Hospimedica Intl Novemeber 2017 by Globetech

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CLINICAL NEWS

Vol.35 No.5 • 10-11/2017

LEADER DAILY CLINICAL NEWS

ISSN 0898-7270

Technique Monitors Nerves During Surgery

Hospital Discharge Program Improves Patient Experience

novel intraoperative technique takes advantage of the laryngeal adductor reflex (LAR) to monitor the laryngeal and vagus nerves in patients under general anesthesia. Developed at Mount Sinai West Hospital (New York, NY, USA; www.mount sinai.org), the method is based on an endotracheal tube with electrodes

standardized hospital-based program provides patients and caregivers the information they need to continue care at home. Developed at Boston Medical Center (BMC, MA, USA; www.bmc.org) and Torrance Memorial Health System (CA, USA; www.torrancememorial.org), the ReEngineered Discharge (RED)

program, first implemented in 2007, is an after hospital care plan (AHCP) set of strategies aimed at improving the discharge process in a way that promotes patient safety and reduces readmission rates and emergency department visits. The AHCP is formatted with large font, color, icons, and simple clear language. It includes information

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Laparoscopy Procedure Cuts Pancreatitis Complication Rates

Cardiac Stents and Bypass Surgery Equally Effective rug-eluting stents are as effective as coronary-artery bypass grafting (CABG) surgery for many patients with left main coronary artery disease (LMCAD), according to a new study. Researchers at Columbia University Medical Center (CUMC; New York, NY, USA; www.cumc.columbia.edu), the Medical University of Silesia (Katowice, Poland; smk.sum.edu.pl), and other institutions conducted a study of 1,905 patients with LMCAD who

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3D Digital Platform Reinvents Mammography new digital breast tomosynthesis (DBT) system delivers superior diagnostic accuracy at the same low dose as a conventional mammography exam. The GE Healthcare (GE, Little Chalfont, United Kingdom; www. gehealthcare.com) Senographe Pristina system is a three dimensional (3D) DBT mammography platform that allows for excellent visualization of breast lesions without increasing the

aparoscopic total pancreatectomy with islet cell auto transplantation (TPIAT), a recently developed minimally invasive transplant procedure, reduces operative times, length of stay, and promises quicker opioid independence for patients suffering from chronic pancreatitis (CP). See article on page 4

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Computerized Anesthesia System Identifies Epidural Space novel anesthesia system provides objective visual and audible pressure feedback, allowing anesthesiologists to correctly identify the epidural space. The CompuFlo Epidural Computer Controlled Anesthesia System is

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Range of Ultrasound Innovations Advance Ob/Gyn Imaging

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INSIDE

range of new ultrasound tools enable simultaneous transparent, photo-realistic and 3D visualizations for Ob/Gyn ultrasound imaging. The new tools are intended to allow clinicians to diagnose complex Obstetric (Ob) and Gynecological (Gyn) situations faster, and with more confidence.

The new TrueVue, GlassVue, and aRevealA.I. systems were all developed by Royal Philips (Amsterdam, the Netherlands; www.philips.com), and are intended for use with the Philips EPIQ 7 and 5, and Affiniti 70 and 50 ultrasound systems. TrueVue provides photorealistic, lifelike, 3D ultrasound Cont’d on page 15

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Technique Monitors Nerves During Surgery cont’d from cover

placed along its side. Electrodes along one side of the endotracheal tube are used to electrically stimulate the brain stem via the superior laryngeal nerve, while the electrodes along the other side are used to record LAR responses in vocal fold mucosa. The technique allows surgeons to monitor nerve function and change their approach to prevent postsurgical voice and swallowing complications resulting from nerve dysfunction. In a case series of 15 patients undergoing thyroid and cervical spine surgeries under total intravenous general anesthesia, the researchers found that they could make immediate surgical modifications and adjustments during the procedures to prevent irreversible nerve damage, with all 15 cases resulting in improved patient outcomes and lower complication rates. The researchers added that as LAR monitors the entire vagus nerve re-

flex arc, it is applicable to all surgeries where vagal nerve integrity may be compromised. The study was published in the July 2017 issue of Clinical Neurophysiology. “This simple technique will likely have widereaching effects by greatly enhancing our ability to monitor the vagus nerve in the head and neck during neurosurgical and cardiothoracic surgeries,” said lead author otolaryngologist Catherine Sinclair, MD, of Mount Sinai. “Never before have we been able to monitor both sensory and motor branches of the vagus nerve. The ability to monitor sensory function for the first time is a huge breakthrough and will hopefully translate into improved patient outcomes.” “Surgery of the lower brain stem is still relatively conservative, given the critical functional role of this small area and the lack of reliable techniques to monitor these structures,” said study co-author Se-

dat Ulkatan, MD, director of intraoperative neurophysiology at Mount Sinai West. “This novel methodology will provide neurosurgeons important feedback to protect vagus nerve and lower brainstem structures, reducing life-threatening surgical complications.” The vagus nerve is the tenth cranial nerve, and interfaces with parasympathetic control of the heart, lungs, and digestive tract. It is the longest nerve of the autonomic nervous system, supplying motor parasympathetic fibers to all the organs (except the adrenal glands), from the neck down to the second segment of the transverse colon. It also innervates several skeletal muscles, including the cricothyroid, the superior, middle and inferior pharyngeal constrictors, and other muscles of the pharynx and larynx, thus controlling muscle movements in the mouth and speech.

Computerized Anesthesia System Identifies Epidural Space cont’d from cover

intended for use with an epidural needle for realtime verification of needle tip placement in the lumbar epidural space in adult patients. The system uses proprietary dynamic pressure sensing (DPS) technology to verify correct placement; once confirmed, the CompuFlo system is disconnected. The system includes an injection-molded plastic housing that contains the motor-driven piston syringe pumps and internal force sensor, syringe retainer, microprocessor, and a liquid crystal display (LCD) screen display. A complimentary tray of single-use disposable supplies includes an external in-line fluid pressure sensor, a 20 mL plastic syringe, and a tubing set and adapter that limit use of the disposables; epidural needles and the injectable solution are not supplied in the disposable kit. The CompuFlo system is not intended for medication infusion, must not be used on patients with skin conditions in the lumbar region greater than four cm2, or in patients with prior surgery in the lumbar area that prevents epidural access. The CompuFlo Epidural system is a product of Milestone Scientific (Livingston, NJ, USA; www. milestonescientific.com), and has been approved by the U.S. Food and Drug Administration (FDA). “Milestone’s painless and precise computerized injection technology platform has the potential to transform drug delivery. Over the coming years, we will be laser-focused on sales and marketing activities, including building our global distribution network,” said Daniel Goldberger, CEO of Milestone Scientific. “Following our recent FDA marketing clearance of the epidural instrument, I look forward to now converting the growing enthusiasm among medical practitioners into broad global commercial adoption.” “For the first time you precisely can control the rate of administration of a drug, but more importantly you can precisely monitor and control fluid pressure,” said Mark Hochman, MD, director of clinical affairs at Milestone Scientific.

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Cardiac Stents and Bypass Surgery Equally Effective cont’d from cover

were randomized to receive an Abbott Vascular (Santa Clara, CA, USA; www.abbott.com) Xience everolimus drug eluting stent (DES), or undergo CABG. The primary end point was a composite of death from any cause, stroke, or myocardial infarction (MI) at three years. The researchers also analyzed data during the first 30 days, when serious complications are most likely to occur. The results showed that within the short 30day period, stent patients had a significantly lower incidence (4.9%) of death, stroke, MI, or revascularization than those who underwent CABG (7.9%). In addition, fewer stent patients had major bleeding, infections, kidney failure, or severe abnormal heart rhythms compared to those treated with surgery. But over the three-year period, the primary end-point event had occurred in 15.4% of the patients in the stent group and in 14.7% of the CABG group patients. The study was published on October 31, 2016, in the New England Journal of Medicine (NEJM). “Our study has shown that many patients with left main coronary artery disease who prefer a minimally invasive approach can now rest assured that a stent is as effective as bypass surgery for at least 3 years, and is initially safer, with fewer complications from the procedure,” said lead author Professor Gregg Stone, MD, of CUMC. “While bypass is still considered a more durable repair, pa-

inimally invasive transplant surgery reduces operative times, length of stay, and promises quicker opioid independence for patients suffering from chronic pancreatitis (CP). Developed at Johns Hopkins University (JHU, Baltimore, MD, USA; www.jhu.edu), laparoscopic total pancreatectomy with islet cell auto transplantation (TPIAT) involves surgically removing the pancreas and reconstructing the gastrointestinal tract. While removing the pancreas often relieves the severe abdominal pain that accompanies CP, it also causes the patient to develop insulin-dependent diabetes. To counter this eventuality, islet cells from the diseased pancreas are isolated and injected into the patient’s liver. To examine the feasibility of using a laparoscopic TPIAT approach in the treatment of CP, 32 patients were offered to undergo the procedure between January 1, 2013, and December 31, 2015. Of the 22 patients who eventually underwent laparoscopic TPIAT, two patients converted to an open procedure because of difficult anatomy and prior surgery. Average operating time was 493 minutes, average islet isolation took 185 minutes, and average length of hospital stay was 11 days. Pain and glycemic outcomes were recorded at follow-up visits every 3’6 months postoperatively. The results showed that that laparoscopic TPIAT (compared to open TPIAT) resulted in shorter average operative time, islet isolation time, warm ischemia time, and length of stay. No patients experi-

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tients and doctors may prefer a percutaneous treatment approach, which is associated with better upfront results, fewer complications, and quicker recovery.” CABG has long been considered the definitive treatment for patients with LMCAD, which affects a large portion of the heart muscle. Previous trials suggested that the first-generation DES, which release antiproliferative medications to prevent the artery from becoming re-occluded after stent placement, might be appropriate in LMCAD patients without extensive blockages in the remaining cardiac arteries. Image: The Xience Prime everolimus-eluting stent (Photo courtesy of Abbott).

Laparoscopy Procedure Cuts Pancreatitis Complication Rates

enced postoperative surgical site infection (SSI), hernia, or small-bowel obstruction, and none died. In all, 90% of the patients experienced a decrease or complete resolution of pain, with 60% no longer requiring opioid therapy. At one-year follow-up, 25% were insulin independent, 45% required 1-10 daily units (U/d) of insulin, 25% required 11-20 U/d, and one patient required greater than 20 U/d of basal insulin. The study was published on June 1, 2017, in JAMA Surgery. “Chronic pancreatitis can be a very painful and debilitating condition. In an era of opioid addiction, performing a major operation through a minimally invasive technique can mean less pain for patients, reducing the need for opioids and their complications,” said senior author professor of surgery Martin Makary, MD, MPH. “Benefits of laparoscopic approaches can include vastly reduced risk of surgical wound and other infection, a quicker recovery, and better pain management.” CP is an inflammation of the pancreas that does not heal or improve, eventually impairing a patient’s ability to digest food and make pancreatic hormones. The prevalence of CP is 50 people per 100,000, often developing between the ages of 30 and 40, and is more common in men than women. Symptoms include upper abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily, clay-colored stools. Patients who have CP may have a decreased quality of life due to pain and often require admission to the hospital for treatment of symptoms.

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ISSN 0898-7270 Vol.35 No.5 • Published, under license, by Globetech Media LLC Copyright © 2017. All rights reserved. Reproduction in any form is forbidden without express permission. Teknopress Yayıncılık ve Ticaret Ltd. S¸ti. adına ˙Imtiyaz Sahibi: M. Geren • Yazı is¸leri Müdürü: Ersin Köklü Müs¸ ir Dervis¸ ˙Ibrahim Sok. 5/4, Esentepe, 34394 S ¸ is¸ li, ˙Istanbul P. K. 1, AVPIM, 34001 ˙Istanbul • E-mail: Teknopress@yahoo.com Baskı: Printkom Ltd. • İpkas Sanayi Sitesi 3. Etap C Blok • 34490 Başakşehir • İstanbul Yerel süreli yayındır. Yılda altı kere yayınlanır, ücretsiz dag˘ıtılır.

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3D Digital Platform Reinvents Mammography cont’d from cover

radiation dose. Tomosynthesis is based on ASIRDBT, an iterative reconstruction algorithm with a calcification artifact correction that delivers off-plane images superior to the traditional filtered back projection (FBP) algorithm. In addition, a specific slabbing algorithm renders calcifications as if each were in its optimal plane, making the images easy to read. The Senographe Pristina was designed with technologist in mind. Space below the collimator is large, and wrap-over tube design makes it easier to position patients. The backspace is large enough to allow technologists to work without hitting their elbows when positioning the breast over the support. When positioning patients in medio-lateral-oblique (MLO), the tube head can be moved to a parked position away from the technologist’s head, clearing the upper space so that patients can be positioned without physical strain. The console and gantry are ready to use within a few minutes of startup, without the need for complex calibration, and switching between 2D mammography and DBT can be made with just one click, thanks to pre-set default acquisition settings. The 2D image contrast can be modified on the fly, with a selection of six contrast levels available in order to accommodate user preferences. The acquisition console is also well aligned with other GE Healthcare products, so that Visit us at the learning curve is minimal for those familiar with the GE Healthcare modus operandi. MEDICA Designed to make the patient experience more 2017 comfortable, the system comes with gentle, rounded Hall 9-D41 corners on the image detector help reduce patient discomfort under the arms. Comfortable armrests replace the conventional handgrips that may cause tensing of the pectoral muscles, making it hard to properly position the tissue; in addition, the redesigned armrest allows women to gently support their arm during the exam in a relaxed position. And a self-compression tool helps give women a sense of control by allowing them to manually adjust the degree of breast compression. “Senographe Pristina offers patients a reinvented mammography experience, one that had not significantly changed for the last 40 years. After having a mammogram on Senographe Pristina, women immediately recognize a pleasant difference: It’s a faster and quieter exam with greater comfort and less pain during compression,” said Kathy Schilling, MD, of Boca Raton Regional Hospital (FL, USA). “Our goal is for all our baseline patients to have their mammograms with this new technology, with the intent that it will help to dismiss any preconceived fears and encourage more compliance with annual screening.” ®

Image: The Senographe Pristina system (Photo courtesy of GE Healthcare).

