HospiMedica International January 2019

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WORLD’S CLINICAL NEWS LEADER Vol.36 No.6 • 12/ 2018-1/2019

DAILY CLINICAL NEWS

ISSN 0898-7270

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Endoscopy Relieves Gastroparesis Symptoms er-oral pyloromyotomy (POP), an endoscopic intramural treatment for gastroparesis, significantly improves patient symptoms and gastric emptying, according to a new study. Researchers at the Cleveland Clinic (Cleveland; OH, USA) and

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Novel Photon Technology Boosts Breast Imaging Accuracy n innovative dedicated breast computerized tomography (CT) scanner offers short scan times utilizing state-of-the-art photon-counting technology.

The AB-CT (Erlangen, Germany; www.ab-ct.com) nu:view is the first breast CT scanner based on

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spiral CT technology, integrating a custom X-ray tube and a detector specifically designed for breast scanning. Beside the X-ray components, the system includes proprietary image reconstruction software optimized for the highest image quality and best dose

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Image: Courtesy of Oregon Health & Science University

Artificial Intelligence to Streamline Patient Flow In Hospitals

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ositron emission tomography (PET) can highlight areas of increased glial activation in the brain of patients with fibromyalgia (FM), claims a new study.

Researchers at Massachusetts General Hospital (MGH; Boston, USA; www.massgeneral.org) and the Karolinska Institutet (KI; Solna, Sweden; www.ki.se) conducted a PET study using a tracer that binds to the translocator protein

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Enhanced Surgical Lamp Reduces Surgeon Eye Strain

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n advanced surgical light system brings best-in-class technology to the operating room (OR), improving working conditions for surgeons and staff.

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News Update . . . . . . . . . . 6 Product News . . . . . . .6-10

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International Collaboration to Focus on Medical Cybersecurity

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n innovative device helps resolve acute coronary artery perforations, a rare outcome of percutaneous coronary intervention (PCI) procedures. The Biotronik (Buelach, Switzerland; www.biotronik.com) PK Papyrus System is a balloon-expandable covered coronary stent – composed of siloxane-based polyurethane, L-605, and cobalt chromium alloy – and a delivery system.

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Stent System Treats Acute Coronary Artery Perforations

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PET Detects Inflammation In Fibromyalgia Patients

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n innovative artificial intelligence (AI) powered command center aims to synchronize all elements of a patient's hospital experience, enabling healthcare providers to enhance patient safety, orchestrate seamless care delivery, and speed up discharge.

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he International Medical Device Regulators Forum (IMDRF; Canberra, Australia; www. imdrf.org), a global congregation of health agencies, is launching a cybersecurity harmonization working group to develop criteria for medical device cybersecurity stan-

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dards. The new working group, cochaired by the U.S. and Canada, aims to produce an international guidance document that provides regulatory definitions of the critical terms of cybersecurity, such as privacy, exploit, theft, threat, vulnerability, harm and others. It will also Cont’d on page 22

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Endoscopy Relieves Gastroparesis Symptoms cont’d from cover

Case Western Reserve University (CWRU; Cleveland, OH, USA; www.case.edu) conducted a retrospective study to compare all 30 patients who underwent laparoscopic pyloroplasty (LP) for treatment of gastroparesis with those undergoing POP from October 2014 through September 2017. Patients were matched on a 1:1 basis, based on gender, age, and etiology of gastroparesis, which was 63.3% idiopathic, 20.0% post-surgical, and 16.7% diabetic (in both cohorts).

The results revealed that patients who underwent LP had an almost triple average length of stay and estimated blood loss than those that underwent POP. There were more overall complications in the LP cohort than in the POP one (16.7 versus. 3.3%, respectively), including surgical site infection (6.7 versus 0%), pneumonia (6.7% versus 0%), and unplanned ICU admission (10% versus 0%). LP and POP both resulted in similar, significant improvements in both in gastroparesis cardinal symptom index (GCSI) scores and objective gastric emptying. The study was published on July 17, 2018, in Surgical Endoscopy.

“When you compare the results in terms of symptom improvement and the complication rate of this as a new procedure, we’re doing much better than every other option that we have for patients with gastroparesis,” said senior author John Rodriguez, MD, director of surgical endoscopy at the Cleveland Clinic. “The procedure is very safe, and there were no procedure-related adverse events, including gastric or duodenal ulcer, intraluminal hemorrhage, or gastric dumping syndrome.”

Gastroparesis, a delayed gastric emptying in the absence of mechanical obstruction, is a debilitating and chronic digestive disease affecting five million people in the U.S. alone. Surgical options are few: gastric electrical stimulation, gastric emptying procedures, gastric diversion or gastric resection. POP is a less invasive method of disrupting the pylorus; the technique involves an initial mucosotomy to create a submucosal tunnel up to the duodenal bulb, followed by a myotomy of the circular fibers of the pylorus. The mucosotomy is subsequently closed with clips.

Image: A simple endoscopic approach helps relieve gastroparesis (Photo courtesy of the Cleveland Clinic).

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Artificial Intelligence to Streamline Patient Flow in Hospitals ne of the world's leading medical technology concerns has initiated a collaboration with healthcare providers across Europe and the US toward implementing an artificial intelligence (AI)-powered command center geared to efficiently synchronize all elements of a patient's hospital experience. The AI-powered system would enable healthcare providers to enhance patient safety, orchestrate seamless care delivery, and discharge patients sooner.

In a first initiative of its kind in Europe, GE Healthcare (Chicago, IL, USA) is collaborating with Bradford Teaching Hospitals of UK's NHS Foundation Trust to build the command center at the Bradford Royal Infirmary (BRI) that would provide a clear, instant, and real-time overview across the 800-bed hospital and help staff make quick and informed decisions on how to best manage patient care. Up to 20 Trust staff based in the command center will monitor a "wall of analytics" that constantly pulls in streams of real-time data from the multiple systems at the hospital.

Advanced algorithms would help staff to anticipate and resolve bottlenecks in care delivery before they occur, recommending actions to enable faster, more responsive patient care and better allocation of resources. The data will be displayed on multiple high definition screens in the command center, as well as on tablets and mobile devices, providing 24-7 support to busy medical teams across the hospital.

In the US, GE Healthcare has joined forces with CHI Franciscan Health to implement a NASA-style "Mission Control" command center, making it the first hospital system in the state of Washington – and the fifth globally – to utilize the leading-edge technology for improving patient care. The mission control center will use the power of AI and predictive analytics to optimize care coordination, speed care delivery, and improve the patient experience, while maintaining patient privacy. The

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powerful system works by looking at each individual hospital as part of a larger system, continually examining real-time data and using machine learning to recommend actions that can predict and prevent risk, balance staff workload, and streamline the discharge process so patients can get home sooner.

From the mission control center, licensed providers would monitor and leverage analytic apps, or "tiles," to optimize patient care operations at each facility, and trigger actions to best leverage resources across the system. Each tile is carefully crafted to solve a specific issue, taking into account the highly nuanced real-world challenges of caregivers and patients. For example, one tile will help streamline the discharge process by monitoring all patients scheduled for discharge and identifying and addressing "pinch points" that can cause significant and preventable delays. The key is that the real-time data in the tiles is predictive and actionable.

“Hospitals are increasingly looking to boost the efficiency of their operations so they can continue to deliver high-quality care as patient volume increases. Command centers help to orchestrate the delivery of care across the organization, bringing consistency to processes, prioritizing actions, eliminating waste and predicting tomorrow’s pressure points,” said Mark Ebbens, European Command Center Lead at GE Healthcare.

"The purpose of any new technology in health care is to enable providers to deliver better care, bringing doctors and nurses closer to their patients," added Ketul J. Patel, CEO, CHI Franciscan Health. "Mission control's powerful predictive analytics identify potential issues and allow our care teams to proactively solve problems and improve care rather than react when issues arise. With the AI focusing on the important nuts and bolts of operational efficiency and care logistics, our caregivers can devote more time to providing the best care and delivering the best outcomes for our patients."

Enhanced Surgical Lamp Reduces Surgeon Eye Strain cont’d from cover

The Getinge (Gothenburg, Sweden; www. getinge.com) Maquet PowerLED II Surgical Lamp uses light emitting diodes (LEDs) to provide clear, shadow-free illumination to the conventional or Hybrid OR, improving tissue visualization for better surgical outcomes. Multiple colors of ambient light are available to limit monitor glare, improving clarity during minimally invasive surgery (MIS) procedures. A vanguard feature is a new comfort light, designed to reduce eye fatigue by supporting a gentle transition from the brightly illuminated surgical field to the obscured surroundings.

The next generation of the Maquet PowerLED, the new model includes several novel features, such as laser guidance for precise positioning, and an adjustable light patch to illu-

minate selected areas. Other technologies include fully automated controls, self-guided intensity adjustment, and dynamic presence sensors for shadow management. The system is fully compatible with the Maquet Satelite anchoring system, which allows equipment to be safely positioned within reach of the surgeon, without hazardous exposed cables and wires. In addition, antibacterial coatings and smooth surfaces minimize turbulent airflow.

The Maquet PowerLED II Surgical Light is compatible with Getinge accessories that can be shared among multiple ORs, minimizing equipment redundancy and helping customers reduce total cost of ownership (TCO). Equipment can be easily added, removed, and upgraded in order to maximize long-term lighting investment.

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ISSN 0898-7270 Vol.36 No.6 • Published, under license, by Globetech Media LLC Copyright © 2019. All rights reserved. Reproduction in any form is forbidden without express permission.

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Stent System Treats Acute Coronary Artery Perforations cont’d from cover

The stent is designed to be advanced into the required coronary artery vessel using a balloon catheter to the perforation site. Once deployed, the stent provides a physical barrier to seal the tear in the artery wall, while still allowing blood to flow through it to the myocardium. The PK Papyrus System is intended for vessels 2.5-5.0 mm in diameter, and is available in 17 sizes.

The system was approved by the U.S. Food and Drug Administration (FDA) based on real-world survey data from 80 patients who received the PK Papyrus Stent for a coronary artery perforation. The stents were successfully delivered to the perforation site in 95% of patients, successfully sealing it in 91.3%. There were two deaths during the PCI procedure itslef, and seven patients underwent treatment to drain pericardial fluids. Post-procedure, in-hospital death occurred in five patients with perforations successfully sealed, and in one patient in which the PK Papyrus Stent did not seal the perforation.

“Perforation is very uncommon, but physicians need to be fully prepared for this emergency event. It’s unacceptable that this critical care area has seen no innovation in nearly two decades,” said Marlou Janssen, President of Biotronik. “Biotronik saw a need, rose to the occasion, and invested in bringing this stent to the United States. We made this decision because patient care is paramount, and we are committed to helping physicians and hospitals save lives and improve patient outcomes.”

“An acute coronary artery perforation is a rare but potentially lifethreatening complication of heart vessel procedures,” said Bram

Novel Photon Technology Boosts Breast Imaging Accuracy

Zuckerman, MD, director of the division of cardiovascular devices at the FDA Center for Devices and Radiological Health (CDRH). “The PK Papyrus Covered Coronary Stent System provides health care providers with a new treatment option that can seal the perforation in order to stop blood leakage during the procedure, and avoid a potentially life-threatening complication or a more invasive surgical procedure.”

The PK Papyrus System is contraindicated for patients not suited for standard PCI procedures, such as those unable to take anti-platelet and/or anticoagulation therapy, patients with allergies to contrast media, patients with uncorrected bleeding disorders, and those with a known allergy or hypersensitivity to amorphous silicon carbide or to any other compound of the PK Papyrus system, including tungsten and nickel.

