Medical Imaging International December 2016

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Vol.26 No.6 11-12 /2016 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 2-28 PACS/ IT Update . . 30-32 Product News . . . . 10-32 Industry News . . . . . . 33 International Calendar . 34

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Stereotactic Body Radiation Improves Lung Cancer Survival in Elderly Patients urvival rates of elderly patients with early-stage non-small cell lung cancer (NSCLC) have risen dramatically over the past decade, concurrent with the increasing adoption of stereotactic body radiation therapy (SBRT), according to a new study.

Researchers at Houston Methodist Hospital (HMH; Houston, TX, USA; www.houstonmethodist.org), Baylor College of Medicine (Houston, TX, USA; www.bcm.edu), and other institutions reviewed the medical records of 62,213 patients age 60 and above who were diagnosed with stage I NSCLC between 2004 and 2012, as extracted from the U.S. Surveillance, Epidemiology, and End Results (SEER) database. The patients were grouped into five-year subsets (60-64; 65-69; 70-74; 75-79; 80-84; 85-89; and 90 and older), and overall survival (OS) and lung cancer-specific survival rates were then calculated to draw population-based comparisons between SBRT and surgery alone.

The results showed that from 2004 to 2012 – the years in which adoption of SBRT in community practice became widespread – the OS rate at 23 months following SBRT alone rose from 39 to 58%; OS rates for surgery alone rose from 79 to 84%. In the same time period, cancer-specific survival increased from 48 to 72% of patients who received SBRT alone, and from 87 to 91% of patients receiving surgery alone. Cancer-specific survival rates remained stable for patients who received neither surgery nor radiation.

Analysis revealed that the use of surgery to treat stage I NSCLC declined with age. While 81% of patients age 60-64 underwent surgery, only 47% of patients age 80 or older were able to undergo surgery.

The use of SBRT, conversely, rose with increasing age, ranging from 11% of patients age 60-64 to 39% of patients age 90 or above. The number of patients receiving no treatment also increased, from 7 to 40% for the youngest and oldest elderly patient cohorts in the study. The study was presented at the 58th annual meeting of the American Society for Radiation Oncology (ASTRO), held during September 2016 in Boston (MA, USA).

“While survival rates remain highest for surgical candidates, this study demonstrates both clear benefits from SBRT for nonsurgical NSCLC patients and that outcomes following radiation therapy have improved at a more accelerated pace over the past decade than those for any other therapeutic approach,” said senior author Andrew M. Farach, MD, of Baylor College of Medicine. “With continued adoption of SBRT in community cancer centers, it is our hope that more patients will receive curative SBRT and the number of patients left untreated based on age or medical comorbidity will continue to fall.”

SBRT is emerging as an attractive option for treating cancers in the lung, head and neck, prostate, liver and other disease sites, with the objective of increasing local control of the target lesion while limiting dose to nearby critical structures and normal tissue. Requirements include precise localization of the target lesion in the treatment planning process; accounting for tumor motion due to respiration or other changes in the body; highly conformal dose distribution to the target volume, including a steep dose gradient to minimize radiation to surrounding healthy tissue; and image-guidance at the time of dose delivery for verification and adjustment of the target localization.

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Image: An example of dose distribution of SBRT for lung cancer (Photo courtesy of the NIH).

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New Technology Using 3D Ultrasonic Holography Unveiled new transducer provides 3D holographic, non-invasive, ultrasound exams of the abdomen, breasts, or joints. The technology enables clinicians to carry out preventative, and post-operative breast exams as often as necessary using a holographic ultrasound exam. The images have a higher resolution than standard ultrasound exams, and can reduce the number of false-positive, and false-negative exam findings.

The holographic images can be reproduced for mammography using computer-based and automated data interpretation, and can detect changes down to a size of 0.1 mm, including micro-calcifications. The ultrasound transducer was developed by Innovision (Edelsfeld, Germany; http://innovision-consult.com) and does away with the need for repositioning for images at various angles.

The system can also be used with a breast scan station in which the woman’s breast hangs freely in a water container. The station measures the breast within several seconds producing a 3D ultrasound image of the breast that can be read by an ultrasound specialist, or automatically compared with previous examinations using automated software algorithms. The 3D holographic ultrasound technology is inexpensive, fast, safe, and painless.

Helmut Strehl, managing director, Innovision,

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Nanoparticle Imaging Agents Reveal Microdamaged Bone Structure revolutionary bone-scanning technique produces extremely high-resolution threedimensional (3D) images of bone, without exposing patients to X-ray radiation.

Developed by researchers at Trinity College Dublin (Ireland; www.tcd.ie), in collaboration with The Royal College of Surgeons in Ireland (RCSI; Dublin, Ireland; www.rcsi.ie), the technique is based on Europium-emitting surface-modified gold nanoparticles (AuNP) that serve as a contrast agent for fluoroscopy imaging of micro-damaged bone structure. The nanostructures can be utilized to generate 3D maps of the cracks formed within damaged bone, since the Europium nanoagents are attracted to calcium-rich surfaces.

Using two-photon excitation fluorescence microscopy, the researchers were able to visualize and understand the manner in which the nanoagents bind to damaged bone, as well as demonstrate their selectivity toward exposed calcium at low concentrations. According to the researchers, the technique will have major implications for the health sector, as it can be used to diagnose bone strength and provide a detailed blueprint of the extent and precise positioning of any weakness or injury. The study was published on September 8, 2016, in Chem.

“We have demonstrated that we can achieve a 3D map of bone damage, showing the so-called microcracks, using non-invasive luminescence imag-

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ing,” said senior author professor of chemistry Thorri Gunnlaugsson, PhD. “The nanoagent we have developed allows us to visualize the nature and the extent of the damage in a manner that wasn’t previously possible. This is a major step forward in our endeavor to develop targeted contrast agents for bone diagnostics for use in clinical applications.”

“Current X ray techniques can tell us about the quantity of bone present, but they do not give much information about bone quality,” added professor of anatomy Thomas Clive Lee, MD, PhD, of the RSCI. “By using our new nanoagent to label microcracks and detecting them with MRI, we hope to measure both bone quantity and quality, and identify those at greatest risk of fracture and institute appropriate therapy. Diagnosing weak bones before they break should therefore reduce the need for operations and implants - prevention is better than cure.”

Fatigue-induced microdamage can accumulate within bones if an imbalance occurs in one of the stages of the bone-remodeling process. Such fatigue can result in the development of stress-induced or fragility fractures and skeletal diseases, notably osteoporosis. At present, in vitro detection of fatigueinduced damage is only possible through the use of colorimetric dyes, which do not provide sufficient contrast or differentiation between pre-existing damage sustained in vivo.

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ISSN 1068-1779 Vol.26 No.6. Published, under license, by Globetech Media, LLC. Copyright © 2016. All rights reserved. Reproduction in any form is forbidden without express permission.

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Study: Radiotherapy Reduces Risk of Death from Prostate Cancer by Half longitudinal Nordic study has shown that a combination of pill-based hormone therapy and local radiotherapy can halve the risk of death from prostate cancer 15 years after diagnosis.

The results of the study were published in the May 2016 issue of the journal European Urology.

The researchers compared the results of treatment using only a standard Nordic pill-based therapy (the hormone antiandrogen) and the same therapy with the addition of local radiotherapy. Treatment using antiandrogens slows down the growth of the cancer cells. A follow-up term of 15 years after diagnosis showed that the treatment that included radiotherapy reduced the risk of patients dying from prostate cancer by half, from 34% to 17%. Approximately 9,000 patients are diagnosed with prostate cancer each year in Sweden.

The Researchers from Umeå University (Umeå, Sweden; www.umu.se/english), and from Norway, and Denmark, followed 875 patients who

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had been treated for locally advanced prostate, or aggressive prostate cancer between the years 1996 and 2002. The patients were from approximately 40 clinics in Sweden and Norway.