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INSTRUMENTATION SYSTEM

INFUSION WORKSTATION

Biocare

Hans Rudolph

Medcaptain

The Smart FM system brings the world a revolution of fetal monitor products. With this Smart FM, you can share the heartbeats with your love ones, be free to walk out to anywhere under WIFI environment, communicate with doctor anytime and anywhere and print reports on demand.

The SmartLab with Insight software is a flexible system for measurement/analysis of respiratory signals in research. The base module can accept up to three sensor modules for measuring flow and pressures. Optional items include an oximeter, CO2 sensor, temp and humidity and digital I/O.

The MP-80 achieves continuous and accurate infusion by adopting a modular design that allows multi-channel extension and free combination of infusion pumps and syringe pumps. It integrates a number of cutting-edge and breakthrough innovative technologies to meet various clinical needs.

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Drones Can Increase Cardiac Arrest Survival specially constructed drone equipped with a defibrillator can be delivered automatically to the site of a cardiac arrest long before an ambulance arrives, according to a new study. Researchers at Karolinska Institutet (KI; Solna, Sweden; www.ki.se) and Stockholm South General Hospital (Sweden; www.sodersjukhuset.se) conducted a field study of a defibrillator-equipped drone that was developed in partnership with FlyPulse (Trollhättan, Sweden; www.flypulse.se). The drone was automatically dispatched and flown to the exact destination to which an ambulance had been driven on 18 incidents of cardiac arrest between 2006 and 2013 in the Norrtälje municipality in Sweden; their respective arrival times were then compared.

The drone was flown out of pilot view within a radius of 10 km from the emergency medical services (EMS) station in Älmsta (Norrtälje municipality). The results showed a response time from initial alarm to being airborne of only three seconds, and an average time from alarm to arrival at the scene of cardiac arrest of approximately five minutes, a full 16 minutes shorter than was stated in the ambulance records. The study was published on June 13, 2017, in the Journal of the American Medical Association (JAMA). “In areas with longer ambulance response times of up to 30 minutes, the chances of surviving a cardiac arrest are tiny,” said lead author paramedic Andreas Claesson, RN, PhD, of the KI center for resuscitation

science. “Drones able to deliver defibrillators can reach the patient inside the first few minutes and are thus a new and important complement to existing emergency services. With an early shock from a defibrillator within the first 3-5 minutes after cardiac arrest, up to 70% of patients can survive the event.” The automatic external defibrillator (AED) used for the study was the Schiller (Baar, Switzerland; www.schiller.ch) FRED Easyport, an external defibrillator that weighs just 490 grams but still meets all requirements of a modern AED. The pocket-sized device uses multipulse biowave, a myocardium-saving biphasic impulse at energies of only 90 and 120 joules, which causes much fewer ST alterations and triggers significantly less creatine kinase and myoglobin in the blood.

Cooling Cap Reduces Alopecia During Chemotherapy

cooling system intended for breast cancer patient receiving chemotherapy can also reduce hair loss (alopecia) in solid tumor cancer patients. The Dignitana (Lund, Sweden; www.dignitana.com) DigniCap

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scalp cooling system works by circulating liquid coolant through a silicone cap placed tightly and directly on the head, thus delivering consistent and controlled cooling to all areas of the scalp. An outer neoprene covering insulates and secures the silicone cap in place, while two built-in sensors continuously monitor scalp temperature, maintaining optimal cooling throughout the treatment. The cap is shaped to leave the patients’ ears uncovered for comfort and ease of hearing. Key system features include quick-disconnect to accommodate bathroom breaks, an intuitive touch screen interface to simplify system operation, and flash memory that makes it possible to save data from each scalp cooling treatment and facilitates software upgrades. A built-in safety sensor ensures cooling temperature does not drop below freezing point. The cooling cap itself is available in multiple sizes to ensure a personalized fit, and has a smooth inner surface to enable optimal contact between scalp and cap. Simultaneous treatment of two patients can be implemented using two independently controlled systems. “We are pleased to expand the use of this product for cancer patients with solid tumors to potentially minimize chemotherapy-induced hair loss,” said Binita Ashar, MD, director of the division of surgical services at the FDA Center for Devices and Radiological Health (CDRH). “Managing the side effects of chemotherapy is a critical component to overall health and quality of life.” Once the temperature of the scalp is lowered, the resulting blood vessel vasoconstriction reduces the amount of chemotherapy agents that reach the scalp, and also reduces cellular uptake of drugs due to a decreased intra-follicular metabolic rate. The combined actions reduce the effect chemotherapy has on the cells in the scalp, which may reduce hair loss. HospiMedica International October-November/2017

In-Hospital Monitor Tracks Patients During Triage n innovative continuous critical care patient monitoring system delivers real-time data during in-hospital transport. The Royal Philips IntelliVue X3 system is designed for portable, uninterrupted patient monitoring, in order to provide a comprehensive, scalable set of clinical measurements that range from basic to advanced monitoring during both stationary and transport situations. Advanced features include dual invasive blood pressure, built in mainstream CO2, a choice between three SpO2 technologies, and stateof-the-art electrocardiogram (ECG) and arrhythmia detection. With an intuitive, smartphone like operation, IntelliVue X3 enables continuous monitoring during in-hospital transport for even the most critical patients. Patient vital data can be integrated and interfaced seamlessly with the existing hospital network, the Philips IntelliVue Patient Monitoring system, mobile applications, other medical devices, and the patient’s electronic medical record (EMR). The IntelliVue X3 system has received the European Community CE mark of approval. “The challenge of delivering care efficiently and effectively within hospitals’ acute environments continues to increase. Health systems need accurate and transparent information and processes to help clinical staff make faster, more consistent decisions based on patient conditions and history,” said Felix Baader, business leader of patient care and monitoring solutions at Philips (Philips; Amsterdam, The Netherlands; www.philips.com). “With the development of the IntelliVue X3, we’re aiming to ensure that data isn’t being lost during transitions and that we’re able to better equip clinicians with the information they need, when they need it.” When patients are transferred from one hospital department to another, clinicians often have to deal with incomplete data records resulting from multiple systems operating independently. As a result, and in order to provide informed clinical decision support based on the complete patient data, hospitals are often required to input data manually, thereby contributing to a higher potential for error, especially when dealing with critical care patients.

Image: A patient being transferred with the IntelliVue X3 monitor (Photo courtesy of Philips Healthcare).

Hospital Discharge Program Improves Patient Experience cont’d from cover

about medications, future appointments, future and pending tests, and a calendar of activities scheduled over the next 30 days. The AHCP is reviewed with the patient before discharge, and, as part of the RED program, discharge summaries are sent to the primary care provider within 48 hours of discharge. In addition, a telephone call is made to the patient within 48 hours of discharge for reinforcement. In a study to examine the impact of RED on the patient’s experience, the researchers compared post-hospitalization responses to the Press Ganey survey item called “Instructions were given about how to care for yourself at home.” The researchers compared survey results for patients receiving the RED program, a standard discharge on the same hospital unit, or a standard discharge on other hospital units. The resulted showed that patients who received the RED intervention were significantly more likely to choose the top-box “very good” response to the Press Ganey survey item (61%) than

HospiMedica International October-November/2017

those receiving a standard discharge on other hospital units (41%), compared to those who did not receive the RED intervention (35%). The study was published online on June 16, 2017, in the Journal of Patient Experience. “Improving patient experience by helping them better understand how to care for themselves in the transition from hospital to home means that we’re improving their overall quality of care while decreasing hospital readmission and decreasing the cost of care, which is our primary goal,” said senior author Brian Jack, MD, chief of family medicine at BMC, who created the Project RED program. Poor preparation for discharged patients can result in confusion about medicines, follow-up and tests appointments, pending test results, and diagnoses. Coupled with the frailty many experience during the hospital to home transition, it is no surprise that many adverse events occur after discharge or that 20% of patients return to the hospital within 30 days of hospital discharge. LINKXPRESS COM

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WOUND TREATMENT MATTRESS

NEEDLE-FREE CONNECTOR

Bionet

Joerns Healthcare

Antmed

The FC 1400 is an antepartum fetal monitor, which detects and displays twin fetus heart rates and uterine activity in real time. It features a 7-inch color touch screen LCD monitor, along with 10 smart keys for 16 functions to make operations easier and faster.

The RecoverAir 3000 Elite utilizes a 3-in-1 air cell inflation/deflation cycle for excellent pressure redistribution therapy and creating air flow under patients. The low friction, vapor permeable comforter protects from shearing and provides a quilted material underneath to keep patients dry.

The range of positive needle-free connectors eliminates the risk of needlestick injuries and bloodstream infections among healthcare workers and patients. Its design prevents blood backflow and its unique silicone seal reduces the potential risk of air bubbles while offering adequate fluid flow.

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Fluorescent Bandage Monitors Healing Process smart wound dressing with integrated pH sensors provides continuous information on the state of the healing process within chronic wounds. Under development by the Swiss Federal Laboratories for Materials Science and Technology (Empa; Dübendorf, Switzerland; www.empa.ch), Centre Suisse d’Electronique et de Microtechnique (CSEM; Neuchâtel, Switzerland; www.csem.ch), and other institutions, the bandage is based on a novel hydrophobic ion pair of pyranine and benzalkonium. The pyranine component is a non-toxic fluorescent dye – also found in highlighters – that allows precise ratiometric detection of pH under ultraviolet

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(UV) light, especially at pH levels between 5.5 and 7.5. Benzalkonium, a quaternary ammonium salt with potent antimicrobial properties, makes the pyranine element sufficiently hydrophobic to allow its incorporation in conventional membranes and commercial wound dressings while maintaining its pH sensing performance unaffected. It also confers the resulting ion pair strong antimicrobial properties. If a wound heals normally, the pH rises to 8 before falling to 5-6; but if the wound fails to close and becomes chronic, pH level fluctuates between 7 and 8. The bandage can therefore inform nursing staff if wound pH is permanently high. On the other hand, if the

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bandage does not need changing for reasons of hygiene and pH levels are low, they could afford to wait. The researchers are now in the process of developing a portable device capable of monitoring several fluorescence parameters at once, such as glucose and oxygen levels, while the wound heals. If parameters change, conclusions key biochemical processes involved in wound healing can be drawn. A study describing the bandage was published in the October 2017 issue of Sensors and Actuators. “The idea of a smart wound dressing with integrated sensors is to provide continuous information on the state of the healing process without the bandages having to be changed any more frequently than necessary. This would mean a gentler treatment for patients, less work for the nursing staff, and therefore lower costs,” said senior author Luciano Boesel, PhD, of the Empa Laboratory for Biomimetic Membranes and Textiles.

pH (potential of hydrogen) is a numeric scale representing the negative of the logarithm to base 10 of the activity of the hydrogen ion. Solutions with a pH less than 7 are acidic and solutions with a pH greater than 7 are basic. Pure water is neutral, at pH 7, being neither an acid nor a base. Image: Using a UV lamp, the pH level in a wound can be verified without removing the bandage (Photo courtesy of Empa / CSEM). V

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VENTILATOR

CRITICAL CARE BED

Rudolf Riester

Siare

Stryker

The RVS 200 combines a vital signs monitor (RVS-100) and ri-scope L EENT diagnostic instruments with high-performance LED illumination. It can communicate through a wired or wireless connection to the hospital‚ and offers several configurations and settings to suit user needs.

The SIARETRON 4000 provides new options for operative modes management and is equipped with different ventilation functions. Key features include a 12-inch monitor for displaying the curves of pressure, flow, volume, the loops of breathing parameters, trends and ventilatory parameters.

The InTouch features front wheel drive and a compact base for tighter turns and greater maneuverability. It allows all bed functions to be controlled with an easy, intuitive touch screen interface using a powerful on-bed Windows computer.

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Super Sensor Measures Multiple Physiologic Parameters n advanced, reusable, spot-check sensor is the first ever to noninvasively measure total hemoblogin (SpHb), carboxyhemoglobin (SpCO), methemoglobin (SpMet), and arterial oxygen saturation (SpO2). The Masimo (Irvine, CA, USA; www.masimo. com) rainbow Super DCI-mini sensor is intended for patients weighing 3 kg or more, and can be applied to an adult or pediatric finger, or to an infant finger, thumb, or great toe. The small, lightweight sensor has a flexible cable to provide stability and comfort during monitoring. The sensor features Masimo rainbow SET measure-throughmotion and low perfusion technology with expanded multiple physiologic measurements, which apart from SpHb, SpCO, SpMet, and SpO2, also include pulse rate (PR), perfusion index (Pi), and pleth variability index (PVi). With the aid of motion tolerance technology, SpHb results can be displayed in as few as 30 sec-

onds, with field performance enhanced for lower hemoglobin ranges; SpCO monitoring may lead to the identification of elevated carbon monoxide (CO) levels that might otherwise go undetected in front-line settings, such as triage and emergency care; and SpMet can help clinicians monitor for methemoglobin in care areas where the drugs that cause methemoglobinemia are most common, such as procedure labs and the operating room. “This is an exciting day for us, and hopefully a great opportunity to improve patient care. Since the invention of rainbow technology, we have been wanting our customers to be able to measure SpCO, SpMet, SpHb and SpO2 simultaneously; now they can!” said Joe Kiani, founder and CEO of Masimo. “We believe the rainbow Super DCI-mini sensor will be especially valuable for use in triage and emergency care situations. We plan to introduce a continuous measurement ver-

sion of the Super Sensor in the near future.” Masimo SET is a noninvasive sensor technology that uses more than seven wavelengths of light to acquire blood constituent data based on light absorption. Advanced signal processing algorithms and unique adaptive filters work together to isolate, identify and quantify various hemoglobin species, delivering blood measurement results in numerical values. Basic Masimo SET measurements include SpO2, PR, PI, and PVI, a measure of the dynamic changes in perfusion index that occur during the respiratory cycle. Image: The Masimo rainbow Super DCI-mini sensor (Photo courtesy of Masimo).