Image: An innovative cardiac stent saves lives by sealing PCI perforations (Photo courtesy of Biotronik).

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usage, thus providing excellent low-contrast resolution for soft-tissue differentiation, and high spatial resolution that allows full three dimensional (3D) images of the breast without superimposition, enhancing calcification detectability.

In a single spiral rotation around the female breast, 2,000 projection images are created; but in contrast to conventional scintillation, nu:view uses detectors made of cadmium telluride (CdTe), which transform every x-ray photon directly into an electric pulse. Benefits of the system include fast acquisition times of 7-12 second per scan; low dose levels, in the range of diagnostic mammograms; clinical integration with picture archiving and communication systems (PACS) and radiological information systems (RIS); and an improved patient experience, as nu:view does away with breast compression.

“For the first time we have a CT scanner that makes is possible to acquire an image of the entire female breast in a single scan in true 3D, imaging both the soft tissue and the calcifications,” said Benjamin Kalender, CEO of AB-CT. “What sets nu:view apart is the very high image resolution coupled with low radiation dose and short scan times. To obtain the best possible image quality and maximize radiation dose efficiency at the same time, the detector uses state-of-the-art single photon counting technology.”

“The images are impressive, the image quality is excellent. Compared to mammography, the three dimensional, non-superimposed images make it far easier to detect micro-calcifications,” said Professor Andreas Boss, MD, of the institute for diagnostic and interventional radiology at University Hospital Zurich (Switzerland), and the first user of nu:view. “This non-compressive method also means less discomfort for the patient and reduces the number of additional ultrasound images into the bargain.”

Spiral CT is used to scan tissues in a helical path, which allows more images to be taken in a shorter time than with older CT methods. Spiral CT can also achieve improved image resolution for a given radiation dose, compared to individual slice acquisition.

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The Presto DR offers a wide choice of Pixium detectors and system configurations. It offers configurations including X-ray generators, tables, DAP and buckies and can be used wherever required, providing an alternative to film screen and CR.

The PowerLook Mammo Detection is based on algorithms that analyze data, automatically identifying and marking suspicious regions in 2D mammography images. It helps detect missed cancers earlier than mammography alone.

The Aquilion Precision is an Ultra-High Resolution CT (UHR CT) that is capable of resolving anatomy as small as 150 microns. It features a newly designed detector that provides more than twice the resolution than today’s CT technology.

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Mobile Carts Offer Flexibility for Ultrasound Scanners new mobile cart designated for wireless ultrasound scanners gives clinicians the flexibility of personal ultrasound with the utility of traditional cart-based systems.

The Clarius Mobile Health (Clarius; Burnaby, BC, Canada; www.clarius.me) Cart holds a lockable cabinet that contains up to seven devices, a working space for scanning procedures, and a charging dock for extra scanner batteries and smart devices. Each scanner can be used simultaneously on different smart devices as required. A height-adjustable tablet mount that can also be rotated supports the iPad 2, 3, 4, iPad Air, and iPad Air 2 allows users to scan comfortably from any position.

The Clarius Cart can be transported easily throughout the hospital to serve clinicians where they need it, including at the patient bedside, as a programmable lock ensures the handheld scanners stay safely in the cart when not in use. In addition, users do not have to worry about access to a nearby power outlet; the built in charging station can charge up to five Clarius batteries and two smart devices at the same time. The power cable can be tucked

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away when not in use.

“We find that some ultrasound users in hospitals prefer to use ultrasound on a cart.

With the Clarius Cart, clinicians can scan however they are comfortable. They can use the display attached to the cart or grab a scanner and go with their own personal device,” said Dave Willis, co-founder and chief strategic Officer of Clarius. “Clarius is delivering the first point of care, wireless ultrasound solution that can accommodate both a cart-use model and a personal ultrasound use model.”

The Clarius C3 and L7 wireless ultrasound scanners use secure point-to-point networking to connect to an app on selected devices. The Clarius C3 is a multipurpose scanner for imaging the abdomen and lungs; it also incorporates a virtual phased array for quick scans of the heart. The Clarius L7 is intended for guiding interventional procedures, such as nerve blocks and targeted injections, and for imaging superficial structures. Both models are encased in a hard magnesium shell that is water submersible for easy cleaning and disinfection, and are powered by a rechargeable battery.

Image: A dedicated ultrasound cart holds multiple wireless scanners (Photo courtesy of Clarius).

PET Detects Inflammation in Fibromyalgia Patients cont’d from cover

(TSPO), which is upregulated in activated microglia and astrocytes. The study included 31 FM patients and 27 healthy controls examined using PET. Standardized uptake values were normalized by occipital cortex signal (SUVR) and distribution volume (VT), as computed from the tracer data. PET imaging metrics were compared across groups, and when differing across groups, against clinical variables.

The results revealed that FM patients demonstrated widespread cortical elevations, and no decreases, which was most pronounced in the medial and lateral walls of the frontal and parietal lobes. The elevations in the tracer and SUVR were correlated both spatially, and, in several areas, also in terms of magnitude. In addition, higher subjective ratings of fatigue in FM patients were associated with higher tracer SUVR in the anterior and posterior middle cingulate cortices. The study was published on September 14, 2018, in Brain, Behavior and Immunity.

“We don’t have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies,” said senior author Marco Loggia, PhD, of the MGH Martinos Center for Biomedical Imaging. “Finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there’s nothing really wrong with them.”

Fibromyalgia is characterized by such symptoms as chronic widespread pain, sleep problems, fatigue, and problems with thinking and memory; the cause is unknown. Fibromyalgia affects around seven times as many women as men, and typically develops between the ages of 30 and 50, but can occur in people of any age, including children and the elderly. Some estimates suggest nearly 1 in 20 people may be affected by fibromyalgia to some degree.

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Sealed Magnet Delivers Helium-Free MRI Scanning new magnetic resonance imaging (MRI) scanner includes a fully sealed magnet that enables helium-free operations, and other innovations that help system reduce downtime. The Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) Ingenia Ambition X 1.5T MRI with BlueSeal magnet technology permanently seals helium inside the device, reducing the total amount of helium needed to operate a conventional MRI system (1,500 liters) to less than 0.5% (a mere seven liters). As a result, the fully sealed system is around 900 kg lighter than its predecessor and does not require a vent pipe, significantly reducing siting challenges and construction costs resulting from the use of conventional magnets.

The Ingenia Ambition X includes features that deliver a step-change in productivity. The EasySwitch solution allows the BlueSeal magnetic field to be easily turned off if an item is stuck in the bore; once resolved, an automated ramp-up sequence brings the magnet back to operation, minimizing downtime. Ingenia Ambition X also combines guided patient setup and Adaptive Intelligence (AI) driven SmartExam analytics for automatic planning, scanning, and processing, freeing up time to enable a single operator to manage the full scan from the patient’s side with just a single touch of a button.

Other features include Philips Compressed SENSE, an advanced acceleration application that reduces exam times by up to 50%. In addition, Philips VitalEye adds a unique approach to detecting patient physiology and breathing movement, using algorithms to intelligently extract signs of breathing, thus allowing exam set-up time to take less than a minute, even for less experienced operators. Together, these innovations help to standardize and speed up clinical workflow, allowing clinicians to focus on the patient.

“We are very proud to be the first hospital in the world to offer this new cutting edge, resource-friendly MRI technology to our patients,” said Andreas Steinauer, MD, chief radiologist at Spital Uster Hospital (Switzerland; www.spitaluster.ch). “With the new Philips Ingenia Ambition X our patients can have the best of two worlds: leading MRI technology with a smaller footprint. This new, leaner platform will allow more sites to deliver advanced MRI technology to their patients, helping to improve patient care.”

Liquid helium is used to keep superconducting magnets cool in an MRI machine. But although Helium is the second most abundant element in the universe (after hydrogen), decades of imprudent use have resulted in its depletion. The mandated sell-off of the U.S. national reserve prompted the U.S. Congress to pass the Helium Stewardship Act, designed to ease the pending global helium shortage. The recent discovery of one of the world’s biggest helium gas fields in the Tanzanian Rift Valley in Africa can also safeguard the future of MRI scanners.

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Image: The Ingenia Ambition X 1.5T MRI with BlueSeal magnet technology (Photo courtesy of Philips Healthcare).

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Advanced TomoTherapy Platform Improves Radiation Therapy Workflow next-generation TomoTherapy platform is capable of treating virtually any radiation therapy (RT) indication including breast, lung, prostate, and head and neck cancers.

The Accuray (Sunnyvale, CA; www.accuray.com) Radixact System is an innovative image guided, intensity modulated radiation therapy (IGIMRT) system with best-in-class clinical workflows and highly conformal treatments enabled by a unique ultra-fast binary multi-leaf collimator (MLC). Additional features include a powerful 1,000 MU/min shielded linear accelerator, a continuous 360 degree ring gantry with low-dose helical fan beam technology that can revolve at speeds of 10 RPM, and three-dimensional computerized tomography (3DCT) image guidance.

Using a refined x-ray beamline and next-generation CTrue imaging technology, the system can deliver scalable and highly reliable treatments for patients with a variety of individual treatment needs. CTrue also provides a sophisticated iterative reconstruction option that combines low dose imaging with good soft-tissue contrast. The integrated

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imaging solution enables clinicians to deliver highly accurate dose distributions that conform precisely to the shape of the patient’s tumor and minimize dose to normal, healthy tissue.

“The Radixact System builds upon the unique strengths of the TomoTherapy platform. Expanded delivery capabilities enable treatment with image-guided, intensity-modulated radiation therapy, an extremely accurate form of radiation therapy to an expanded range of patients,” said Jennifer Smilowitz, PhD, of the University of Wisconsin School of Medicine and Public Health (Madison, USA). “New database features make the ring gantry-based system even easier to operate and integrate within a radiation oncology department.”

The Radixact System is accompanied by the Radixact treatment delivery system, a fully integrated platform for intelligent treatment planning, data management, and treatment delivery; the PreciseART adaptive RT software, which provides clinicians with a unique midcourse decision-making tool and enables them to adapt RT delivery to changes in tumor size, shape, and location; and the PreciseRTX retreatment option, which helps accelerate and enhance the process of creating new treatment plans for patients who have received previous irradiation.

Image: The Radixact image guided, intensity modulated radiation therapy (IG-IMRT) system (Photo courtesy of Accuray).

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Medical Imaging

New MRI Device Offers Fully Guided Patient Setup new magnetic resonance imaging (MRI) scanner and an integrated suite of software innovations enable clinicians to perform exams up to 50% faster without compromising image quality. The Royal Philips (Amsterdam, The Netherlands; www. philips.com) Ingenia Elition 3T MRI scanner presents a patient-centric imaging experience from initial set-up to final image. The system features the VitalScreen user interface for workflow optimization, which provides operators with fully guided patient setup, and VitalEye, which senses the patient and detects breathing automatically, without the need for operator interaction. Using both technologies allows a routine examination to be launched in less than a minute, significantly improving scanner utilization.

Other features include SmartExam capability, an artificial intelligence (AI) platform for the planning, scanning, and processing of scans; dStream digital broadband technology; 3D APT, a contrast-free brain MRI solution that differentiates low-grade and high-grade gliomas; compressed SENSE, which reduces scan time by 50% while delivering sharp images for all 2D and 3D scans in all anatomies with anatomical contrasts; and the Philips Ambient Experience and Connect solution, which engages the patient using video and audio to reduce the claustrophobic experience and the need for rescans.