The leader of the study, Anders Widmark, senior physician and professor, Umeå University, said, “When we published the first results of this study in the Lancet in 2009, we contributed to changing the attitude towards radiotherapy for older patients with advanced prostate cancer. In this follow-up study, we present even more evident results that clearly show how patients who previously were considered incurable, to a large extent can be cured and that these patients should therefore be offered radiotherapy as an additional treatment. We are also

in the process of evaluating how hormone therapy against prostate cancer affects the patients’ quality of life. We will publish that study shortly.”

Image: A patient undergoing radiotherapy for prostate cancer (Photo courtesy of Umeå University).

Study Shows fMRI Scans May Include Too Many False Positive Results esearchers in Sweden have shown that statistical techniques in widespread use today for analyzing brain activity based on fMRI scans may be unreliable. The study was published online before print in the June 28, 2016, issue of the Proceedings of the National Academy of Sciences (PNAS). The researchers tested existing analysis techniques by using them to analyze know reliable data, and found that functional spatial extent inferences from Magnetic Resonance Imaging (fMRI) images showed false positive activity in the brain in up to 60% of the cases, instead of the accepted number of 5%.

The researchers from Linköping University (Linköping, Sweden; https://liu.se), and the University of Warwick (Coventry, UK; www2. warwick.ac.uk) used new statistical analysis methods, based on fewer assumption and one thousand times more calculations than existing methods, and were able to achieve results that were significantly more certain. The researchers used modern computer graphic processing cards and were able to reduce the processing time considerably.

The researchers used imaging data from 499 healthy subjects, made three million comparisons of randomly selected groups of subjects, and analyzed the data using existing calculation methods and the new heavier calculation techniques. The researchers found that the new methods achieved a considerably better result, with only 5% difference, compared to differences of up to 60% using existing analysis techniques.

Dr. Eklund, Linköping University, said, “It really feels great; it’s recognition and I hope we can get a discussion going in research circles regarding how we validate models. Today, there is both data available to validate and enough processing power to perform the calculations.”

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PET Scan Could Help Diagnose Head Trauma Damage roteins are deposited in a characteristic pattern in the brains of athletes suffering from in chronic traumatic encephalopathy (CTE), according to a new study.

Researchers at the University of California, Los Angeles (UCLA; USA; www.ucla.edu), NorthShore University Health System (NSUHS; Evanston, IL, USA; www.northshore.org), and other institutions conducted a study in 14 retired national football league (NFL) football players, all of whom sustained at least one concussion during their career. Study participants underwent a positron emission tomography (PET) scan using a chemical marker called FDDNP, which binds to deposits of neurofibrillary tau tangles and amyloid beta plaques. The PET scans were also compared to those of 28 men and women with healthy brains, and 24 men and women with Alzheimer’s disease (AD), all of similar ages.

The results revealed that the retired football players showed tau deposit patterns consistent with those previously observed in autopsy studies of people with CTE, which indicated that brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting

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mood, emotions, and behavior. The deposition pattern was different from the progressive pattern of neuropathology in AD, which typically begins in the medial temporal lobe and progresses along the cortical default mode network, with minimal involvement of subcortical structures.

In addition, the areas in the brain where the patterns occurred were also consistent with the types of symptoms experienced by some of the study participants. When compared with healthy people, the former athletes had higher levels of FDDNP in the amygdala and subcortical regions of the brain, while people with AD had higher levels of FDDNP in areas of the cerebral cortex. Athletes who suffered more concussions also had higher FDDNP levels. The study was published in the June 2016 issue of Proceedings of the National Academy of Science (PNAS).

“We found that the imaging pattern in people with suspected CTE differs significantly from healthy volunteers and those with Alzheimer’s dementia,” said study author Julian Bailes, MD, director of the Brain Injury Research Institute at NSUHS. “These results suggest that this brain scan may also be helpful as a test to differentiate trauma-related cognitive issues from those caused by Alzheimer’s disease.”

CTE is thought to cause memory loss, confusion, progressive dementia, depression, suicidal behavior, personality changes, and abnormal gaits and tremor. Currently, it can only be diagnosed definitively following autopsy. To help identify the disease, doctors look for an accumulation of tau in the regions of the brain that control mood, cognition, and motor function. Tau is also one of the abnormal protein deposits found in the brains of people with AD, although in a distribution pattern that is different from that found in CTE. Image: A PET scan of a brain with suspected CTE; red and yellow indicate abnormal brain protein (Photo courtesy of UCLA).

X-Ray Technique Visualizes Microscopic Structures in Brain novel X-ray imaging technique can be used to identify individual Purkinje cells in the cerebellum, according to a new study.

Researchers at the University of Basel (UB; Switzerland; www.unibas.ch) and University Hospital of Basel (Switzerland; www.unispital-basel.ch) have developed a specific mathematical filter for use with X-ray phase tomography that can visualize a volume of up to 43 mm3 of human post mortem or biopsy brain samples in three dimensions (3D), with automatic cell feature quantification at isotrop-

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ic resolution in a label-free manner. The researchers used synchrotron radiation to determine local phase shifts, which provided better contrast than conventional X-ray techniques that rely on the attenuation of X-rays.

Using the technique, they succeeded in setting a pixel size of 0.45 micrometers, a hundred times smaller than the diameter of a human hair. The researchers then demonstrated the method on the cerebellum, automatically identifying 5,000 Purkinje cells with an error of less than 5%, and determined that the local surface density was 165 cells per mm2, on average. They also used the 3D data to segment sub-cellular structures, including the dendritic tree and Purkinje cell nucleoli, without the need for dedicated staining. The study was published in the September 2016 issue of Scientific Reports.

Purkinje cells are large neurons with many branching extensions that are found in the cortex of the cerebellum, and which play a fundamental role in controlling motor movement. They are characterized by cell bodies that are flask-like in shape, by numerous branching dendrites, and by a single long axon. Purkinje cells release gammaaminobutyric acid (GABA), a neurotransmitter that inhibits transmission of nerve impulses, which allows the cells to regulate and coordinate motor movements. The cells were first discovered in 1837 by Czech physiologist Jan Evangelista Purkinje.

Image: The surface representation of a Purkinje cell with the main part of its dendritic tree (Photo courtesy of the University of Basel).

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MRI Aids Clinicians in Diagnosing Early Liver Disease safe, non-invasive 15-minute magnetic resonance imaging (MRI) scan can eliminate unnecessary biopsies for liver assessment. LiverMultiScan is a non-invasive medical imaging software tool, which uses MRI data to calculate proton density fat fraction, T2, and T1 in the liver, which correlate histologically with steatosis, hemosiderosis, and fibrosis of the liver. T1 and T2 are physical parameters, which describe the ‘relaxivity’ of tissue in an induced magnetic field. The strong magnetic field in an MRI machine is used to excite water and fat molecules which – depending on their local environment – relax at different speeds. As they relax, they emit a signal, which is used to create the T1 and T2 MR images.

T2 is influenced by iron deposits, which act as small magnets, causing signal decay at a rate proportional to the iron concentration. Tissues with high iron typically have very small T2’s, whilst tissues with very low iron have high T2’s; it can therefore be used as a biomarker in the assessment of hepatic iron overload (hemosiderosis). T1 is influenced by the

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type and structural organization of a tissue; denser tissues such as fat have very low T1’s, whilst tissues with a high water content such as muscle and spleen have very high T1’s.

T1 is thus useful as a biomarker the assessment of myocardial fibrosis. But since more than 40% of liver disease patients have iron overload, T1 values are distorted, increasing the risk of misdiagnosis. The T2 image is thus used to correct for iron, producing a proprietary metric called cT1, which be used to identify and treat non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). LiverMultiScan was developed by Perspectum Diagnostics (Oxford, United Kingdom; www.perspectum-diagnostics.com), and is marketed by Mirada Medical (Oxford, United Kingdom; www. mirada-medical.com).