Central Catheters Tied to Dialysis-Related Infections entral venous catheter (CVC) use for hemodialysis is linked to an increased rate of bloodstream infections, according to a new study. Researchers at the U.S. Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA; www.cdc.gov) conducted an analysis of data from 6,005 outpatient hemodialysis facilities across the United States who reported incidence rates of three types of dialysis events to the CDC National Healthcare Safety Network (NHSN) – bloodstream infection (BSI); intravenous antimicrobial start; and pus, redness, or increased swelling at the vascular access site. The data included events for hemodialysis outpatients treated at each facility during the first two working days of each month. The hemodialysis facilities reported data on a total of 160,971 dialysis events, which included 29,516 BSIs; 149,722 intravenous antimicrobial

starts; and 38,310 episodes of pus, redness, or increased swelling. The researchers then calculated event rates stratified by vascular access type – arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous catheter (CVC). They then standardized infection ratios by comparing each individual facility observed with predicted numbers of infections for bloodstream infections. The results showed that 77% of BSIs were related to accessing the patients’ circulation. A majority – 63% of BSIs and 70% of access-related BSIs – occurred in patients that had a CVC. Other dialysis event rates were also highest among patients using CVCs. Staphylococcus aureus was the most commonly isolated BSI pathogen (31%) among those that suffered an infection, and 40% of S. aureus isolates tested were methicillin resistant. The study was published on June 29, 2017, in the Clinical Journal of the American Society of Nephrology (CJASN).

“We now have a clearer picture of the rates and types of infections hemodialysis patients in the United States are experiencing, as nearly all US outpatient hemodialysis facilities are participating in CDC’s NHSN dialysis event surveillance,” said lead author Duc Bui Nguyen, MD, of the Division of Healthcare Quality Promotion. An AVF is the most recommended access for kidney patients who must undergo dialysis, created by connecting a patient’s vein and artery to form a long-lasting site through which blood can be removed and returned. Alternatively, in patients who are unsuitable for a fistula, an AVG – a plastic conduit between an artery and a vein – may be used. Some patients, however, prefer a CVC, for reasons that include inadequate preparation for dialysis, avoidance of surgery, or fear of needles (since the connection to the dialysis machine via a catheter does not require needles). HospiMedica International October-November/2017

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Critical Care

E-Health Device Helps Patients Manage Heart Disease novel tablet device attached to a weighing scale provides patients with heart failure (HF) education, registers body weight and symptoms, and assists treatment. The OPTILOGG tablet device, a product of Careligo (Åkersberga, Sweden; www.careligo.se) is a pre-programmed tool designed to detect HF deterioration and help treat it by titrating diuretics dosage according to weight. If the patient’s weight gain is above a pre-determined range, they are instructed to contact the HF clinic. Patients can use OPTILOGG as required, without pushing any buttons; a typical weighing session lasting less than 30 seconds a day. A recent study that included 32 patients (average 65 years of age, 31% female) in four Swedish clinics evaluated the effectiveness of the device in primary care. Adherence was registered automatically, with data retrieved after four months; implementation was assessed by semi-structured interviews with eight HF nurses at four months; and self-care behavior was monitored using the European Heart Failure Self-Care Behavior Scale (EHFScB-9). The results showed that 94% of patients used OPTILOGG as intended, and the HF nurses reported that it did not increase their workload. The median total score on the EHFScB-9 significantly decreased from 28.5 at baseline to 18 at four months. The study was presented at EuroHeartCare, held during May 2017 in Jonkoping (Sweden).

Image: A simple tablet device helps HF patients improve treatment (Photo courtesy of Careligo)

“Patients’ self-care behaviors improved by 10.5 points or 37% when they used OPTILOGG. The nurses said patients felt safer and were more committed to taking better care of themselves when using the tool. We also found that it did not create more work for nurses,” said lead author and study presenter Maria Liljeroos, RN, a PhD student at Linköping University (Sweden). “Our study shows that introducing OPTILOGG into primary care is feasible, and has the potential to help patients with heart failure to manage their condition.”

Systemic and pulmonary congestion is a central aspect of both acute and chronic HF, leading directly to many of the clinical manifestations of these syndromes. Diuretic therapy to treat congestion therefore plays a fundamental role in HF management. Aldosterone antagonists are indicated for patients with systolic failure and moderate to severe symptoms, as long as renal function and serum potassium are stable and monitored closely. All diuretic therapy requires careful monitoring of electrolytes and renal function.

Heart Rate Apps Show Inconsistent Results here is a huge variability among commercially available photoplethysmography (PPG) heart rate apps, even those using the same technology, according to a new study. Researchers at Heart Clinic Zurich (Switzerland; www.swiss-heart-clinic. com) and University Hospital Zürich (USZ; Switzerland; www.en.usz.ch) conducted a study to test the clinical diagnostic accuracy of four iPhonebased heart rate measuring apps that use the built-in camera and flash. These included the Instant Heart Rate (IHR) and Heart Fitness (HF) apps, which work via contact PPG, and the What’s My Heart Rate (WMH) and Cardio Version (CAR) apps, which are based on non-contact PPG. In all, app-based PPG was performed on 108 randomly selected patients. The results showed substantial differences in accuracy between the four apps, with non-contact apps performing less well than contact apps, particularly at higher heart rates and lower body temperatures. The overall accuracy of PPG app-measured heart rate, reported as mean absolute error in beats per minute compared to

HospiMedica International October-November/2017

ECG, was 2 for pulse oximetry, 4.5 for IHR, 2 for HF, 7.1 for WMH, and 8.1 for CAR. The study was published on May 2, 2017, in the European Journal of Preventive Cardiology. “While it’s easy to use the noncontact apps – you just look at your smartphone camera and it gives your heart rate – the number it gives is not as accurate as when you have contact with your smartphone by putting your fingertip on the camera,” said senior author cardiologist Christophe Wyss, MD, of Heart Clinic Zurich. “But the performance of the two contact apps was also different. The one contact app was excellent, performing almost like a medically approved pulse oximeter device, but the other app was not accurate, even though they use the same technology.” As the heart pumps blood to the periphery a pressure pulse is created, which distends the arteries and arterioles in the subcutaneous tissue. The change in volume caused by the pressure pulse is detected by illuminating the skin with the light from a lightemitting diode (LED), and then measuring the amount of light either transmitted or reflected to a photodiode, generating a PPG.

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The CMS800G can acquire FHR, TOCO and FMOV in real-time, which can provide reference data for clinical use. It can be used individually or connected to the central monitoring system in the obstetrical department to form a network monitoring system.

The IE15 is integrated with state-of-the-art acquisition technology and VCG modules, and simultaneously displays 12/15 leads. Featuring a laptop design and a 12.1-inch TFT LCD touch screen, it provides a wide range of comprehensive applications.

The TCM400 provides up to six simultaneous TCOM measurements of oxygen tension (pO2) for patients suffering from wound/vascular disease. It is useful in hyperbaric, wound care for wound healing prediction, diagnosis of ischemia, amputation level determination and vascular medicine.

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Novel Stretcher Could Prevent Neonatal Deaths in Ambulances stretcher interface device (SID) for newborn babies will help to isolate them from sudden ambulance accelerations and decelerations and in the event of a crash. Under development by Birmingham City University (United Kingdom; www.bcu.ac.uk) and Evac+Chair International (Birmingham, United Kingdom; www.evac-chair.co.uk) the SID was designed to withstand collisions at speeds of up to 65 km/h. In addition, it will include a quick attach and release mechanism for engagement and disengagement from oxygen, power, and other survival instruments in the event of a road traffic incident, allowing newborns to be transferred quickly to another ambulance. The SID and neonatal equipment will be securely attached to European Ambulance Loading Stretchers (EALS) and similar stretchers in other markets worldwide, complementing the existing range of goods and services offered by Evac+Chair International under the ParAid brand. ParAid already includes an award-winning ambulance child restraint (ACR) consisting of a flexible and fully adjustable harnessing system for the safe and effective transport of infants and children. “The major challenge in this project will be the development of a stretcher interface device with impact-resistant fixing points and ports for oxygen, power, and other survival supplies situated around what encapsulates the newborn,” said Panch Suntharalingam, PhD, of Birmingham City University. “In order for the product to be desirable, it needs to be compatible with any European ambulance trolley, so this adds an additional complication, as the variation in emergency vehicles and their components differs across the continent.” In the USA there were an average of 1,500 crashes annually between 1992 and 2011, resulting in 2,600 incapacitated in the aftermath; 29% of the deaths caused in these incidents were passengers.

Image: A new stretcher interface device could save the lives of neonates during transit by ambulance (Photo courtesy of Birmingham City University). V

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HospiMedica International October-November/2017

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Critical Care

Powered Stretchers Could Reduce Paramedics Injuries aramedics with access to stretchers with battery-powered hydraulic systems and assisted ambulance-loading experience significantly fewer musculoskeletal injuries, according to a new study. Researchers at the University of Waterloo (Canada; https:// uwaterloo.ca) conducted a study to compare paramedic injury rates at Niagara Emergency Medical Service (NEMS; Niagara-on-the-Lake, Canada; www.niagararegion.ca), which had implemented powered stretchers at the time of the study, with Hamilton Paramedic Services (HPS; Canada; www.hamilton.ca), which used manual stretchers. The study compared injury incidence rates, days lost, and compensation costs before and after implementation of powered stretcher and load systems in NEMS. The results showed that prior to the intervention, stretcher related musculoskeletal disorder (MSD) incidence rates averaged 20 and 17.9 full time equivalent (FTE), in NEMS

and HPS respectively. One-year postintervention rates decreased to 4.3 FTE in NEMS, a 78% reduction. On the other hand, MSD rates modestly increased to 24.6 FTE in HPS during the same period. Cost-benefit analysis estimated that the added cost to purchase powered stretcher and load systems would be recovered within seven years. The study was published on February 27, 2017, in Applied Ergonomics. “Each unit can cost approximately of CAD 40,000; although the units may seem expensive, they appear to offer a significant return on investment,” said lead author Daniel Armstrong, MSc, a graduate student in the University of Waterloo department of kinesiology. “We found that the added cost to purchase power stretchers and load systems would be recovered within their expected seven-year service life, due to the reduction in injury-related costs.” “In many cases, paramedics face spine compression that is well above the threshold limit. A manual

stretcher alone can weigh nearly 100 pounds. Add on a 200-pound patient and a paramedic team is handling 300 pounds every time they raise, lower, lift or load the stretcher,” said senior author assistant professor of kinesiology Steven Fischer, PhD. “We estimate that a paramedic is lifting more than 1,700 pounds per shift on average, approximately the same weight as moving all of the furniture in a one-bedroom apartment.” Kinesiology is the scientific study of human movement, performance, and function, and incorporates the

sciences of biomechanics, anatomy, physiology, psychology and neuroscience. Kinesiologists work with people of all ages and physical abilities to treat and prevent injury and disease, and improve movement and performance. Field areas include health promotion, injury rehabilitation, pain and chronic disease management, ergonomics, fitness training, and public health. Image: A new study shows powered stretchers could reduce injuries to paramedics (Photo courtesy of Applied Ergonomics).

Mobile Airway System Improves Patient Lifestyles novel mobile respiratory care solution provides high frequency chest wall oscillation (HFCWO) to people suffering from long-term pulmonary issues. The Hill-Rom Holdings (Batesville, IN, USA; www.hill-rom.com) Monarch Airway Clearance System is intended for patients suffering from a variety of issues that cause chest congestion and which cannot be cleared by conventional therapies such as drugs, chest physical therapy, special coughing techniques, or cough-assist aids. The wearable vest device has a sporty design, stylish shells, and a customizable, personalized fit. HFCWO is delivered via pulmonary oscillating discs (PODs) that provide targeted kinetic energy to the lungs in order to thin mucus and move it up and out of the lungs. Designed to treat issues such as bronchiectasis, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), muscular dystrophy, cerebral palsy, and chest congestion associated with more than 400 different medical conditions – including neuromuscular and immune disorders – the Monarch system also incorporates LTE and WiFi technology to

HospiMedica International October-November/2017

keep patients wirelessly connected to their care team via the Hill-Rom VisiView Health Portal, a secure, cloudbased system that automatically receives information from respiratory care devices in a patient’s home. The secure therapy adherence data is then displayed on a user-friendly dashboard that facilitates data and trending information, which can then be used to enhance communication between health care teams and patients. The VisiView Health Portal thus supports informed care decisions and reduced risk of respiratory infections, hospitalizations, and medical costs. The Monarch Airway Clearance System has been approved by the U.S. Food and Drug Administration (FDA). HFCWO assist devices generate either positive or negative trans-respiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways. The oscillations can lead to changes in mucus volume of 15–57 ml and in flow up to 1.6 L/s, which can generate minimal coughing to mobilize lung secretions. Typical treatments last 20–30 minutes, and consist of periods of compression at different frequencies, separated by coughing. LINKXPRESS COM

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

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

The Symbia Intevo Bold allows users to expand dual-use capabilities in CT by acquiring both sets of images on the same system. Its new CT options enable lower patient dose, reduced metal artifacts for enhanced detail, and improved image quality via dual-energy scanning.