“As value-based care initiatives challenge healthcare organizations to drive better outcomes, radiology departments are specifically caught between ever-increasing imaging volume demands, while also facing pressure to engage more deeply with both referring physicians and patients,” said Arjen Radder, global business leader for MRI at Philips.

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“Philips is responding to these challenges through the development of solutions such as Ingenia Elition to improve image quality and the patient and staff experience, as well as operational efficiency.”

“To deliver fast, consistent and accurate diagnoses, our staff need to be supported with technology that gives them the ability to provide the best patient care, in an efficient and cost-effective way,” said Chip Truwit, MD, chair of radiology at Hennepin Healthcare. “Philips’ Ingenia Elition plays a critical role in elevating the standard of care for our patients in imaging and in improving overall operations in our new imaging center.”

Image: The Ingenia Elition 3T MRI scanner (Photo courtesy of Royal Philips).

Artificial Intelligence Technology Automates Obstetric Ultrasound Workflow he SonoScape Medical (Shenzhen, China; www.sonoscape.net) S-fetus algorithm, designed for the S60 ultrasound system, has been designed to simplify a standard obstetric ultrasound procedure by reducing it to just scanning the patient for a cine loop and pressing the touch screen button, without the need to navigate through menus or press different buttons. S-Fetus simply selects the best section image and automatically performs the various measurements required to monitor fetus growth and development, such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL).

S-Fetus can reduce each measurement by at least 40 seconds by eliminating 10-11 keystrokes at a time. And for sonographers using the S60 that wish to perform part of the process (or all of it) manually, S-Fetus can deliver the desired selection plane alone. Sonographers can manually adjust measurement parameters or the image itself after it has been automatically selected. The system can also help users develop their technique by informing them if the performed scan did not result in any adequate section images. Thus, not only does S-Fetus grow and improve with each examination, but the sonographer using the S60 also improves along the way.

To create the S-fetus AI algorithm, it was exposed to a massive repository of images and reports from thousands of ultrasound records.

With the knowledge from this data base it grew, learning to identify the key factors needed for clear and accurate ultrasound images, as well as how to perform the select measurements based on a given image. The system also learns from every additional exam it performs, continually evolving and improving as it encounters more and more real-world situations, while making decisions on its own in real time.

“For obstetric scanning, many fetus physiological indexes should be measured in order to evaluate fetal growth and development. Freeze, press

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measure button, move track ball, set and reset cursor, slight adjustment, all of those procedures are time consuming,” said Dr. Annette Cheng, an ultrasound clinical application specialist at SonoScape. “We believe that with the help of AI we can not only make the examinations easier and faster, but also more consistent and accurate, giving doctors more confidence and parents more assurance in the knowledge about their precious fetus.”

Obstetric ultrasonography is a standard part of prenatal care in many countries. The first primary exam is the nuchal translucency scan (at 1114 weeks) to assess the quantity of fluid collecting within the nape of the fetal neck to detect chromosomal and cardiovascular abnormalities.

The second major scan is the anatomy scan (at 18-22 weeks) to confirm pregnancy timing, measure fetus diameters and lengths so that growth abnormalities can be recognized, and to assess for congenital malformations and multiple pregnancies.

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PRODUCT NEWS NIV MASKS

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The V2 masks for non-invasive ventilation fit comfortably under the chin. Key features include five sizes for all patients face sizes, no skin breakdown, and leak-free patient fits for NIV & CPAP.

The Unite Cardiomax integrates with clinical systems for customized alarm filtering and alert message notifications. It contributes to a reduction in alarm fatigue and work interruptions by reducing the number of alert messages received.

The FM-9000 Plus for NIV and invasive monitoring also monitors the physiological parameters of pregnant women during ante partum exam, labor and delivery. It can monitor the FHR using ultrasound and uterine activity via a TOCO transducer.

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Wireless Patch Provides Continuous Temperature Monitoring soft, comfortable, disposable patch can significantly improve the way temperature is measured in the clinical environment. The Blue Spark Technologies (BST; Westlake, OH, USA; www.bluesparktechnologies.com) TempTraq is a Bluetooth-enabled wearable temperature monitor in the form of a soft, comfortable adhesive patch that continuously monitors body temperature for up to 72 hours. At the heart of the device is a thin, malleable, printed electronic system that includes a proprietary flexible battery. The hygienic, single-use, disposable design eliminates the need to wake up patients to take their temperatures, and the hassle, time, and cost of sterilizing thermometers between uses.

Alerts can be sent directly to Apple or Android mobile devices, or via a gateway capture device to TempTraq Connect, a platform that offers direct integration with healthcare provider electronic health records (EHR) systems and central nurse’s stations. Nurses can then view the temperature in their system and receive real-time audible or visual temperature change alerts at patient bedsides and/or through

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the central nursing station. TempTraq Connect is also supported by the Google Healthcare (Mountain View, CA, USA; www.google.com) Cloud Platform that allows parents and caregivers to remotely monitor body temperature.

“When we talk to clinicians about overall biometric monitoring, they say temperature is one of the most important vital signs where there hasn’t been any significant evolution in measurement during the past century,” said John Gannon, president and CEO of BST and co-inventor of TempTraq, in an interview with BioTuesdays. “The standard of care is single point readings every four-to-six hours, which are manually entered to a patient’s chart. Compare that with finger clips for continuous oxygen readings and continuous readings of blood pressure. We think continuous monitoring of temperature is a trend whose time has come.”

Printed electronics is a term used for a relatively new technology that defines the printing of electronic circuits and components on common media such as paper, plastic, and textile, using standard graphic arts printing processes and press equipment. Newly developed electronic inks print the active devices, such as thin film transistors and thin printed batteries. Leading-edge companies are currently using the technology to transform basic circuit elements, such as thin-film transistors, resistors, inductors, and capacitors into printed batteries, displays, sensors, radio-frequency identification (RFID) tags, interactive packaging, solar panels and even speakers.

Image: The soft, foam-filled patch is designed to continuously monitor temperature (Photo courtesy of BST).

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Connected Health Devices Support Hypertension Management ew premium smart monitors promote better blood pressure (BP) control by allowing users to share data with healthcare providers.

The A&D Medical (San Jose, CA, USA; www.andmedical.com) ULTRACONNECT blood pressure monitors offer a range of features and capabilities, including a sleek, tubeless design that slips easily onto the wrist or arm; a bright organic light-emitting diode (OLED) display that provides illuminated BP feedback to the user; a light-weight, compact design that allows users to transport the device wherever they go, ensuring consistent tracking of blood pressure readings; and multi-user support functionality for up to five regular users plus an anonymous guest.

Users can operate, access data, and share their BP results via Smart Connect, an automatic feature that detects and connects the monitor to the proprietary A&D Connect app, which is designed to enhance the enduser experience with engaging, easy-to-use features such as graphing, trending, unlimited memory, reminders, and goal setting. In addition, an offline, stand-alone setup allows for transfer of up to 100 readings to the A&D Connect app at a later time. A&D Connect offers robust compatibility with both iOS and Android devices.

“The recent change in hypertension guidelines from the AHA underscores the need for more consumers to monitor and understand their own blood pressure readings. That means providing patients with the right tools to make it extremely easy to self-monitor on a regular basis, so they can make changes in their own lives to reduce hypertension-related risks,” said Terry Duesterhoeft, President and CEO of A&D Medical. “The new product line leverages our more than four decades of experience in designing and deliverINTERACTIVE ing connected products to both the DIGITAL EDITION consumer and healthcare spaces.”

The 2014 AHA BP recommendations, issued by an expert panel appointed to the Eighth Joint National Committee (JNC 8, http://jnc8.jama network.com), suggest that for most hypertensive individuals 60 or older, pharmacologic treatment should be started when systolic BP is 150 mm Hg or higher or diastolic BP is 90 mm Hg or higher, with the goal of achieving readings below those cutoffs. For younger patients and for those with chronic kidney disease or diabetes, (regardless of age) treatment should be initiated when systolic BP is 140 or higher or diastolic BP is 90 or higher.

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PRODUCT NEWS ANESTHESIA SYSTEM

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The BleaseSirius offers unparalleled performance in ventilation and vaporization. Its enhanced flow meter visualization provides instant info about the fresh gas flow, enables traditional flow control and positioning of info, and offers gas data for export.

The HypAir offers a range of pulmonary function tests in a single system with cart or tabletop configurations.

Its open circuit spirometry, lung volumes, diffusion and respiratory mechanics make it ideal for modular pulmonary function testing.

The Smart Battery Kit is designed for providing safe and efficient power and facilitating remote power monitoring. It provides remote access to RT battery info without client PC and features a fast charging battery to reduce wait time.

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Fifth Wheel Facilitates Medical Bed Transport ntuitive drive assist technology reduces ergonomic risk, supports user safety, and improves the ease and efficiency of transporting patients on medical beds.

The Arjo (Malmö, Sweden; www.arjo.com) IndiGo system is essentially a powered fifth wheel installed beneath the bed that is designed to assist the caregiver to move a hospital bed, using automatic slope detection to provide additional power when moving up slopes, and braking assistance when moving down slopes, while tolerating small positioning adjustments and sideways movements. Users activate IndiGo by lifting the brake pedal with their foot before pushing the bed. An intuitive user interface does away with complex additional equipment or controls, and requires minimal training to operate.

Features include responsive assistance that avoids disadvantages associated with traditional power drive systems; an intuitive 360º operation with no buttons, handles, or controls; automatic slope detection; a clear on/off indicator provides by a blue LED light that illuminates the floor on both sides of the bed when the drive wheel is active; a steering mode for easy maneuverability; and emergency stop buttons at the head and foot ends of the bed. IndiGo can be supplied factory-fitted to new Enterprise and Citadel beds, or retrofitted to select bed frames, including the Enterprise 9000X and Citadel Patient Care System.

“We put ourselves in the customers’ shoes and tried to imagine what their dream product would be like. We realized that to truly make a difference in terms of convenience, efficiency, safety and ease of use, we

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would have to come up with a completely new product concept,” said Peter Lambord, senior medical beds product specialist at Arjo. “This led us to the idea of an integrated power assist that responds directly to user input, which became the basis for the IndiGo concept.”

Pushing a modern hospital bed with a patient in it can be a strenuous task, adding an extra ergonomic challenge to already overtaxed staff. Additional challenges may include narrow corridors, inclines, soft floorings, elevators, and long distances to triage between departments.

Current assistive devices, including separate bed movers, can be impractical and difficult to operate.

Image: IndiGo makes light work of patient transport (Photo courtesy of Arjo).

Insertion Support Assists Hemodialysis Catheter Placement new study describes a device that guides accurate placement of a tunneled cuffed catheter (TCC) in hemodialysis patients for whom other options are unsuitable.

Developed by researchers at Okayama University (Japan; www. okayama-u.ac.jp), the new device is a bendable ribbon made of expanded polytetrafluoroethylene (ePTFE) with eyelets spaced one centimeter apart; the eyelets allow markings to be placed on the patient’s body with a felt-tip pen. The device is laid on the skin surface so as to mark both catheter entry and exit points before the actual catheterization. The ePTFE ribbon is chemically processed so as to enable it to maintain its plasticity and shape when being autoclaved.

In a test study, ten adult hemodialysis patients (six men, mean age 71.3 years) underwent TCC insertion at Shigei Medical Research Hospital (Okayama, Japan). The ePTFE device was placed with the aid of X-ray imaging: the tip of the device, for marking the TCC entry site, was laid

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so that it overlapped with the right cardiac atrium. With the help of the markings made on the patient’s body, physicians inserted the TCC within an error of about one cm. Patients were observed for two months, during which there was no catheter replacement needed. The study was published on May 3, 2018, in The Journal of Vascular Access.

