HospiMedica International January 2018 by Globetech

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CLINICAL NEWS

Vol.35 No.6 • 12/2017- 1/2018

LEADER DAILY CLINICAL NEWS

ISSN 0898-7270

Miniature Acoustic Sensor Monitors Respiration Rate n acoustic monitoring system noninvasively and continuously measures respiration rate using an innovative adhesive sensor. The Masimo (Irvine, CA, USA; www.masimo.com) RAS-45 acoustic respiration sensor for rainbow acoustic monitoring (RAM) uses signal extraction technology (SET) to

World's First 7 Tesla MRI Doubles Static Magnetic Field Strength he world’s first 7 Tesla (7T) magnetic resonance imaging (MRI) scanner offers higher resolution and faster acquisition times in clinical applications. The Siemens Healthineers (Erlangen, Germany; www.healthcare. siemens.com) Magnetom Terra MRI scanner is an advanced ultra-high-

field scanner for neurological and musculoskeletal (MSK) applications in the head and extremities, which has the potential to reveal functional and anatomical details not visible in devices with lower magnet field strengths. A unique “Dual Mode” feature permits the user to switch between an investigational research

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New Monitor Enables MRI Procedures for Critical Care Patients

Robotic Surgery Platform Facilitates Laparoscopy new robotically assisted surgical device (RASD) helps direct small surgical instruments and a camera with precise movements and comfort. The TransEnterix (Research Triangle Park, NC, USA; www.transenterix. com) Senhance is a multi-port robotic system intended to assist in the accurate control of laparoscopic instruments for visualization and endoscopic manipulation of tissue, which includes

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Fluorescent Dye Detects Benign Brain Tumors n intraoperative molecular imaging (IMI) dye helps surgeons identify pituitary adenomas, which can cause blindness, hormonal disorders, and in some cases, gigantism. Researchers at the University of Pennsylvania (Penn; Philadelphia, USA; www.upenn.edu) conducted a study to examine if OTL38, a folate analog conjugated to a near-infrared (NIR) fluorescent dye, could help identify pituitary adenomas, which

n innovative compact monitor is designed to facilitate transportation of patients from a critical care unit to the magnetic resonance imaging (MRI) scanner and back, ensuring uninterrupted vital signs monitoring and reducing the time critically ill patients are away from their care units.

A Image: Courtesy of Iradimed

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Biometric Garment Could Offer Breakthrough in Patient Monitoring mart clothing with embedded body sensors provides a non-invasive monitoring solution for cardiac, respiratory, and daily activity monitoring. Developed by Hexoskin (Montreal, Canada; www.hexoskin.com), the Hexoskin connected healthcare platform is a

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Cloud-Based Portal to Provide Medical Education and Training

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new education and clinical training solution for medical students and staff is now installed and being used for the first time in a medical center in the Netherlands. The portal will enable all medical students and staff to access and interact digitally with full-body Computed Tomography (CT) rendered virtual-

representations of real-life medical cases for improved understanding and insight into the human anatomy during their studies. The Education Portal was developed by Sectra (Linköping, Sweden; www.sectra.com) and installed at the Amsterdam Medical Center (AMC; Cont’d on page 5

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HospiMedica International

Fluorescent Dye Detects Benign Brain Tumors cont’d from cover

are known to overexpress folate receptor alpha (FRα). To do so, they enrolled 19 adult patients who presented with pituitary adenomas who were infused with OTL38 two to four hours prior to surgery. The VisionSense (Horsham, PA, USA; www. visionsense.com) Iridium 4mm endoscope, with both visible and NIR light capabilities, was used to visualize the pituitary adenoma and its margins in real time during surgery. The signal-to-background ratio (SBR) was recorded for each tumor and surrounding tissues at various distances, and immunohistochemical analysis was performed to assess the FRα expression levels in all specimens and classify patients as having high or low FRα expression. Data from 15 of the patients were analyzed, with the remaining four patients excluded for technical considerations. The results showed that intraoperative NIR imaging delineated the main tumors in all 15 patients, with an average SBR of 1.9. The FRα expression level of the adenomas and endoscope-to-sella distance had significant impact on the fluorescent SBRs. The rate of gross-total resection (GTR) for the 15 patients was 73% (on MRI), compared to 50-70% with conventional approaches. Residual tumor tissue was identified on MRI only in patients with more severe tumors, including cavernous sinus invasion or a significant extrasellar tumor. In three patients with high FRα expression, perfect classification of the tumor margins with 100% sensitivity

and 100% specificity was achieved, and intraoperative residual fluorescence predicted postoperative MRI results with perfect concordance. The study was published on September 5, 2017, in Journal of Neurosurgery. “The study shows that this novel, targeted, near infrared fluorescent dye technique is a safe, and we believe this technique will improve surgery. Surgeons are now able to see molecular characteristics of patient’s tumors; not just light absorption or reflectance,” said lead author associate professor of neurosurgery John Y.K. Lee, MD. “In real time in the operating room, we are seeing the unique cell surface properties of the tumor and not just color. This is the start of a revolution.” OTL38 consists of two parts; vitamin B9 (a necessary ingredient for cell growth), and a NIR glowing dye. As pituitary adenomas grow and proliferate, they overexpress folate receptors more than 20

times above the level of the normal pituitary gland. The dye binds to these receptors and thus permits tumor identification. Image: The OTL38 conjugated to a NIR fluorescent dye can help identify cancer cells (Photo courtesy of the University of Pennsylvania).

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Biometric Garment Could Offer Breakthrough in Patient Monitoring cont’d from cover

range of textile-based, washable, silver coated nylon garments embedded with cardiac, abdominal, and respiratory digital signal processing (DSP) sensors, and a 3-axis accelerometer used to track activity and acceleration. The cardiac sensors allow for electrocardiogram (ECG) one channel data at 256 Hz, heart rate detections at rates ranging from 30 to 220 BPM, respiratory rate intervals at 4 ms resolution, and heart rate variability (HRV) analysis. The breathing sensors include two channels (at 128 Hz) and can sense breathing rates from three to 80 breaths per minute (BPM), and the movement sensors can detect acceleration at .004 g resolution. The respiratory inductance plethysmography (RIP) sensors have additional assessment channels that include 50-60 Hz noise detection, disconnection detection, and baseline change detection. Additional features include 14+ hours of battery life, 600+ hours of standalone recording, and Bluetooth connectivity with iPhone, iPad, and Android platforms. “We spend such a huge chunk our economy to cure people. If you want to keep them healthy you have to do preventive health,” said Pierre-Alexandre Fournier, CEO and co-founder of Hexoskin. “If want to do that, we have do education and you have to put sensors on a large group of people. The best way to do that is to have biometric clothing.”

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Robotic Surgery Platform Facilitates Laparoscopy cont’d from cover

grasping, cutting, approximation, ligation, blunt and sharp dissection, electrocautery, suturing, mobilization, and retraction. The system is designed so that the surgeons is provided with a three dimensional (3-D) high-definition view of the surgical field and remote control of three separate robotic arms while sitting at a cockpit console unit. Image: A novel multi-port robotic The system also includes technological system provides haptic feedback characteristics that include force feedand eye-control (Photo courtesy back, which provides the surgeon with of TransEnterix). haptic control to sense the stiffness of tisminimally invasive care performed with handheld sue being grasped by the robotic arm; and eye sensmanual instruments and cameras, and are seeking ing camera control, which helps further control new technologies that will allow us to advance bemovement of the surgical tools. The system utilizes yond these boundaries,” said Steve Eubanks, MD, an open architecture, which allows hospitals and of Florida Hospital (Orlando, USA). “The future will surgeons to leverage existing technology investbe driven by the appropriate use of robotics and inments within the operating room ecosystem. The formation tools in the operating room. The Senreusable instruments are based on laparoscopic colhance platform grants laparoscopic surgeons robotorectal and gynecological surgery tools. ic precision, control of our vision, and haptic feed“Millions of surgical procedures in the United back, while minimizing procedural costs, and is a States are performed each year laparoscopically welcome revolution in our field.” with basic manual tools that limit surgeons’ capabilTransEnterix is a late-stage surgical robotics comity, comfort, and control,” said Todd Pope, Presipany, founded in 2006, that acquired the surgical dent and CEO of TransEnterix. “New choices are robotics division of SOFAR S.p.A (Trezzano Rosa, needed that enhance the senses, control and comItaly; www.sofarfarm.it) in 2015. This included the fort of the surgeon, minimize the invasiveness of TELELAP ALF-X advanced robotic system, which is surgery for the patient, and maximize value for the now being commercialized as the Senhance robotic hospital. Senhance is this new choice.” system. “Surgeons are approaching the boundaries of

New Monitor Enables MRI Procedures for Critical Care Patients n innovative magnetic resonance imaging (MRI) compatible vital signs monitor allows patients to be supervised during imaging. The Iradimed (Winter Springs, FL, USA; www. iradimed.com) 3880 MRI compatible patient monitoring system is a compact, lightweight device designed to facilitate transportation of patients from a critical care unit to the MRI scanner and back, increasing patient safety by ensuring uninterrupted vital signs monitoring and decreasing the amount of time critically ill patients are away from their care units. The system features a 30,000 gauss rating in a non-magnetic construction with a small form fac-

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tor, which means it can operate virtually anywhere in the MRI scanner room. An optional paired tablet allows for remote viewing of patient vital signs and control of the monitoring unit from within the MRI control room. Additional features include wireless electrocardiogram (ECG) with dynamic gradient filtering; wireless oxygen saturation (SpO2) using Masimo algorithms; respiratory CO2; non-invasive blood pressure and patient temperature measurement; and optional advanced multi-gas anesthetic agent unit featuring continuous minimum alveolar concentration measurements. “The Iradimed 3880 monitor’s compact nonmagnetic design positions Iradimed as the only company in the world with an MRI compatible patient monitor that can be used to transport patients from the critical care departments of hospitals to the MRI scanner room and back to critical care,” said Roger Susi, President and CEO of Iradimed. “It has an easy-to-use design and unique wireless tablet remote control that allows for the effective communication of vital signs information to clinicians.” The MRI Compatible definition is typically applied to devices not considered to significantly affect the quality of the diagnostic information, nor have their operations affected by the MRI scanner. The MRI conditions in which the device was tested need to be specified, since a device which is safe under one set of conditions may not be found to be so under more extreme MRI conditions.