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MRI Reveals Spinal Atrophy Tied to MS Progression new magnetic resonance imaging (MRI) study among early stage multiple sclerosis (MS) patients reveals detectable cord gray matter atrophy in both the cervical and thoracic cord. Researchers at the University of California, San Francisco (UCSF; USA; www.ucsf.edu) and University Hospital Basel (Switzerland; www. unispital-basel.ch) enrolled 64 patients with early MS and 53 controls in an observational study. The MS patients (mean age 36.9, 26 women) had a mean duration from first symptom onset of 1.2 years, and a median expanded disability status scale (EDSS) score of 2. Among the healthy controls, the mean age was 37.4 and 38 were women. MRI scans of the C2/C3 cervical spine among the

early MS patients revealed a 14% reduction in gray matter area among patients diagnosed with progressive MS, compared with a 3% reduction in gray matter area among patients diagnosed with relapsing MS; the 3% decrease in gray mater area in the cervical spine was also significantly lower than in controls. Total spinal cord area matter was reduced by 10% among patients with progressive disease, but actually increased by a non-significant 2% from controls. There was also a significant difference in white matter, reduced 9% in those with progressive disease compared with an increase of 3% among patients diagnosed with relapsing MS. The researchers did not find significant differences in the loss of gray matter in the spinal cord at the T9/T10

location among patients with or without spinal cord lesions, but there was a significant difference in spinal cord white matter. In addition, cervical and thoracic gray matter areas were not correlated with the number of spinal cord T2-lesions. The study was presented at the annual American Academy of Neurology meeting, held during April 2017 in Boston (MA, USA). Historically in neuroscience, the vast majority of research effort has been invested in understanding and studying gray matter and neurons, while white matter has received relatively little attention, largely due to the lack of effective research tools to study white matter, even though it comprises about half the volume of the brain.

Digital Tomosynthesis Reduces Re-Excision in Breast Surgeries

new study shows that digital breast tomosynthesis (DBT) can reduce surgical positive

margins by offering a better view of lesion margins than mammography alone.

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Researchers at the University of Turin (Italy; www.unito.it) conducted a study of 925 patients who had breast surgery between 2010 and 2015. Of these, 685 were breast-conserving surgeries, while 240 were mastectomies. Prior to surgery, 537 patients were staged with digital mammography and ultrasound, and 388 were staged with digital mammography, ultrasound, and DBT. In the first group, 348 women had lesions two cm or smaller, and 189 had lesions larger than two cm; in the second group, 207 women had lesions two cm or smaller, and 181 had lesions larger than two cm. Histology revealed that 7.9% of the patients had positive margins at histology. The re-excision rate for the first group was 10%, significantly higher than for the second group, who underwent DBT as well, which was 5%. Re-excision planning was also less extensive for patients in the second group, with one of 20 pa-

tients receiving a mastectomy, compared with 20 of 53 patients having mastectomies in the first group. The re-excision rate for lesions smaller than two cm was not statistically significant between the two groups, in contrast to larger lesions. The study was presented at ECR 2017, held during March 2017 in Vienna (Austria). “Margin status is one of the most important predictors for local recurrence following breast cancer surgery, and accurate pre-operative staging helps to plan appropriate surgical treatment and reduce the consequences of re-excision,” said lead author and study presenter Alessia Milan, PhD. “These consequences can include emotional burden for the patient, a worse cosmetic outcome and higher costs. Our findings suggest that DBT has a role in improving conventional imaging for preoperative breast cancer surgical treatment staging.” HospiMedica International October-November/2017

New X-Ray System Uses Carbon Nanotube Technology novel non-motorized mobile X-ray system uses carbon nanotube technology to provide a lighter weight, allowing easier movement and positioning even in cramped critical care areas. The Carestream (Rochester, NY, USA; www.carestream.com) DRX-Revolution Nano Mobile X-ray system offers an automatic collapsible column for the tubehead and a compact footprint that makes it easy to maneuver and position in tight spaces and provides an unobstructed view. The long tubehead reach also allows better patient access and more accurate positioning, even in crowded rooms. Carbon nanotube technology and an advanced lithium iron phosphate battery contribute to maneuverability by reducing weight to 93 kilograms. The DRX-Revolution Nano system also includes independent controls of the diaphragm without moving the tubehead and two touch-screen displays with an intuitive graphical user interface (GUI) that enables quick image review or technique changes from the console or the tube. A powerful 32kW generator, dual focal spot tube, a tube-and-grid alignment system, and the proprietary Carestream EVP Plus image processing software combine to optimize images, resulting in fewer retakes and more support for faster, more accurate diagnoses. The DRX-Revolution also offers prior image review, including techniques and exposure history, based on a PACS query/retrieve capability. Custom capabilities for the intensive care unit (ICU) includes tube and line visualization that provide a companion image enhanced for a clearer view of tube and PICC lines in order to verify correct positioning. A pediatric package uses image processing views that optimize image quality via customized acquisition and processing parameters that suppress noise and enhance detail, based on patient size. “When we launched the DRX-Revolution Mobile X-ray System, we introduced a new generation of mobile imaging that features an automatic collapsible column for enhanced visibility, powerful dual motor drive, long tubehead reach, and specialized image visualization software,” said Sarah Verna, worldwide global marketing manager for X-ray solutions at Carestream. “The new DRX-Revolution Nano system will use carbon nanotube technology to deliver an innovative lighter weight, non-motorized system that will be even easier to transport and position in cramped critical care areas.” The DRX-Revolution Nano system, like the entire DRX Family, supports sharing of the X-Factor wireless detector platform, which allows the same detector to work seamlessly across the entire line-up of DRX products, helping healthcare providers maximize return on investment and reduce costs, and also facilitates digital conversion, replacement, or expansion of current systems.

Image: The DRX-Revolution Nano mobile X-Ray system (Photo courtesy of Carestream Health)

Range of Ultrasound Innovations Advance Ob/Gyn Imaging cont’d from cover

images, with a virtual light source. The operator can move the light source anywhere in the 3D volume. GlassVue also has an internal light source, and provides an early and more transparent view than traditional ultrasound. GlassVue can also reveal internal structures in the fetus such as bone, and organs. The aReveal Anatomically Intelligent Ultrasound (AIUS) 3D fetal-face algorithm enables the user to automatImage: New visualization tools ically reveal or hide the fetal face in one touch. include TrueVue, which uses a The system enables clinicians to perform virtual light source to provide post-processing of exam parameters, and fi- more lifelike 3D ultrasound imnalize images before transferring them to the ages (Photo courtesy of Philips Picture Archiving and Communication Sys- Healthcare). tem (PACS). Philips also offers MaxVue for the EPIQ and Affiniti systems that enable clinicians to view ultrasound images in 16:9 Full High Definition (FHD). Maternal-fetal medicine specialist, Dr. Michael Ruma, Perinatal Associates (Albuquerque, NM, USA; http://panm.com), said, “Philips’ latest technological advancement in Ob/Gyn ultrasound is a novel tool allowing clinicians to further explore the anatomic evaluation of the fetus. A clinician’s relationship with our patients is at its heart a personal one, especially during pregnancy. The ability to provide high-quality, lifelike images not only helps clinicians improve diagnostic confidence, but also supports the important connection between mother and fetus.”

HospiMedica International October-November/2017

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RADIOGRAPHIC SYSTEM

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The Apogee 3300 Neo offers a compact design, abundant application packages and streamlined workflow. It uses Nanoview technology for reducing noise and artifacts, purifying tissue shading and edging, improving contrast and helping early identification of tissue/structure lesion.

The URS (Universal Radiographic System) provides unique space-saving and workflow benefits for orthopedic and urgent care X-ray suites. With an easy to use, easy to deploy form factor, it is available in various configurations for upgrading an orthopedic suite or urgent care imaging suite.

The CMDR2S-Wireless features a wireless PerkinElmer or Toshiba Cesium Imaging Panel integrated with a MinXray HF120/60H PowerPlus or HF100H+ portable X-ray unit. The ultra-portable equipment sets up in under one minute and completes image acquisition in less than 10 seconds.

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Ultrasound Platform Enhances Musculoskeletal Imaging powerful ultrasound platform expands musculoskeletal (MSK) imaging with enhanced resolution and penetration, by way of innovative tools designed to streamline clinical workflow. The Toshiba Medical (Tokyo, Japan; www. toshiba-medical.co.jp) Aplio i-series is a scalable ultrasound solution comprised of the Aplio i700, Aplio i800, and Aplio i900 systems, which include a new beam-forming optimization technology called iBeam that increases ultrasound penetration for shoulder and deep muscle imaging, while maintaining high spatial and contrast resolution, and at the same time reducing artifacts and clutter. Another feature is shear wave technology, which provides a quantitative measure and realtime display of tissue elasticity in a variety of clinical settings. The premium Aplio i-series also feature Smart Fusion, which is used to merge live ultrasound imaging with pre-acquired magnetic resonance imaging (MRI) data, thus making it easier to locate anomalies in complex anatomy. For comprehensive evaluation, Smart Fusion can work in multiple im-

aging modes, including color Doppler and contrastenhanced ultrasound (CEUS). A concise quad display shows the live ultrasound image in sync with multiple views of the pre-loaded data. All systems provide an image-guided user interface, which visually guides the clinician through the exam to simplify system operation and help improve efficiency. To make ultrasound exams faster, the systems feature touch control screens and realtime Quick Scan, which makes automatic image adjustments without pushing a button. The i800 also offers an ultra-high frequency transducer at 24 MHz that makes it easier for clinicians to image superficial MSK structures, and also expand the utility of diagnostic ultrasound in a variety of clinical situations. “With the Aplio i-series, our customers have access to the high-quality imaging they rely on for confident diagnoses without sacrificing clinical efficiency or patient safety,” said Dan Skyba, director of the ultrasound business unit at Toshiba America Medical Systems. “By combining excellent image quality with brand new controls and ergonomic fea-

tures in a real-time workflow, the Aplio i-series systems make ultrasound the go-to solution for musculoskeletal imaging, as well as for a wider array of imaging needs.” Image: The Aplio i700, Aplio i800, and Aplio i900 systems (Photo courtesy of Toshiba Medical Systems).

New Technology Improves Ultrasonic Tumor Ablation novel high-intensity focused ultrasound (HIFU) ultrasound transducer can be used to generate a steady, standing-wave field with a subwavelength-scale focal region and extremely high intensity. To achieve subwavelength focusing, researchers at Nanjing University (NJU; China; www.nju. edu.cn) the Chinese Academy of Medical Sciences (CATCM; Beijing; www.catcm.ac.cn) and Chongqing Medical University (CQMU; China; www. cqmu.edu.cn) developed a semi-enclosed, ultrasonic spherical cavity resonator (USCR) with two open ends. The size of the focal region generated by the USCR is 50-70% of the millimeter-scale wavelength, with a pressure amplitude gain over three orders of magnitude, rapidly raising the tempera-

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

ed by acoustic diffraction to usually the order of the ultrasound wavelength, but this does not meet the needs of more sophisticated treatments,” said Dong Zhang, PhD, of the NJU Institute of Acoustics. “Because it is crucial to reduce the size of the focal region while supplying sufficient ultrasonic energy, we were prompted to design a new kind of ultrasonic transducer.” HIFU technology is based on nonlinear acoustic mathematical optimization methods to analyze and simulate the propagation of sound in material. The information is then used to enhance the shape of an acoustic lens so that that ultrasound pressure is focused precisely on the location of the tissue to be ablated, while the surrounding tissue retains as little damage as possible. HospiMedica International October-November/2017

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The RORA 3000/3100 features a full-size Cesium Iodide flat panel detector technology and advanced modular components. Its large capacity, high-quality tube ensures minimal X-ray exposure, high load operation and excellent image quality, making it suitable for all X-ray applications.

The M7 Premium is equipped with advanced technologies and easy-to-operate workflow software. It uses transducer technology to increase image bandwidth and transmission efficiency, and PHI for better contrast resolution to provide clearer images with excellent resolution and less noise.

The Moonray 500 Dual features a small footprint offering point and shoot usage, vascular capabilities and excellent image quality. It is equipped with an n.1 TFT/LCD 17-inch touch screen color monitor/console and an n.2 TFT/LCD 19-inch medical color monitor mounted on the mobile cart.

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Ultrasound/MRI Fusion Scanner Advances Prostate Imaging new micro-ultrasound/MRI fusion application offers advances in prostate imaging and biopsy guidance. The application allows urologists to import radiological reports from Magnetic Resonance Imaging (MRI) scans, or annotated MR images with MRI-identified lesions, co-aligned with the live real-time micro-ultrasound scan. The urologist can also use the MRI-identified lesions during the total biopsy procedure. The FusionVu application was developed by Exact Imaging (Markham, ON, Canada; www.exactimaging.com) and runs on the company’s ExactVu platform. According to Exact Imaging this provides the urologist with a total urological solution that can be upgraded, and scaled up. The system is based on standard urological workflows, and does not need any additional hardware or radiological software to run. FusionVu is intended for patients with exclusive anterior lesions, or those

with previous negative biopsies. Exact Imaging’s ExactVu micro-ultrasound platform works at 29 MHz, and has received the European Union (CE Mark), US FDA 510(k) approval, and the Health Canada license. The system can be used for systematic biopsy protocols, and can visualize areas of interest in the prostate and target biopsies in those areas. President and CEO of Exact Imaging, Randy AuCoin, said, “At least 70% of prostate cancer is located in the peripheral zone, which is exquisitely visualized and targetable with the 70 micron resolution of the ExactVu micro-ultrasound system. Our evidence-based PRI-MUS protocol is easily applied to help urologists identify and characterize regions and then to target those suspicious regions.” Image: The micro-ultrasound platform enables urologists to perform targeted biopsies using standard urological workflows (Photo courtesy of Exact Imaging).