“Accurate placement of a tunneled cuffed catheter is necessary for safe hemodialysis, but placement is sometimes difficult because of individual body differences,” concluded lead author assistant professor Toshiaki Ohara MD, of Okayama University and colleagues. “Our newly developed insertion support device enhances safety and prevents catheter waste during replacement.”

For hemodialysis patients for whom an arteriovenous fistula (AVF) or arteriovenous graft (AVG) is not suitable due to heart failure (HF) or low cardiac reserve, the TCC provides a reliable, long-term access point and can also serve as a bridging device during maturation of newly placed AVFs. HospiMedica International December/2018-January/2019

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Critical Care

Infusion Catheter Delivers Therapeutics to Cardiac Patients novel catheter designed for retrograde coronary sinus infusion (RCSI) procedures imbues therapeutic agents directly into the heart. The Cook Regentec (Indianapolis, IN, USA; www. cookregentec.com) Advance CS coronary sinus infusion catheter is intended for temporary occlusion of the coronary sinus for infusion of contrast media, drugs, and therapeutic agents, or possible introduction of devices into the coronary venous system.

The device consists of a double lumen catheter with a balloon near its distal tip; each lumen is individual. The distal lumen extends the length of the catheter and is used for placement of wired guides and infusion. The balloon lumen is used to expand the balloon. Platinum/Iridium radiopaque markers are positioned on the shaft for placement under fluoroscopy.

To monitor therapeutic drug infusion flow rate and pressures, the proprietary Compass CT Disposable Pressure Transducer is used to continuously monitor physiological pressure, displaying measurements during the infusion process on an integrated digital display. The Compass CT transducer can measure pressures ranging from -199 to +999 mm Hg, with an accuracy of ±3% above 50 mm. The measurements are constant, with zero drift of ±1 mm Hg per 4 hours. Multiple readings can be performed throughout one procedure.

“Using the Advance CS Coronary Sinus Infusion Catheter, clinicians can deliver therapeutics, including cell and gene therapies, in an out-patient setting,” said Amit Patel, MD, MS, chief of cardiac surgery at the University of Miami Health System (FL, USA). “What we once performed on patients through invasive surgery can now be done in a minimally invasive procedure, lowering medical costs, increasing patient safety, and delivering the most effective biologics to treat each patient.

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In the evolution of gene and cell therapies, this is a revolutionary medical device for both clinicians and patients.”

Image: A novel catheter infuses drugs into the heart (Photo courtesy of Cook Regentec).

Smart Pillbox Enhances Medication Adherence smart pillbox provides a stress-free disease management solution for people struggling with the rigors of maintaining a daily medication routine. The Qualife (Hong Kong; www.qualife. com.hk) CYCO smart pillbox is an innovative medication device and accompanying smartphone application that uses simple information input (drug name, frequency, and dosage) to automatically generate a weekly dose schedule. The circular design of the pillbox is optimized for a hand twisting motion, with dual sensor technology ensuring the lid turns and opens to the correct compartment every time, and that pills and capsules are poured out at the correct dosage for each medication.

A light emitting diode (LED) indicator and sound alert indicate the correct compartment to turn when it’s time for medication, with pitch frequency and LED brightness optimized for young or old users. Sound alerts ring in circumstances of overdose or wrong dosage. The accompanying CYCO mobile app provides additional reminders, wrong dosage, and overdose alerts, real-time monitoring by 3rd party trackers, medication performance tracking, and health tips. An add-on 7-slot exchangeable compartment allows flexibility in fitting the user’s medication pattern.

“The CYCO incorporates an innovative, intelligent app that calculates the user’s medication information inputs and creates an accurate dose schedule, enabling them to sort their medication with ease,” said Ivan Wan, founder of Qualife. “The CYCO integrates a dual sensor system with visual and audio aids, ensuring that the correct pills are consumed at the appropriate time by the user.”

Medication adherence involves getting prescriptions filled, remembering to take medication on time, and understanding the directions.

Common barriers to medication adherence include inability to pay for drugs, disbelief that the treatment is necessary or helping, difficulty maintaining multiple and complex dosing schedules, and confusion about how and when to take the medication. Poor adherence can interfere with the ability to treat many diseases, leading to greater complications from the illness and a lower quality of life for patients.

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PRODUCT NEWS PATIENT WARMING BLANKET

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INFANT WARMER

DEFIBRILLATOR/ANALYZER

Cincinnati Sub-Zero

Ginevri

Fluke Biomedical

The FilteredFlo permits the use of a lower velocity blower to supply gently moving, clean air. The air warming method helps minimize air currents during pre-op care, intra-op care, post-op care, and outpatient care in the PACU, ICU and OR.

The Alhena Plus provides more direct control of temp, observation and free access to the baby for execution of medical procedures. It features four white daylight LEDs that make it possible to observe the baby without altering its natural color.

The Impulse 7000DP ensures proper operation and ultimate performance of critical life-support cardiacresuscitation equipment. A sleek exterior is paired with first-class technology, making the defib tester superior in compliance and efficiency.

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Handheld Device Identifies Heart Problems in Cancer Survivors novel handheld platform can accurately detect cardiac dysfunction in childhood cancer survivors, according to a new study. The Vivio device, developed at the California Institute of Technology (Caltech; Pasadena, USA; www.caltech.edu), the University of Southern California (USC; Los Angeles, USA; www.usc.edu), and other institutions, is a handheld device that collects pulse waves and phonocardiogram data from the carotid artery and sends it wirelessly to an app on a compatible device, such as a smartphone or tablet. Using a specialized algorithm, left ventricular ejection fraction (LVEF) is calculated; an LVEF measure of less than 50% may indicate signs of abnormal heart function.

To test the accuracy of the device, researchers at the Childhood Cancer Survivorship Clinic (CCSC) at City of Hope (Duarte, CA, USA; www.cityofhope.org) conducted a cross-sectional study that compared LVEF using the Vivio wireless device, two-dimensional (2D) echocardiography, and gold-standard cardiac magnetic resonance (CMR) imaging in childhood cancer survivors exposed to anthracycline, who risk potential cardiac dysfunction from the exposure, which can often develop at a time when they are least engaged in long-term survivorship care.

In all, 191 consecutive cancer survivors participated in the study, with a median anthracycline dose of 225 mg/m². The researchers found that echocardiography overestimated mean LVEF by 4.9% compared with CMR, but no difference was seen between mean LVEF derived from the Vivio and CMR. Also, when compared with CMR, the detec-

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tion of cardiac dysfunction via echocardiography was poor, but Viviobased measurements had considerably better sensitivity. The study was published on June 21, 2018, in Clinical Cancer Research.

“The pediatric oncology community is becoming increasingly aware that there are new issues faced by many cancer survivors that may not manifest themselves until decades after their cancer treatment is done,” said lead author pediatric hematologist/oncologist Saro Armenian, DO, MPH, director of the CCSC. “One of these issues is a higher burden of cardiovascular disease, which can result from exposure to anthracyclines as part of their cancer treatment.” “One possible implementation of Vivio could be for preliminary screening. If the patient’s heart function is below a specific threshold as measured by Vivio, that patient could schedule an in-depth evaluation,” concluded Dr. Armenian. “Vivio could keep these survivors engaged, and help to reduce the burden of inconvenient tests for individuals with a normal heart function as determined by the device. It could also pave the way for a mobile healthbased care management program for childhood cancer survivors.”

LVEF is the measurement of how much blood is being pumped out of the left ventricle of the heart with each contraction, and is usually expressed as a percentage. A normal LVEF ranges from 55-70%. An LVEF of less than 40% may confirm a diagnosis of heart failure. An LVEF of less than 35% increases the risk of an arrhythmia that can cause sudden cardiac arrest or death, and an ICD may be recommended for these patients.

Implants Create Niche for Fungi and Bacteria new study reveals that implants provide a distinct alcove for microbial colonization, but that the most prevalent microbes are not those responsible for implant infections.

Researchers at the University of Copenhagen (KU; Denmark; www.ku.dk), Rigshopitalet University Hospital (Copenhagen, Denmark; www.rigshospitalet.dk), the Georgia Institute of Technology (Atlanta, USA; www.gatech.edu), and other institutions conducted a study of 106 implants (ranging from screws and knees to pacemakers) surrounding tissues in four groups (aseptic loosening, healed fractures, craniofacial complications, and the recently deceased) in five different hospitals in the Capital region of Denmark. The aim of the study was to detect and identify implant microbiomes from patients with no prior indications of implant-related infections.

The researchers also made 39 controls to ensure the implants were not contaminated during collection or subsequent analysis. This was done by opening a sterile implant in the laboratory, during surgery or an implant removed shortly after placement. The results revealed 78 implants (70%) were colonized by bacteria, fungi or both. A significant majority of screws

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were colonized by bacteria, but the prevalence of fungi was the same for all implants. None of the bacteria or fungi detected were pathogens, none of the patients showed signs of infection, and all controls were negative.

The study was published on July 2, 2018, in APMIS. “We have always believed implants to be completely sterile. It is easy to imagine, though, that when you insert a foreign body into the body, you create a new niche, a new habitat for bacteria. The question is whether this is beneficial, like the rest of our microbiome, whether they are precursors to infection, or whether it is insignificant,” said senior author Professor Thomas Bjarnsholt, PhD, of the KU department of immunology and microbiology. “This opens up a brand new field and understanding of the interplay between the body and bacteria and microbiomes.”

“It is important to stress that we have found no direct pathogens, which normally cause infection. Of course if they had been present, we would also have found an infection,” concluded lead author Tim Holm Jakobsen, PHd, of Rigshopitalet. “The study shows a prevalence of bacteria in places where we do not expect to find any, and they manage to remain there for a very long time, probably without affecting the patient negatively.”

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PRODUCT NEWS SURGICAL TABLE

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NAVIGATION SYSTEM

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BenQ Medical Technology

Stryker Worldwide

Uzumcu

The POSEIDON Q200 Series provides comprehensive flexibility for patient positioning, no matter the procedure or imaging requirement. It features an alarm system to identify all positioning adjustments in any improper articulation.

The NAV3i Platform delivers flexible surgical solutions for cranial, spine, ENT and orthopedic procedures. It offers the maximum integration and configuration options, along with additional image-import capability and microscope integration.

The Novela Extractor immediately evacuates the blood accumulated in the surgical areas and respiratory tract. It creates a vacuum at a certain flow rate, increasing surgical area visibility and providing continuous respiration.

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Integrated Technology Treats Uterine Fibroids n intrauterine ultrasound system incorporated into a proprietary radiofrequency ablation (RFA) device provides an incisionfree, uterus-preserving treatment for uterine fibroids.

The Gynesonics (Redwood City, CA, USA; https://gynesonics.com) Sonata sonography-guided transcervical fibroid ablation system combines a miniaturized high-resolution intrauterine ultrasound (IUUS) probe with an RFA handpiece to create a compact delivery system that avoids the peritoneal cavity and tissue morcellation. The incisionless alternative to hysterectomy and myomectomy uses the proprietary setting margins of ablation in real time (SMART) Guide to provide a graphic overlay of the live ultrasound image for precise targeting and deployment of the RFA handpiece.

The graphic overlay is controlled by the operator directly from the RFA handpiece to determine the size and location of ablation, determine mechanical stops for introducer and needle electrode advancement, and plan the duration of RFA energy delivery. The ablation zone is marked on-screen within an inner red ellipse, with the thermal safety border marked by an outer green ellipse. By controlling energy levels, delivery time, and precise localization of the uterine fibroids, the Sonata system can deliver predictable ablations to a wide range of fibroids and avoid post-embolization syndrome.

