EFSUMB Newsletter
European Federation of Societies for Ultrasound in Medicine and Biology
EFSUMB Young Investigator Award 2019 The winner at EUROSON 2019 of the Young Investigator 3000 euro prize was Rogier R Wildeboer, The Netherlands for the abstract entitled
3 D Multiparametric Ultrasound for Prostate Cancer Diagnosis Rogier R Wildeboer, Ruud JG van Sloun, Hessel Wijkstra, and Massimo Mischi Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
Introduction Prostate Cancer (PCa) is the most frequently occurring type of non-skin cancer among American [1] and European men [2]. Due to the lack of reliable imaging, however, PCa diagnosis relies on systematic needle biopsy without targeting suspicious lesions–in spite of its associated complications and known risk of underdiagnosis and overtreatment [3]. In the United States, for example, an estimated 1300 000 systematic biopsies are performed annually [4], even-
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tually leading to only 164 690 PCa diagnoses in 2018 [1]. Hence, there is a high clinical demand for reliable PCa imaging allowing targeted biopsy. In recent years, a lion’s share of clinical attention has been directed towards multiparametric magnetic resonance imaging (MRI). Despite being more cost-effective, practical and much wider available, ultrasound (US) has not received the same attention. Moreover, a multiparametric US approach, combining promising US techniques such as shear-wave elastography (which visualizes the increased stiffness of malignant tissue) and contrast-enhanced ultrasound (CEUS, which allows the characterization of angiogenic vasculature), has never been investigated. My objective was therefore to examine the full potential of US for PCa diagnosis.
Methods To this end, I focussed on two challenges. First of all, the development of methods to analyse US videos in three dimensions (3 D). A 3 D US implementation does not only allow rapid characterization of the entire
prostate in a single recording, but it also enables the development of 3 D features that are impossible to estimate in 2 D. The second challenge was to optimally combine different US techniques in a multiparametric fashion, improving on the diagnostic performance of US by exploiting the complementary information among its features.
Results Both challenges required additional development of registration and segmentation tools to enable 3 D histology-ultrasound fusion for accurate validation and data labelling. I showed how digital 3 D reconstruction of the histology ensured a near-millimetre-scale matching [5]. Furthermore, a dedicated neural network architecture was designed for automated deep-learning-based (zonal) segmentation. This algorithm was successfully validated in three large datasets of 181 patients in total, acquired in several expert centres with different US scanners to ensure its robustness and generalizability, reaching an accuracy of over 97 % [6]. Exploiting the 3 D nature of 3 D CEUS data, I developed a method to solve the full con-
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vective-dispersion equation describing the spreading of a contrast-bolus through the prostate [7]. This allowed the extraction of novel 3 D features to characterize convection and dispersion in the (micro)vasculature. Using the 3 D reconstructions of histopathology, these features were shown to localize PCa with a ROC curve-area of 0.80 in a preliminary set of 6 patients that underwent CEUS at the Second Affiliated Hospital of Zhejiang University (SAHZU, Hangzhou, China). Expanding on these results, now a range of 3 D CEUS features can be extracted, from point-to-point dispersion to fractal dimensionality [8]. These features are conveniently visualized through a probabilistic tractography approach revealing the level of dispersion and convection in the 3 D vascular network to the clinician [9]. Meanwhile, to investigate the feasibility of multiparametric US, machine learning by means of a Gaussian mixture model using only CEUS features already achieved a higher detection performance than individual parameters, increasing the accuracy from 73 % to 81 % [10]. Thus, in collaboration with clinical partners at the Academic Medical Centre (University of Amsterdam, Amsterdam, The Netherlands) and the Martini Klinik in Hamburg (University Hospital, Hamburg–Eppendorf, Germany), I conducted the first clinical study combining B-mode US, CEUS, its quantification, as well as shear-wave elastography [11]. A total of 50 patients referred for radical prostatectomy were enrolled in this study; my preliminary work on registration allowed me to accurately match the histopathology to the imaging planes and automatically segment the prostate. The first results show that clinical reviewers of mpUS can detect Gleason > 3 + 4 PCa with a sensitivity of 86 %, more than 10 % higher than individual US techniques, without compromising the sensitivity [12]. Moreover, a computeraided detection algorithm, which was developed concurrently, was able to locate significant tumour regions with an ROCcurve area of 0.9 by actively exploiting the automatic zonal segmentation as well as a range of feature radiomics.