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

clotron during the PET scan. The distribution of Axumin in the body also differs from other tracers, with a low native brain uptake compared to Fludeoxyglucose (FDG). Axumin is a product of Blue Earth Diagnostics (London, United Kingdom; www.bluearthdx.com), and has been approved by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA). “An imaging agent with sufficient diagnostic performance to adequately detect and localize recurrent prostate cancer can provide referring physicians with actionable information to guide biopsy, and inform management decisions for their patients,” said David Schuster, MD, director of the division of nuclear medicine and molecular imaging

at Emory University (Atlanta, GA, USA). “The product will be convenient for patients and imaging facilities, as it can be made widely available and the entire imaging procedure can typically be completed in less than 30 minutes.” A variety of imaging techniques and tests are currently used to diagnose and monitor prostate cancer, including PSA blood tests, magnetic resonance imaging (MRI), PET, SPECT, and CT scans. Each method has strengths and weaknesses, but there is no single method that is able to successfully identify and monitor primary tumors, metastatic lymph nodes, and bone lesions, which can cause the patient to undergo unnecessary treatments or painful biopsies. HospiMedica International October-November/2017

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Medical Imaging

Innovative Angiography System Supports Interventional Radiography n innovative robot-supported angiography system advances minimally invasive surgery, interventional radiology, and interventional cardiology in the hybrid operating room (OR). The Siemens Healthineers (Erlangen, Germany; www.healthcare. siemens.com) Artis pheno angiography system is based on a the zen40HDR flat panel detector and the Gigalix X-ray tube, which provide the system with 2k imaging technology that offers a fourfold increase in resolution for 2D imaging, with up to 15% faster scan times in the body area. This increase is made possible by syngo DynaCT 3D imaging, which uses less contrast agent during the imaging process; if the patient is sensitive to contrast agents, Artis pheno can also support CO2 imaging of the extremities. The C-arm has a free inner diameter of 95.5 centimeters, which offers more space for handling adipose and moribund patients, while the systemâ&#x20AC;&#x2122;s multi-tilt table can accommodate patients weighing up to 280 kilograms. The robotic construction provides a flexible isocenter that allows the Carm to follow all table positions and

provide the best possible imaging support for the patientâ&#x20AC;&#x2122;s treatment, presenting the target area of the body from virtually any angle. The end of the table can also be tilted in order to stabilize the patientâ&#x20AC;&#x2122;s blood pressure or to make breathing easier. Optional application packages are available to suit complex cases. For example, up to ten vertebrae can be represented in 3D using syngo DynaCT Large Volume, giving surgeons a larger overview during spinal fusion procedures. Another application, syngo DynaCT 360, can generate arge-volume images of the lung or the liver, including the anatomy of the tumor and the vessels leading to it, providing effective support for tumor transarterial chemoembolization (TACE), which involves supplying embolic particles coated with a chemotherapeutic drug via a catheter directly into the arteries leading to the tumor. Another application, Syngo Needle Guidance, makes it possible to plan extensive procedures using orthopedic screws or surgical needles. Screw paths can be planned with precision, with an automatic path alignment function that automatically aligns the C-arm to follow them.

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

CT May Replace Colonoscopy For Diagnosing Colitis Infections new study affirms that computerized tomography (CT) scans are a fast, reliable, and noninvasive mode of diagnosing immune-related colitis. Researchers at Dana-Farber Cancer Institute (Boston, MA, USA; www. dana-farber.org), Boston University (BU; MA, USA; www.bu.edu), and other institutions conducted a retrospective study in 303 patients with advanced melanoma who received the monoclonal antibody agent ipilimumab between 2008 and 2015 and suffered gastrointestinal (GI) problems. In all, 33% of patients developed diarrhea during therapy, and 15% received corticosteroids for colitis. Among the patients with diarrhea, 48% underwent a colonoscopy and 46% underwent both a colonoscopy and a CT. The researchers then evaluated the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the CT scans, compared with the gold standard of colonoscopy with biopsy. The results showed that biop-

HospiMedica International October-November/2017

sy results validated the CT findings with a positive predictive value of 96%. In patients who had GI symptoms and a CT evaluation, CT was also highly predictive of the need for steroids to reach resolution of symptoms, with a positive predictive value 92%. The study was published on April 3, 2017, in Cancer Immunology Research. Colitis can be life-threatening for patients treated with immune checkpoint blockade antibodies such as ipilimumab, which inhibits the programmed cell death protein 1 (PD1) mechanism in T lymphocytes, allowing them to destroy cancer cells. Patients treated with these antibodies can develop GI symptoms, especially diarrhea, at any time during or after treatment. About one-third of patients develop mild symptoms, while 5-8% experience moderate to severe symptoms that can become serious. Currently, a colonoscopy with biopsy of the colonic mucosa is the only validated tool to confirm immune-related colitis. LINKXPRESS COM

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PRODUCT NEWS ULTRASOUND PHANTOM

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The Doppler 403 measures axial & lateral resolution from the surface to 16 cm deep. Its precision pulsatile flow mode allows reliable testing of system velocities and ensures that all transducers and system settings are fully tested across the entire frequency range from 2 to 18 MHz.

The DR100e features a powerful generator power, compact size and small width, which allows it to fit down narrow corridors and hallways. Its flexible handling enables imaging in small spaces, such as ICU and bedside imaging, and it can be used with CR or film, for flexible workflow.

The JUSHA HONOR iDR200A features an ultrahigh frequency voltage generator and uses lowdose flat panel detector technology. It offers extraordinarily high-resolution images and is suitable for a wide range of conventional applications as well as soft tissue X-ray inspection.

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PET-MRI Hybrid Enables New Approaches for Neuro-Imaging Scans ybrid imaging techniques that combine Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) make use of the detailed images of human anatomy that MRI can provide, together with assessments of tissue function characteristics provided by PET imaging. The new PET-MRI technique and other advanced neuro-imaging modalities, intended for the early diagnosis of conditions such as dementia and stroke are being displayed at the RadiologyAsia 2017 conference (Singapore; www.radiology asia.com). The conference will host advanced medical imaging experts, and is taking place on May 19-20, 2017. The conference theme is “Bringing state-ofthe-art imaging into clinical practice.” The occurrence of dementia among an aging population is on the rise, and as the disease progresses it can result in ever increasing neuro-degenerative problems for patients. For this reason, early diagnosis is critical for improved patient outcomes. The new PET-MRI technology provides both volumetric imaging information, as well as metabolic data for the diagnosis of early dementia. PET-MRI and the other new imaging techniques are already enabling clinical researchers to evaluate new drug therapies in clinical trials, and treat dementia and other conditions early, before they result in significant morbidity.

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

Echotherapy Option Addresses Breast Fibroadenomas n innovative system uses high intensity focused ultrasound (HIFU) for the non-invasive treatment of breast fibroadenomas. The Theraclion (Paris, France; www.theraclion.fr) EchoPulse device is based on ultrasound both for the image-guided targeting system and for the delivery of HIFU for tissue necrosis. The system includes an ultrasonic transducer, an amplifier, a visualization and treatment unit (VTU), and an interchangeable cooling system (TH-Kit), which ensures both cooling and coupling functions. The EchoPulse is designed to provide optimal image quality, a milimetric range accuracy of wave shots, and step-by-step procedure control via a touch screen monitor. The VTU head includes an ultrasound transducer for real-time monitoring of the target area, an HIFU emission device used for treatment, an articulated arm for easy positioning on the treatment area, and a motorized head which is can perform not on-

ly sagittal and transverse slices, but also micromovements. Other advantages offered by the system are non-invasive, scarless treatment and conscious sedation for the patient; fast, efficient, and harmless procedures for practitioners; and lower costs of hospitalization for medical centers. “HIFU technology is exciting because it has the potential to provide patients with an alternative to surgery, avoiding a scar, with minimal interruption in their normal daily activity,” said David Brenin, MD, chief of breast surgery at the University of Virginia, and principal investigator of the U.S. trial for the Echopulse. “An ultrasound transducer generates the energy over a broad surface area and focuses it underneath the skin. At the focus point of the energy, the tissue is heated up to about 60 degrees celsius, and there’s also a physical disruption that occurs from the sound energy itself.” “We believe that patients are searching for alter-

natives to invasive surgery that are outpatient, of short duration, generate minimal or no post-treatment pain, and no scarring,” said David Caumartin, CEO of Theraclion. “There are approximately 400 thousand surgeries to remove breast fibroadenomas in the United States each year. This clinical trial is a significant step toward bringing our Echopulse echotherapy to U.S. patients.” Fibroadenoma is the most widely spread breast benign tumor, with as much as 10% of women at risk of developing it in their lifetime; it also represents more than half of breast biopsies. It affects women of all ages, but is a lot more frequent with women under 30. The pathology is often found during a medical examination or by self-palpation, and radiologic images using mammography and ultrasound are used to confirm the diagnosis. In some cases, a micro biopsy is necessary to confirm its benign nature. HospiMedica International October-November/2017

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Medical Imaging

SPECT/CT Could Prevent Unnecessary Surgery for Kidney Tumors esearchers have shown that a non-invasive imaging exam, 99mTc-sestamibi SPECT/CT, together with a regular CT or MRI scan, can prevent unnecessary surgery for many patients with benign kidney tumors. The 99mTc-sestamibi Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) scan provides additional diagnostic data, when used with conventional CT and Magnetic Resonance Imaging (MRI) scans, and helps clinicians distinguish between malignant and benign kidney tumors. The results of the study were published in the April 2017 issue of the journal Clinical Nuclear Medicine. The study included 48 patients diagnosed with a kidney tumor using regular CT or MRI. The patients underwent an additional sestamibi SPECT/CT scan at Johns Hopkins University School of Medicine (Baltimore, MD; www.hopkinsmedicine.org) before surgery. Radiologists graded the tumors in both the conventional and the sestamibi SPECT/CT images as benign or malignant using a 5point scale. The researchers found that adding the sestamibi SPECT/CT scan helped identify seven out of nine benign tumors. The research also suggests that the sestamibi SPECT/CT test is a faster, and less expensive option than surgery. In the US alone, surgeons surgically remove benign kidney tumors in 5,600 patients every year. One of the developers of the new approach, Steven P. Rowe, MD, PhD, at Johns Hopkins, said, “As radiologists, we have struggled to find noninvasive ways to better classify patients and spare unnecessary surgery, but this has not been easy. Sestamibi SPECT/CT offers an inexpensive and widely available means of better characterizing kidney tumors, and the identical test is now being performed as part of a large trial in Sweden, for which the first results have just recently been published and appear to confirm our conclusions.”

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

HD Tomosynthesis Provides Heightened Sensitivity ew technology applies iterative and machine learning algorithms to provide a clearer, more concise three-dimensional (3D) breast reconstruction during digital breast tomosynthesis (DBT). Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) High Definition (HD) DBT technology incorporates enhanced multiple parameter iterative reconstruction (EMPIRE) software, which builds on the company’s established DBT platform, offering a wide sweep of 50 degrees and a total of 25 projections. The wide range provides a perspective required for optimal

depth resolution, which cannot be achieved with smaller angles. The state-of-the-art panel detector also offers readout at full resolution without the need for pixel binning. EMPIRE technology also upgrades image quality by reduction of noise and artifacts, enhanced detection and display of micro-calcification morphologies, and improvements in subcutaneous tissue and skin line visualization. EMPIRE also includes Insight synthetic software, which visualizes tomosynthesis volumes in 2D and 3D as obtained from the EMPIRE 3D image set, providing surgeons with a functional navigational support tool that does not

subject the patients to an additional radiation dose. “The 50-degree angle and 25 projections provide better image quality,” said Ana Maria Rocha Garcia, MD, of Povisa (Spain). “3D imaging gives you more information and a wider angle reduces the effect of overlapping tissue, which is the main problem of 2D mammography. This allows for a better diagnosis.” EMPIRE is available with the Mammomat Inspiration mammography system, a highly flexible platform that offers a tailored tomosynthesis solution that optimizes clinical outcomes by supporting screening, diagnostics, stereotactic biopsy, and DBT.

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PRODUCT NEWS SURGERY / EXAM LIGHT

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FILTRATION SYSTEM

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The SOLED15 is designed for minor surgery, ICUs, recovery rooms, first aid, cosmetic surgery and the dental sector. Key features include excellent light intensity, IR-free light beam, CCT of 4.500°K, CRI of 95, long life, and a low power consumption.

The UV24 system reduces the risk of HAIs, defending patients, staff and visitors from airborne bacteria, viruses and mold. It provides 24/7 UV protection using UV-C and filtration to draw in and treat environmental air, all safely hidden behind standard-sized fluorescent or LED ceiling lights.

The Autoforce generator features more advanced computer algorithms, friendly UI, durable hand piece with detachable metal connector and without restriction of times of use. Additional benefits include an ergonomic shear for a much easier operation.

