................ Pin .................................................... Phone ............................................... Fax .......................................... Mobile.............................................. Email ............................................................................................................................................................ Payment enclosed Cheque/DD No ..................................................................Dated..................................... For office use

You can also subscribe online by logging on to

BP No .................................................... Order No ..................................................................................... Docket No ............................................ Period No ......................................................................................







Registered with RNI under No:KERENG/2012/41766, Postal Reg No: KL/CT/206/2012-2014, Posted at Calicut RMS on 8, 9th of every month. License to post without prepayment. License No. KL/PMG/NR/WPP/56/KKD/2012-2014; Date of Publication: 01/04/2014



April 2014  

This issue of Color Doppler focuses on Advanced Diagnostic Ultrasound and features the latest technological advancements in the field. ECR 2...