The Kids4LIFe consortium has

been awarded a ğ1.1million grant to develop and validate LiverMultiScan specifically for patients under 16, which could save them from having to undergo biopsies. As part of the project, a cloud-based health data management system will be developed by the Polish telemedicine company Silvermedia (Krakow, Poland; www.silvermedia.pl) which will allow rapid transfer of liver scans, as well as other health information and diagnostic test results, between local pediatricians and experts in other cities and countries.

“Liver biopsy is important for making diagnosis of various liver diseases and is frequently used in follow up to make decisions on therapy. We try to decrease indications for liver biopsy in children because it can cause complications and needs sedation and anesthesia,” said Professor Piotr Socha, of Children’s Memorial Health Institute (Warsaw, Poland), where the clinical trial will be held.

Image: A LiverMultiScan image of a post-bariatric liver (Photo courtesy of Perspectum Diagnostics).

Results of PRI-MUS High Resolution Micro-Ultrasound Protocol Published nitial results supporting the development of a Prostate Risk Identification using Micro-Ultrasound (PRI-MUS) protocol are expected to result in a new standard for micro-ultrasound targeted prostate biopsies. The initial results supporting the development of the PRI-MUS protocol were published in a peer-reviewed article in the July 2016 issue of the journal Urology.

The protocol was developed by Exact Imaging (Markham, ON, Canada; www.exactimaging.com). The company produces high-resolution micro-ultrasound systems for realtime imaging and guidance, for prostate biopsies. This is the first risk identification protocol specifically developed for prostate micro-ultrasound and is expected to be become the new standard for micro-ultrasoundbased stratification and visualization of prostate tissue imaging. The protocol is also intended to help surgeons target suspicious regions in the prostate, using micro-ultrasound, in real-time. Exact Imaging is planning

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to submit the ExactVu micro-ultrasound system for CE approval and FDA clearance in Q3/Q4, 2016.

Randy AuCoin, president and CEO of Exact Imaging, said, “Prostate cancer is a diffuse disease and with the significant increase in spatial resolution enabled by our ExactVu technology, we wanted to develop an evidence-based protocol that would allow urologists to identify sonographic features now visible in prostate tissue, to characterize those features in terms of a standardized risk identification protocol, and then to target those areas that appeared suspicious. This led us, along with the clinical leadership of our PRI-MUS Advisory Group, to develop the PRI-MUS protocol for micro-ultrasound based imaging of the prostate. The protocol is completely evidence-based, having been developed based on retrospective studies referencing over 1,000 micro-ultrasound biopsy images and cine-loops and all validated with clinical pathology.“ Medical Imaging International November-December/2016

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Imaging Provider Releases New Digital Radiology Detectors new family of Digital Radiology (DR) core detectors are designed for use in mobile imaging, imaging centers, small and midsized hospitals, urgent care centers, specialized clinics, and other facilities.

The detectors provide high-quality DR imaging exams, and include 35 x 43 cm, and 43 x 43 cm wireless Gadolinium (GOS) and Cesium (CsI) scintillators, and 43 x 43 cm fixed detectors for both scintillators.

The DRX Core detectors were released by Carestream Health (Rochester, NY, USA; www. carestream.com) and are intended for use with the DRX-Ascend system, for DRX-Mobile retrofit kits, and the DRX-Motion mobile X-Ray system. Each system can register up to two DRX Core detectors at the same time. Users can combine DRX Plus,

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DRX Core, and DRX-1 detectors and a total of eight detectors simultaneously, using the DIRECTVIEW Software on each imaging system.

It takes only three seconds to obtain a preview image using the DRX Core detectors, and 12 seconds for a full-resolution image. The detectors use the same battery as the DRX Plus and DRX-1 detectors, and are intended for use with the DIRECTVIEW software, or Image Suite software. The new detectors have a Level 4 liquid rating, and tri- and bi-colored LED lights provide feedback of detector status.

Sarah Verna, Global Marketing Manager for X-Ray Solutions, said, “The ability to integrate DRX Core, DRX Plus and DRX-1 detectors offers exceptional flexibility for healthcare providers of all sizes. Providers can select a detector that offers the desired features and budget requirements for each imaging area.”

Image: The DRX Core detector (Photo courtesy of Carestream Health).

Large Imaging Equipment Manufacturer Introduces New CT Scanner newly-introduced Computed Tomography (CT) scanner is dedicated to radiation therapy treatment. The scanner was specifically designed for radiation oncologists, and physicists.

The manufacturer also released updates to the accompanying software suite, which now includes advanced treatment of moving tumors.

The Somatom Confidence RT Pro CT radiation therapy scanner was introduced by Siemens Healthineers (Erlangen, Germany; www.healthcare. siemens.com) together with Enhancing Somatom Confidence RT Pro, a new version of the syngo.via RT Image Suite software.

The new scanner uses the new DirectDensity algorithm, and is one of the first CT scanners that can provide electron density images independent of kV settings, and can simplify the dose calculation workflow. The scanner also provides personalized patient images that the clinician can use for optimal contouring of tumors and organs-at-risk.

The images are optimized to enable physicists to perform radiation therapy treatment dose calculations. The scanner also features iMAR1, which can reduce the number of metal artifacts in the images of patients with implants.

The Somatom Confidence RT Pro also features Dual Energy1 capabilities. The scanner can automatically acquire two CT scans at different kV voltages. This allows the images to be manipulated for improved visualization. The new scanner functions like a CT simulator, providing images physicians can use to define at-risk organs and tumor targets.

Dr. Gabriel Haras, Radiation Oncology head at Siemens Healthineers, said, “This new offering complements the dedicated Siemens Healthineers MR, CT, PET/CT and software portfolio for radiation therapy and demonstrates how it can help healthcare facilities improve their outcomes while also lowering costs.”

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Strong Compression During Mammography Screening May Be Unnecessary researcher in Sweden has found that strong breast compression during mammography screening may not be necessary for improved diagnosis of abnormal changes and tumors.

Previous research has shown that some women decline to undergo regular mammography screening because of the pain from the compression plate that is used, and as a result many women have learned to detect breast cancer at home.

The researcher from Lund University (Lund, Sweden; www.lunduniversity.lu.se) measured pressure distribution on the breast during mammographic screening and found that compression could be reduced by half with minimal effect on pressure distribution on the central breast areas that are most important for cancer diagnosis.

The researcher used patient data from 20-150 participants from Skåne University Hospital (Lund and Malmö, Sweden; http://vard.skane.se) and

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demonstrated that flexible compression plates can reduce the pressure on stiff tissue close to the chest wall, but increase the pressure on the central areas of the breast.

Using compression plates with pressure sensors before taking the image could also improve measurements. The data from the sensors could help clinicians find potential tumors since tumors are stiffer than healthy breast tissue and fat.

Magnus Dustler, said, “Flexible plates therefore enable better image quality without increased compression force. One can also choose to be satisfied with existing image quality and in that case reduce the compression force and the pain. The results indicate that it could be possible to set a threshold value: women who exceed this threshold would undergo additional investigation. However, the method is not yet ready for clin-

ical application. But the interest in our findings is increasing and I hope that they will be put to use.”

Image: New research shows that strong compression of the breast during mammography screening does not automatically lead to a better basis for diagnosis (Photo courtesy of Shutterstock).

Injectable Spacer Preserves Bowels During Prostate Radiotherapy novel hydrogel rectal spacer used during radiotherapy (RT) for prostate cancer results in significantly less rectal toxicity and urinary incontinence, according to a new study.

Researchers at Texas Oncology (Irving, USA; www.texasoncology.com) reported the three-year follow-up results from a phase III trial in patients with low-intermediate risk prostate cancer who were injected with the SpaceOAR, an absorbable hydrogel rectal spacer that separates the rectum from the prostate during RT to potentially reduce the risk of adjacent organ-at-risk (OAR) injury. The researchers examined the cumulative incidence of toxicity and mean changes in quality of life (QoL) summary scores, based on previously established thresholds.