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Renal Nutrition Vital Following Bariatric Surgery pecific renal nutrition needs must be met to improve postbariatric surgery outcomes, particularly for patients with chronic kidney disease (CKD), according to a new review. According to researchers at the University of Washington (UW; Seattle, USA; www.washington.edu), the phys-

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iologic changes a patient experiences after bariatric surgery require consideration of overall dietary requirements, in addition to specific renal nutrition needs that must be met in order to improve post-surgical outcomes. Patients should begin changing their diet prior to surgery, as a preoperative weight loss of at least a 5% loss in total body weight

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is associated with fewer post-surgical complications, as well as predicting greater weight loss following the procedure. Patients who undergo bariatric followed by renal transplant surgery face a particular challenge in staying hydrated, requiring a fluid intake of around 2.5-3 liters of liquid daily for improved kidney outcomes. Frequent lab checks are required for all postbariatric surgery patients, but particularly for those with CKD or on dialysis in order to monitor vitamin and mineral deficiencies very closely. Calcium, folic acid, and iron are among some of the most common deficiencies, even prior to surgery, mainly due to lack of food intake during the first six months post-surgery. To mitigate post-surgical deficiencies, complete water-soluble multivitamin tablet supplements, rather than gummies and liquid vitamins are recommended, as most of these lack minerals. The researchers also suggest taking higher quality bariatric-specific formulas, even at a higher cost. Hormonal issues, such as hair loss, can arise if supplement quality is low, and particularly if the patient loses a lot of weight very rapidly. They endorse the American Society of Bariatric and Metabolic Surgery (ASMBS) clinical practice guidelines, which recommend checking values of vitamins A, E, K, serum copper, B12 as methylmalonic acid, folate, and others. Other post-surgical hormonal issues may include dumping syndrome, an endocrine response within the first

fifteen minutes after eating due to food dumping from the pouch to the small intestine, resulting in serious, flu-like side effects, and reactive hypoglycemia, when blood glucose levels become dangerously low following a meal. On the positive side, most patients will not require phosphate binders following bariatric surgery, mainly due to the small portion sizes of meals. “The ASMBS is expected to release updated, integrated clinical practice guidelines later this year. These new guidelines will recommend patients take about 200% of daily value of vitamins and minerals for at least the first three to six months after surgery, which is about two multivitamins daily,” said Debra Clancy, RD, CD, who presented the oral session at the National Kidney Foundation (NKF) spring clinical meeting, held during April 2017 in Orlando (FL, USA). “Dialysis patients on renal supplements will be guaranteed to have deficiencies in some minerals, and these patients will require additional supplementation.” Image: New research shows CKD and dialysis patients require renal nutrition following weight-loss surgery (Photo courtesy of Getty Images). HospiMedica International October-November/2017

Morcellation Solution Provides Complete Tissue Containment and Extraction minimally invasive system can provide a laparoscopic surgery option to avoid open hysterectomy and myomectomy. The Olympus Contained Tissue Extraction System is comprised of the Pneumoliner containment device and the next-generation PK Morcellator. The PneumoLiner is designed to create a barrier between the targeted tissue and non-targeted abdominal contents, significantly reducing the risk of disseminating cells and tissue into the peritoneal cavity during power morcellation. Once insufflated, it allows space and vision throughout the procedure, while maintaining a barrier to the escape of fluids, cells, and tissue fragments. The laparoscopic PK Morcellator uses energy rather than blades to break up tissue. Attachments include cutting forceps with a unique five-in-one design that grasps, dissects, coagulates, transects, and retracts tissue all in one easy-touse device across a wide variety of procedures; the Lyons dissecting forceps, with a two-tiered, tapered jaw design with serrated surfaces to provide secure grasping and retraction of tissue as well as pinpoint or wide-based coagulation; and the Plasma Spatula with a unique angled tip and broad surface to provide the ability to precisely cut, coagulate and dissect in a variety of procedures. Also available are the Plasma J-Hook, which simultaneously cuts and coagulates to reduce procedure time, with a tip design that is designed for skeletonization and mobilization. FiVisit us at nally, an adjustable needle electrode allows the surgeon to adjust the depth of the cut for precise conMEDICA trol and minimal damage to surrounding tissue. The 2017 Olympus Contained Tissue Extraction System is a Hall 13-A54 product of Olympus Medical (Tokyo, Japan; www. olympus-global.com), and has been approved by the U.S. Food and Drug Administration (FDA). “The Olympus Contained Tissue Extraction System provides gynecologists and their appropriate, low-risk patients with what they want again: a choice,” said Todd Usen, President of the Olympus Medical Systems Group at Olympus Corporation of the Americas. “The Olympus Contained Tissue Extraction System is the solution that will allow gynecologists to once again safely and effectively offer minimally invasive hysterectomies and myomectomies as options to certain low-risk patients.” “Contained tissue extraction is continually evolving. As surgeons, it is our duty to evaluate potential solutions to the surgical challenges we face in clinical practice,” said Arnold Advincula, MD, vice-chair and chief of gynecology at Sloane Women’s Hospital (New York, NY, USA). All surgeons who wish to use the containment system will be required to complete aformal training protocol before use, as required per mandate of the FDA. The system is not indicated for women with tissue that is known or suspected to contain malignancy, and should not be used for removal of uterine tissue containing suspected fibroids in patients who are peri- or post-menopausal, or in candidates for en bloc tissue removal vaginally or via mini-laparotomy.

Image: The Contained Tissue Extraction System (Photo courtesy of Olympus). V

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PRODUCT NEWS BIOPSY PUNCHES

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ENDOSCOPY SYSTEM

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The stainless steel biopsy punches take a perfect sample every time. As a necessary instrument for an ob/gyn professional to help diagnose any irregularities of the cervix, the biopsy punches are now available with heavy grip handles.

The Endoflip provides an internal view of the gastroesophageal junction during endoscopic/surgical procedures. It captures vital measurements of the pressure/dimensions in the esophagus to assist in motility assessment and evaluating gastrointestinal disorders.

The ZeroWire G2 wireless HD-video system delivers full HD-video without noticeable video delay. Designed for user-friendly operation, it allows clinical teams to enjoy greater mobility and positioning flexibility with wireless video imaging, while promoting quicker turnaround times.

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Unbraided Sutures Linked to Lower Infection Rate on-braided absorbable sutures are associated with a significantly lower wound complication rate following caesarean delivery when compared to braided sutures, according to a new study. Researchers at the Albert Einstein College of Medicine (New York, NY, USA; www.einstein.yu.edu) conducted a randomized study to compare unbraided poliglecaprone 25 (Monocryl) and braided polyglactin 910 (Vicryl) for cesarean incision closure in order to determine rates of wound complication in 383 women undergoing non-emergent cesarean delivery. The primary outcome was wound complication within the first 30 days postpartum, defined as wound separation of one centimeter in length, seroma, hematoma, and surgical site infection (SSI). During the 14-month study period, 192 women were randomized to Monocryl and 191 to Vicryl, with no significant difference in age, body

mass index (BMI), ethnicity, gestational age, gravidity, and parity between groups. The composite wound complication rate for Monocryl was 6.5%, compared to 13.7% for Vicryl. SSI rate was 4.3% for Monocryl, versus 9.1% in the Viceryl group. The study was presented at the Society for MaternalFetal Medicine annual pregnancy meeting, held during January 2017 in Las Vegas (NV, USA). “Patients who received Monocryl sutures were linked with having significantly lower rates of a wound composite outcome than patients who received coated Vicryl sutures. The Vicryl suture group had a 65% increased risk of wound complications compared with the Monocryl suture group,” said lead author and study presenter Arin Buresch, MD, adding that Monocryl sutures are 1.6 times more expensive than Vicryl sutures. Vicryl is an absorbable, synthetic, braided suture indicated for soft tissue

approximation and ligation. The suture has a smooth, low friction proprietary coating that reduces tissue drag, and holds its tensile strength for approximately three to four weeks in tissue, and is completely absorbed by hydrolysis within 60 days. Monocryl is a synthetic, absorbable monofilament

suture generally used for soft-tissue approximation and ligation. It has a consistency close to nylon suture material; both are manufactured by Ethicon (Atlanta, GA, USA; www.ethicon.com). Image: A crosscut of the Vicryl braided suture (Photo courtesy of Ethicon).

Reprogramming Fibroblasts Promotes Scarless Healing groundbreaking study shows that myofibroblasts can be transformed into adipocytes during wound healing, resulting in regenerated skin rather than scar tissue. Researchers at the University of Pennsylvania (Penn; Philadelphia, USA; www.upenn.edu), the University of California Irvine (UCI, USA; www.uci.edu), and other institutions discovered in a mouse model that myofibroblast reprogramming required neogenic hair follicles, which triggered bone morphogenetic protein (BMP) signaling. This, in turn, activated adipocyte transcription factors that are expressed during development, instructing the myofibroblasts to become fat cells. Overexpression of the BMP antagonist, noggin, or deletion of the BMP receptor in the

myofibroblasts prevented adipocyte formation. The researchers showed that the process was dependent on the presence of hair follicles. Adipose cells will not form without new hairs, but once they do, the new cells are indistinguishable from pre–existing fat cells, giving the healed wound a natural look instead of leaving a scar. The researchers added that the increase of fat cells in tissue can also be helpful for conditions that induce adipocyte loss, such as HIV treatment, or for filling in permanent, deep wrinkles. The study was published on January 5, 2017, in Science. “The secret is to regenerate hair follicles first. After that, the fat will regenerate in response to the signals from those follicles,” said senior author pro-

fessor of dermatology George Cotsarelis, MD, of Penn. “Our work shows we have the ability to influence myofibroblasts, and that they can be efficiently and stably converted into adipocytes. This was shown in both the mouse and in human keloid cells grown in culture.” Scars are areas of fibrous tissue that replace normal skin after injury. Apart from very minor lesions, every wound results in some degree of scarring. The scar tissue is composed of collagen, but the fiber composition is different; instead of the normal, random, basket-weave formation of the collagen fibers found in normal tissue, the collagen cross-links and forms a pronounced alignment in a single direction, which results in inferior functional quality. HospiMedica International October-November/2017

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PRODUCT NEWS SURGICAL SYSTEM

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The da Vinci system features an ergonomically designed console, a side cart, interactive robotic arms, 3D HD vision system, and EndoWrist instruments. It is powered by robotic technology that allows the surgeon’s hand movements to be scaled, filtered and translated into precise movements.

The SharnSelect brand has been tested to comply with ASTM standards for MR-conditional devices in up to 3.0 Tesla environments. The line of laryngoscopes offers a wider selection that fills current gaps in the MR laryngoscope market at affordable prices.

The KT-E320Z Ultra HD monitor features a 32inch widescreen with LED backlight system and multi-picture display. With DICOM Part 14 standard and 14-bit look-up table support, it is designed for high-quality imaging and ensures precise representation of grayscale images.

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Surgical Stapler Supports Minimally Invasive Surgery new stapling system developed for minimally invasive surgery (MIS) technologies provides surgeons with real-time feedback and automated responses. The Medtronic (Dublin, Ireland; www.medtronic.com) Signia system is a fully powered ambidextrous laparoscopic stapler designed for single-handed use, which allows the surgeon to operate and access all functions and controls with either the left or right hand. Improved ergonomics ensure that the controls are seamless and intuitive, enabling surgeons to open, close, fire, articulate, and rotate the device using just the thumb and fingers of one hand, thus freeing their other hand and allowing them to stay focused on the surgical site. An innovative feature of the Signia system is adaptive firing technology, which measures the firing force and adjusts the stapler’s speed based on tissue variability measurements, providing consistent staple lines. Feedback at the tissue level is provided via a microprocessor-controlled computer in the device’s handle, which relays the information to an intelligent light emitting diode (LED) screen on the top of the handle. The screen also walks technicians through every step of the setup process, from

Image: The Signia system fully powered ambidextrous laparoscopic stapler (Photo courtesy of Medtronic).

inserting the power pack into the clamshell and how to fit the adapter. During stapling, the device provides the surgeon with an initial reading of the force that it took the stapler to clamp down on the tissue, displayed onscreen. Once the thickest zone of tissue is detected, the surgeon has the option to change the reload selection based on that zone. The LED screen also informs users how many times the stapler has been fired, and if a reload has already been used; none of the reloads can be re-fired thanks to a mechanical

lockout function. “In open procedures, surgeons can directly touch the tissue, which provides them with a sense of how they need to interact with it. During laparoscopic procedures, surgeons’ ability to sense the tissue is definitely muted, as they look down a port and up at a screen,” said Ethan Loiselle, senior director of global surgical stapling at Medtronic. “Our aim with adaptive firing technology, and Signia, is to give surgeons back the direct knowledge of tissue open procedures provide.”

Laser Ablation System Treats Complex PAD Blockages n innovative catheter-and-laser atherectomy system treats peripheral artery disease (PAD), which commonly causes pain in the legs and can require amputation if left untreated. The DABRA (Destruction of Arteriosclerotic Blockages by laser Radiation Ablation) system is comprised of a single-use catheter that tracks the true lumen (without a guidewire), a full catheter tip forward cutter that delivers fast and complete photochemical ablation of all types of plaque, and the DABRA excimer laser power source for the catheters. The laser produces 308-nm ultraviolet B (UVB) photons that can ablate arterial blockages, reducing calcium, thrombus, and atheroma into their fundamental chemistry, thus minimizing downstream debris.