A uterine fibroid (leiomyomata) is a benign tumor originating from the myometrium, the smooth muscle layer of the uterus. Fibroids are often multiple, and if there too many to count, they are referred to as diffuse uterine leiomyomatosis. Fibroids are the most common benign tu-

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mors in females and typically found during the middle and later reproductive years. While most are asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency.

Image: The Sonata sonography-guided transcervical fibroid ablation system (Photo courtesy of Gynesonic).

Kidney Stone Retrieval Device Improves OR Experience n innovative flexible ureteroscopy (URS) device enables urologists to operate the ureteroscope and basket simultaneously when retrieving kidney stones. The Boston Scientific (Marlborough, MA, USA; www.bostonscientific.com) LithoVue Empower Retrieval Deployment Device is an ambidextrous, physician-controlled stone retrieval system designed to turn a two-person task into a one-person operation, eliminating the possibility of potential miscommunication during stone basketing. The device seamlessly integrates with the Boston Scientific LithoVue Single-Use Digital ureteroscope and the Zero Tip, Dakota, Escape, and Graspit nitinol retrieval baskets.

A recent study by researchers at Johns Hopkins University (JHU; Baltimore, MD, USA; www.jhu.edu) to evaluate the ergonomics of URS using single operator, dual operator, and LithoVue simulation models found that median procedure time was significantly improved when

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compared to single-surgeon URS (29.4 versus 51.3 seconds). In addition, average muscular work per second (AWS) was significantly improved to compared to single-surgeon URS, specifically in the thenar, flexor carpi ulnaris, and extensor carpi ulnaris muscles.

“The LithoVue Empower Device was developed in direct response to a need to improve procedural bottlenecks during kidney stone removal procedures,” said David Pierce, executive VP and president of MedSurg at Boston Scientific. “We are committed to identifying and addressing unmet needs to enable healthcare providers to advance patient outcomes, reduce procedural costs, enhance quality of care, and evolve the treatment of urologic and pelvic conditions.”

Ureteroscopic stone manipulation and retrieval typically requires two experienced individuals: one to drive the ureteroscope and a second to manipulate the stone basket or grasper.

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Cryoablation System Uses Noble Gas to Destroy Tumors new argon-based cryoablation system offers predictable, reliable performance with seamless therapy delivery and ease of technical operation.The BTG (London, United kingdom; www.btg-im.com) ICEfx Cryoablation System is a minimally invasive, easy-to-use percutaneous cryoablation (PCA) device designed to precisely destroy kidney, prostate, and other types of solid tumors by injecting compressed gases into them using closed-tip cryoablation needles (1.5 mm or 2.4 mm in diameter).

A mobile console with a large high definition (HD) touch screen provides an interface to control the circulation of the high-pressure gases, as well as to monitor real-time temperatures through connected thermal sensors, thus helping to protect critical anatomy.

The PCA procedure itself involves ultrasound or computed tomography (CT) image-guided positioning of the cryoablation needles into the tumors via catheters. Once in position, the pressurized argon gas is delivered into the tumor, effectively killing the cancerous tissue; helium gas is subsequently pumped in to release the needle. A proprietary software algorithm optimizes performance of the cryoablation needles and monitors the ablation zone by differentiating between the surrounding normal tissues and the frozen cancer tissue, which has a lower density.

“BTG has added the most advanced cryoablation technology to its portfolio of minimally invasive therapies, and is currently supporting a number of active clinical research studies in bone, kidney, lung, pain and prostate,” said Peter Pattison, head of interventional oncology at BTG. “We strive to provide health care professionals with easy access to innovative product choices. Our interventional oncology portfolio allows them to select and tailor each clinical solution to match a specific patient need.”

“The ICEfx Cryoablation System is a new, more compact design that simplifies the procedure through a set of user-friendly on-screen prompts,” said interventional radiologist AJ Gunn, MD, of the University of Alabama (Birmingham, USA). “It is easy for my technicians to set up, operate, and shut down. Importantly, this updated

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version is designed to work with the current line of BTG cryoablation probes, meaning that physicians can still create the reliable ablation zones they have come to expect.”

Argon is a noble inert gas, with its inertness making it very suitable for applications where reactions are not wanted. It was first isolated from air in 1894 by Lord Rayleigh and Sir William Ramsay at University College London by removing oxygen, carbon dioxide (CO2), water, and nitrogen from a sample of clean air.

It is the third-most abundant gas in the Earth’s atmosphere, more than twice as abundant as water vapor, 23 times more abundant than CO2, and more than 500 times as abundant as neon, another inert gas.

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FLUORESCENCE SYSTEM

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The APA with interchangeable blades is designed to aid intubation for routine and difficult airways. Its 3.5inch high-res viewing screen provides RT wide-angle viewing during the procedure, resulting in faster and more successful intubation.

The SPY Elite enables surgeons to visualize microvascular blood flow and perfusion in tissue intraoperatively. It provides images that may assist surgeons in making critical decisions in the operating room.

The Electric Suction Unit features a high vacuum, high flow, oil-free diaphragm vacuum pump along with air filters and anti-flooding protection. Other features include low noise, continuous regulation of negative pressure and pressure gauge display.

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Balloon Angioplasty Matches Stents for Small Blocked Arteries rug-coated balloons (DCB) are non-inferior to drug-eluting stents (DES) for treating small native coronary artery disease (CAD), according to a new study. Researchers at University Hospital Basel (Switzerland; www.unispital-basel.ch), University Hospital Saarland (Homburg, Germany; www.uniklinikum-saarland.de), and other institutions conducted a randomized non-inferiority trial involving 758 patients with small (under three mm) de-novo lesions in coronary vessels, who were randomly allocated to receive angioplasty with DCB or implantation of a second-generation DES; dual antiplatelet therapy was given according to current guidelines. The primary outcome was non-inferiority of DCB for major adverse cardiac events (MACE) after 12 months.

The results showed that after one year of follow-up, MACE were similar in both groups (7.5% for the DCB group versus 7.3% for the DES group). There were five (1.3%) cardiac-related deaths in the DES group and 12 (3.1%) in the DCB group. Probable or definite stent thrombosis occurred in three patients in the DCB group and four in the DES group, and major bleeding affected four patients in the DCB group compared to nine in the DES group. The study was presented at the European Society of Cardiology (ESC) annual congress, held during August 2018 in Munich (Germany).

“The potential benefits of a stent-free option to treat small blocked arteries are numerous. With no permanent implant left after the procedure, the problem of tissue growth and clot formation within the stent is eliminated,” said lead author Professor Raban Jeger, MD, of University Hos-

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pital Basel. “In addition, there may be no need for prolonged treatment with anticlotting medicines, which has been controversial since it increases the risk of bleeding. Drug coated balloon angioplasty has the possibility to become the standard treatment for small blocked arteries.”

One of the standard treatments for opening blocked arteries is to insert a permanent expandable DES via percutaneous coronary intervention (PCI). But in smaller arteries, there is a risk that tissue will grow inside the stent, causing the artery to become blocked a second time (instent restenosis), or that a blood clot will develop, which may lead to a heart attack or stroke. DCB are a novel therapeutic strategy approved in the European Union for treating restenosis; the balloon is removed after the procedure.

Image: New research shows DCB matches DES in surgery of small blocked arteries (Photo courtesy of iStock).

Spinal Decompression Drill Reduces Risk of Dural Tear unique surgical drill is both powerful enough to efficiently cut bone, and small enough for use in all sections of the spine. The Carevature Medical (Rehovot, Israel; www.carevature.com) DReal Decompression System (DDS) is a minimally invasive, highspeed bone removal device with a curved active tip and a forward facing drill positioned at its distal end, shielded on the underside in order to protect neural elements from multiple angles. Feature include integrated irrigation, a nine mm radius of curvature, and a small, two mm active tip that covers all anatomical segments of the spine (cervical, thoracic, and lumber).

The system comes with a range of single use drill tips, including a 45 degree angle regular tip, a 75 degree extended tip, tips with front or rear

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facing shields, and fluted drills or diamond burr cutters available in two or three mm diameter sizes. The DReal system is powered by a range of recommended electric or pneumatic motors compatible with a micro connection, or by using appropriate adaptors; the motor system is not included and not part of the device.

The dura mater encloses the brain, spinal cord, cauda equina, nerve roots, and cerebrospinal fluid (CSF). A durotomy, or dural tear, can occur during spinal surgery, requiring a water-tight closure in order to prevent a CSF leak, as without adequate treatment, it can lead to various clinical complications, such as pseudomeningocele, meningitis, and reoperation. In addition, dural tears can often lead to longer hospitalization and increased costs.

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Surgical Techniques

Structural Septal Device Relieves Heart Failure Symptoms novel shunt forms a passage between the left and right atria, enabling the left atrium to decompress at rest and physical activity, lowering left atrial pressure. The Corvia Medical (Tewksbury, MA, USA; http://corviamedical. com) Interatrial Shunt Device (IASD) is an innovative transcatheter implant intended for diastolic heart failure (HF) patients with preserved ejection fraction (HFpEF) or mid-range (HFmrEF) ejection fraction. After creating a small opening in the atrial septum, the IASD implant is deployed, forming a permanent passage between the atria and facilitating continuous and dynamic decompression of the left atrium. As a result, HF symptoms and quality of life are improved and HF hospitalization rates are reduced.

One-year follow-up data of the IASD clinical study, held in 64 patients implanted at 18 centers in eleven countries, demonstrated shunt patency for all participants who received the implant. Study endpoints, as measured by exercise pulmonary capillary wedge pressure (PCWP) reduction, showed a reduction in New York Heart Association (NYHA) class. Procedural safety, assessed by major adverse cardiovascular, cerebral, or renal events (MACCRE), showed that the IASD is also safe. The study was presented at the European Society of Cardiology (ESC) annual congress, held during August 2018 in Munich (Germany).

“The clinical study is of tremendous interest to me, because HFpEF is a clinical problem for which there is no effective therapy,” said co-lead author and study presenter Ted Feldman, MD, of Evanston Hospital (IL, USA). “We’ve now studied the IASD in several consecutive trials. The

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Expansion System Stabilizes And Restores Vertebral Body novel spinal implant provides a fully controlled and comprehensive solution for the reduction of painful osteoporotic vertebral compression fractures (VCFs).

The Stryker (Kalamazoo, MI, USA; www.stryker.com) SpineJack implantable fracture reduction system is based on a modifiable titanium expander designed to realize the biomechnical restoration of a VCF by simultaneously restoring sagittal and coronal balance, coronal angulation, and endplate restoration. The procedure involves placement using a percutaneous transpedicular approach with fluoroscopic guidance, followed by a controlled anatomical cranio-caudal expansion that preserves the surrounding bone trabeculae.

During expansion, a 500-Newton distraction force is applied along the cranio-caudal axis, similar to a car jack. Device expansion is achieved using a specific tool that pulls the two ends of the implant towards each other, shortening the device and deploying the central titanium component.

A rack-and-pinion system blocks the expansion of the implant at the desired height, preventing loss of correction before low-pressure injection of polymethylmethacrylate (PMMA) bone cement, which envelops the implants, ensuring definitive stabilization of the fracture.

By optimizing biomaterial positioning and interdigitation, the Spinejack system provides controlled uni-directional cranio-caudal expansion to restore sagittal and coronal balance; adaptation of the implant’s expansion to restore coronal angulation, and adaptation of implant positioning for endplate restoration. The SpineJack implantable fracture reduction system is available in three sizes (5.8, 5, and 4.2 mm), and includes three dimensional (3D) mapping software that uses computerized tomography (CT) scans to evaluate the anatomical restoration.