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ISSN 0898-7270 Vol.35 No.6 • Published, under license, by Globetech Media LLC Copyright © 2018. All rights reserved. Reproduction in any form is forbidden without express permission. Teknopress Yayıncılık ve Ticaret Ltd. S¸ti. adına ˙Imtiyaz Sahibi: M. Geren • Yazı is¸leri Müdürü: Ersin Köklü Müs¸ ir Dervis¸ ˙Ibrahim Sok. 5/4, Esentepe, 34394 S ¸ is¸ li, ˙Istanbul P. K. 1, AVPIM, 34001 ˙Istanbul • E-mail: Teknopress@yahoo.com Baskı: Printkom Ltd. • İpkas Sanayi Sitesi 3. Etap C Blok • 34490 Başakşehir • İstanbul Yerel süreli yayındır. Yılda altı kere yayınlanır, ücretsiz dag˘ıtılır.

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HospiMedica International

Miniature Acoustic Sensor Monitors Respiration Rate cont’d from cover

separate and process the respiratory signal so as to continuously display acoustic respiration rate (RRa). Similar to the Masimo RAS-125c acoustic sensor, it operates with Masimo MX technology boards to display RRa results in an acoustic respiration waveform, with an option that allows clinicians to listen to the sound of the patient breathing. Both the RAS-45 and the RAS-125c acoustic sensors are intended for adult and pediatric patients who weigh more than 10 kilograms, but the RAS-45 is especially well suited for monitoring pediatric patients and patients with shorter necks. To facilitate placement on and improve attachment to the neck, the RAS-45 sensor is designed with a small, flexible, and transparent adhesive patch. The RAS-45 sensor is recommended for use with the Masimo Root patient monitoring and connectivity platform. “RAM harnesses the power of our breakthrough signal processing technology, using Masimo SET and rainbow technologies, and applies those achievements to a respiratory measurement derived from the sound of breathing,” said Joe Kiani, founder and CEO of Masimo. Respiration rate is a critical vital sign that provides early identification of respiratory compromise and patient distress, and is especially important for post-surgical patients receiving patient-controlled analgesia (PCA) for pain management. In a study comparing pediatric patient tolerance of sidestream capnography with a nasal cannula to respiration rate monitoring with an RRa acoustic sensor, 15 out of 40 patients removed the cannula, while only one removed the acoustic sensor.

Cloud-Based Portal to Provide Medical Education And Training cont’d from cover

Amsterdam, the Netherlands; www.amc.nl/ web/Zorg.htm), Amsterdam Center for Radiological Anatomy (ACRA). The system will be used to help combine anatomy and radiology data for medical education purposes. The AMC already has approximately 500 full-body CT cases and will scan around 150 more bodies used for medical education every year. The cloud-based Education Portal also allows remote access and enables the cases to be shared between portal users outside AMC creating an international shared educational workspace. Read access to all medical image types, including 3D renderings, will allow student and researchers to find anatomical variations in multiple cases. Lecturer in Anatomy and Embryology at the Academic Medical Center, MD Bernadette S de Bakker, said, “To interact with the 3D renderings on the Sectra Table enables our students to learn and explore in a realistic environment. The portal itself is yet another way for enhancing medical training since students can access cases from their own workstations.”

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Image: The Masimo Root patient monitoring and connectivity platform with the RAS-45 acoustic respiration sensor (Photo courtesy of Masimo).

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The EAGLE masks allow one mask to stay with patient from emergency site to transport, acute/sub-acute care, surgery and hospital room. Features include three color-coded sizes, integrated ports for scope and gases, and four optional swivels for connection to respiratory devices.

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Piezoelectric Sensor Measures Antibiotic Efficacy new study claims that a quartz-based sensor could determine within an hour if an antibiotic will be effective against an infection. The novel piezoelectric resonator, developed by researchers at the U.S. National Institute of Standards and Technology (NIST; Gaithersburg, MD, USA; www.nist.gov), is extremely sensitive, and can detect the mechanical motion of microbes adhered to it, and their response to antibiotics. The sensor is composed of a thin piezoelectric quartz disk sandwiched between two electrodes. An alternating voltage at a stable frequency – near the crystal’s resonant frequency – is applied to one electrode to excite crystal vibrations.

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At the other electrode (on the opposite side of the crystal), oscillating voltages resulting from crystal response can be recorded; the fluctuations in the resonant frequency result from microbial mechanical activity of the several million bacterial cells coupled to the crystal surface. The ultrasensitive approach can enable detection of cell-generated frequency fluctuations at a level of less than one part in 10 billion, with the amount of frequency noise generated correlating with the density of the living bacterial cells. When E. coli bacteria were ex-

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posed to different antibiotics, the sensor showed that the frequency noise from the bacteria fell to zero within seven minutes of being treated with polymyxin B, and within 15 minutes of receiving ampicillin; the results mirrored the normal pharmacokinetics of the antibiotic drugs. The researchers added that since they used bacteria with paralyzed flagella, they concluded that the frequency fluctuations resulted from vibrations of cell walls. The study was published on September 22, 2017, in Nature Scientific Reports. “Current tests require colonies of bacteria to be cultured for days, which can allow an improperly treated infection to advance and give the bacteria a chance to develop drug resistance,” concluded lead author Ward Johnson, PhD. “The NIST sensor is a quartzcrystal resonator that vibrates differently when bacterial cells on its surface change their behavior; it detects

the mechanical motion of microbes to gauge a response to antibiotics…the amount of frequency noise emitted by the bacterial cells increased with the density of bacteria.” Piezoelectricity, discovered in 1880 by French physicists Jacques and Pierre Curie, is a reversible effect in crystals that describes the internal generation of an electrical charge resulting from a mechanical force. For example, lead zirconate titanate crystals will generate measurable piezoelectricity when their static structure is deformed by about 0.1%. Conversely, the same crystals will change about 0.1% of their static dimension when an external electric field is applied to the material. The inverse piezoelectric effect is used in the production of ultrasonic sound waves. Image: Dr. Ward Johnson observes signals generated by bacteria coating quartz crystals (Photo courtesy of Burrus / NIST. HospiMedica International December/2017-January/2018

Advanced Technology Maps Complex Cardiac Arrhythmias n innovative high-resolution ultrasoundbased electrophysiology system visualizes cardiac anatomy and maps dipole density to chart the pathway of every heartbeat. The Acutus Medical (Carlsbad, CA, USA; www.acutusmedical.com) AcQMap High Resolution Imaging and Mapping System detects and displays both standard voltage-based and higher resolution dipole density (charge-source) maps of the human heart. The system combines ultrasound anatomy construction with an ability to map the electrical-conduction of each heartbeat, in order to identify complex arrhythmias across the entire atrial chamber. Following each ablation treatment, the heart can be re-mapped in real-time in just a few seconds to continually visualize any changes from the prior mapping. Using ultrasound, electrophysiologists can acquire more than 115,000 points every minute, providing computerized tomography (CT)-quality cardiac chamber reconstructions with electrical activity displayed as waveform traces. Dynamic, threedimensional (3D) dipole density maps are overlaid on the cardiac chamber reconstruction to show chamber-wide electrical activation. The system can be used with all existing commercially available cardiac ablation platforms, and allows remapping of the entire chamber at any time during the procedure.

“The AcQMap System was designed in close collaboration with some of the most respected names in the field to provide practitioners with a suite of tools that enables them to rapidly map and re-map to visualize changes throughout the ablation procedure,” said Steven McQuillan, senior VP of regulatory and clinical affairs at Acutus Medical. “We firmly believe that by working together with EP practitioners and scientists, we will continue to uncover breakthrough innovations to improve and advance cardiac care.” “The AcQMap System is able to provide global dipole density mapping of irregular and chaotic activation in the atrial chambers, whereas conventional sequential mapping may struggle to provide us with the information that is required,” said Tom Wong, MD, of Royal Brompton Hospital (London, United Kingdom). “In the cases we have performed thus far, real-time mapping of complex arrhythmias has allowed us to focus on areas of interest and terminate the arrhythmia using ablation therapy. We can now offer individualized, tailored therapy, and are one step closer to identifying the mechanisms of complex arrhythmias.” Cardiac mapping collects and displays electroanatomical maps of the heart, and includes activation, isochronal, propagation, or voltage maps. Isochronal vector maps are commonly used to study the mechanisms and to guide the ablative

Image: The AcQMap high-resolution imaging and mapping system workstation (Photo courtesy of Acutus Medical).

therapies of arrhythmias; activation maps display local activation time, color-coded and overlaid on reconstructed 3D geometry; propagation maps show a dynamic color display of the propagation of the activation wavefront across the reconstructed chamber; and voltage map displays the peak-to-peak amplitude at each site.

Fully Digital Mist Inhaler Targets Respiratory Diseases novel breath-actuated digital inhaler helps treat a wide range of respiratory issues, such as asthma and chronic obstructive pulmonary disorder (COPD). The Pneuma Respiratory (Boone, NC, USA; www.pneumarespiratory. com) digital soft mist inhaler is an device that uses an electronic breath actuation mechanism to deliver medication droplets directly into the patient’s lungs integrated while inhaling, without the need for propellants. As the patient inhales, the ejector senses the breath and activates automatically, creating a soft mist. Studies have shown that both small-molecule and large, complex biologics can be delivered pharmacologically intact. According to Pneuma Respiratory, the devices ability to deliver different sized droplets of medicine via the proprietary droplet ejector technology will enable the device to potentially target different areas of the lungs, selectively. An added benefit is that the digital soft mist device can be wirelessly paired with a proprietary mobile app, thus delivering true realtime dose verification, an important

HospiMedica International December/2017-January/2018

issue for doctors, patients, and the health provider. “More than forty million people suffer from asthma or COPD in the United States. It’s well documented that patients have problems adopting the correct inhaler technique and receiving the expected dose of medication, both with dry powder and existing metered-dose inhalers,” said James Bauler, director of business development at Pneuma Respiratory. “With a proven team of technology and health care leaders, Pneuma expects to make significant gains in pulmonary drug delivery.” COPD is a debilitating lung disease, the third-leading cause of death worldwide, and prevalence is increasing as baby boomers reach the prime age for disease manifestation. In the U.S, 20% of patients who are hospitalized for COPD flare-ups are re-admitted within 30 days, representing a significant cost for most hospitals. In fact, readmission rates are so high that the Affordable Care Act fined more than 78% of U.S. hospitals for their readmission performance related to COPD during 2015.