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Also the first step to a complete 3 D multiparametric analysis has been made. In a systematic-biopsy-validated 43-patient cohort that underwent 3 D CEUS at the SAHZU, I showed that a multiparametric Gaussianmixture-model-based approach, including all the novel-developed 3 D CEUS features, can improve over single-parametric investigation [8].
Conclusion In my research, a 3 D and multiparametric approach to US imaging of PCa was shown to be feasible and promising. Expanding on this work, a full 3 D multiparametric US framework will be developed. Such a framework can be expected to enable costeffective biopsy targeting in the future.
References [1] Siegel RL, Miller KD, Ahmedin J. CA Cancer J Clin. 2018; 68(1): 7–30 [2] Ferlay J, Colombet M, Soerjomataram I, et al. Eur J Cancer. 2018; 103: 356–387 [3] Ukimura O, Coleman JA, de la Taille A, et al. Eur Urol. 2013; 63(2): 214–230 [4] Hutchinson RC, Costa DN, Lotan Y. Urol Oncol Semin Orig Investig. 2016; 34(7): 296–302 [5] Wildeboer RR, Schalk SG, Demi L, Wijkstra H, Mischi M. Biomed Phys Eng Express. 2017; 3(3): 35 014 [6] van Sloun RJG, Wildeboer RR, Postema AW, et al. 2018 IEEE Int Ultrason Symp Proc. 2018 [7] Wildeboer RR, van Sloun RJG, Schalk SG, et al. IEEE Trans Med Imaging. 2018; 37(12): 2593–2602 [8] Wildeboer RR, van Sloun RJG, Huang P, Wijkstra H, Mischi M. 2018 IEEE Int Ultrason Symp Proc. 2018 [9] Wildeboer RR, Sloun RJG Van, Mannaerts CK, et al. 2018 IEEE Int Ultrason Symp Proc [10] Wildeboer RR, Postema AW, Demi L, Kuenen MPJ, Wijkstra H, Mischi M. Eur Radiol. 2017; 27: 3226–3234 [11] Mannaerts CK, Wildeboer RR, Postema AW, et al. BMC Urol. 2018; 18(1): 98 [12] Mannaerts CK, Wildeboer RR, Van Kollenburg RAA, et al. Eur Urol Suppl. 2019; 18(1): e1884–e1885
Rogier R. Wildeboer
Rogier R. Wildeboer received his B.Sc. degree with honours in Biomedical Technology and obtained an M.Sc. degree cum laude in both Biomedical Engineering and Applied Physics at the University of Twente. During his M.Sc. curriculum, he spend four months at the University College London to study the characterisation of magnetic nanoparticles for breast cancer treatment. His theses on photoacoustic breast cancer imaging as well as differential magnetometry for sentinel lymph node mapping were awarded several student research prizes. Currently, he is a PhD candidate at the Eindhoven University of Technology in collaboration with Philips Research and the Jeroen Bosch Hospital in ‘s-Hertogenbosch. Working closely together also with the Amsterdam University Medical Centres and the Martini Clinic in Hamburg, Germany, he studies the use of multiparametric and multidimensional ultrasound imaging of prostate cancer. Rogier authored more than 15 journal publications, three book chapters, and over 25 conference contributions, focusing on machine learning, biomedical imaging, and quantitative biophysical modelling.
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EFSUMB Newsletter
EFSUMB AWARDS AT EUROSON 2019
The EFSUMB Best Published Paper 500 euro Prize was awarded to Eleanore Terzi, Italy for the paper Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter retrospective study of 1,006 nodules published http://dx.doi.org/ 10.1016/j.jhep.2017.11.007
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Congratulations to Prof Hadi Ozer, Turkey who was elected EFSUMB newest Honorary Member. In the field of ultrasound, Prof. Ozer, Professor of Radiology, is the pioneer in Turkey and one of the pioneers in the United States, as well. Born 1927 he enjoys good health and is still active in the world of ultrasound. In 2018 he gave a lecture in Poznan about the history of ultrasound in USA and Turkey.