Non-operative treatment of VCF is often poorly tolerated, and surgical options include percutaneous vertebroplasty and kyphoplasty. Vertebroplasty is associated with higher rates of procedure-related complications and cement leakage, while kyphoplasty can result in significant loss of restored vertebral height after balloon deflation. The Spinejack system, developed originally by Vexim (Toulouse, France), which was recently acquired by Stryker, has been shown to overcome both problems and provide superior clinical results.

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early single-arm studies demonstrated that people felt better and their exercise capacity improved. Now, a sham-controlled randomized study conclusively proves the mechanism of action and again suggests clinical efficacy in midterm follow-up.”

HFpEF accounts for approximately 50% of all HF, affecting more than 6.2 million people in the United States and Europe, but treatment options remain limited, consisting mainly of diuretics and fluid balance control. People with HFpEF suffer from difficulty breathing, find simple daily activities tiring (if not impossible), and are frequently hospitalized, with a resultant dramatic reduction in their quality of life. Although the pathophysiology of HFpEF is complex, many of the symptoms are a result of excessive rises in left atrial pressure, in particular during exercise.

Image: A small interatrial shunt helps relieve heart failure symptoms (Photo courtesy of Corvia Medical).

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PRODUCT NEWS ELECTROSURGICAL UNIT

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OPERATING TABLE

EXAM LAMP

Erbe Elektromedizin

Merivaara

Zenith Lab

The VIO 3 features a user interface that reacts immediately to changing tissue parameters during surgical interventions. It displays all active instruments during the operation and suggests experienced settings used in various applications.

The Practico is designed to improve ergonomics with the widest range of posture possibilities. Available in three different models with optional motorized leg sections, it is one of the lowest mobile tables in the market.

The C-12A is designed for use in a small surgery room, outpatient exam and doctor’s office. The glass color filter creates white and soft light as natural light, making it ideal for ENT, ObGYN and outpatient departments.

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Hybrid Operating Room Streamlines Lung Cancer Treatment new study describes how integration of cone-beam computed tomography (CT) scanning and hybrid operation room (OR) technology has caused a paradigm shift in thoracic surgery. The Medical College of Georgia (MCG; Augusta USA; www.augusta.edu/ mcg) hybrid OR, inaugurated in May 2017, brings together three surgical techniques into a single space: cone-beam CT scan augmented navigational bronchoscopy, cone-beam CT-guided percutaneous biopsy and/or fiducial placement, and fiducial or image-guided video-assisted thoracic surgery resection. The single-stage procedure allows for diagnosis and treatment in one setting, with rapid on-site evaluation of cytology or pathology specimens a key element of the “all-in-one” approach.

By using intra-operative cone beam CT imaging technology from a single provider, Royal Philips (Philips; Best, The Netherlands; www.philips.com), the time from diagnosis to curative treatment is significantly reduced when compared to a traditional operating room, leading to decreased upstaging, increased patient survival, and simplifying the otherwise difficult intraoperative detection and resection of smaller and deeper lung cancer lesions.

For the study, the researchers compiled data from 25 patients and reviewed the medical charts of 11 others. Each of those patients underwent a same-day bronchoscopy, CT-guided biopsy, and surgical resection, if indicated, in the hybrid OR. Of the 11 patients, 10 had a successful diagnosis in one setting, with six diagnosed with cone beam CT-guided biopsy. Four of the six patients then went on to have a surgical resection of the cancerous nodule removed. The study was published on August 17, 2018, in Innovations: Technology and Techniques in Cardio-

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thoracic and Vascular Surgery.

In a Hybrid OR, advanced diagnostic imaging equipment is used to create a multidisciplinary space that allows different specialties to work together in order to diagnose and treat patients in the same location, as well as perform both open and minimally invasive procedures. The advanced room design allows for a patient to transition from an interventional to a surgical procedure without needing to be transported to another setting, allowing for reduced time in the OR setting and improved clinical outcome for patients.

Image: A new study claims a hybrid OR can reduce lung cancer diagnosis and response time (Photo courtesy of MCG).

Targeted Airway Ablation Reduces COPD Exacerbations ymptoms of persistent chronic obstructive pulmonary disease (COPD) can be significantly reduced when obstructed airways are opened by targeted lung denervation (TLD), claims a new study. Researchers at University Medical Center Groningen (UMCG; The Netherlands; www.umcg.nl), University Hospital Leuven (UZ Leuven, Belgium; www.uzleuven.be), and other institutions conducted a multinational phase 2 clinical study of the Nuvaira (Minneapolis, MN, USA; www.nuvaira.com) lung denervation system and dual cooled radiofrequency ablation (RFA) catheter probe. The trial included 82 patients (50% male, average age 64); half the participants underwent an outpatient TLD procedure, and the other half underwent a sham procedure.

During TLD, performed under general anesthesia, a bronchoscope is used to insert a balloon catheter that contains the RFA probe into the airway. Specific nerves are selectively ablated to target the cholinergic

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pathway, which regulates the inflammatory response and smooth muscle constriction. The esophagus itself is protected from the electrodes with a tissue-mimicking gel during the 75-minute procedure. In addition, all patients received tiotropium, an anticholinergic bronchodilator.

Eighty-one patients completed a six-month follow-up.

The results revealed that TLD improved lung function in COPD patients; while 71% of the patients who received the sham treatment had an adverse respiratory event related to COPD, only 32% of the TLD patients suffered one. None of the patients died, and there were no TLDrelated adverse effects. Five patients (12%) in the treatment group experienced gastrointestinal problems such as nausea, abdominal bloating, and digestion discomfort, which disappeared after six months. The study was presented at the European Respiratory Society International Congress, held during September 2018 in Paris (France).

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Surgical Techniques

Implant Solution Restores Cranial Voids and Corrects Deformities clear, patient specific implant enables neurosurgeons to reconstruct the cranium and observe neuroanatomy and critical functional components.

The Longeviti Neuro Solutions (Longeviti; Hunt Valley, MD, USA; https://longeviti.com) ClearFit implant is a polymethyl-methacrylate (PMMA) construct that is custom made using a patient’s computerized tomography (CT) scans and a novel three dimensional (3D) printing process to ensure a precise fit and restorative contour. Neurosurgeons can order a ClearFit by uploading a CT scan to Longeviti’s Secure File Exchange. The CT scans are converted to a CAD/CAM compatible file, following which an expert design team plans a personalized implant for the patient.

The ClearFit implant is available in three different designs: standard, complex, and single-stage. The devices are provided sterile to the surgeon, and are fixated to the surrounding bone using commercially available fasteners. The clear, radiopaque, and sonolucent implant enables surgeons the newfound ability to see important neuroanatomy through the implant, providing increased ultrasound visibility for post-operative monitoring.

“For patients who require a cranioplasty as a result of trauma and/or restorative surgery, there is no one-size-fits-all treatment option,” said Jesse Christopher, co-founder and CEO of Longeviti. “Building on the recent launch of the InvisiShunt and our ‘first-in-human’ experiences published in several journals such as Operative Neurosurgery, Longeviti is proud to be able to offer patients innovative, customizable solutions for various neurological procedures.”

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“The real advantage to this system is the ability to see what’s underneath the cranioplasty,” said Justin Caplan, MD, an assistant professor of neurosurgery at the Johns Hopkins School of Medicine (Baltimore, MD, USA). “Now, instead of having to worry if there is blood accumulating putting pressure on the brain, the surgeon can see this directly right up until the wound is closed. Here the advantage is clear!”

Ideally, surgeons restore the skull in the secondary cranial reconstruction procedure using with the same piece of bone removed during the original operation, which is stored in a freezer between operations.

In some cases, surgeons must substitute the original bone with a custom-made implant.

Image: A clear PMMA implant reconstructs the skull following a craniotomy (Photo courtesy of Longeviti).

Carbon Fiber Implants Beneficial For Oncological Patients novel carbon fiber pedicle screw system restores the integrity of the spinal column in patients with advanced-stage cancer in whom life expectancy is too short to permit fusion. The CarboFix Orthopedics (CarboFix; Herzliya, Israel; www.carbo-fix.com) CarboClear Pedicle Screw System is intended to restore the integrity of the thoracic and lumbar spine – even in the absence of fusion – for a limited period in patients with advanced tumors. The implant system consists of pedicle screws, rods, intramedullary nails, plates, and locking elements in various dimensions, used to build a spinal construct; and of a set of instruments, intended to assist in the insertion and placement of the implants. The threaded portion of the pedicle screws is encased within a thin titanium shell.

The system elements are made of carbon fiber-reinforced polyetheretherketone (CFR-PEEK), consisting of continuous carbon fibers layered in a unidirectional, longitudinal orientation, as well as in a helical and diagonal orientation, which adhere together. The composite material makes the CarboFix implants radiolucent, which is beneficial during surgery and follow up on magnetic resonance imaging (MRI) and computerized tomography (CT) scans with minimal artifacts. The material also enables radiation therapy (RT) with no backscatters.

“These unique implants provide enhanced imaging follow-up and radiation treatment. These implants are a game changer for spinal oncology cases,” said Ron Szekely, director of VP sales and marketing at CarboFix. Carbon fiber implants provide unique advantages to the oncological patients, including enhanced RT planning capabilities, allowing dose optimization with minimal collateral tissue damage and enhanced follow up abilities due to artifacts-free MRI and CT. In addition, unparalleled fatigue strength supports the impaired healing process in such patients, as well as compatibility with particle radiation (proton and carbon ion) and other stereotactic radio-surgery modalities.

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PRODUCT NEWS DICOM PACS WORKSTATION

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CV INFORMATION SYSTEM

CANCER CARE PLATFORM

Aycan Digitalsysteme

Fujifilm Europe

Varian Medical Systems

The workstation is designed for conventional, multislice and other image reading. Its unique design for navigation and visualization of multimodality and multi-dimensional images makes post-processing and primary diagnosis easy.

The Synapse Cardiovascular 5.0 creates CV reports quickly and easily, and offers advanced tools that help quantify results. It is uniquely suited to fit into any facility's IT infrastructure, physical or virtual.

The 360 Oncology connects the entire care team, engages patients and places predictive intelligence at the fingertips. The platform allows users to make better, more informed decisions while also keeping patients engaged.

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International Collaboration to Focus on Medical Cybersecurity cont’d from cover

outline the cybersecurity responsibilities shared between all stakeholders, as well as explore the adoption of coordinated policies for the public disclosure of device vulnerabilities. The completed guidance document is due to be presented at the IMDRF September 2019 meeting, to be held in Russia.

In addition to an international guidance document, the IMDRF standards working group will aim to help assure international standards development organizations (SDOs) produce relevant regulatory-grade work, so it can be used to aid agency decision-making. A critical aspect is that these standards must include validated methodologies and measurements for success. To address that, the IMDRF also plans to publish a document on optimizing standards for regulatory use, and will liaise more closely with country SDOs. “One of the reasons that we do not recognize standards is because there’s not an objective basis for determining conformance with the standards. We’ve been finding that a number of these standard development organizations are not taking the voice of regulators into account,” said leader of the U.S. delegation Jeff Shuren, director of the FDA Center for Devices and Radiological Health (CDRH). “What you’re going to see is IMDRF coming together as an organization, with all of the participating countries saying, with one voice, that you need to take our issues into account or we’re not going to recognize your standards.”