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Critical Care

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Cardiac Stents Offer No Relief for Stable Angina new study has concluded that percutaneous coronary intervention (PCI) is no better than a placebo procedure at providing relief to stable angina patients. Researchers at Imperial College London (ICL; United Kingdom; www3.imperial.ac.uk), Queen Mary, University of London (QMUL; United Kingdom; www.qmul.ac.uk), and other institutions conducted a blinded trial involving 230 patients with severe single-vessel stenosis, who were randomized to undergo PCI with a drug-eluting stent (DES) or a placebo procedure at five study sites in the United Kingdom. An assessment of cardiac function, including exercise time increment, was conducted at baseline and at six weeks of follow-up. The primary endpoint was difference in-between groups. The results revealed similar improvements in exercise time with PCI (28.4 more seconds) compared to placebo (11.8 more seconds), and that most other endpoints yielded no differences either, including time to ST depression, change in peak oxy-

gen uptake, change in the Seattle Angina Questionnaire (SAQ) physical limitation score, change in SAQ angina frequency and stability, quality of life, and the Duke treadmill score. The sole significant advantage of PCI was a greater improvement in dobutamine stress echocardiography (DSE) peak stress wall motion score index. The study was published on November 2, 2017, in The Lancet. “Forgetting the potential magnitude of placebo effects prevents exploration of the inevitably complex relationship between anatomy, physiology, and symptoms,” concluded senior author Justin Davies, MD, and colleagues. “Clinicians have hoped there might be a simple entity named ischemia, which manifests as positive tests and clinical symptoms, and that treatment by PCI would eliminate all these manifestations concordantly; perhaps this notion is too optimistic.” “We commend them for challenging the existing dogma around a procedure that has become routine, ingrained, and profitable. The results show once again why regulatory

agencies, the medical profession, and the public must demand high-quality studies before the approval and adoption of new therapies,” commented David Brown, MD, and Rita Redberg, MD, in an accompanying editorial: “Based on these data, all cardiology guidelines should be revised to downgrade the recommendation for PCI in patients with angina, despite use of medical therapy.” PCI, also known as coronary angioplasty, is a nonsurgical technique for treating obstructive coronary artery disease (CAD), unstable angina,

and acute myocardial infarction (MI). It is usually performed by an interventional cardiologist, who feeds a catheter from the inguinal femoral artery or radial artery through the vasculature until they reach the site of blockage. X-ray imaging is used to guide the catheter threading. Angioplasty is then used to open the artery and allow blood flow, with stents used at to hold the artery open. Image: A new study concluded cardiac stents are ineffectual for stable angina (Photo courtesy of iStockPhoto).

Combination Therapy Device Hastens Wound Healing non-invasive, portable device combines the benefits of therapeutic ultrasound with electrostimulation to heal chronic ulcers, reduce lesion size and wound pain, and accelerate tissue regrowth. The BRH Medical (Jerusalem, Israel; www.brhmedical.com) BRH-A2 device implements a combination of therapeutic ultrasound and electrostimulation in modulating cycles of independent and joint activity in order to create a micro-circulation effect, providing in essence a massage-like process within the tissues and blood vessels of the impacted medium that increases blood flow to cellular structures, modifying the direction of cellular and subcellular aggregation, and as a result rapidly increasing the healing rate. The portable system can be used together with any treatment modality. The BRH-A2 system includes proprietary integrated user-friendly software that provides detailed patient data, including specific data regarding the location, type, and characteristics of specific wounds, which can be saved for improved patient management. Using algorithms, the device can accurately measure ulcer size, even while the edges may not be

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clearly defined due to loss of tissue. The system, which has been approved by the U.S. Food and Drug Administration (FDA), also stores individual clinical data on thousands of patients for efficient treatment and follow-up procedures. “The market for products that ease the pain of chronic wounds is large and growing. Our vision is to become the gold standard for treatment of chronic wounds of all kinds, including pressure wounds, diabetic leg wounds, and wounds caused as a result of ischemia,” said Motti Oderberg, CEO of BRH Medical. “We are now exploring the most efficient way to penetrate the market, and are currently focusing on identifying strategic partnerships.” Electrostimulation is known to pull taut fibroblasts and resultant collagen, yielding a stronger weave; in addition, a proven effect of ultrasound is stimulating fibroblasts to create collagen, and also inducing the new collagen to lay out in a more ordered pattern, resulting in a better weave for epithelialization. The end result of combining the two technologies is a more ordered and tighter collagen weave. HospiMedica International December/2017-January/2018

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The WATO EX-65 Pro comes with new integrated functions that enable the user to precisely control the system and different types of patients easily. It features a self-test procedure and smart alarm management with graphs and charts to simplify complicated operation steps.

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High Blood Pressure Linked to Mitral Regurgitation new study establishes a strong link between high blood pressure and mitral regurgitation, the most common heart valve disorder in high-income countries. Researchers at the University of Oxford (United Kingdom; www. oxford.ac.uk), the University of Sydney (Australia; sydney.edu.au), and other institutions affiliated with the George Institute for Global Health (Sydney, Australia; www.george institute.org) used linked electronic health records (EHRs) from the UK Clinical Practice Research Datalink (CPRD) from January 1, 1990, to December 31, 2015, in order to test the hypothesis that elevated systolic

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blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation. The results revealed that of the 5,553,984 patients registered in the CPRD that met inclusion criteria, 28,655 (0.52%) were diagnosed with mitral regurgitation during the 10year follow-up period, and a further 1,262 (0.02%) were diagnosed with mitral stenosis. SBP was continuously related to the risk of mitral regurgitation, with no evidence of a nadir down to 115 mmHg. Each 20 mmHg increment in SBP was associated with a 26% higher risk of mitral regurgitation. No link was identified between SBP and mitral stenosis. Associations were similar for each

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10 mmHg increment in diastolic blood pressure (DBP), or each 15 mmHg increment in pulse pressure (PP). The association was partially mediated by diseases affecting the left ventricle that resulted in secondary mitral regurgitation, such as myocardial infarction (MI, ischemic heart disease, cardiomyopathy, and heart failure (HF). However, the excess risk mediated by these causes was only 13%, with little effect on long-term association between SBP and mitral regurgitation. The study was published on October 17, 2017, in PLOS Medicine. “With worldwide aging and population growth, we are likely to see an increasing number of cases of this condition. We need to find effective and affordable measures to tackle it, and our study suggests one possible avenue for prevention, by reducing high blood pressure,” said lead author Professor Kazem Rahimi, MD,

PhD, deputy director of The George Institute UK. “Given the large and growing burden of mitral valve disease, particularly among older people, we believe these findings are likely to have significant implications for medical policy and practice around the world.” There is a well-established association between hypertension and increased risk for stroke, coronary heart disease, and renal failure. Another common cardiovascular condition is atrial fibrillation (AF), the most common sustained cardiac arrhythmia, which is associated with a high mortality and morbidity rate from stroke, thromboembolism, and HF. Studies have shown that the risk of stroke doubles in patients with AF who also suffer from hypertension. Image: A new study links hypertension to common mitral regurgitation (Photo courtesy of Shutterstock). HospiMedica International December/2017-January/2018

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PRODUCT NEWS MOBILE X-RAY SYSTEM

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WIRELESS SCANNER

ULTRASOUND SYSTEM

Samsung

Meditech

Esaote

The GM85 improves user convenience when moving through narrow hallways and being positioned in tight patient rooms. Its advanced imaging functions ensure superior image quality for accurate diagnoses, while its multi-touch function allows users to control and adjust images easily.

The iSono works with a tablet or smartphone and uses advanced digital imaging technology for delivering clear images. Small and light, easy to carry, it comes with a built-in and replaceable battery and is suitable for use in emergencies, clinics and outdoor inspections.

The MyLab 9 eXP offers smart upgradability, remote serviceability, long-term maintenance options and transducer compatibility. It offers an ultra-ergonomic experience and has been developed to provide ultra-quality technology to hospitals, clinics and private practices.

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Catheter Melds Light and Ultrasound to Detect Plaque novel catheter probe combines intravascular ultrasound (IVUS) with fluorescence lifetime imaging (FLIm) in order to help predict heart attacks. Developed at the University of California Davis (UCD, USA; www.ucd.edu), the 3.7 Fr single rotational intravascular FLIm-IVUS catheter sends short laser pulses into surrounding tissue, which fluoresces in return; different tissues – such as collagen, proteins, and lipids – emit different biochemical fluorescence profiles. At the same time, the IVUS probe in the catheter records structural information on the blood vessel. The combination can provides a comprehensive insight into how atherosclerotic plaque forms, aiding diagnosis and providing a way to measure how plaques shrink in response to therapy. The researchers successfully demonstrated the ability of the system to acquire robust bi-modal data in coronary arteries in healthy swine via standard percutaneous coronary intervention (PCI) techniques in combination with a Dextran solution bolus flush. They also imaged several representative diseased human samples, showing that different types

of lesions in diseased coronary arteries, as identified via histology, are also characterized by specific FLIm biochemical signatures in the first 200 m of the intima. The study was published on August 21, 2017, in Scientific Reports. “New imaging techniques for evaluation of plaque pathophysiology are of great interest to both improve the understanding of mechanisms driving plaque formation, as well as support the development of new preventative, pharmaceutical, and interventional therapies,” concluded senior author biomedical engineer Laura Marcu, PhD. “The unique FLIm-IVUS system evaluated here has the potential to provide a comprehensive insight into atherosclerotic lesion formation, diagnostics, and response to therapy.” IVUS enables identification of plaque burden due to its high penetration depth (up to 10 mm), but lacks the spatial resolution to identify small-scale features such as details of the intima, or the biochemi-

cal changes linked with atherosclerotic lesion formation and evolution. FLIm, on the other hand, depends on a wealth of environmental parameters such as pH, ion or oxygen concentration, molecular binding or the proximity of energy acceptors, making it ideal for functional imaging. Image: A new combined IVUS/FLIm catheter probe can image arteries of a living heart (Photo courtesy of Marcu Lab / UCD).