The laser is small enough for any cath lab, with an easy-to-use, simple and intuitive operator interface, and can be used with proprietary DABRA introducers, sheaths, and guide catheters, and can be operated ipsilateral and contralateral, and antegrade and retrograde. Weighing just 48 kilograms, the system is portable both in and between rooms, plugging into a standard outlet and ready to treat in four minutes. The DABRA system is product of Ra Medical Systems (Carlsbad, CA, USA; www.ramed.com), and has been approved by the U.S. Food and Drug Administration (FDA). “DABRA is what we have been waiting for to better treat our patients. It is a two-in-one; you cross the blockage and remove the plaque from the artery,” said Athar Ansari, MD, director of California Heart &

Vascular Clinic (El Centro, CA, USA). “It is safe, because it stays in the patient’s true lumen and does not go subintimal or perforate, common complications of other devices, and it’s effective on all types of lesions. It is revolutionary wireless technology and effective in cases in which other devices have failed.” PAD results when the peripheral arteries become too narrow or obstructed due to plaque, limiting blood flow to the legs. If left untreated, it can cause pain or aching in the legs, difficulty with walking, resting pain in the foot at night in bed, non-healing sores or infections in the toes or feet, and can ultimately lead to limb loss in its most severe form. In addition, it can be associated with other serious arterial conditions that can lead to heart attacks and stroke. HospiMedica International October-November/2017

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Surgical Techniques

Small Bone Fixation System Addresses Foot and Ankle Injuries novel plating system offers a comprehensive set of implants that match the size and anatomy of small bones within the foot and ankle. The Baby Gorilla Mini Plating System provides 65 unique plating options from 13 plating families, which include straight plates, L and oblique-L plates, Y and double-Y plates, navicular plates, cuboid plates, mesh plates, Jones fracture compression and hook plates, 5th metatarsal avulsion fracture hook plates, and Akin osteotomy plates. The plates can accept both locking and non-locking variable angle screws, with diameters of 2.0 mm or 2.5mm, and in lengths ranging from 8 to 50mm. The locking screws allow up to 15° off-axis locking placement. Some of the plates also feature compression slots and are compatible with non-locking screws. The system also includes a robust assortment of instrumentation including curettes, reduction clamps, osteotomes, plate-bending tools, and compression

and distraction devices engineered specifically for use in the foot and ankle for small bone fractures and reconstruction procedures. The Baby Gorilla Mini Plating System is a product of Paragon 28 (Englewood, CO, USA; www.paragon28.com), and has been approved by the U.S. Food and Drug Administration (FDA). “Committed to creating tailored solutions to improve surgical outcomes, Paragon 28 has launched innovative products and instrumentation that help to streamline procedures, allow surgeons flexibility in technique and approach, and facilitate reproducible results benefitting both the surgeon and patient,” said the company in a press statement. “Paragon 28 continues to honor a tradition of comprehensive and innovative solutions with the launch and release of the Baby Gorilla Mini Plating System.” Bone plating is a method of fracture fixation in which one or more metal plates are applied across the fracture and anchored, usually by screws, into

the fragments; the broken bones must first be surgically reset into their proper position. The method does have some drawbacks; after initially placing the plate on the break or fracture the bones are compressed together and held under some slight pressure, which helps to speed up the healing process of the bone. Unfortunately, the tension provided by the steel plate is lost after several days and the break or fracture is no longer under compression, slowing the healing process. Image: A lateral view of the Baby Gorilla Mini Plating System options (Photo courtesy of Paragon 28).

Bone Growth Stimulators Help Spinal Fusion Patients Recover wo new medical devices use a low-level pulsed electromagnetic field (PEMF) to activate and augment the body’s natural healing process, promoting post-operative spinal fusion. The Orthofix (Lewisville, TX, USA; http://web. orthofix.com/Pages/Home.aspx) CervicalStim and SpinalStim bone growth stimulators are lightweight, all-in-one devices intended as a post-operative adjunct to lumbar and cervical fusion surgical procedures, providing a PEMF signal that covers 360 degrees and up to five levels of fusion. The Spinal-Stim device is indicated as a adjunct to spinal fusion to increase the probability of fusion success and as a nonoperative treatment of salvage of failed spinal fusion, where a minimum of nine months

has elapsed since the last surgery. The Cervical-Stim device is indicated as an adjunct to cervical fusion surgery in patients at high risk for non-fusion; there are no known contraindications. Both the devices work effectively even when worn over clothing or bracing, and have no power cords, thus allowing for unrestricted patient mobility during the treatment. They also include several patient enhancements aimed at improving fit, comfort, and ease of use. Adverse effects may include increased pain, numbness and tingling, headache, migraines and nausea, which may or may not be directly related to use of the device. Both systems are available with Stim onTrack, an interactive app designed for smartphones and other mobile devices to help patients follow their

treatment plan that includes daily reminders and a device usage calendar. The mobile app also includes a feature that enables physicians to receive realtime data on how their patients are adhering to their prescribed treatment protocol. The Stim onTrack app is free of charge and available through the iTunes App Store and Google Play. Electricity’s potential to aid bone healing was reported as early as 1841, but it was not until the 1950’s that serious study began. During the 1970s, a new approach for the treatment of delayed fractures was introduced, which employed a very specific biphasic low frequency signal that was applied for non-union/delayed fractures. The first use of electrical stimulation in the lumbosacral region was reported by Alan Dwyer of Australia in 1974.

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PRODUCT NEWS MEDICAL DISPLAY

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PACS DATA MANAGEMENT

DOSE MONITORING SOFTWARE

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The MODALIXX G202MDL is designed for enhanced clarity and brightness in LED-lit images offering user-friendly OSD, low power consumption, and a wide viewing angle. It is considered ideal for cath lab, MRI, CT, CR, PET scanners, RF rooms, C-arm, and portable X-ray applications.

The 3Di PACS features the latest available medical image archiving, visualization and communication technologies. It offers cost reduction, enhanced productivity and a single point of access to radiologists, referring physicians, clinicians, and surgeons.

The DoseCare software allows users to rigorously monitor the doses received by patients and automatically builds a detailed history of patient exposure. It allows the user to evaluate patient risk in real time and react quickly, as well as allows data to be exported for sharing and further analysis.

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AI and Information Integration Aid Therapy Decisions new research alliance between the Fraunhofer Institute for Medical Image Computing (MEVIS; Bremen, Germany; www. mevis.fraunhofer.de) and Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) will develop artificial intelligence (AI) software systems to facilitate diagnosis and therapy decisions using advanced data integration, comprehensive databases, and deep machine learning. The collaboration will initially focus on tumor diseases, such as lung cancer, in order to help determine the necessity of a biopsy by displaying all information that could be relevant to making a decision. The physician would not have to gather information from separate sources, saving valuable time, and would also be informed of specific guidelines issued by medical specialist societies, which will be integrated automatically into the system, providing valuable support. Ultimately, the algorithms will link the case at hand with a comprehensive database of similar cases. In addition, the system will help determine the best possible course of therapy by enabling physi-

cians with different specialties to access one central system to view all relevant information, including X-ray and magnetic resonance imaging (MRI) images, tissue analyses, genetic parameters, lab values, and relevant data from the patient’s electronic medical record (EMR). The algorithms will then search for similar patterns that could deliver insight into the case at hand. For example, did surgery outperform radiation therapy in similar cases? Does an ongoing course of chemotherapy bring the anticipated success, or should it be ceased? “When it comes to detecting relevant patterns and correlations in complex data volumes, computers are now better than humans,” said professor of medical imaging Horst Hahn, PhD, director of Fraunhofer MEVIS. “This does not mean, however, that computers will make therapy decisions. They will simply support physicians with database-driven knowledge.” “The applications developed in collaboration with Fraunhofer MEVIS will support our customers to increase diagnostic quality and to make better decisions for their patients,” said Walter Maerzen-

dorfer, president of diagnostic imaging at Siemens Healthineers. Most of the information in clinics and medical practices is stored digitally, but until now image data, findings, lab values, digital patient records, and surgery reports have been handled separately. A current trend aimed at data integration into one unified software framework will eventually enable faster handling of medical information and is laying the foundation for more efficient interaction between different specialties and more precise and personalized clinical decisions. Image: Research suggests comprehensive, unified databases linking clinicians will aid therapy decisions (Photo courtesy of Alamy).

Wearable Tracker to Advance Health Research erily (Mountain View, CA, USA; www. verily.com), formerly known as Google Life Sciences, is launching Project Baseline, a four-year longitudinal health study designed to understand how people transition from being healthy to becoming sick, and to identify additional risk factors for diseases. Together with Duke University (Durham NC, USA; www.duke.edu) and Stanford University (CA, USA; www.stanford.edu), Verily will enroll 10,000 volunteers from diverse backgrounds at half a dozen study sites in California and North Carolina. Study participants will wear the Verily-developed Study Watch health tracker and will also have their genomes sequenced. Molecular indicators, such as microbiome and proteomics, will also be studied.

The Baseline researchers are hoping that the sleep, activity, heart rate, genomics and other data will help identify find early warning signs for disease. The Study Watch, which will be worn by participants on a daily basis, includes multiple physiological and environmental sensors designed to measure health data, including electrocardiogram (ECG), heart rate, electrodermal activity, and inertial movements. The watch has a long battery life of up to one week in order to improve user compliance. And large internal storage capacity and data compression will allow it to store weeks’ worth of raw data, thus relaxing the need for frequent synchronization. The firmware is also designed to be robust for future extensions, such as over-the-air updates, new algorithms, and user interface upgrades.

Because the investigational device stores health data, all data are encrypted, uploaded, and processed in the cloud using backend algorithms and machine learning tools. The infrastructure is highly scalable and can serve future population studies consisting of large volumes of data. The low power, high-resolution display is always on for an appealing look and a robust user interface. Currently, only time and certain instructions are displayed, with no other information provided back to the user. The Baseline Project is modeling itself on prior efforts, like the Framingham Heart Study, which kicked off in the late 1940s with more than 5,000 participants. The results of that study showed the importance of regular exercise and a healthy diet in maintaining good health, as well as the deleterious effects of smoking. HospiMedica International October-November/2017

First Surgical Use of 3D Reality System new augmented reality system has been used for the first time on a patient during surgery rendering interactively overlaid imaging studies in 3D on the body of the patient. The system uses 3D imaging, advanced segmentation and rendering, motion correction, registration, various virtual tools, 3D annotation, and other new technologies. The OpenSight Augmented Reality (AR) system was developed by Novorad (American Fork, UT, USA; www.novarad.net) and was used together with the HoloLens Virtual Reality (VR) headset developed by Microsoft (Redmond, WA, USA; www.microsoft.com). The system was used to perform an Automated Percutaneous Lumbar Discectomy (APLD) procedure intended to reduce pain linked to a herniated disk. The OpenSight software is designed to render patient imaging studies in 3D overlaid directly over a patient’s body in real-time. The system works by registering Magnetic Resonance Imaging (MRI), Computed Tomography (CT), or other imaging studies over the patient during a procedure allowing the surgeon to see dynamic holograms of the internal anatomy of the patient. The system could increase the accuracy and efficiency of surgical procedures. The OpenSight software is still pending US FDA approval. Research and Development Director at Novarad, Steve Cvetko, said, “We are using cutting-edge augmented reality to display a 3D version of a patient’s anatomy on the actual patient. It offers a true, lifesize rendering with exact alignment and orientation, which is valuable for medical education, research and, of course, surgery.”

Health IT I

Image: A patient undergoing an APLD procedure with the help of OpenSight augmented reality technology (Photo courtesy of Novorad).

Specialty Applications For Radiology Platform Receive Clearance he US FDA has provided 510(k) clearance for new oncology, neurology and cardiology advanced applications for image comparison and analysis, and evaluation treatments and therapy response assessment. The latest release of the clinical informatics platform now includes new advanced clinical applications for multi-modality tumor tracking, optimized lung-nodule assessment, and longitudinal brain imaging. The new applications are for the Royal Philips (Amsterdam, the Netherlands; www.philips.com) IntelliSpace Portal 9.0 portal, and are now available for marketing in the US. The most recent innovation cleared by the FDA was the Longitudinal Brain Imaging (LoBI) application that can be used to analyze brain images for tracking neurodegenerative disorders including stroke, Multiple Sclerosis (MS), and Alzheimer’s disease. New oncology functionality includes qEASL, part of the Multi-Modality Tumor Tracking application, for enhanced tumor volume measurements using Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans. The new Lung Nodule Assessment tool provides information about lung nodules from a single CT study, and can also track them across multiple studies. The IntelliSpace Portal 9.0 portal already offers more than 70 radiology, cardiology, oncology, and neurology applications, and provides a comprehensive overview of a patient’s health. The new applications can enable clinicians to evaluate patients faster, across modalities, and to track therapy response over time.

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PRODUCT NEWS PET/CT IMAGE VIEWER

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ENTERPRISE IMAGING PLATFORM

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Shina Systems

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The 3Di PET/CT Viewer offers innovative powerful fusion and visualization technology. It contains viewing sections for PET and CT MPR images, and for fused MPR images, while allowing different viewing manipulations, measurements and image filters for each of these views.

The Exa offers a diagnostic quality Zero Footprint Universal Viewer for DICOM and non-DICOM images that minimizes unwanted exposure to data. The platform provides hospitals and imaging centers the ability to view images across departments and facilities, regardless of image source.

The RadiForce EX271W offers full HD resolution and powerful LED backlight for optimal presentation of critical images. Its sleek, encapsulated design with laminated safety glass and IP rating, and modular concept for integration into current and future systems make it ideal for the OR.