Cybersecurity threats to medical devices and exploitation of cybersecurity vulnerabilities present a potential risk to the safety and effectiveness of such devices. While manufacturers can incorporate controls in the design of a product to help prevent these risks, they must also consider improvements during maintenance of devices, since the evolving nature of cyberthreats means risks may arise throughout a device’s entire lifecycle. A structured and systematic comprehensive approach that responds in a timely fashion to identified vulnerabilities is thus warranted.

Image: An international collaboration aims to safeguard medical devices from cybersecurity threats (Photo courtesy of Shutterstock).

Patient Health Information Frequently Shared Electronically he most common electronically sent and received types of patient health information (PHI) include laboratory results and medication lists, claims a new report.

For the report, researchers at the U.S Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA; www.cdc.gov) extracted data from the 2015 National Electronic Health Records Survey (NEHRS), a nationally representative survey of nonfederal, office-based physicians that collects information on physician and practice characteristics, including the adoption and use of electronic health record (EHR) systems.

Estimates of the types of PHI shared electronically were ranked based on whether participating physicians electronically sent, received, integrated, or searched for PHI. The results showed that the most commonly observed types of PHI sent electronically were referrals (67.9%), laboratory results (67.2%), and medication lists (65.1%). The most commonly observed types of received PHI were laboratory results (78.8%), imaging reports (60.8%), and medication lists (54.4%). The most commonly observed types of in-

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tegrated PHI were laboratory results, imaging reports, and hospital discharge summaries. PHI electronic searches were mostly for medication lists (90.2%), medication allergy lists (88.2%), and hospital discharge summaries (80.4%). The report was published on August 15, 2018, in National Health Statistics Reports.

“EHRs have the advantage of providing accurate and complete information about patients, reducing health care costs, and enhancing privacy and security of patient data. EHRs also allow physicians to obtain access to current medication lists, allergies, and laboratory results, which may facilitate quality of care,” concluded lead author Ninee Yang, PhD, and colleagues. The 2009 U.S. Health Information Technology for Economic and Clinical Health (HITECH) Act provides financial incentives to eligible providers using a certified EHR system, and those who can demonstrate meaningful use of the system. In 2010, the Office of the National Coordinator for Health Information Technology began certifying EHR systems based on their ability to meet the meaningful use criteria.

By 2015, 77.9% of office-based physicians had a certified EHR system.

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AIrtificial Intelligence Urged For Educating Next Generation Of Medical Professionals new viewpoint study suggests that educating the next generation of medical professionals with the right machine learning (ML) techniques will enable them to become part of the emerging data science revolution.

Researchers at Boston University School of Medicine (BUMC; MA, USA; www.bumc.bu.edu/busm) searched PubMed to uncover the number of papers published in the area of ML since the beginning of this decade. They found that while the number had increased, the number of publications related to undergraduate and graduate medical education in the field remained relatively unchanged since 2010, with a grand total of just 16 studies. Realizing the need for educating the students and trainees within BUMC about ML, the researchers designed and taught an introductory course.

The course is intended to educate the next generation of medical professionals and young researchers with biomedical and life sciences backgrounds about ML concepts to help prepare them for the ongoing data science revolution. The researchers believe that if medical education begins to implement a ML curriculum, physicians may begin to recognize the conditions and future applications where AI could potentially benefit clinical decision-making and management early on in their career, and be ready to utilize these tools better when beginning practice. The study was published as a perspective in the September 2018 issue of NPJ Digital Medicine.

“The general public has become quite aware of AI and the impact it can have on health care outcomes such as providing clinicians with improved diagnostics. However, if medical education does not begin to teach medical students about AI and how to apply it into patient care, then the advancement of technology will be limited in use and its impact on patient care,” said lead author Vijaya Kolachalama, PhD. “Technology without physician knowledge of its potential and applications does not make sense and will only further perpetuate healthcare costs.”

The rising popularity of ML techniques for medical applications is evident from the increasing amount of research, the number of products obtaining regulatory approvals, and entrepreneurial efforts over the past few years. Venture capital funding for healthcare AI startup companies was about USD 3.6 billion in the last five years, underscoring the increasing appreciation of the value that ML can potentially bring to the medical community.

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Image: A new study asserts that future medical education should include AI and machine learning (Photo courtesy of Getty Images).

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IMAGE SOFTWARE

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ADVANTECH iHealthCare

The Nexxis allows the sharing of video/audio in and outside the OR with zero latency and no compression for artifacts elimination and perfect hand-eye coordination. The platform was designed specifically for integration into the digital OR.

The Illumeo augments the skills of clinicians and redefines how they currently interface with images. Designed to empower radiologists and work for them, it provides the technology and tools that enhance expertise and efficiency.

The PDC-WP240 features a 24-inch screen, high contrast ratio, wide viewing angle, gloved operation responsiveness and internal power supply. It provides consistent, highquality images, making it suitable for use in critical care environments.

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Virtual Dissection Table Visualizes Anatomical Structures n updated anatomy table uses a digital cadaver to provide a complete and striking journey into the human body, with detailed regional content.

The Anatomage (San Jose, CA, USA; www.anatomage.com) virtual dissection table allows medical and other students to replicate a true operating table experience, using realistic interactive visualization of human three-dimensional (3D) anatomies. The virtual cadaver is recumbent as students stand beside the table and interact with it, rotating it, dissecting the body, peeling off soft tissues, or removing an organ entirely using finger gestures. But unlike cadavers, the students can redo and undo the dissection over and over again.

The new Table 6 software update contains all-new anatomy content, dynamic visualization tools, and interactive testing features, with a new female cadaver joining the previous three real cadavers on the Table.

Newly added regional anatomy structures include the head and neck as well as the male and female abdomen. High-resolution regional anatomy and an expansive photorealistic sectional library provide a full cadaver lab experience, with over 2,000 3D structures annotated and segmented for easy visualization and reference.

Custom annotations and flexible annotation tools allow institutions to create innovative programs, quizzes, and new methods of study.

Unique visualization tools provide an active educational experience, including a new histology feature that allows students to engage with pathology at a microscopic level by tapping on any structure and instantly seeing its related histology. Simulated endoscopies and other proce-

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dures are accessible using the newly added Flythrough tool.

The Anatomage table is based on a liquid crystal display (LCD) highcontrast screen with a 3960 x 1080 resolution. Optical touch interactive sensors are used for image manipulation, which can be used with a finger or a stylus. Around a dozen people can easily stand around and comfortably interact with each other and the Table at the same time. If needed, it can be moved to a different room on rollers that can be locked into a position.

Image: The Anatomage virtual dissection table (Photo courtesy of Anatomage).

Novel App Measures Blood Pressure without Accessories new study describes how oscillometric finger pressing (colloquially known as â&#x20AC;&#x153;Peek and Popâ&#x20AC;?) can provide accurate blood pressure (BP) readings on an iPhone, with no special equipment. Developed at Michigan State University (MSU; East Lansing, USA; www.msu.edu), the new application, designed for the iPhone X, visually guides fingertip placement and actuation on both the front camera and screen in order to artificially increase the external pressure of the underlying transverse palmer arch artery. The app then measures both variable-amplitude blood volume oscillations via the camera, and applied pressure via the strain gauge array under the screen to compute BP from the measurements, similar to automatic cuff devices.

In a proof of concept test conducted in 18 volunteers, against both a finger cuff BP and a standard cuff device, the app yielded bias and precision errors of -4.0 and 11.4 mmHg for systolic BP, and -9.4 and 9.7

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mmHg for diastolic BP, respectively; the errors were closer to the finger cuff device errors. According to the researchers, the study indicates that cuff-less and calibration-free BP monitoring may be feasible with many existing and forthcoming smartphones. The study was published on September 3, 2018, in Scientific Reports.

The oscillometric method of measuring blood pressure involves occluding a major artery, typically the brachial artery in the arm with an external pneumatic cuff. When the pressure in the cuff is higher than the blood pressure inside the artery, the artery collapses. As the pressure in the external cuff is slowly decreased, blood begins to spurt through the artery, causing the famous Korotkoff sounds. The pressure measured in the cuff region when blood first passes through is an estimate of systolic pressure. The pressure measured when blood first starts to flow continuously is an estimate of diastolic pressure.

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Industry News

Global Refurbished Medical Equipment Market Seen to Grow at 10% Annually he global refurbished medical devices market is expected to grow at a CAGR of over 10% during the forecast period 20192023, driven by the organized healthcare ecosystem in the developed economies. Moreover, privatization in the healthcare sector is increasing rapidly due to the inability of governments to invest efficiently in the sector, coupled with high demand for innovation and technology for superior healthcare services. These are the latest findings of Technavio Research, (London, UK; www.technavio.com), a global technology research and advisory company.

Based on product, the diagnostic imaging equipment segment held the largest share of close to 76% in the refurbished medical devices market in 2018 and is expected to maintain its dominance during the forecast period. Geographically, the Americas held the largest share of close to 44% in the global refurbished medical devices market in 2018, followed by the EMEA and APAC regions, respectively. The North American refurbished medical devices market is being driven by high investments in healthcare in countries such as the US and Canada.

Medical equipment and devices involve huge costs, which can be attributed to high R&D and technology costs associated with designing new medical devices. Additionally, medical devices generally contain various redundant and high-end components to reduce the probability of device failure, which further increases their manufacturing cost. This high cost of new medical devices makes it lucrative for healthcare service providers to use refurbished medical devices.

“Due to the high cost of new medical devices, refurbished medical devices serve as cost-effective alternatives,” said a senior analyst at Technavio. “They are certified, updated with new technologies, and have valid warranties. Refurbished medical devices enable healthcare service providers to stay updated with the latest consumer demand, at affordable prices.”

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

International Calendar HospiMedica International E-mail: info@globetech.net Yellow-highlighted listings are available at US$500 for a 12-month period.

FEBRUARY 2019 CACVS 2019 – Controversies & Updates in Vascular Surgery. Feb 7-9; Paris, France; Web: cacvs.org HIMSS19 Global Conference & Exhibition – Healthcare Information and Management Systems Society. Feb 11-15; Orlando, FL, USA; Web: www.himssconference.org Critical Care Congress 2019 – 48th Annual Meeting of the Society of Critical Care Medicine (SCCM). Feb 17-20; San Francisco, CA, USA; Web: www.sccm.org Medical Japan 2019. Feb 20-22; Osaka, Japan; Web: www.medical-jpn.jp Medical Fair India 2019. Feb 21-23; New Delhi, India; Web: www.medicalfair-india.com 15th WINFOCUS World Congress on Ultrasound in Emergency & Critical Care. Feb 2124; Dubai, UAE; Web: winfocus.org/winfocus15th-world-congress APSCVIR 2019 – 14th Annual Meeting of the Asia Pacific Congress of Cardiovascular and Interventional Radiology. Feb 21-24; Bali, Indonesia; Web: apscvir2019.com ECR 2019 – European Congress of Radiology. Feb 27-Mar 3; Vienna, Austria; Web: www.myesr.org MARCH 2019 Acute Cardiovascular Care 2019. Mar 2-4; Malaga, Spain; Web: www.escardio.org AAEM19 – 25th Annual Scientific Assembly of the American Academy of Emergency Medicine. Mar 9-13; Las Vegas, NV, USA; Web: www.aaem.org/aaem19 AAOS 2019 – Annual Meeting of the American Academy of Orthopaedic Surgeons. Mar 1216; Las Vegas, NV, USA; Web: www.aaos.org KIMES 2019 – 35th Korea International Medical & Hospital Equipment Show. Mar 14-17;

Seoul, Korea; Web: www.kimes.kr EAU19 – 34th Annual Congress of the European Association of Urology. Mar 15-19; Barcelona, Spain; Web: eaucongress.uroweb.org ACC.19 – American College of Cardiology’s 68th Annual Scientific Session & Expo. Mar 16-18; New Orleans, LA, USA; Web: accscientificsession.acc.org EHRA – Annual Congress of the European Heart Rhythm Association. Mar 17-19; Lisbon, Portugal; Web: www.escardio.org SAR 2019 – Annual Scientific Meeting of the Society of Abdominal Radiology. Mar 17-22; Orlando, FL, USA; www.abdominalradiology.org ISICEM 2019 – 39th International Symposium on Intensive Care and Emergency Medicine.