Congratulations also to Nico de Jong, The Netherlands, elected as an EFSUMB Fellow for his career spent on the clinical development and translation of contrast agents for ultrasound.
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FUTURE EUROSON SCHOOLS – visit efsumb.org for more details
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The World Congress for Ultrasound The line-up of speakers for the WFUMB 2019 Congress is outstanding; over 120 ultrasound experts will deliver the exceptional program. Plus, take the opportunity to explore Australia!
Most Influential Radiology Researcher 2018 Semi-finalist – Welcome Dr Richard Barr Dr Richard Barr is a Professor of Radiology at Northeast Ohio Medical University and has been involved in elastography and ultrasound contrast for over 15 years; presenting over 400 scientific and educational presentations and invited lectures worldwide. The current Editor-in-Chief of Journal of Ultrasound in Medicine, Dr Barr has published over 100 peer reviewed papers, several book chapters, and books “Breast Elastography” and “Elastography, a Practical Approach”. Aunt Minnie named him a semi-finalist for the Most Influential Radiology Researcher in 2018. Dr Barr will be presenting on day 2 of the Congress: ▪ Breast – How to incorporate strain and shear wave Elastography into your practice?
▪ General liver – WFUMB guidelines liver elastography ▪ General abdomen – Re-defining Bozniak with CEUS of complex renal cysts Click here to see the Congress speakers, click here to see the Congress program. Don’t miss out, REGISTER NOW. We sincerely hope you take this opportunity to be a part of the world congress for ultrasound and we hope you take the chance to extend your stay and enjoy some of the amazing sights of Melbourne and the rest of Australia. Melbourne is an exciting, ever-changing city with extraordinary surprises to be discovered in every laneway, rooftop and basement. A city that regularly tops the World’s Most Liveable list, there’s always something going on with an enviable array of major events and festivals.
Known for its style and sophistication, Melbourne exudes a distinct bohemian charm with its maze of hidden laneways, opulent bars, exclusive restaurants, charming gardens and off-the-beaten-track boutiques. It’s also a cultural hub of museums, galleries and music venues.
Internationally recognised MSK radiologist – Welcome Dr Ronald Adler With 30 years of experience performing MSK ultrasound, WFUMB is proud to host Dr Ronald Adler, a Professor of Radiology at the NYU Langone Medical Center, New York. Dr Adler’s primary research interests have included ultrasound guided interventions and applications of blood flow imaging, assessment of soft tissue mechanical properties to evaluate bone-tendon healing and skeletal muscle. He authored or co-authored 200 papers and 26 book chapters.
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Dr Adler has previously developed MSK ultrasound programs at the University of Michigan and the Hospital for Special Surgery in New York. Dr Adler will be presenting Using ultrasound contrast agents to assess tendon healing on day 1 of the Congress and MR-US Fusion Techniques for MSK Interventions on day 2. Click here to see the Congress speakers, click here to see the Congress program. Don’t miss out, REGISTER NOW.
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EFSUMB Newsletter
Platinum Sponsor – GE Healthcare Thank you to WFUMB 2019 Congress Platinum Sponsor, GE Healthcare. The support of sponsors like GE Healthcare, is essential to ensure the ongoing success of events that support and develop the local and international ultrasound industry.