Three-year results showed that grade 1+ rectal toxicity incidence in patients with the SpaceOAR

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was just 2%, compared with 90% in controls. Incidence of grade 2+ rectal toxicity was 6% in the controls, with no cases of grade 2+ toxicity reported in those receiving SpaceOAR spacer. Grade 1+ urinary incontinence was lower in patients with the spacer (4%) than in controls (15%), but there was no difference in grade 2+ urinary effects between groups. The study was presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), held during September 2016 in Boston (MA, USA).

“The distance between the prostate and rectum is typically 1-2 mm; a trans-perineal procedure can be used to place the hydrogel device between the prostate and the rectum, increasing the distance to approximately 1 cm, thus putting the rectum out of harm’s way during radiotherapy,” said lead author and study presenter Daniel Hamstra, MD, PhD.

“Rectal dosimetry was tremendously better after placement of the hydrogel spacer, and what this correlated with was a decrease in rectal toxicity.

We saw significant and dramatic relative reductions of rectal dosimetry at all levels assessed.”

The SpaceOAR system, a product of Augmenix (Waltham, MA, USA; www.augmenix.com), is a temporary hydrogel injected through the perineum, guided by transrectal ultrasound. The material flows into the space between the prostate and the rectum and expands within ten seconds, reducing rectum radiation during prostate RT. Shielding the rectum also permits dose escalation and hypo-fractionation, resulting in more prostate radiation, improved cancer kill rates, and fewer radiation treatment sessions. The hydrogel remains in place for three months and is then liquefied and absorbed, leaving nothing behind.

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Cancer Risk Due to CT Not Fully Appreciated esearchers at the University of Saskatchewan (Saskatoon, Canada; www.usask.ca) conducted a survey among 328 medical professionals in Saskatchewan province to assess healthcare providers’ knowledge regarding radiation dosing from CT scans. To do so, they queried them regarding the average radiation dose from an abdominal-pelvic CT, which is 10 millisieverts (mSv), compared to 0.02-0.2 mSv from one chest x-ray, which indicates that the radiation dose from an abdominal-pelvic CT scan is between 100-250 times that of a chest radiograph.

The results showed that 73% of physicians, 97% of radiologists, and 76% of technologists correctly iden-

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tified that there is an increased cancer risk from one abdominal-pelvic CT. However, just 18% of physicians, 28% of radiologists, and 22% of technologists were able to correctly identify the dose in relation to chest x-rays. And although 48% of physicians, 78% of radiologists, and 63% of technologists either accurately estimated or overestimated this dose, many respondents underestimated the dose level.

The survey also showed that 93% of respondents were interested in radiation dose feedback when considering ordering a CT scan. Another interesting finding was that there is some confusion regarding radiation exposure from magnetic resonance imaging (MRI) and ultrasound. While MRIs and ultra-

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sounds do not employ ionizing radiation, 20% of physicians, 6% of radiologists, and 7% of technologists attribute radiation exposure to MRI, and 11% of physicians and 7% of technologists believed an ultrasound used radiation. The study was published on June 22, 2016, in the Journal of Medical Imaging and Radiation Sciences.

“Healthcare providers, including physicians, radiologists, and medical imaging technologists are often not aware of radiation doses for common CT scans,” said lead author David Leswick, MD. “It is important for healthcare professionals to be aware of radiation dose levels and risks from imaging tests for several reasons, including the ability to weigh the risks and benefits of tests, counsel patients on relevant risks, optimize protocols to minimize radiation dose, and select appropriate protocols to minimize radiation dose.”

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Findings of Zika Virus Effects Detailed in Special Imaging Report esearchers in Brazil have released imaging findings of the effects of the Zika virus on babies and fetuses infected with the virus.

The researchers used Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasound imaging to investigate the wide array of effects on the brain, including microcephaly.

The report was published in the August 2016 issue of the journal Radiology. The researchers used imaging and autopsy findings from babies and fetuses affected by the congenital Zika virus infection, and treated at the Northeast Brazilian Instituto de Pesquisa in Campina Grande state Paraiba (IPESQ). The researchers performed a retrospective review of the CT, MRI, and ultrasound images collected between June 2015 and May 2016. The researchers used images and related data of 17 fetuses or neonates of women who had been scanned at IPESQ, and 28 other fetuses or neonates with brain findings that were suspicious for Zika infections.

Lead author of the report, Fernanda TovarMoll, MD, PhD, said, “Imaging is essential for identifying the presence and the severity of the structural changes induced by the infection, especially in the central nervous system. Microcephaly is just one of several radiological features. The severity of the cortical malformation and associated tissue changes, and the localization of the calcifications at the grey-white matter junction were the most surprising findings in our research. More than one ultrasound or MRI scan in pregnancy may be needed to assess the growth and development abnormalities of the brain. We are also interested in investigating how congenital Zika virus infection can interfere with not only prenatal, but also postnatal gray and white brain maturation.”

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Deep Learning Advances Breast Cancer Ultrasound Algorithm novel computer-aided diagnosis (CADx) solution for ultrasound is based on deep learning from an independently acquired anonymous set of real-life data. Developed at Samsung (Seoul, Korea; www.samsung.com), the innovative S-Detect for Breast CADx algorithm is based on a database of over 10,000 anonymous breast ultrasound images and decades worth of clinical experience from partnering medical institutes and doctors, such as Samsung Medical Center (SMC; Seoul, South Korea; www.samsunghospital.com). The deep-learning algorithm uses the standardized Breast ImagingReporting and Data System (BI-RADS) score for analysis and classification of targeted regions.

The user simply touches a seed point on the touch screen and the S-Detect automatically sets lesion boundaries, providing multiple images; the BIRADS score is automatically displayed. The intelligent technology then helps to determine the size and shape of the lesions, gives advice on whether they are benign or malignant, and integrates all that information into a single report that aids in effective diagnosis and reduction of unnecessary biopsies.

The S-Detect algorithm is already incorporated into an upgraded version of the Samsung RS80A with Prestige ultrasound device, offering standard-

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ized analysis and classification of suspicious lesions.

It includes three modes to set the level of sensitivity and specificity requiered. The RS80A also provides E-Breast elastography technology to calculates the strain ratio for thyroid lesions, and contrast-Enhanced Ultrasound (Low-MI) to process reflected signals from contrast agents, stimulated by particular ultrasound pulses, which produce a unique sonogram with increased contrast.

While final diagnosis and decisions are made by doctors, the S-Detect for Breast can equip them with the knowledge to help them make better decisions faster. Samsung announced that the Samsung Advanced Institute of Technology (SAIT) will conduct further work with partnering medical institutes such as SMC to further improve the S-Detect algorithm and to expand application of the technology to other areas of ultrasound diagnosis, such as the thyroid, liver, and more.

Image: The RS80A with Prestige ultrasound device (Photo courtesy of Samsung).

Superconducting MRI Coil Offers Higher Resolution and Shorter Scan Times esearchers in the U.S. have developed a new high-temperature superconducting cryo-coil for Magnetic Resonance Imaging (MRI) scanners that increases the Signal-to-Noise Ratio (SNR) and is more sensitive compared to conventional coils.

The new coil technology was developed by a multidisciplinary team of researchers and can reveal brain structures that conventional MRI coils cannot.

Initial testing was performed on rat brains for imaging of neurological disorders.

Researchers from the University of Houston (UH; Houston, TX, USA; www.uh.edu) developed the 7T high-temperature superconducting MRI Cryoprobe, with which MRI scanners can produce higher-resolution images or acquire images faster than with conventional coils. Currently the coil is optimized for experiments using brain tissue samples, or on live animals. According to researchers they were able to demonstrate an isotropic resolution of 34 microns during imaging of rat brains.