Contrast-Enhanced Ultrasound Helps Detect Liver Cancer new study reveals that contrast-enhanced ultrasound (CEUS) can achieve correct diagnosis without radiation, and at lower cost. Researchers at the University of Calgary (Alberta, Canada; www.ucalgary.ca) and Stanford University (CA, USA; www.stanford.edu) conducted a study in 200 patients at risk for hepatocellular carcinoma in order to assess detection and characterization of malignant focal liver lesions using CEUS, an imaging technique that allows pathology detection without radiation, expensive magnetic resonance imaging (MRI) equipment, or biopsies. The researchers also utilized the Liver Imaging Reporting and Data System (LI-RADS), a tool used to classify liver tumors using computed tomography (CT), MRI, and CEUS.

The results revealed that CEUS can provide dynamic real-time imaging with high spatial and temporal capability, and with 97% accuracy. The researchers suggest that in liver cancer patients with lesions that are indeterminate on CT and MRI, CEUS can serve as a useful tool to improve management and assist guidance of liver biopsies and local treatment of hepatocellular cancer. The study was presented at the 32nd annual conference of the International Contrast Ultrasound Society (ICUS), held during October 2017 in Chicago (IL, USA). “Patients with hepatocellular carcinoma, the third leading cause of cancer deaths worldwide, were found to benefit from contrast-enhanced ultrasound imaging when magnetic resonance imaging was in-

conclusive,” said senior author Professor Stephanie Wilson, MD, of the University of Calgary, and co-president of ICUS. “This is an exciting option, because hepatocellular carcinoma is the most common form of liver cancer, and standard imaging with MRI is often an insufficient option for characterizing the tumor.” CEUS uses liquid suspensions of miniscule gas microbubbles to improve the clarity and reliability of an ultrasound image. The microbubbles are smaller than red blood cells, and when they are injected into a patient’s vein, they flow through the microcirculation and reflect ultrasound signals, thus improving the accuracy of diagnostic ultrasound exams. The microbubbles are expelled from the body within minutes. HospiMedica International December/2017-January/2018

New System Shortens Radiation Treatment Time next generation radiotherapy system that can significantly reduce treatment times, while also increasing the accuracy of the treatment, has been installed in the US. The system allows for a shorter radiotherapy treatment time, resulting in less danger of tumor drift, and a reduced chance that the patient will move during irradiation. The Halcyon radiotherapy system is manufactured by Varian Medical Systems (Palo Alto, CA, USA; www.varian.com), and was installed at the UC San Diego Health Moores Cancer Center (UCSD; San Diego, CA, USA; http:// health.ucsd.edu/cancer). This is one of only two centers in the world that treat patients using the new technology. Using the Halcyon system oncologists can select either Intensity-Modulated Radiation Therapy (IMRT), or Volumetric modulated Arc Therapy (VMAT) to treat a patient, depending on which delivers the best outcome. The Halcyon system uses a multi-leaf collimator that shapes the radiation beam to fit the exact shape, size, and position of a tumor, and reduces the possibility that stray radiation reaches healthy tissues that surround the tumor. The system has a circular bore that is larger than standard Computed Tomography (CT) machine bores, allowing for more patient comfort, as well as a soft ambient lighting designed. According to a clinician at USCD, the new technology has a high level of automation, and results in 20% faster patient treatment times. Professor at UC San Diego School of Medicine, Todd Pawlicki, PhD, said, “Compared to conventional radiation treatment devices, this linear accelerator is a significant technologic step forward that simplifies operation and streamlines workflow. The goal is improved patient care and a more comfortable treatment experience.”

Image: The Halcyon radiotherapy system (Photo courtesy of Varian Medical Systems).

World's First 7 Tesla MRI Doubles Static Magnetic Field Strength cont’d from cover

mode and a clinical Mode for imaging, keeping research data and clinical images safe on separate databases, respectively. The Magnetom Terra features a new magnet that is 50% lighter than any 7T magnet to date, and can be shipped cold via airfreight and integrated more easily into clinical environments, even on upper floors. In addition, a Zero Helium boil-off feature reduces evaporation in both standby and operational modes. Up to 64 receive channels and 80/200 gradients provide high levels of power, to not only perform diffusion MRI and functional MRI (fMRI), but also utilize the simultaneous multi-slice (SMS) application to accelerate advanced neurological applications for clinical routine. An ultrafine 0.2 mm in-plane anatomical resolution potentially enables visualization of previously unseen anatomical structures. For example, cerebral cortex imaging at 0.2mm in-plane resolution may yield never-before-visible clinical details in cortical structure. The scanner’s submillimeter blood-oxygen-level dependent (BOLD) fMRI contrast increases linearly with field strength; in clinical use, this could translate to higher resolution in neuroimaging, as compared to 3T applications. “With the Magnetom Terra 7T scanner, Siemens Healthineers proudly introduces the first MRI field strength above 3T to be cleared for clinical imaging in nearly 20 years,” said Christoph Zindel, MD, senior vice president and head of MRI at Siemens Healthineers. “Armed with the Magnetom Terra’s ultra-highfield strength, clinicians may be able to achieve new, unforeseen levels of patient care and clinical advancements through improved visualization of a wide variety of neurological disease states.” The MAGNETOM Terra leverages the Siemens Healthineers syngo MR E11 software platform, enabling users to work in the same manner as they would 1.5T and 3T technology. The systems measurement and reconstruction system (MaRS) computer offers hyperfast image reconstruction technology at speeds up to 20 times faster than previous generations of 7T research scanners.

HospiMedica International December/2017-January/2018

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PRODUCT NEWS DR FLUOROSCOPY TABLE

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MRI SYSTEM

PORTABLE CT SCANNER

Italray

Hitachi Aloka Medical

Samsung

The CLINODIGIT OMEGA is designed for performing all types of DR and digital radio-fluoroscopy exams. It features the latest-generation 43 cm x 43 cm dynamic flat panel detector, which ensures enhanced image quality, unsurpassed productivity, and minimal dose.

The ECHELON Smart offers superb clinical images, sophisticated applications, reduced exam time, quiet patient experience, low running costs and the smallest possible installation footprint. It features a 1.5T superconducting system for fast scanning and offers a wide range of sequences.

The OMNITOM 16-slice scanner delivers highquality, non-contrast CT, CT angiography, and CT perfusion scans at the POC, along with effective dose optimization. Rapid scan time, small footprint, and immediate image viewing make it suitable for collecting RT data of critically ill patients.

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Portable 3D Scanner Assesses Elephantiasis Severity portable scanning device that measures limb enlargement and disfigurement in patients with elephantiasis can help determine if treatments to reduce swelling are effective. Researchers at Washington University (WUSTL; St. Louis MO, USA; www.wustl.edu) have adapted a portable infrared (IR) three-dimensional (3D) scanner developed by LymphaTech (Atlanta, GA, USA; www.lymphatechnology.com) to produce accurate virtual reconstructions of the legs. They then tested the device on 52 patients with varying stages of lymphedema at a clinic in

Galle (Sri Lanka), comparing scanner results with water displacement (WD), tape measurement of limb circumference (TMLC), and skin thickness ultrasound (STU) results. The system, which using a scanning technology similar to that found in the Microsoft (Redmond, WA, USA; www.microsoft.com) Xbox Kinect video game system, showed nearly perfect correlation with both WD and TMLC. The average time to acquire scanner measurement for both legs was 2.2 minutes, as compared to 17.4, 7.5, and 31.7 minutes, respectively, for WD, TMLC, and STU. The researchers plan to use the

device to examine if the antibiotic doxycycline can reduce the severity of swelling. The study was published on October 16, 2017, in The American Journal of Tropical Medicine and Hygiene. “To our knowledge, this is the first time that infrared 3D scanning technology has been used in patients with filarial lymphedema. Many patients with swollen limbs often have great difficulty traveling from their homes to the clinic to have their measurements taken,” said senior author Philip Budge, MD, PhD, of the WUSTL division of infectious diseases. “The scanner should make it possible to take extremely accurate limb measurements in the patients’ homes or villages, without cumbersome equipment or inconveniencing patients.” LINKXPRESS COM

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Elephantiasis, or lymphatic filariasis, is a parasitic, mosquito-borne disease marked by severe swelling in the arms, legs, or genitals. The skin may become thicker as well, and the condition may become painful. The changes to the body may harm the affected person’s social and economic situation. Three types of worms are known to cause the disease: Wuchereria bancrofti, Brugia malayi, and Brugia timori, which damage the lymphatic system. In 2015 about 38.5 million people were infected, and about 950 million people are at risk of the disease in 54 countries. Image: A portable scanning device produces a 3D reconstruction of swollen legs caused by lymphatic filariasis (Photo courtesy of Michael J. Weiler / LymphaTech). HospiMedica International December/2017-January/2018