Visit GE at WFUMB 2019 to see first-hand how the LOGIQ E10’s new approach to acquiring and reconstructing data in a similar way to MRI or CT systems, delivers image uniformity from near to far field. The result? Focal zones become a thing of the past as every pixel is in focus producing in-
credibly detailed images faster than ever before. High quality, efficient exams across a wide variety of clinical applications – even technically challenging cases such as high BMI or advanced disease. Learn more
Gynaecology Keynote Speaker – Welcome Dr Wouter Froyman Dr Wouter Froyman is a doctoral researcher in the International Ovarian Tumor Analysis (IOTA) group. The subject of his current thesis is the development and validation of diagnostic methods (i. e. in imaging, ultrasound in particular) for the management of patients with adnexal masses, with a focus on the investigation of the long-term behaviour of adnexal lesions followed conservatively (IOTA phase 5). He is also coordinating the ongoing studies IOTA phase 7 and IOTA-MRI. An invited speaker at over 25 national and international conferences and trainings, Dr Froyman received the Dame Hilda Lloyd Congress Medal for best abstract at RCOG 2016 in Birmingham, and in 2017, he received the best abstract award at the ISUOG World Congress.
Dr Froyman will be presenting in the gynaecology sessions Managing ovarian masses: how to classify them using IOTA terminology and From ovaries to endometrium: how do we differentiate benign from malignant? on days 1 and 2 of the Congress: ▪ What are IOTA easy descriptors and simple rules: How to use them ▪ Balancing risks of surgery with risks of conservative management of benign adnexal masses ▪ Solid ovarian masses: Lessons and pitfalls ▪ Reporting the endometrium and intracavitary lesions using IETA terminology Click here to see the Congress speakers, click here to see the Congress program. Don’t miss out, REGISTER NOW.
Stay up-to-date For registration, program, sponsorship, venue information and more, visit the website – www.wfumb2019.org
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Be part of the conversation, use #WFUMB19 #ASUM19.
Butterfly Network Butterfly Network has reinvented ultrasound from the ground up through it’s pocket-sized device, Butterfly iQ, the first handheld whole-body ultrasound system. Powered by a single silicon chip on a handheld, smartphone-connected device, Butterfly provides a personalized experience for healthcare providers at a drastically lower cost – starting under $2000. For over 50 years, ultrasound machines have used incredibly fragile and expensive piezo crystals, with systems costing upwards of $50 000, each wired and attached with cables to a separate machine. Those crystals must be tuned to produce three
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types of ultrasonic waves – linear, curved and phased – requiring separate transducers to capture specific imaging depths to view different parts of the body. Comparatively, Butterfly has replaced these delicate crystals with a single silicon chip. The chip, made from an array of thousands of programmable micro-machined sensors (you can think of this as a grid of very small drums) is capable of emulating all three ultrasonic wave patterns with a single probe, all on one handheld device. Through this fundamentally new invention, Butterfly is able to drastically lower the cost of its device by leveraging
the same manufacturing as consumer products, allowing for high precision, high quality ultrasound to be produced at scale.
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Butterfly iQ was cleared by the FDA for 13 indications, making it the broadest FDA clearance ever for a single ultrasound transducer. The result is a whole-body ultrasound system that is unlike any device on the market.Most recently, Butterfly iQ received CE Mark approval that allows the device to be sold in the UK, Europe, Australia and New Zealand. At a significantly reduced cost with no drop in quality, Butterfly iQ is making medical imaging universally accessible and affordable. Soon, the newest software updates will also incorporate AI, making it drastically easier to capture a usable image. Through both of these important updates, nurses, EMTs and physician assistants, among many other medical professionals, will now be able to easily and safely administer ultrasound for their patients. Leveraging an integrated software platform, Butterfly seamlessly connects users to collaborate across the hospital or around the world. Ultrasound studies are uploaded to Butterfly’s platform for safe and secure access, storing patient data in a HIPAAcompliant cloud that leverages best-inclass security and encryption. For almost every disease across every stage of human life, ultrasound can play an im-
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portant role. Butterfly envisions a world where personal ultrasound is just like a glucose meter, blood pressure cuff or a thermometer. Whether you have a chronic disease or a condition that requires regular monitoring, personal ultrasound will be there to find disease in time. Working with many global health partners, including Bridge to Health, a non-profit that used these devices to help train doctors in Uganda to diagnose pneumonia and other
ailments in children and other local residents, Butterfly iQ is helping to save lives in low resource settings around the world. By making medical imaging universally accessible and affordable, Butterfly is democratizing healthcare. For more information on handheld mobile devices, visit www.efsumb.org. The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper, Michael Bachmann Nielsen
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