Research team leader from the University of Houston, Jarek Wosik, said, “Research in animal models yields critical information to improve diagnosis and treatment of human diseases and disorders. This work also has the potential to clearly benefit clinical MRI, both through high quality imaging and through shortening the time patients are in the scanner. Compared to corresponding standard room temperature MRI coils, the performance of the cooled normal metal and/or the high-temperature superconducting receiver coils lead either to an increase in imaging resolution and its quality, or to a very significant reduction in total scan time.

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The RadPRO OMNERA 400T provides servo tracking to the wall stand and table for precision positioning for easy patient access and transfer.

Constructed of aircraft aluminum with a lightweight design, it provides the high throughput needed in high-volume imaging departments.

The FDR Smart f features an ergonomically designed floor-mounted tube stand to provide lighter and smoother movement for faster, more efficient workflow. It offers a choice of a four-way floating tabletop and a six-way elevating table, making it flexible for patients of all shapes and sizes.

The SSI-8000 uses high-density transducer technologies to achieve uniform spatial and contrast resolution and penetration in near/far fields. It is compatible with a full range of transducers, making it ideal for use in superficial diagnosis and emerging medical applications.

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Study: Whole Brain Radiotherapy Does Not Improve Metastatic Lung Cancer Outcomes hole brain radiotherapy (WBRT) adds no value to length or quality of survival in patients with metastatic non-small cell lung cancer (NSCLC), according to a new study.

Researchers at Newcastle Hospitals NHS Foundation Trust (Newcastle upon Tyne, United Kingdom; www.newcastle-hospitals.org.uk), University College London (UCL, United Kingdom; www. ucl.ac.uk), and other institutions recruited 538 NSCLC adult patients with brain metastases between March 2007 and August 2014. Study participants were randomly assigned to receive best supportive care and dexamethasone, or best supportive care, dexamethasone, and WBRT (20 Gy in five daily fractions).

Benefits of treatment were measured in terms of quality adjusted life years (QALYS), which combines length and quality of life (evaluated during weekly telephone assessments). By October 2015, 536 patients had died (267 in the WBRT group and 269 in the best supportive care alone group); patients in both groups lived a similar length of time after randomization (about two months). The difference between the groups in terms of average QALYs was just 4.7 days.

Hardly any differences in steroid use or serious adverse events were reported in either group, al-

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though more episodes of drowsiness, hair loss, nausea and dry/itchy scalp were reported by WBRT patients. The researchers concluded that while WBRT may be beneficial in patients who are younger than 60 years old, it should no longer be considered standard treatment for the majority of patients with NSCLC that has spread to the brain. The study was presented at the annual European Respiratory Society meeting, held during September 2016 in London (United Kingdom).

“Whole brain radiotherapy was widely adopted into clinical practice based on the assumption it improves tumor control in patients with brain metastases. But in our lung cancer clinics, we were not seeing the improvements we had hoped for in our patients,” said lead author consultant clinical oncologist Paula Mulvenna, MD. “Survival times are poor and have hardly changed since the 1980s. What’s more, the technique’s toxicity can be substantial and it can damage cognitive function.”

“Whole brain radiotherapy cannot be considered as the standard treatment for all patients with brain metastases because it does not extend survival, im-

prove quality of life, or reduce steroid use,” said senior author Professor Ruth Langley, PhD, of UCL. “In the future, potential new treatments (whether using drugs or stereotactic radiotherapy techniques) should be assessed in addition to best supportive care rather than in addition to, or in place of, whole brain radiotherapy.”

Image: A new study shows WBRT noes not improve outcomes in patients with cancer metastasis in the brain (Photo courtesy of Getty Images).

FDA Approval for Cardiac Devices in Diagnostic Imaging he US Food and Drug Administration (FDA) has approved a suite of cardiac rhythm and heart failure devices, including leads, for use in 3T and 1.5T Magnetic Resonance Imaging (MRI) machines.

The FDA approval will allow patients fitted with MR-conditional pacemakers, Cardiac Resynchronization Therapy-Defibrillators (CRT-Ds), Implantable Cardioverter-Defibrillators (ICDs), and their leads, to undergo MRI scans.

The approved devices are the Medtronic (Dublin, Ireland; www.medtronic.com) Advisa

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MRI, and Micra Transcatheter Pacemakers, Amplia MRI and Compia MRI CRT-Ds, Evera MRI and Visia AF MRI DF-1 and DF4 ICDs, Reveal LINQ insertable cardiac monitor, SureScan pacing, defibrillation and left-heart leads. Medtronic is a large medical technology, services and solutions company and manufactures a range of devices for interventional, and surgical treatment of cardiac arrhythmias, and cardiovascular disease.

Yair Safriel, MD, neuroradiologist, CMO, Pharmascan Clinical Trials, and University of South Florida, said, “While 1.5T scanners still comprise

the majority of installations, 3T scanners are expected to comprise more than half of new units – with some centers having only 3T scanners – since they offer faster scans and higher resolution images. Approval for MRI conditional scanning at both 1.5 and 3T allows patients to have improved access to MRI at a time and place most appropriate for their care. And with 3T scanning, physicians and radiologists gain a clearer look into soft tissues, particularly critical when diagnosing serious conditions, often involving the brain and spine.”

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Targeted Ultrasound Reboots Brain Following Coma ltrasonic stimulation in order to excite the neurons in the thalamus could be used to treat severe brain injury, according to a new study.

Researchers at the University of California, Los Angeles (UCLA; USA; www.ucla.edu) used a lowintensity focused ultrasound pulsation technique in order to stimulate the brain of a 25-year-old man recovering from a coma. The ultrasonic pulsations were delivered using a small transducer to create a small sphere of acoustic energy that was aimed at the thalamus region to excite brain tissue. The researchers placed the transducer at the side of the man’s head, and activated it 10 times for 30 seconds each during a 10-minute period.

The researchers reported that before the procedure began, the man showed only minimal signs of being conscious and of understanding speech, performing only small, limited movements when asked. But by the next day, his responses had improved measurably; three days later, the patient had regained full consciousness and full language comprehension, and could reliably communicate by nodding or shaking his head and making hand gestures. The study was published on July 22, 2016, in Brain Stimulation.

“The changes were remarkable. It’s almost as if we were jump-starting the neurons back into function,” said lead author Martin Monti, MD, PhD, a

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UCLA associate professor of psychology and neurosurgery.

“Until now, the only way to achieve this was a risky surgical procedure known as deep brain stimulation, in which electrodes are implanted directly inside the thalamus. Our approach directly targets the thalamus but is noninvasive.”

The thalamus is a midline egg-shaped symmetrical structure within the vertebrate brain, situated between the cerebral cortex and the midbrain. It serves as the brain’s central hub for processing information, relaying sensory and motor signals to the cerebral cortex, and participating in the regulation of consciousness, sleep, and alertness. The new technique targets the thalamus, since people

whose mental function has been deeply impaired after a coma show diminished thalamus performance.

Image: A 3D reconstruction of patient’s head with transducer (L); axial view of the transducer and approximate thalamic target (R) (Photo courtesy of Martin Monti/ UCLA).

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New Compact Ultrasound System Announced he commercial launch of a new high-performance, battery-powered diagnostic ultrasound system was announced at the European Society of Cardiology Congress, in Rome Italy. The new generation portable compact cardiovascular ultrasound system weighs 4.5 kg and boasts improved image quality, and additional functionality than previous systems.

The new ultrasound system, named Vivid iq, was announced by GE Healthcare (Chalfont St Giles, Buckinghamshire, UK; www3.gehealthcare.co.uk) and is intended for cardiac care in Cath laboratories, operating and emergency rooms, or for use in remote locations that are difficult to access.

According to GE Healthcare, this is their most advanced portable cardiovascular ultrasound. The system was developed in cooperation with cardiologists, interventional cardiologists, and international healthcare providers.

The Vivid iq is 10% lighter and thinner the Vivid q, and has a new transportable cart, and a battery life of up to one hour. The system has a cleanable design and has a rugged build for use in difficult conditions.

Other new features include a touch screen, and 4D Trans-Esophageal Echocardiography (TEE).