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Medical Imaging

Radioimmunotherapy System Effectively Treats Colorectal Cancer new study describes a three-step theranostic nuclear medicine strategy that targets and eliminates colorectal cancer without any treatment-related toxic effects. Developed at the Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; www.mit.edu) and Memorial Sloan-Kettering Cancer Center (MSKCC; New York, NY, USA; www.mskcc.org), the 1,4,7,10-tetra-azacyclododecane-1,4,7,10-tetraacetic acid pretargeted radioimmunotherapy (DOTAPRIT) strategy is based on a glycoprotein bispecific antibody and a small-molecule radioactive hapten. In the murine study, the researchers used a fractionated 3-cycle regimen that targeted glycoprotein A33 (GPA33), an antigen found on over 95% of primary and metastatic human colorectal cancers. In the mice undergoing treatment, serial singlephoton emission computed tomography/computed tomography (SPECT/CT) imaging was used to monitor treatment response and calculate radiation-absorbed doses to tumors. The results revealed a 100% cure rate, with all DOTA-PRIT-treated animals toler-

ated the treatment well. All mice had no trace of cancer remaining upon microscopic examination, and there was no detectable radiation damage to critical organs, including bone marrow and kidneys. The study was published in the November 2017 issue of The Journal of Nuclear Medicine. “Until now, radioimmunotherapy of solid tumors using antibody-targeted radionuclides has had limited therapeutic success,” concluded lead author Sarah Cheal, PhD, of MSKCC, and colleagues. “The success in murine tumor models comes from the unique quality of the reagents developed by our group, and the reduction to practice methodology, including a theranostic approach that can be readily transferred, we believe, to patients.” “The system is designed as a ‘plug and play’ system, which allows for the use of many fine antibodies targeting human tumor antigens and is applicable, in principle, to virtually all solid and liquid tumors in man. If clinically successful, our approach will expand the repertoire of effective treatments for oncologic patients,” said senior author Steven Lar-

son, MD, of MSKCC. “There is a huge unmet need in oncology, especially for the solid tumors, for curative treatments for advanced disease. This includes, colon, breast, pancreas, melanoma, lung, and esophageal, to name a few.” Theranostics uses specific biological pathways to acquire diagnostic images and deliver a therapeutic dose of radiation. Once a specific diagnostic test shows a particular molecular target on a tumor, the therapy agent can be specifically targeted to that receptor, providing a more targeted and efficient form of pharmacotherapy. Image: A new study shows theranostic radioimmunotherapy targets colorectal cancer (Photo courtesy of RSNA).

MRI Predicts Long-Term Recovery Following Cardiac Arrest agnetic resonance imaging (MRI) measures of cerebral functional connectivity measured within four weeks of cardiac arrest (CA) are associated with a favorable outcome at one year, according to a new study. Researchers at Johns Hopkins University School of Medicine (JHU-SOM; Baltimore, MD, USA; www.hopkinsmedicine.org/som), Pitie-Salpetriere Hospital (Paris, France; http://pitiesalpetriere. aphp.fr), and other institutions conducted a prospective multicenter study of 46 patients who were comatose after CA in order to assess whether early brain functional connectivity is associated with functional recovery after one year. All participants underwent multiparametric structural and

functional MRI about 12 days after CA. Within-network and between-network connectivity was measured in the dorsal attention network (DAN), default-mode network (DMN), salience network (SN), and executive control network (ECN). The results showed that 11 of the patients had a favorable outcome at one year. Higher within-network DMN connectivity was seen for patients with a favorable outcome, who also had greater anti-correlation between SN and DMN, and between SN and executive control network, when compared with patients with unfavorable outcome; the effect was maintained after adjustment for multiple variables. Compared with fluid-attenuated inversion recovery or diffusion-weighted imaging scores, anti-

correlation of SN-DMN predicted outcomes with higher accuracy. The study was published on October 18, 2017, in Radiology. The set of identified brain areas that are linked together in a large-scale network are identified by their function, and provide a coherent framework for understanding cognition. Main networks identified include the DAN, involved in voluntary deployment of attention and reorientation to unexpected events; the DMN, active during introspection; the SN monitors the salience of external inputs and internal brain events; and the ECN is engaged during cognitive tasks that require externally-directed attention, such as working memory, relational integration, response inhibition, and task-set switching.

Clinical Trials Begin Using Radiopaque Microscopic Beads esearchers in the US have begun clinical trials of a new experimental cancer treatment that makes use of microscopic beads loaded with a targeted cancer drug, that are visible on a Computed Tomography (CT) scan. The goal of the Vandetanib-Eluting Radiopaque Beads in Patients with Resectable Liver Malignancies (VEROnA) trial is to evaluate delivering a precisely controlled dose of the drug into the arteries that feed a liver tumor, and to improve treatments for metastatic Colorectal Cancer (mCRC), and primaryliver cancer patients. The technique was developed by researchers from the University College London Cancer Institute (UCL; London, UK; www.ucl.ac.uk/cancer), and BTG (London, UK; www.btg-im.

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com), a specialist healthcare company, and is intended for treating liver-cancer patients. The technique makes use of microscopic radiopaque beads loaded with a targeted anti-cancer drug called vandetanib, which are placed directly into the liver. Primary investigator of the study, professor Ricky Sharma, at University College London, said, “The incidence and mortality rates for primary liver cancer continue to climb and it is vital that we explore new treatment approaches. This research is exciting because it is the first time we have been able to pre-load a targeted cancer drug on to an imageable bead, to deliver the targeted drug in high doses to the cancer and see exactly how well the beads reach the target we have defined.” LINKXPRESS COM

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PRODUCT NEWS SURGICAL MONITOR

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CAMERA PLATFORM

WASTE MANAGEMENT SYSTEM

Ampronix

Karl Storz

Stryker

The LG-27HJ710SW features a 27-inch IPS 8MP display that delivers superior detailed picture quality. It improves work efficiency by enabling detailed observation, as well as displaying multiple imaging applications, making it ideal for surgeons who favor minimally invasive surgical techniques.

The IMAGE1 S modular camera platform combines various technologies (e.g., rigid, flexible and 3D endoscopy) in a single system for all applications. It also allows for the use of near infrared (NIR/ICG) for fluorescence imaging, integration of operating microscopes and use of VITOM 3D.

The Neptune 3 multi-tasking hazardous fluid and smoke evacuation solution features a Hush vacuum pump and produces only 4.3 sones. Its large interactive touch screen simplifies viewing and navigation, with displays and controls providing access to multiple options and functions.

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Convertible Catheter Opens Ureteral Obstructions n innovative nephroureteral stent (NS) system keeps the ureter patent, without the need for additional interventional procedures. The ConvertX NS system for the treatment of ureteral obstructions enables interventional radiologists to eliminate a second invasive procedure to treat the patient. In conventional treatment, two separate interventional procedures are needed to treat the obstruction. The first uses standard interventional radiology techniques to insert a percutaneous nephrostomy catheter through the patient’s flank into the kidney; a drainage bag is then attached to the catheter. The second procedure, conducted 3–14 days later, involves

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removing the catheter and placing a NS to allow urine to be naturally voided. The ConvertX System, in contrast, is implanted only once, and converts from a catheter to a NS in a brief office procedure, without the need for radiation or sedation, and all in under one minute. The ConvertX Stent then remains implanted in the patient, just like a standard internal ureteral stent. The ConvertX NS System is a product of BrightWater Medical (Murrieta, CA, USA; www. brightwatermed.com), and has been approved by the U.S. Food and Drug Administration (FDA). “Ureteral blockages due to kidney stones, tumors, or scarring from previous surgeries must be treated quick-

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ly so urine can be voided,” said Professor Bob Smouse, MD, founder and CEO of BrightWater Medical. “The ConvertX System saves the patient the risk and discomfort of an additional second interventional procedure and may reduce healthcare costs, free up the hospital’s angio suite for other procedures and save the IR procedural time that can be devoted to care of other patients.” “The ConvertX System is the kind of technology advancement that we

require to meet the dual goals of improving patient care and reducing the financial burden to the health care system,” said clinical associate professor of radiology James Benenati, MD, of the University of South Florida (USF, Tampa, USA; www.usf.edu). “Interventional radiology enables patients with severe ureteral blockages to be quickly treated, and technologies like the ConvertX platform provide the IR with simpler, more costeffective solutions.”

Combination Labor Induction Method Shortens Delivery Time combination of mechanical and pharmacologic labor induction leads to delivery several hours earlier than either method alone, claims a new study. Researchers at the University of Pennsylvania (PA, USA; www. upenn.edu) conducted a randomized trial to compare four labor induction methods: misoprostol (a prostaglandin-like drug) alone, cervical Foley catheter alone, concurrent use of misoprostol and a cervical Foley catheter, and concurrent use of a Foley catheter and the contraction-inducing hormone oxytocin. In all, from May 2013 to June 2015, 491 women undergoing labor induction with full-term singleton, vertex-presenting gestations, and no contraindication to vaginal delivery participated, with the primary outcome being time to delivery. The results showed the average time between treatment and delivery was lowest for the misoprostol-Foley combination at 13.1 hours, com-

pared to 14.5 hours for Foley-oxytocin, 17.6 hours for misoprostol alone, and 17.7 hours for the Foley method alone. According to the researchers, the more than four-hour gap between misoprostol-Foley and either method alone is clinically meaningful, particularly considering that the various methods did not produce significant differences in the rates of cesarean deliveries or of serious medical complications for the mother or child. The study was published in the December 2016 issue of Obstetrics & Gynecology. Labor induction is one of the most common medical procedures in the world, with nearly one million women who deliver in the United States alone undergoing the procedure annually. But despite its widespread use, including for medical conditions such as preeclampsia, gestational diabetes, or other health risks to the mother or baby, labor induction is still costly and has no widely accepted best practice guideline. HospiMedica International December/2017-January/2018

Robotic Digital Microscope Drives Surgical Innovation new robotic digital microscope provides superior visualization of the anatomy to meet the complex needs of cutting-edge surgery. The Synaptive Medical (Synaptive; Toronto; Canada; www.synaptivemedical. com) Modus V is a next generation robotic digital microscope that provides powerful optics that are fully integrated with a robotic surgical arm. The integration provides enhanced hands-free tracking of surgical instruments, with auto-focus and programmable motions that give surgeons more control without disrupting workflow. Increased arm flexibility covers a larger volume of space, permitting more versatile positioning, ergonomic alignments, and greater versatility in the operating room. The Modus V is part of the Synaptive BrightMatter product suite, which combines the BrightMatter Guide trajectory-centric navigation system to allow surgeons to visualize the brain’s internal networks; BrightMatter Vision optics; and BrightMatter Drive robotic arm technologies. The result is an operating room solution that transforms surgical planning, patient data collection, and intraoperative vision from disjointed analog methods to a fully integrated platform with navigation, robotic automation, digital microscopy and data analytics. “Modus V is an integral part of our overall BrightMatter surgical solution. Conceptualized for the digital era as a fully integrated set of devices, our solution collects and delivers data, be it imaging, tractography or other patient information, when and where it’s most needed to drive surgical decision making,” said Peter Wehrly, CEO of Synaptive. “It’s part of our ongoing commitment to give surgeons the most advanced tools with which to treat their patients.” “Collaboration is hardwired into Synaptive’s culture. Modus V’s improvements are grounded in the collaboration and extensive feedback from neurosurgeons in our customer community on both Modus V prototypes and BrightMatter Drive,” said Cameron Piron, president and chief strategy officer of Synaptive. “We’re grateful for their support, and look forward to deeper commentary from the surgical community as Modus V enters the market.”