Mar 19-22; Brussels, Belgium; Web: www.intensive.org Africa MedExpo 2019. Mar 21-23; Addis Ababa, Ethiopia; Web: expogr.com/ethiopia/medexpo ENDO 2019 – Endocrine Society’s Annual Meeting & Expo. Mar 23-26; New Orleans, LA, USA; Web: www.endocrine.org/endo2019 SIR 2019 – 44th Annual Meeting of the Society of Interventional Radiology. Mar 23-28; Austin, TX, USA; Web: www.sirmeeting.org Asia Health 2019. Mar 26-28; Singapore; Web: www.medlabasia.com ExpoMed Eurasia 2019. Mar 28-30; Istanbul, Turkey; Web: expomedistanbul.com

APRIL 2019 Gulf Health Exhibition & Conference 2019.

Apr 2-4; Mishref, Kuwait; Web: www.gulfhealt hexhibition.com Indohealthcare Expo 2019. Apr 4-6; Jakarta, Indonesia; Web: indohealthcareexpo.com 15th Emirates Critical Care Conference. Apr 4-7; Dubai, UAE; Web: www.eccc-dubai.com WCO-IOF-ESCEO Paris 2019 – World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Apr 4-7; Paris, France: www.wco-iof-esceo.org North Africa Health Expo. Apr 6-8; Cairo, Egypt; Web: www.northafricahealthexpo.com 2019 AIUM Annual Convention – American Institute of Ultrasound in Medicine. Apr 6-10; Orlando, FL, USA; Web: www.aium.org ECIO 2019 – European Conference on Interventional Oncology. Apr 8-11; Amsterdam, The Netherlands; Web: www.ecio.org SEACare 2019 – 22nd Southeast Asian Healthcare & Pharma Show. Apr 9-11; Kuala

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Lumpur; Malaysia; Web: abcex.com EUROPREVENT 2019 – Annual Meeting of the European Association of Preventive Cardiology (EAPC). Apr 11-13; Lisbon, Portugal; Web: www.escardio.org/europrevent 78th Annual Meeting of the Japan Radiological Society (JRS). Apr 11-14; Yokohama, Japan; Web: www.radiology.jp WCN 2019 – World Congress of the International Society of Nephrology (ISN). Apr 12-15; Melbourne, Australia; Web: www.isnwcn2019.org Charing Cross International Symposium 2019. Apr 15-18; London, UK; Web: www. cxsymposium.com IMTEC Oman 2019 – International Medical Tourism Exhibition & Conference. Apr 23-25; Muscat, Oman; Web: www.medicaltourismfair.com ESTRO 38 – Annual Congress of the European Society of Radiology & Oncology. Apr 26-30; Milan, Italy; Web: www.estro.org SPR 2019 – Annual Meeting of the Society for Pediatric Radiology. Apr 30-May 4; San Francisco, CA, USA; Web: www.pedrad.org

MAY 2019 EuroCMR 2019 – 17th Annual Meeting of the European Association of Cardiovascular Imaging (EACVI). May 2-4; Venice, Italy; Web: www.escardio.org/EACVI ESTES 2019 – 20th European Congress of Trauma & Emergency Surgery. May 5-7; Prague, Czech Republic; Web: www.estesonline.org 2019 ARRS Annual Meeting – American Roentgen Ray Society. May 5-10; Honolulu, HI, USA; Web: www.arrs.org Vietnam Medi-Pharm 2019. May 8-11; Hanoi, Vietnam; Web: vietnammedipharm.vn ISMRM 2019 – 27th Annual Meeting of the International Society for Magnetic Resonance in Medicine. May 11-16; Montreal, Canada; Web: www.ismrm.org ESPR 2019 – 55th Annual Meeting of the European Society of Paediatric Radiology. May 14-18; Helsinki, Finland; Web: www.espr.org CMEF Spring 2019 – China International Medical Equipment Fair. May 14-17; Shanghai, China; Web: www.cmef.com.cn KIHE 2019 – Kazakhstan International Healthcare Exhibition. May 15-17; Almaty, Kazakhstan; Web: kihe.kz ATS 2019 International Conference – American Thoracic Society. May 17-22; Dallas, TX, USA; Web: conference.thoracic.org

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ECE 2019 – 21st European Congress of Endocrinology. May 18-21; Lyon, France; Web: www.ese-hormones.org ASNR 2019 – 57th Annual Meeting of the American Society of Neuroradiology. May 1823; Boston, MA, USA; Web: www.asnr.org MedtecLIVE 2019. May 21-23; Nuremburg, Germany; Web: www.medteceurope.com Hospitalar 2019. May 21-24; Sao Paulo, Brazil; Web: www.hospitalar.com EAPC 2019 – 16th World Congress of the European Association for Palliative Care. May 2325; Berlin, Germany; Web: www.eapc-2019.org Heart Failure 2019 – World Congress on Acute Heart Failure. May 25-28; Athens, Greece; Web: www.escardio.org/heartfailure Africa Health 2019. May 28-30; Johannesburg, South Africa; Web: www.africahealthexhibition.com Deutscher Röntgenkongress – 100th Annual Meeting of the German Roentgen Society.

May 29-June 1; Leipzig, Germany; Web: www.roentgenkongress.de EUROSON 2018 – 31st Congress of the European Federation of Societies for Ultrasound (EFSUMB). May 29-Jun-1; Granada, Spain; Web: www.euroson2019.org ASCO 2019 Annual Meeting – American Society of Clinical Oncology (ASCO). May 31-Jun 4; Chicago, IL, USA; Web: www.asco.org

JUNE 2019 EuroAnaesthesia 2019. Jun 1-3; Vienna, Austria; Web: www.esahq.org EFORT 2019 – 20th Congress of European Federation of National Associations of Orthopaedics and Traumatology. Jun 5-7; Lisbon, Portugal; Web: www.efort.org ESGAR 2019 – 30th Annual Meeting of the European Society of Gastrointestinal and Abdominal Radiology. Jun 5-8; Rome, Italy; Web: www.esgar.org WCD 2019 – 24th World Congress of Dermatology. Jun 10-15; Milan, Italy; Web: www. wcd2019milan.org EAES 2019 – 27th Annual International Congress of the European Association for Endoscopic Surgery. Jun 12-15; Sevilla, Spain; Web: eaes.eu EULAR 2019 – Annual European Congress of Rheumatology. Jun 12-15; Madrid, Spain; Web: congress.eular.org EHA24 – 24th Annual Congress of the European Hematology Association. Jun13-16; Am-

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International Calendar sterdam, The Netherlands; Web: ehaweb.org CARS 2019 – 33rd International Conference of Computer Assisted Radiology & Surgery. Jun 17-22; Rennes, France; Web: www.cars2019.org ESPNIC 2019 – 30th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care. June 18-21; Salzburg, Austria; Web: espnic2019.kenes.com FIME 2019 – Florida International Medical Exhibition. Jun 26-28; Miami Beach, FL, USA; Web: www.fimeshow.com Medical Taiwan 2019. Jun 27-30; Taipei, Taiwan; Web: www.medicaltaiwan.com.tw

JULY 2019 INAC 2019 – 5th Conference of the International Neonatology Association. Jul 12-14; Tijuana, Mexico; Web: 2019.worldneonatology.com

AUGUST 2019 WCS 2019 – 48th World Congress of Surgery.

Aug 11-15; Krakow, Poland; Web: www. wcs2019.org SEPTEMBER 2019 ESC Congress 2019 – European Society of Cardiology. Aug 29-Sep 4; Paris, France: Web: www.escardio.org Medical Fair China 2019. Sep 6-8; Suzhou, China; Web: www.medicalfair.cn WFUMB 2019 – 17th World Federation for Ultrasound in Medicine and Biology Congress.

Sep 6-9; Melbourne, Australia; Web: www. wfumb2019.org Medical Fair Thailand 2019. Sep 11-13; Bangkok, Thailand; Web: www.medicalfair-thailand.com ESRA 2019 – 38th Annual Congress of the European Society of Regional Anaesthesia and Pain Therapy. Sep 11-14; Bilbao, Spain; Web: esra-congress.com CIRSE 2019 – Annual Congress of the Cardiovascular and Interventional Radiological Society of Europe. Sep 22-25; Lisbon, Portugal; Web: www.cirse.org ESVS 2019 – 33rd Annual Meeting of the European Society for Vascular Surgery. Sep 2327; Hamburg, Germany; Web: www.esvs.org Medic East Africa 2019. Sep 24-26; Nairobi, Kenya; Web: www.mediceastafrica.com ExpoMedical 2019. Sep 25-27; Buenos Aires, Argentina; Web: www.expomedical.com.ar 2019 SDMS Annual Conference – Society of Diagnostic Medical Sonography. Sep 26-29; V

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National Harbor, MD, USA; Web: www.sdms.org ERS International Congress 2019 – European Respiratory Society. Sep 28-Oct 2; Madrid, Spain; Web: www.ersnet.org ECISM LIVES 2019 – 32nd Annual Congress of European Society of Intensive Care Medicine. Sep 28-Oct 2; Berlin, Germany; Web: www.esicm.org ESMO 2019 – Annual Congress of the European Society for Medical Oncology. Sep 29–Oct 1; Barcelona, Spain; Web: www.esmo.org

OCTOBER 2019 ESMRMB 2019 – 37th Annual Meeting of the European Society for Magnetic Resonance in Medicine and Biology. Oct 3-5; Rotterdam, The Netherlands; Web: www.esmrmb.org EANM 2019 – 32nd Annual Congress of the European Association of Nuclear Medicine. Oct 12-16; Barcelona, Spain; Web: www.eanm.org ISUOG World Congress 2019 – International Society of Ultrasound in Obstetrics & Gynecology.

Oct 13-16; Berlin, Germany; Web: www.isuog.org 14th World Congress of Intensive Care 2019 – World Federation of Societies of Intensive and Critical Care Medicine. Oct 14-18; Melbourne, Australia; Web: www.worldcongress intensivecare2019.com UEG Week 2019 – United European Gastroenterology. Oct 19-23; Barcelona, Spain; Web: www.ueg.eu ESCR Annual Scientific Meeting 2019 – European Society of Cardiovascular Radiology.

Oct 24-26; Antwerp, Belgium; Web: www.escr.org CMEF Autumn 2019 – China International Medical Equipment Fair. Oct 29-Nov 1; Shanghai, China; Web: www.cmef.com.cn

NOVEMBER 2019 43rd World Hospital Congress of the International Hospital Federation 2019. Nov 7-9; Muscat, Oman; Web: worldhospitalcongress.org APSR 2019 – 24th Congress of the Asian Pacific Society of Respirology. Nov 14-17; Hanoi, Vietnam; Web: www.apsresp.org MEDICA 2019. Nov 18-21; Dusseldorf, Germany; Web: www.medica-tradefair.com

DECEMBER 2019 RSNA 2019 – Annual Meeting of the Radiological Society of North America. Dec 1-6; Chicago, IL, USA; Web: www.rsna.org

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