Dr. Ferran Rosés Noguer, Pediatric Cardiology Department, Vall d’Hebron University Hospital (Barcelona, Spain), said, “Vivid iq is a huge step forward in terms of image quality and innovative design. It is extremely user friendly, truly portable, with a fantastic interface and a great design that is really futuristic and elegant at the same time.”

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The VINNO G50 allows users to retain more information and obtain more accurate RF raw data for post processing. The platform’s higher frequency range allows it to support probes from 1-25MHz, and offers intuitive and fast workflow for ease of use.

The MAGNETOM Prisma 3T MRI features Diffusion Spectrum Imaging (DSI) acquisition, which enables the user to potentially resolve fine anatomical details of the brain. It also makes the scanner suitable for cardiac and body imaging, and spectroscopy applications.

The EVO series is equipped with an easy-open, lever-style handle to facilitate access into and out of the MRI suite. It features a low-friction design, aided by a reduced contact surface, to make it easy to open for MR technicians, and an architectural style suited for all environments.

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Premium Ultrasound System Introduced in Europe new robust ultrasound system designed for emergency departments has been launched for the European market. The system is designed for ease of movement, and features improved image quality and battery storage, integrated Internet Technology (IT) functionality, and a hybrid user interface with a touch screen and tactile buttons.

The system has a short boot-up time and includes workflow guidance to increase efficiency.

The bk3500 ultrasound system was developed

by Analogic (Peabody, MA, USA; www.analogic. com), a healthcare company, and launched at the annual European Congress on Emergency Medicine (EuSEM) in October 2016 in Vienna, Austria.

The ultrasound system works together with the bkHub software image management system that provides image storage, training, quality assurance, and billing.

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Analogic develops and markets advanced imaging and real-time guidance technologies for diagnosis and treatment of disease. The systems are used for surgery, urology, and point-of-care. Analogic also develops imaging technology for Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scanners, and digital mammography systems.

Jacques Coumans, PhD, VP, CMO, and CSO at Analogic, said, “We had a very positive response to the introduction of our bk3500 ultrasound system to the European healthcare market. Many physicians came by our booth at EuSEM to learn more about our Vector Flow Imaging Assist technology, which is currently being studied to measure its impact on fluid responsiveness in septic patients. This novel technology automatically finds maximum velocity, measures the diameter of the vessel, and cal-

culates flow volume in a matter of seconds. VFI Assist has the potential to be a clinical game changer in emergency medicine.”

Image: The bk3500 ultrasound system designed for use in emergency departments (Photo courtesy of Analogic).

Cone Beam Computerized Tomography System Simplifies Extremity Imaging n innovative cone beam computerized tomography (CBCT) system images extremities in three dimensions (3D) for use by orthopedic and sports medicine practices and other healthcare providers.

The Carestream (Rochester, NY, USA; www. carestream.com) OnSight 3D Extremity System enables healthcare providers to capture high-quality 3D images at the point of care (POC) and conduct a patient consultation in a single visit, allowing specialists to visually illustrate to their patients their condition or injury, and help them understand the reason for a suggested treatment or surgical procedure. The system provides an easily accessible open bore to allow weight-bearing studies that are not possible with traditional CT. System features include the ability to perform upper and lower extremity exams, including weight bearing tests; high-resolution, large field,

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isotropic 3D images that can help to reveal subtle or occult fractures; reduced doses compared to conventional CT systems; advanced metal and scatter correction algorithms and reduced noise by using iterative reconstruction techniques; and a small footprint and simplified design that cut the time and cost of system installation.

“Our extremity imaging system can help in treating a host of orthopedic conditions that affect the biomechanical behavior of the joints such as arthritis, meniscus loss, instability and malalignment syndromes,” said Helen Titus, worldwide marketing director for ultrasound and CT solutions at Carestream. “Orthopedic imaging is a major focus for Carestream because of the prevalence of musculoskeletal conditions among people of all ages.”

During CBCT, the region of interest is centered in the field of view. A single 200-degree rotation

acquires a volumetric data set, which is used to produce a digital volume composed of 3D voxels of anatomical data, which can then be manipulated and visualized. CBCT has only recently become practical with the introduction of large-area high-speed digital X-ray imagers, such as hydrogenated amorphous silicon (a-Si:H)-based flat-panel detectors.

Image: The OnSight 3D extremity system imaging a knee (Photo courtesy of Carestream Health).

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IBM Collaborative to Bring Imaging into Daily Clinical Practice BM (Armonk, NY, USA; www. ibm.com) has announced a new global Watson Health medical imaging collaborative that includes more than 15 leading health systems, academic medical centers, ambulatory radiology providers, and imaging technology companies.

The new collaborative aims to bring cognitive imaging into daily practice to help doctors address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease and related conditions, such as stroke. The members of the imaging collaborative will use Wat-

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son to extract insights from unstructured imaging data and combine it with a broad variety of data from other sources, such as data from electronic health records (EHRs), radiology and pathology reports, lab results, doctors’ progress notes, medical journals, clinical care guidelines, and published outcomes studies.

Members of the collaborative will team with Watson Health cognitive computing experts to train Watson on cardiovascular disease (CVD), eye health, and other conditions using the data provided by the members of the collaborative or from population-based

Radiologists Need to Become Central Members of Cancer Teams adiologists need to become established as central members of cancer teams because of an expected increase in the importance of imaging for cancer between the years 2016 and 2026. Radiologists are responsible for early identification of toxicity using precision oncology imaging, and need to interpret these findings, including the relationship of the findings with tumor response, and the effect on metastasectomy.

The review article was published in the July 2016 issue of the American Journal of Roentgenology by radiologists and researchers at the Dana Farber Cancer Institute radiology department (Boston, MA, USA; www. dana-farber.org). The purpose of the article is to help radiologists under-

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disease registries, which house millions of de-identified cases from around the world. Watson could then identify CVD and other conditions early and spot frequently overlooked heart conditions, such as congestive heart failure (CHF). IBM envisions Watson learning how patients’ hearts are likely to start failing, and then monitoring the progression of the disease.

“With the ability to draw insights from massive volumes of integrated structured and unstructured data sources, cognitive computing could transform how clinicians diagnose, treat and monitor patients,” said Anne Le Grand, vice president of imaging at Watson Health. “Through IBM’s medical imaging collaborative, Watson may create opportunities for

clinicians to extract greater insights and value from imaging data while better managing costs.”

In addition to better preventive and personalized care, the collaborative could help health systems and companies save billions on inefficient and uncoordinated care. A recent National Academy of medicine (Washington, DC, USA; https://nam.edu) study concluded that between 35% and half of the more than USD three trillion the United States spends on healthcare each year is wasted on suboptimal business processes and inefficient, inadequate, unnecessary, and uncoordinated care. By sharing and improving the use of imaging data, IBM hopes the collaborative will reduce waste and improve the quality of care.

stand imaging-evident toxicity.

Study leader, Stephanie A. Holler Howard, Department of Radiology, Dana Farber Cancer Institute (Boston, USA), said, “This article attempts to expand the radiologist’s view of the effect of imaging-evident toxicity by delineating how oncologists grade toxicity, highlighting the potential relationship between toxicity and drug efficacy, discussing how toxicity affects patients who may ultimately undergo metastasectomy, and exploring the effect of combining multiple drug classes on severity of adverse events. Radiologists must understand the language and multifaceted nuances of toxicity to contribute to optimized care of cancer patients and remain relevant effective members of the oncologic team.”

Non-Invasive PET Scanning Technique Provides Insights into Adult Neurogenesis cientists at a Japanese university have used a new PET scanning technique to study neuron proliferation in the hippocampal dentate gyrus. Neurogenesis in the hippocampal dentate gyrus is affected by depression but is also used in learning, and memory. The scientists focused on the subventricular and subgranular zones where neural stem cells create new neurons.