Image: The Modus Vis the new cornerstone of the Synaptive BrightMatter platform (Photo courtesy of Synaptive Medical).

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PRODUCT NEWS DISPOSABLE SCALPEL HANDLE

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VIDEO LARYNGOSCOPE SYSTEM

SURGICAL STAPLER

Hill-Rom

Verathon

Tibet

The Bard Parker line of weighted SafeSwitch Disposable scalpel handles offers surgeons the ability to safely retract, pass and disarm surgical blades in one step using one hand. They offer the convenience of compatibility with a wide range of blades and sizes.

The GlideScope Go features a scratch-resistant 3.5-inch color display with anti-glare coating and a wide field of view. Designed for improved visualization and rapid, first-pass intubation, it is compatible with GlideScope Spectrum single-use blades, for patients from neonates to adults.

The third-generation endoscopic linear cutting stapler with unequaled intelligent stapling technology and GSTTM technology, ensure the staple in a perfect “B” formation and provide outstanding performance in suturing and hemostasis.

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Head Position Cap Improves Endonasal Surgery granular jamming cap filled with coffee grounds conforms closely to the shape of a patient’s head, helping surgeons to better track movements. Developed at Vanderbilt University (Nashville, TN, USA; www. vanderbilt.edu), the cap is based on a flexible silicone bladder headpiece that is filled with coffee grounds. Once the cap, which is covered with pattern of reflective dots, has been placed on the patient’s head, it is attached to a vacuum pump that evacuates the air in the headpiece to jam the coffee grounds together, forming a rigid layer. Prior to surgery, a video scanner registers the location of the reflective dots – which serve as fiducial markers – relative to key features on the patient’s head. During the surgery itself, an overhead camera observes the position of the dots, allowing the surgical navigation system to accurately track the position of the patient’s head even when the surgeon moves and repositions it. The computer uses this information to combine a computerized tomography (CT) scan, which provides a detailed three-dimensional (3D) view of the bone and tissue with the position of the surgical instruments the surgeon is using, displaying them together in real time on a monitor in the operating room. While current fiducial markers, usually attached by an elastic headband and double-backed tape, are subject to jarring and slipping, the granular jamming cap conforms to the patients head and locks firmly into place. In tests designed to determine how well the cap performed relative to current headbands, they found that the cap reduced targeting errors by 83%, improved resistance to external displacement forces by 76%, and reduced head repositioning error rates by 66%. The new tracking cap was presented at the International Conference on Information Processing in Computer-Assisted Interventions, held during

June 2017 in Barcelona (Spain). “It’s a very clever way that doesn’t involve drilling holes in patients’ skulls to greatly improve the accuracy of the guidance system when we are operating in the middle of a person’s skull: a zone where the accuracy of the current system is inadequate,” said associate professor of otolaryngology Paul Russell, MD, who is collaborating with the engineers on the project. Image: Granular jamming cap (L) compared to current elastic headband (R) (Photo courtesy of Joseph Howell / Vanderbilt).

Surgery Unnecessary for Early-Stage Prostate Cancer esults of a 20-year follow-up study among men with localized prostate cancer suggest that surgery is not associated with significantly lower all-cause or prostate-cancer mortality than observation. Researchers at the Minneapolis Veterans Administration (VA) Health Care System (MN, USA; www.minneapolis.va.gov), Washington University School of Medicine (WUSTL; St. Louis, MO, USA; www.medschool.wustl.edu), and other institutions reported the most recent results of the prostate cancer intervention versus observation trial (PIVOT), which randomly assigned 731 men with localized prostate cancer to radical prostatectomy or observation from November 1994 to January 2002. Fol-

low-up was extended through August 2014 for allcause mortality and prostate-cancer mortality. The results showed that during 19.5 years of follow-up, death attributed to prostate cancer or treatment occurred in 27 men (7.4%) assigned to surgery and in 42 men (11.4%) assigned to observation. Surgery was associated with lower all-cause mortality among men with intermediate-risk disease, but not among those with low-risk or highrisk disease. Treatment for disease progression was less frequent with surgery than with observation, and was primarily for asymptomatic, local, or prostate-specific antigen (PSA) progression. Urinary incontinence, erectile, and sexual dysfunction were each greater with surgery than with observation.

The study was published on July 13, 2017, in the New England Journal of Medicine (NEJM). Observational strategies include active surveillance (AS), which involves close follow-up after diagnosis, typically with serial PSA testing, digital rectal exam, and prostate biopsies; and watchful waiting (WW), which refers to a strategy of observing patients without monitoring and providing palliative care when prostate cancer becomes symptomatic. AS is recommended for the 30% of men who will eventually require treatment for prostate cancer, while WW is historically reserved for men with less than 10 years’ life expectancy or major comorbidities, and who are not expected to die of prostate cancer. HospiMedica International December/2017-January/2018

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New NPWT System Manages Two Incisions at Once novel single use negative pressure wound therapy (NPWT) system has been designed specifically for the simultaneous management of two closed surgical incisions. The Prevena Duo Incision Management System is intended for use in bilateral procedures, such as vascular harvesting, breast reconstruction, and orthopedic trauma surgeries, in which surgical incisions continue to drain following sutured or stapled closure. Using easy to use pre-configured dressings, the system enables clinicians to manage linear incisions up to 20cm in length, as well as non-linear and intersecting incisions of up to 90cm in length with an adjustable dressing, thus minimizing surgical site infections (SSIs). A foam bolster is used to provide NPWT at -125 mmHg for up to seven days, continuously removing fluid and infectious material from the site, with SensaT.R.A.C technology used to monitor negative pressure at the incision site. Visual and audible alarms and ionic silver within the interface layer are designed to reduce bacterial colonization in the fabric. A replaceable 150ml canister keeps exudates away from the incision site. The Prevena Duo NPWT system and SensaT.R.A.C are products of Acelity (San Antonio, TX, USA; www.acelity.com), and have been approved by the U.S. Food and Drug Administration (FDA). “Until now, clinicians did not have the option to manage two incisions simultaneously with a single, disposable negative pressure source. The new Prevena Duo platform offers one efficient, easy-to-use method for providing therapy to these patients,” said Ron Silverman, MD, chief medical officer at Acelity. “We are finding that surgeons around the world are adopting Prevena therapy as standard practice to provide care for their post-operative patients.” “SSIs encompass more than 20% of all health acquired infections, and represent a significant burden both financially and psychologically for the patient, so there is a need to proactively address this issue,” said Allen Gabriel, MD, of PeaceHealth Medical Group Plastic Surgery (Vancouver, WA, USA). “With the Prevena Incision Management System, surgeons can rely upon a significant body of clinical evidence demonstrating the system’s efficacy and coupled with its ease of use, ensures that we are doing all we can to help reduce this burden in an effort to improve outcomes for patients.” NPWT is a therapeutic technique used to promote healing in acute or chronic wounds and enhance healing of first and second-degree burns. The therapy involves controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management increased dramatically over the 1990s and 2000s.

Image: The Prevena Duo Incision Management System (Photo courtesy of Acelity).

HospiMedica International December/2017-January/2018

Surgical Techniques

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Google Searches Can Track Dengue Fever Outbreaks n analytical tool that combines Google (Mountain View, CA, USA; www. google.com) search data with governmentprovided clinical data can quickly and accurately track dengue fever in less-developed countries, according to a new study. Researchers at Harvard University (Cambridge, MA, USA; www.harvard.edu) and Boston Children’s Hospital (BCH; MA, USA; www.childrens hospital.org) modified a mathematical modeling tool known as AutoRegression with GOogle search queries (ARGO) to explore its potential to track dengue activity in Mexico, Brazil, Thailand, Singapore, and Taiwan. The researchers used Google Trends to track the top ten dengue-related search queries made by users in each country during the study period; they also gathered historical dengue data from government health agencies and input both datasets into ARGO. Using the assumption that more dengue-related

searches occur when more people are infected, the researchers used ARGO to calculate near realtime estimates of dengue prevalence for each country. When ARGO’s estimates were compared with those of five other methods, it returned more accurate estimates than did any other method for Mexico, Brazil, Thailand, and Singapore. Estimates for Taiwan were less accurate, possibly because the country experienced less-consistent seasonal disease patterns from year to year. The study was published on July 20, 2017, in PLOS Computational Biology. Dengue transmission is subject to complex environmental factors influencing the Aedes aegypti and Aedes albopictus mosquitoes, which spread the disease. A mosquito is able to transmit dengue within a few weeks of contracting the virus, and a person bitten by such a mosquito will usually fall ill within a week, with symptoms lasting for up to 10 days afterward. There is thus a 5-day window when

another mosquito can pick up the virus from an infected person. The time scale of these transmission dynamics lends itself to tracking patterns of infection at a weekly or monthly level. Image: Google search trends can help identify dengue outbreaks (Photo courtesy of Google).