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3D Models Improve Outcomes For Heart Surgery Patients esearchers have shown that cardiologists could benefit from using patientspecific heart valve models while preparing for heart valve replacement surgery. The scientists used new 3D printing technologies and standard Computed Tomography (CT) scans to create patient-specific heart valve models. The researchers from the Georgia Institute of Technology (Georgia Tech; Atlanta, GA; USA; www.gatech.edu) and the Piedmont Heart Institute (Atlanta, GA, USA; www.piedmont.org/heart) intend to use the technology to increase the success rate of Transcatheter Aortic Valve Replacements (TAVR) procedures. The study was published in the July 3, 2017, issue of the journal JACC: Cardiovascular Imaging. The researchers used CT imaging to scan 18 valve-replacement surgery patients, and created the models using a multi-material 3D printer. The researchers were able to recreate calcium deposition, aortic stenosis, and other patient-unique cardiac aspects. The researchers found that the 3D-printed valves accurately mimicked the physiological qualities of the real heart valves and could help cardiologists reliably predict paravalvular leakage, and pick the best prosthetic valve. Zhen Qian, chief of Cardiovascular Imaging Research at Piedmont Heart Institute, part of Piedmont Healthcare, said, “Paravalvular leakage is an extremely important indicator in how well the patient will do long term with their new valve. The idea was, now that we can make a patient-specific model with this tissue-mimicking 3D printing technology, we can test how the prosthetic valves interact with the 3D-printed models to learn whether we can predict leakage. Even though this valve replacement procedure is quite

mature, there are still cases where picking a different size prosthetic or different manufacturer could improve the outcome, and 3D printing will be very helpful to determine which one. Eventually, once a patient has a CT scan, we could create a model, try different kinds of valves in there, and tell the physician which one might work best.” Image: Kan Wang, a postdoctoral researcher at Georgia Tech, and Zhen Qian, chief of cardiovascular imaging research at Piedmont Heart Institute, inspect a printed heart valve (Photo courtesy of Rob Felt, Georgia Tech).

Soft Artificial Heart Mimics Natural Form and Function completely soft, pneumatically driven artificial heart made of silicone elastomers beats almost like a human heart, according to a new study. Developed by researchers at ETH Zurich (Switzerland; www.ethz.ch) and Deutsches Herzzentrum Berlin (DHZB; Germany; www.dhzb.de), the soft total artificial heart (sTAH) is similar in form to the human heart, but consists of only two ventricles, which are separated not by a septum but by an additional chamber that is inflated and deflated by pressurized air. The function of the inner chamber is to replace the muscle contractions of the natural human heart. The sTAH was created from silicone using a 3D-printed, lostwax casting technique, and weighs 390 grams,

with a volume of 679 cm3. The sTAH was evaluated using a hybrid mock circulation model under various conditions, generating physiologically shaped signals of blood flow and pressures. When operated at 80 bpm, the soft heart achieved a blood flow of 2.2 L/min against an afterload systemic vascular resistance of 1.11 mm Hg, with mean pulmonary venous pressure fixed at 10 mm Hg. A resulting aortic pulse pressure of 35 mm Hg was measured, with a mean aortic pressure of 48 mm Hg. The study was published on July 10, 2017, in Artificial Organs. “The soft artificial heart fundamentally works and moves in a similar way to a human heart. However, it still has one problem; it currently lasts for about only 3,000 beats, which corresponds to a life-

time of half to three quarters of an hour,” said study co-author Anastasios Petrou, MSc, a doctoral student at the ETH Product Development Group. “After that, the material can no longer withstand the strain. As a mechanical engineer, I would never have thought that I would ever hold a soft heart in my hands.” A functional artificial heart remains one of the long-sought holy grails of modern medicine, as it would dramatically lower the need for heart transplants. But straightforward emulation of the anatomy of the human heart with synthetic materials is difficult due foreign-body rejection, the need for external power sources, and other complications that limit their lifespan and that of the human recipients. HospiMedica International October-November/2017

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Three-Dimensional Hologram Player Displays Human Organs n interactive holographic video player shows live footage of internal organs created from a magnetic resonance image (MRI) or computerized tomography (CT) scan. Developed by Holoxica (Edinburgh; United Kingdom; www.holoxica.com), the 3rd generation holograms are created by gathering multiple slices of an internal organ, such as a brain or a heart, from a normal CT or MRI scanner. These slices of data are then assembled through a diffractive holographic screen to produce monochromatic voxels. The voxel images are not projected, but are instead holographically reconstructed using diffractive optics elements to bend or form light, producing the images in mid-air. The holographic image can then be rotated, panned, enlarged, and isolated in real time by the user using the dynamic display, presenting an array of opportunity for the future of surgery and anatomical study. Holoxica has so far produced digital holograms of almost all human organs, including the liver, lungs, heart, brain, and the entire human anatomy (skeleton, vascular system, nerves, muscles and major organs). The results are presented in many public venues including the MIT Museum (Boston, MA, USA), and The National Museum of Scotland (Edinburgh; United Kingdom). “Take current imaging techniques like CT scans where radiologists are trained to interpret the multiple levels of data, or ‘slices’ of the brain. Medical consultants, specialists and surgeons are not trained to do this and therefore need to build up a mental stack of the scans or rely on second-hand interpretation,” said Javid Khan, PhD, CEO of Holoxica. “For the first time, a physician will be able to see a tumor in an impossible part of the brain and make an informed decision; this is also easier for patients to understand what is going on.” “Although we are looking at targeting medical, scientific, and engineering imaging fields to start with, holographic video will change gaming, communication, and create a new digital revolution,” concluded Dr. Khan. “Our world is three dimensional, our brains are wired for three dimensions. Holoxica’s work is spearheading an entirely new Renaissance for our time. Teaching anatomy with this device will give students a hitherto unrivalled understanding.” A hologram is a photographic recording of a light field, rather than of an image formed by a lens, and it is used to display a 3D image of the holographed subject, which is seen without the aid of special glasses or other intermediate optics. The hologram itself is not an image, but rather an encoding of the light field shown as an interference pattern of seemingly random variations in the opacity, density, or surface profile of the photographic medium. When suitably lit, the interference pattern diffracts the light, with perspectives that change realistically with any change in the relative position of the observer.

Image: A holographic display of the lungs (Photo courtesy of Holoxica).

HospiMedica International October-November/2017

Health IT

Hospital News I

Singapore Group to Launch Second Hospital Project in China affles Medical Group (Singapore; www.rafflesmedicalgroup. com), one of the leading integrated healthcare organizations in Asia, has announced that it is developing its second international tertiary hospital in Chongqing (China). When completed, the international Raffles Hospital Chongqing will be able to serve local and expatriate patients in the western part of China, as well as foreign patients from Central Asian republics. The new 700-bed capacity hospital and the soon to be completed 400-bed capacity Raffles Hospital Shanghai are expected to start operations at the end of 2018 with 200 private beds each. Raffles Medical clinics in Chongqing, Shanghai, Beijing, Nanjing, Tianjin, Dalian, and Shenzhen, which have access to the Raffles Medical network, will feed into the two new China hospitals. Raffles Medical Group, which is

based in Singapore, currently operates in 13 cities across Asia, and has announced plans for two new hospitals in Beijing and Shenzhen, and is considering a third. The medical group currently holds representative offices in Indonesia, Vietnam, Cambodia, Brunei, Bangladesh, and the Russian Far East, as well as business associates throughout the Asia Pacific region. “We have done our market survey, and found that the top 10% of 33 million people in Chongqing can afford internationally priced health care,” said Loo Choon Yong, MD, executive chairman of Raffles Medical Group. “Together with the upcoming Shanghai hospital, we will be a major player in tertiary hospital services in China, where there is significant demand for good quality healthcare from locals and foreigners.” The State Council of the People’s Republic of China (Beijing; www.gov.

cn) announced in June 2015 that it will reduce bureaucratic red-tape for new facilities. Among other measures, private-capital-invested hospitals will be integrated into the medical insurance system, a move designed to encourage the development of new medical institutions. The State Council also stipulated that

public health insurance will extend healthcare coverage to qualified private facilities, and will not be able to reject them for reasons other than their medical service abilities. Image: An artist’s impression of Raffles Hospital Chongqing (Photo courtesy of Raffles Medical Group).

Advanced Treatments Begin Using New Radiosurgery System eorgia has started using a new radiosurgery system, installed in the capital Tbilisi, to treat a female breast cancer patient. The system is a non-invasive alternative to conventional surgery and can be used to treat patients with metastatic tumors using Stereotactic Body Radiotherapy (SBRT), together with enhanced motion management and respiratory gating to take account

of breathing patterns. The Varian Medical Systems (Palo Alto, CA, USA; www.varian.com) Edge system was installed at the Tbilisi-based Research Institute of Clinical Medicine (Tbilisi, Georgia; http://clinicalmedicine. ge/en), and has now been put to clinical use for the first time. The Edge system features real-time tracking, high definition collimator leaves, and a high dose rate that together allow clinicians to deliver precise and fast radiosurgical treatments. The system reduces the treatment time compared to other approaches, and uses shaped high-energy X-Rays without surgical incisions. The system also features a treatment couch with six axes of motion that allows tumors to be targeted from more angles than was possible before. Dr. Natalia Jankarashvili, head of Research Institute of Clinical Medicine, radiation oncology department, said, “We are pleased to be the first center in this region to begin clinical treatments using Edge radiosurgery. Radiosurgery with Edge is very fast and it enables us to carry out radiosurgery on small tumors, which we couldn’t do before. We think it will make a big difference for cancer patients throughout Georgia, Armenia and Azerbaijan.”

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Image: The Edge radiosurgery system being used for non-invasive treatment of a patient (Photo courtesy of Varian Medical Systems).

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Industry News

Smart Hospital Market to Reach USD 63.5 Billion by 2023 he global smart hospital market was valued at USD 13.52 billion in 2016 and is projected to grow at a CAGR of 24.00% from 2017 to 2023 to reach USD 63.5 billion, driven by the increasing prevalence of chronic diseases, rising need for better patient care, and efficient and accurate solutions. Additionally, the benefits of a smart hospital such as lower treatment costs, improved treatment outcomes, enhanced patient experience, reduced errors, and improved disease management are also boosting the growth of the smart hospital market. These are the latest findings of MarketsandMar-

Explosive Growth Predicted Worldwide For Surgical Robotics In Coming 5 Years he global medical robotics market is expected to grow at a CAGR of 21.6%from USD 6.36 billion in 2016 to USD 20.56 billion by 2022, driven by the enhancement of automation technologies, rising incidence of disabilities in human beings and growing baby boomer population, that impede their day-to-day physical motions. These are the latest findings of Research and Markets (Dublin, Ireland; www.researchandmarkets.com), a global market research company. Medical robots are used by surgeons to gain greater access to areas under operation using more detailed and less invasive methods. They are present in most telemanipulators, which use the surgeon’s actions on one side and to control the “effector” on the other side. Currently, the demand for medical robots is driven by the rapidly growing demand for precise and efficient minimally invasive surgeries, although the high cost of surgery, negative publicity, and wariness among people continue to pose a challenge to the market growth. The neurology segment is expected to register the fastest growth in the medical robots market during the forecast period, driven by the advent of newer applications in neurosurgery and the growing popularity of robotic neurosurgery. In 2016, North America held the highest share of the global medical robotics market, due to the high adoption rate of medical robots in the region and the government’s strong focus on medical robots to improve the quality of healthcare. The medical robotic systems market in Asia Pacific is expected to grow at the fastest rate during the forecast period due to the availability of untapped market opportunities.

HospiMedica International October-November/2017

kets (Seattle, WA, USA; www.marketsandmarkets. com), a global market research company. The outpatient vigilance segment is projected to record the highest CAGR in the smart hospital market, by application, during the forecast period, due to the technology’s ability to allow healthcare facilities to effectively monitor every patient bed and constantly monitor a patient’s status without having to connect cables, leads, and sensors to the individual. The systems and software segment is projected to record the highest CAGR in the smart hospital market, by component, during the forecast period, due to its focus on device management and integration,

information security, data collection, and data analytics, as well as its ability to create a high degree of smart characteristics and autonomy among healthcare providers, hospital infrastructure, and patients. APAC is projected to record the highest CAGR in the smart hospital market, by region, during the forecast period, on account of increasing number of hospitals and surgical centers in the region, coupled with the growth of the healthcare industry in China, Japan, India, and South Korea, driven by the modernization of healthcare infrastructure, rising start-up companies, and mergers & acquisitions in the healthcare sector.

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

International Calendar, HospiMedica International P.O.Box 802214, Miami, FL 33280-2214, USA Fax: 1-954-893-0038 • E-mail: info@globetech.net

JANUARY 2018 The Finnish Medical Convention & Exhibition. Jan 10; Helsinki, Finland; http://laakaripaivat.messukeskus.com 2018 Gastrointestinal Cancers Symposium. Jan 18-20; San Francisco, CA, USA; http://gicasym.org CACVS 2018 – Controversies & Updates in Vascular Surgery. Jan 25-27; Paris, France; http://cacvs.org ICID 2018 – 20th International Conference on Infectious Diseases. Jan 29-30; Sydney, Australia; www.waset.org Arab Health 2018. Jan 29-Feb 1; Dubai, United Arab Emirates; www.arabhealthonline.com

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

MARCH 2018 Acute Cardiovascular Care 2018. Mar 3-5; Milan, Italy; www.escardio.org HIMSS Annual Meeting 2018 – Health IT Conference and Exhibition. Mar 5-9; Las Vegas, NV, USA; www.himssconference.org SALMED 2018 – International Trade Fair of Medical Equipment and Instruments. Mar

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HospiMedica International October-November/2017

Advertising Index

Vol. 35 No.5 10-11/2017

Inq.No.

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126 102 103 – 125 – 120 115 107 – 132 – 119 111 122 114 121 108 106 109 124 129 105 127 117 113 136 112

ACEM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Ampronix Medical Imaging Technology . . . . . . . . . . . . . . . . . . . . . .2 Antmed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Arab Health 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Biocare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 CARDIOSTIM 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Cincinnati Sub-Zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 CIRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Clear Image Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 CMEF 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Control-X Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 ExpoMedical 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Gammex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Hans Rudolph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Joerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Med-X International . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 MedCaptain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 MedGyn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Okuman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Nova Biomedical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Nuvo Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 PACS Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Parker Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 QMI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 SonoScape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 SunMed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Varex Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Well.D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

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