The study was carried out by scientists from the RIKEN Center for Life Science Technology (CLST; Hyogo, Japan; www.riken.jp/en/research/ labs/clst). Neurogenesis can also be investigated using Magnetic Resonance Imaging (MRI) but this requires direct injection of tracers into the brain. For this study the scientists used the non-invasive PET technique and probenecid, a drug which can in-

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hibit the active transport of molecules such as [18F]FLT, outside the brain.

The scientists performed their research on laboratory rats.

Leader of the research team, Yosky Kataoka, said, “This is a very interesting finding, because it has been a longtime dream to find a noninvasive test that can give objective evidence of depression and simultaneously show whether drugs are working in a given patient. We have shown that it is possible, at least in experimental animals, to use PET to show the presence of depression and the effectiveness of drugs. Since it is known that these same brain regions are involved in depression in the human brain, we would like to try this technique in the clinic and see whether it turns out to be effective in humans as well.”

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The Mammomat Fusion features Single-Touch Positioning, which moves it between predefined positions at the touch of a button. It allows the user to switch quickly and easily from one view to the next while the detector center remains at the same height with isocentric rotation.

The SOFIA provides rapid whole breast image acquisition with one button operation without operator interaction during the procedure. It provides data sets that can be presented in 2D, 3D, and MPR views for enhanced characterization of abnormal anatomical features.

The CereTom delivers the highest quality non-contrast, angiography, and contrast perfusion scans in a variety of patient locations. Its combination of rapid scan time, easy-to-use interface, and immediate image viewing make it ideal for clinicians requiring RT high-quality images.

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Interventional Tumor Analysis and Therapy Solution Unveiled new interventional oncology solution for minimally invasive liver cancer treatment offers the first solution for use with radiopaque beads that minimize damage to healthy tissue and organs during tumor treatment.

Royal Philips (Amsterdam, the Netherlands; www.philips.com) introduced the OncoSuite solution that provides complete coverage of the liver enabling clinicians to visualize peripheral hepatic tumors, and provide analysis, and minimally invasive, targeted tumor lesion treatment. The solution gives clinicians an improved view of treatment targets during a procedure.

The Philips OncoSuite enhances tumor embolization and ablation procedures, and works together with Philips interventional X-Ray systems. The OncoSuite enables targeted treatment of an entire tumor, and feeder vessels, while minimizing damage to surrounding organs, and healthy tissues.

Minimally invasive, image-guided interventional oncology procedures provide an alternative for patients who cannot be treated using conventional surgery, chemotherapy or radiation therapy.

Dr. Jeff Geschwind, chairman and chief of the Department of Radiology and Biomedical Imaging, Yale School of Medicine, said, “While OncoSuite can be used for a number of different cancers including bone, kidney and lung, the solution and its specific tools have been optimized for the treatment of patients

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with liver cancer. Given the steady increase in the prevalence of non-alcoholic fatty liver disease and liver cancer, the development and availability of new technology is much needed to provide interventional oncologists with a breakthrough that allows best possible treatment for these patients.”

Image: The OncoSuite interventional oncology suite (Photo courtesy of Philips Healthcare).

CT Nodule Detection App Clears Lung Structure novel lung nodule detection application allows superior automatic nodule detection performance for all primary nodule types, including solid, sub-solid, and ground glass nodules.

The Riverain Technologies (Miamisburg, OH, USA; www.riveraintech.com) ClearRead CT nodule detection application, powered by acquisition normalization technology, is designed to seamlessly processes computerized tomography (CT) scans from a wide range of manufacturers and acquisition protocols, suppresses lung vessel without the need for new hardware or customized tuning to specific protocols. The app is comprised of two powerful tools, ClearRead CT – Vessel Suppress, and ClearRead CT – Vessel.

The ClearRead CT – Vessel Suppress tool was built using hundreds of normal scans spanning many different acquisition protocols, using thousands of simulated nodules to capture the large va-

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riety of different morphologies, texture, and attenuation characteristics of real nodules. The tool works by predicting the local lung air value, except where there is nodule tissue, which is left unaltered. Vessel suppression also suppresses the bronchial tree and pulmonary fissures, thus essentially suppressing all normal structures.

ClearRead CT–Detect is built on top of ClearRead CT–Vessel Suppress; using the vessel suppressed CT series, candidate nodules are detected using nothing more than simple thresholding and morphological post-processing. Through vessel suppression, nodules can thus be robustly and consistently detected, segmented, and characterized. Detect attempts to limit the number of false positives – such as residual vascular structure, bronchial wall, or scarring – but the radiologist must remain diligent, as some nodules may be inadvertently removed in the process.

Concurrent reading and deep learning enable the

vessel suppression technology to assist both machine and humans in the detection and characterization of all primary nodule types, allowing for previously unattained detection performance. In a recent multireader, multi-case clinical trial, radiologists achieved a 29% reduction in missed actionable nodules, while reducing reading time by 26%. The ClearRead CT nodule detection application has been approved by the U.S. Food and Drug Administration (FDA).

“Achieving high reading efficiency while maintaining accuracy is increasingly important given the burden placed on today’s radiologists. With more patients and increased data volume due to thinner sections, ClearRead CT offers a critical advantage,” said Steve Worrell, CEO of Riverain. “The use of deep learning and other key technologies to suppress the vessels in CT scans proved to be essential in realizing a product capable of achieving the two competing objectives.”

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Brain MRI Reveals Key Mechanism of Common Cognitive Disorder n assessment of brain MRI scans and cognitive examination results, in patients suffering from symptomatic carotid artery disease, indicates that disruption in the communication networks of the brain is a key mechanism of vascular cognitive disorder.

The results also indicate that brain MRI scans could be used to help improve the diagnosis of patients with the common cognitive disorder. The study was published online, in the September 2016 issue of the journal Radiology.

The researchers from the University of Nottingham (Nottingham, UK; www.nottingham.ac.uk) assessed Magnetic Resonance Imaging (MRI) brain scans, and the cognitive exam results of 108 patients suffering from symptomatic carotid artery disease. Fifty-three of the patients suffered from cognitive impairment.

The researchers found a clear correlation between cognitive performance of the patients, and chronic vascular disease-related lesions in white matter tracts of the brain. The researchers concluded that white matter tract skeleton mean diffusivity was a useful tool to improve the diagnostic accuracy of vascular cognitive disorder, because it offered a close correlation with impaired cognitive performance.

Vascular cognitive disorder is becoming more common in the elderly, and is difficult to diagnose, and distinguish from Alzheimer’s disease, and other forms

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Short-Lived Isotope Opens New Possibilities for Cancer Treatment radioisotope of the element actinium is a promising agent for targeted- therapy to destroy malignant cells, while minimizing the damage to healthy surrounding tissue.

Developed by researchers at Los Alamos National Laboratory (LANL; NM, USA; www.lanl.gov), and in collaboration with the Stanford Linear Accelerator Center (SLAC) Laboratory (SLAC; Menlo Park, CA, USA; www6.slac.stanford.edu), targetedtherapy is based on the radioisotope actinium-225, which has a relatively short half-life of 10 days and emits powerful alpha particles as it decays to stable bismuth. But targetedtherapy can only become a reliable cancer treatment if actinium securely binds to a chelator, as the radioisotope is very toxic to healthy tissue.

In an attempt to clarify the limited understanding of actinium chemistry, the researchers used X-ray absorption spectroscopy and molecular dynamics density functional theory to investigate actinium coordination chemistry. They were able to determine information about chemical bonds formed by actinium, including what binds to the element, how many atoms are present, and the distances between them. The researchers will now attempt to engineer a chelator carrier molecule that could safely transport actinium-

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225 through the body to tumor cells. The study was published on August 17, 2016, in Nature Communications.