Surgeons Perform MIS in Hybrid OR with Robot System urgeons in a Brazilian hospital have for the first time performed a liver resection on a patient in a hybrid OR using robotic imaging system, and a surgical robot. The success or failure of endophytic liver tumor resection surgery often depends on the quality of the diagnostic images acquired before and during the procedure. The surgeons at the Albert Einstein Hospital Interventional Medical Center (São Paulo, Brazil; http://apps.einstein.br/english) used the Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) hybrid OR, the da Vinci multiarm surgical robot, the Artis zeego robotic imaging system, and the syngo DynaCT software for the procedure. The patient who underwent the liver resection had three hypovascular endophytic liver tumors. Instead of using standard ultrasound imaging to mark the tumors, the surgeons used both pre-operative Computed Tomography (CT) imaging and intra-operative imaging with Siemens’ Artis zeego. The tumors were clearly visible in the pre-operative CT images and were followed during the procedure using the intra-operative syngo DynaCT and the Artis zeego system. The surgeons then fused both CT datasets to create a combined 3D volume image dataset and analyzed this using Siemens’ syngo Embolization Guidance software to locate and highlight the tumors and feeding arteries. The surgeons

then docked the da Vinci system to the patient for the tumor resection using the da Vinci system. During the procedure they used the highlighted tumors in the combined 3D dataset as a reference to help them navigate to the tumors during surgery. The surgeons also plan to use the procedure for kidney or lung cancer resections in the future. Image: The CT image shows how the surgeons adjusted the trapezoid controls on the table window for improved liver segmentation (Photo courtesy of Siemens Healthcare). HospiMedica International December/2017-January/2018

Machine Learning Tool Identifies Breast Lesions

Health IT I

esearchers have trained a machine-learning tool to identify high-risk, biopsy-diagnosed breast cancer lesions that are unlikely to become cancerous, and do not require immediate surgery. The model was 97% accurate in its predictions and could help reduce unnecessary breast cancer surgeries by 33%. High-risk lesions have a higher risk of developing into cancer, but many such lesions could be safely monitored using imaging, without requiring surgery. The study was published online in the October 2017 issue of the journal Radiology by researchers from Massachusetts Institute of Technology (MIT; Boston, MA, USA; http://web.mit.edu), and Massachusetts General Hospital (MGH; Boston, MA, USA; www.massgeneral.org). The machine-learning tool enabled the researchers to find those high-risk lesions that have a low risk of being upgraded to cancer. The model took account of patient age, lesion histology, and other standard risk factors, but also included keywords from biopsy pathology reports. The researchers trained the model using patients with biopsy-proven high-risk lesions. After training the model on two-thirds of the high-risk lesions, the researchers found that they were able to identify 97% of the lesions that were upgraded to cancer. The researchers also found that by using the model they could help avoid almost NE one-third of the surgeries of benign tumors. DES W IGN The author of the study, radiologist Manisha Bahl, MD, MPH, from MGH and Harvard Medical School, said, “There are different types of high-risk lesions. Most institutions recommend surgical excision for high-risk lesions such as atypical ductal hyperplasia, WORLD’S MEDICAL PRODUCT MARKETPLACE for which the risk of upgrade to cancer is about 20%. For other types of high-risk lesions, the risk of upgrade varies quite a bit in the literature, and patient management, including the decision about whether to remove or survey the lesion, varies across pracSIGN UP tices. Our goal is to apply the tool in clinical settings FOR FREE! to help make more informed decisions as to which patients will be surveilled and which will go on to surgery.”

Image: The scatterplot shows the machine learning model score compared to a random number in the independent test set (Photo courtesy of RSNA).

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n innovative device rapidly assesses macular pigment density, a marker for increased risk of age-related macular degeneration (AMD), the worldwide leading cause of incurable blindness in people over 55. Developed at the University of Bristol (United Kingdom; www. bristol.ac.uk), the device is based on an entoptic phenomenon that allows certain people to perceive polarization of light as a yellow horizontal bar or bow-tie shape visible in the center of the visual field, typically occupying roughly 3–5 degrees of vision. The direction of light polarization is perpendicular to the yellow bar; fainter bluish or purplish areas may be visible. Dr. Shelby Temple, PhD, of the School of Biological Sciences first encountered the phenomenon while studying the ability of octopuses, cuttlefish, and coral reef fish to see polarized light. “What I was seeing was an effect known as Haidinger’s brushes, which is an effect that happens within the eye when people perceive polarized light. A person’s ability to see this phenomenon is linked to an aspect of eye health and can be an early indicator of disease,” explained Dr. Temple. “It became clear that the tools I had developed for fish could become the foundation for a novel ophthalmic device that could rapidly screen people for susceptibility to AMD.” “If we can catch this early, people can make simple changes, like eating more brightly colored fruits and vegetables, quitting smoking and wearing protective eyewear, to help reduce the chances of going blind later in life,”

added Dr. Temple, who is a co-founder of Azul Optics (Bristol, United Kingdom; www.azuloptics.com), a company created to commercialize the technology. Dr. Shelby Temple recently received the UK Biotechnology and Biological Sciences Research Council (BBSRC; Swindon, United Kingdom; www.bbsrc.ac.uk) award of Innovator of the Year 2017 for his research. “The BBSRC Innovator of the Year competition recognizes and rewards BBSRC-funded scientists that have identified and taken an active part in realizing the impact from their research,” said Karen Lewis, interim executive director at the BBSRC. “Dr. Temple’s technology has the potential to make a significant difference to people’s lives. The journey that Dr. Temple is taking to realize this opportunity from very fundamental research epitomizes the spirit of the competition. As well as being named Innovator of the Year 2017, Dr. Temple also received the award in the Commercial Impact category.” AMD is a major cause of blindness and visual impairment in older adults in the center of the visual field (the macula) due to damage to the retina. Occurring in both dry and wet forms, AMD makes it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life. In the dry (nonexudative) form, cellular debris called drusen accumulates between the retina and the choroid, and the retina can become detached. In the more severe wet (exudative) form, blood vessels grow from the choroid behind the retina, and the retina can also become detached. HospiMedica International December/2017-January/2018

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Soft Artificial Heart Mimics Natural Form and Function completely soft, pneumatically driven artificial heart made of silicone elastomers beats almost like a human heart, according to a new study. Developed by researchers at ETH Zurich (Switzerland; www.ethz.ch) and Deutsches Herzzentrum Berlin (DHZB; Germany; www.dhzb.de), the soft total artificial heart (sTAH) is similar in form to the human heart, but consists of only two ventricles, which are separated not by a septum but by an additional chamber that is inflated and deflated by pressurized air. The function of the inner chamber is to replace the muscle contractions of the natural human heart. The sTAH was created from silicone using a 3D-printed, lost-wax casting technique, and weighs 390 grams, with a volume of 679 cm3. The sTAH was evaluated using a hybrid mock circulation model under various conditions, generating physiologically shaped signals of blood flow and pressures. When operated at 80 bpm, the soft heart achieved a blood flow of 2.2 L/min against an

Virtual Reality System Helps Reassure Surgical Patients new software system combines magnetic resonance imaging (MRI), computerized tomography (CT), and angiograms to create a virtual reality (VR) three-dimensional (3D) model. The Surgical Theater (Mayfield Village, OH, USA; www.surgicaltheater.net) Precision VR medical visualization platform is designed to work on multiple levels of interaction and immersion for both patient and surgeon, with the aid of Oculus (Irvine, CA, USA; www.oculus.com) Rift or HTC (Taoyuan, Taiwan; www.htc.com) Vive VR headset. When wearing the VR headset, the patient can explore the 3D model generated from his own imaging, thus bridging a critical gap in patient education and providing increased shared decision-making opportunities. The Precision VR visualization platform also delivers powerful surgical planning capabilities and provides professional education and rehearsal functionality. Neurosurgeons can navigate their patientsâ&#x20AC;&#x2122; anatomy and simulate complex operations in surgical VR before making an incision. In addition, neurosurgical training for residents is available for even the most challenging surgical cases. Residents can hone their surgical techniques and situational awareness of the patientâ&#x20AC;&#x2122;s brain anatomy, optimizing performance and skill acquisition before entering the operating room. VR technology provides an immersive, multisensory, and 3D environment that enables users to have modified experiences of reality by stimulating the visual, auditory, and proprioception senses. VR has already been used to help treat anxiety disorders, support physical rehabilitation, and distract patients during wound care. For example, VR coupled with medication is effective in decreasing pain during bandage changes for severe burns, and provides positive distraction during routine procedures such as intravenous line placements and dental procedures.

HospiMedica International December/2017-January/2018

afterload systemic vascular resistance of 1.11 mm Hg, with mean pulmonary venous pressure fixed at 10 mm Hg. A resulting aortic pulse pressure of 35 mm Hg was measured, with a mean aortic pressure of 48 mm Hg. The study was published on July 10, 2017, in Artificial Organs. A functional artificial heart remains one of the long-sought holy grails of modern medicine, as it would dramatically lower the need for heart transplants. But straightforward emulation of the anatomy of the human heart with synthetic materials is difficult due foreign-body rejection, the need for external power sources, and other complications that limit their lifespan and that of the human recipients. Image: A soft artificial heart made of silicon mimics natural function (Photo courtesy of ETH).

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Hospital News I

Image: The American College of Cardiology, together with several prominent hospitals in central and eastern China, is debuting a series of educational forums on valvular heart disease prevention, diagnosis, and management (Photo courtesy of iStock).

American College of Cardiology To Launch Valvular Heart Disease Program in China he American College of Cardiology (ACC; Washington, DC, USA; www.acc.org), together with several prominent hospitals in central and eastern China, is debuting a series of educational forums on valvular heart disease prevention, diagnosis, and management. The forums are aimed at physicians, and will be delivered by valvular heart disease specialists from the ACC, who will join local Chinese speakers for lecture-style presentations and interactive discussions based on case studies. The program will reach out to hundreds of health care professionals in Kunming, Yunnan Province; Wuhan, Hubei Province; and Fuzhou, Fujian Province and support their efforts to offer high-quality, readily accessible care for patients from underserved communities that may be at risk for developing valvular heart disease. In addition to the edu-

cational forums for clinicians, ACC presenters will be distributing patient education materials for each hospital to use with patients to ensure they have the latest information regarding risk factors and lifestyle modification strategies. The trainings sessions, which are supported by the Edwards Lifesciences Foundation (Irvine, CA, USA; www.edwards.com) Every Heartbeat Matters initiative, will provide a comprehensive overview regarding common manifestations of valvular heart disease, with a focus on the latest updates regarding international guidelines-based patient care. The forums will also seek to improve coordination between different health care specialists who may treat patients with indications of valvular heart disease, including internists, general cardiologists, and cardiac surgeons. “We are committed to working with our colleagues in China to im-

plement this program in a way that achieves maximum impact for underserved patients in these areas, and furthers the ACC’s mission to prevent cardiovascular disease and improve patient care on a global scale,” said Mary Norine Walsh, MD, president of the ACC. “By directly working with clinicians where they live and practice, we are aiming to change the culture around treating and preventing heart disease in China.” “We have identified China as one

of our focus regions for ‘Every Heartbeat Matters’ because of the many underserved people suffering from heart valve disease in this country,” said Amanda Fowler, executive director of global corporate giving for Edwards Lifesciences Foundation. “By partnering with the ACC to provide expert clinical education, we believe we can exponentially increase our impact on patients and build-up sustainable high-quality care for the people of this region.”

U.S. Hospital Readmission Fines Linked to Higher Mortality new study suggests that the U.S. Hospital Readmission Reduction Program (HRRP) may be so focused on avoiding readmissions that heart failure (HF) related death rates are increasing. Researchers at Harvard Medical School (HMS; Boston, MA, USA; https://hms.harvard.edu), the University of California, Los Angeles (UCLA; USA; www.ucla.edu), and other institutions conducted a study to examine the association of the HRRP with readmission and mortality outcomes among 115,245 Medicare patients hospitalized with HF between January 2006 and December 2014 in 416 U.S. hospitals. Time intervals related to HRRP were examined before implementation (March 31, 2010), during HRRP implementation, and after penalties went into effect (October 1, 2012). Main outcomes and measures were 30-day and one year all-cause readmission and mortality rates. The results showed that 30-day risk-adjusted readmission rate declined from 20% before HRRP implementation to 18.4% in the HRRP penalties phase. In contrast, 30-day risk-adjusted mortality rate increased from 7.2% before HRRP implementation to 8.6% in the HRRP penalties phase. One year risk-adjusted readmission and mortality rates followed a similar pattern; risk-adjusted readmission rate declined from 57.2% to 56.3%, and risk-adjusted mortality rate increased from 31.3% to 36.3% after HRRP

implementation. The study was published on November 12, 2017, in JAMA Cardiology. “To avoid the penalties, hospitals now have incentives to keep patients out of hospitals longer, possibly even if previously some of these patients would have been readmitted earlier for clinical reasons,” said lead author Ankur Gupta, PhD, a cardiovascular researcher at Harvard Medical School. “Therefore, this policy of reducing readmissions is aimed at reducing utilization for hospitals, rather than having a direct focus on improving quality of patient care and outcomes.” “Medicare financially penalizes approximately two-thirds of U.S. hospitals, based on their 30-day readmission rates,” said senior author Professor Gregg Fonarow, MD, co-chief of cardiology at UCLA. “This data suggests it also incentivized strategies that unintentionally harmed patients with heart failure. The policy should focus on incentivizing improving quality and patient-centered outcomes of those with heart failure, and not on a mis-

guided utilization metric of re-hospitalizations.” The HRRP was introduced by Medicare (Baltimore, MD, USA; www.medicare.gov) in order to improve patient care by penalizing hospitals with poor outcomes. One key outcome measure is the readmission rate; one possible result is that Medicare may begin to withhold reimbursements to hospitals with excessively high readmission rates. Image: A new study suggests federal hospital readmission fees may lead to more deaths (Photo courtesy of Shutterstock). HospiMedica International December/2017-January/2018

Industry News

Global Hybrid OR Market to Approach USD 1.2 Billion in 2022 he global hybrid operating room (OR) market is expected to grow at a CAGR of 12.5% from USD 652 million in 2017 to USD 1.175 billion by 2022, driven by technological advancements in robot-assisted surgeries, increasing minimally invasive surgeries, and growing patient preference for affordable & effective surgical treatments. However, high establishment costs and procedural risks for patients associated with hybrid ORs are expected to limit the market growth during 2017 to 2022. These are the latest findings of MarketsandMarkets (Seattle, WA, USA; www.marketsandmarkets.com), a global market research company.

Based on component, the intraoperative diagnostic imaging systems segment is expected to record the highest CAGR during the forecast period, led by significant installation costs for diagnostic imaging products, increasing installation of hybrid ORs across the major countries, ongoing integration and automation of OR workflows, and continuous technological advancements in diagnostic imaging. Based on application, the thoracic segment is expected to record the fastest growth during the forecast period, driven by increasing thoracic surgeries performed globally, and rising awareness among healthcare professionals about the cost & therapeutic efficacy offered by hybrid ORs.

GE Healthcare in Alliance to Bring Artificial Intelligence to Medical Imaging ealthcare-solution providers GE Healthcare (Chicago, IL, USA; www.gehealthcare. com) and Nuance Communications, Inc. (Burlington, MA, USA; www. nuance.com), have partnered with NVIDIA (Santa Clara, CA, USA; www.nvidia.com), a leader in visual computing technologies, for using the company’s deep learning platform to bring Artificial Intelligence (AI) to medical imaging. NVIDIA’s deep learning platform, which includes hardware and software to train and deploy neural networks from the cloud to the edge, is designed to be accessible for healthcare providers and researchers. GE Healthcare’s partnership with NVIDIA will bring the company’s AI computing platform to its 500,000

imaging devices worldwide. The partnership will deliver the new NVIDIApowered Revolution Frontier CT, which is two times faster in imaging processing than its predecessor. NVIDIA will also power GE Healthcare’s Applied Intelligence analytics platform to accelerate the creation, deployment and consumption of deep learning algorithms for the instruments of the future. NVIDIA’s partnership with Nuance, a provider of intelligent voice and language solutions, aims to bring machine learning to radiologists and data scientists across the entire healthcare system. Nuance is announcing its new AI Marketplace for Diagnostic Imaging, built on NVIDIA’s deep learning platform.

Siemens to List Siemens Healthineers On Frankfurt Stock Exchange iemens AG (Munich, Germany; Munich; www.siemens. com), a provider of medical imaging and laboratory diagnostics equipment, is preparing to list its separately managed healthcare unit, Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com), on the Prime Standard segment of the Frankfurt Stock Exchange’s Regulated Market. The move was approved at a meeting by the company’s Supervisory Board and has been planned for the first half of 2018. Siemens Healthineers AG will be established for the public listing. “For Siemens Healthineers, the public listing is the next logical step

HospiMedica International December/2017-January/2018

and the foundation for expanding our strong position as a leading global supplier of healthcare technology,” said Michael Sen, Chairman of the Siemens Healthineers Supervisory Board and the member of Siemens’ Managing Board responsible, among other things, for healthcare technology. “Frankfurt is one of the world’s largest trading centers for securities, and its importance will continue to increase due to Brexit. The public listing will give Siemens Healthineers entrepreneurial flexibility and access to the capital market. The goal is to grow sustainably and profitably while actively shaping the paradigm shift in the healthcare industry.”

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ISET 2018 – International Symposium on Endovascular Therapy. Feb 3-7; Hollywood, FL, USA; www.iset.org AAP 2018 – Annual Meeting of Association of Academic Physiatrists. Feb 13-17; Atlanta, GA, USA; www.physiatry.org MEDICAL JAPAN 2018. Feb 21-23; Osaka, Japan; www.medical-jpn.jp SCCM 2018 – Annual Meeting of the Society for Critical Care Medicine. Feb 25-28; San Antonio, TX, USA; www.sccm.org ECR 2018 – European Congress of Radiology. Feb 28-Mar 4; Vienna, Austria; www.myesr.org

MARCH 2018 Acute Cardiovascular Care 2018. Mar 3-5; Milan, Italy; www.escardio.org HIMSS Annual Meeting 2018 – Health IT Conference and Exhibition. Mar 5-9; Las Vegas, NV, USA; www.himssconference.org SALMED 2018 – International Trade Fair of Medical Equipment and Instruments. Mar 15-18; Poznan, Poland; www.salmed.pl/en KIMES 2018. Mar 15-18; Seoul, South Korea; www.kimes.kr/eng Medical Fair India 2018. Mar 16-18; Mumbai, India; www.medicalfair-india.com EAU 2018 – Annual Congress of European Association of Urology. Mar 16-20; Copenhagen, Denmark; http://eau18.uroweb.org ENDO 2018 – World Congress of GI Endoscopy. Mar 17-20; Chicago, IL, USA; http://2018endo.org ISICEM 2018 – International Symposium on Intensive Care and Emergency Medicine. Mar 20-23; Brussels, Belgium; www.intensive.org ExpoMed Eurasia 2018. Mar 22-25; Istanbul, Turkey; http://expomedistanbul.com CHINAMED 2018. Mar 23-25; Beijing, China; www.chinaexhibition.com 2018 AORN – Association of periOperative Registered Nurses – Surgical Conference and Expo. Mar 24-28; New Orleans, LA, USA; www.aorn.org/ surgicalexpo

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HospiMedica International December/2017-January/2018

Vol. 35 No.6 Advertising Index 12/2017-1/2018

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