“Imagine if someone gave you the element iron and nothing was known. That’s almost the same place we were in with actinium, as far as macroscopic chemistry goes. The Manhattan Project scientists used film to see the X-rays released off the sample,” said study co-author Stosh Kozimor, PhD, an isotope chemist at Los Alamos, “but the radioactivity from actinium darkened the film before they could make meaningful measurements. They were only able to get a fingerprint of the actinium compounds that were suggestive of what formed. Beyond that, there isn’t much information in those measurements.”

Actinium (Ac), discovered in 1899, is a radioactive chemical element with the atomic number 89.

It was the first non-primordial radioactive element to be isolated. A soft, silvery-white metal, it reacts rapidly with oxygen and moisture in air, forming a white coating of actinium oxide that prevents further oxidation. One ton of natural uranium in ore contains about 0.2 milligrams of actinium-227. Owing to its scarcity, high price, and radioactivity, actinium has no significant industrial use.

of dementia. The researchers plan to continue to track the progression of subcortical disconnection, and look for changes in the patients over time.

The researchers concluded that sub-cortical disconnection is a key mechanism of vascular cognitive disorder. The result is a breakdown of communication in the large-scale cognitive neural networks of the brain.

Senior author of the study, Dorothee P. Auer, PhD, University of Nottingham, said, “Using standard clinical brain MRI, we found that microscopic damage of main white matter tracts allowed us to distinguish patients with symptomatic carotid artery disease and cognitive impairment from those who were cognitively intact. Our findings mean that a simple MRI test might improve the diagnostic work-up of people with suspected vascular cognitive disorder, and holds further promise to track progression of the disorder”.

Image: The topography of chronic ischemic lesions related to global cognitive impairment (A), and the topography of chronic ischemic lesions related to impaired fluency (B) (Photo courtesy of RSNA).

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DIGITAL RECORDER

MAMMOGRAPHY SYSTEM

Fujifilm

Ampronix

Villa Sistemi Medicali

The FCR PRIMA Tm can process 73 images per hour and 40 mammography images per hour. Being a fully digital reader, it does not require a darkroom or automatic processor, and its light and compact tabletop design allows the instrument to be placed on a desk, shelf or limited space.

The ChromaPaxx 17C2D4G160HD integrates a 17-inch display and digital recorder to capture video/images via S-Video or Composite and record in three formats. It is suitable for recording/displaying videos and images for endoscopy, surgical applications, and X-ray procedures.

The Melody IIID TS is equipped with an automatic collimator specifically designed for tomosynthesis to ensure more accurate detection of tumors and lesions, especially in patients with dense breast tissue. It uses an anti-scattering grid for allowing dose reduction even during tomosynthesis.

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New Digital Radiography Product Innovations new comprehensive Digital Radiography (DR) portfolio was introduced at the annual American Healthcare Radiology Administrators (AHRA 2016) meeting in Nashville, Tennessee, USA. The new DR equipment was developed by Fujifilm Medical Systems U.S.A. (Stamford, CT, USA; www.fujifilmusa.com) and includes the FDR D-EVO GL system, the world’s first longlength DR detector that can acquire fast, longlength, low-dose, single-exposure radiography exams of patients with conditions such as scoliosis. The system features a 17x49” field-ofview requires only a single exposure and reduces the chance of movement artifacts, and is more efficient than existing multi-exposure DR equipment. When compared to conventional Computed Tomography (CR) equipment, the detector of the FDR D-EVO GL system uses less radiation dose, and does not require CR processing steps.

Another innovation showcased at the AHRA meeting by Fujifilm Medical Systems was the Virtual Grid, a second-generation grid simula-

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tion image processing system. The Virtual Grid can adapt image contrast and improve image quality for acquired images without a grid, by interpreting and correcting radiation scatter effects. The Virtual Grid is intended for both DR and CR imaging systems. The Virtual Grid makes the detector lighter detector and enables technologist to perform exams faster, and position patients more easily. The system has a 50% lower dose than imaging exams performed with a grid.

Director of strategic marketing in the Digital Radiography and Women’s Health group of Fujifilm Medical Systems U.S.A., Rob Fabrizio, said, “Our participation at AHRA 2016 will extend well beyond the walls of our booth, offering radiology professionals valuable information, insights and experience that they can take back to their facilities to improve department processes and patient outcomes.”

Image: The FDR D-EVO GL system, the world’s first long-length DR detector (Photo courtesy of Fujifilm).

Trained Radiologists Can Detect Breast Cancer in An Instant esearchers at Brigham and Women’s Hospital (BWH; Boston, AM, USA; www. brighamandwomens.org), the University of York (United Kingdom; www.york.ac.uk), and other institutions showed radiologists mammograms for half a second, and found that they could identify abnormal mammograms at better than chance levels. They further tested this ability through a series of four experiments to explore what signal may alert radiologists to the presence of a possible abnormality, in the hopes of using these insights to improve breast cancer screening and early detection.

They found that radiologist performance did not depend on detection of breaks in the normal symmetry of left and right breasts. Moreover, above-

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chance classification is possible using images from the normal breast of a patient, even when overt signs of cancer are present only in the other breast.

They speculate that parts of the parenchyma that do not contain a lesion, or that are in the contralateral breast, confer an abnormal ‘gist’ that may be based on a widely distributed image statistic that is learned by experts. The study was published on August 29, 2016, in Proceedings of the National Academy of Sciences (PNAS).

“Radiologists can have ‘hunches’ after a first look at a mammogram. We found that these hunches are based on something real in the images. It’s really striking that in the blink of an eye, an expert can pick up on something about that mammogram that indicates abnormality,” said senior author Jere-

my Wolfe, PhD, director of the Visual Attention Laboratory at BWH. “Not only that, but they can detect something abnormal in the other breast, the breast that does not contain a lesion. Radiologists may be picking up on some sort of early, global signal of abnormality that is unknown to us at this point.”

According to the researchers, defining the signal that experienced radiologists are detecting could help researchers refine and improve computer-aided detection (CAD) systems that can aid in medical screening and could be incorporated into clinician training to improve detection rates. The researchers are also interested in exploring whether other medical image experts, such as dermatologists and pathologists, can use analogous signals.

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Medical Imaging International

Narrow Band Imaging Can Reduce Bladder Tumor Recurrence new study concludes that narrow band imaging (NBI) technology can significantly reduce the risk of bladder tumor recurrence.

Researchers at Harasanshin Hospital (Fukuoka, Japan; www.harasanshin. or.jp), the University of Birmingham (UK; www.birmingham.ac.uk), and other institutions conducted a randomized study in 965 patients with primary non–muscle-invasive bladder cancer following transurethral resection of bladder tumor (TURBT). The patients were randomized to NBI compared to white light (WL) guidance, the established imaging modality for TURBT. The primary outcome was 12-month bladder tumor recurrence rates.

The results showed WL-assisted TURBT recurrence rates of 27.1% and NBI-assisted TURBT recurrence rates of 25.4%. In patients at low risk for disease recurrence, recurrence rates at 12 months were significantly

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higher in the WL group (27.3%) than in the NBI group (5.6%). Although TURBT took longer on average with NBI plus WL compared with WL alone, lesions were significantly more often visible. The study was published on April 24, 2106, in European Urology.

“Narrow band imaging makes it easier to identify bladder tumors. It can detect small bladder tumors that might otherwise by overlooked by more conventional ‘white light’ cystoscopy,” said study co-author Richard Bryan, MD, PhD, of the University of Birmingham. “My colleague, Mike Wallace, and I immediately saw the potential of this technology. Now this potential has been confirmed by a large international randomized controlled trial, and the results can only be good news for bladder cancer patients worldwide.”

NBI technology, developed by Olympus Medical Systems (Tokyo, Japan; www.olympus-global.com), is

a powerful optical enhancement technology that improves the visibility of blood vessels and other structures on the bladder mucosa by illuminating them with two specific wavelengths strongly absorbed by hemoglobin. The shorter wavelength (415 nm) only penetrates the top layer of the mucosa, and shows up as

brown on the NBI image, The longer wavelength (540 nm) is absorbed by blood vessels located deeper within the mucosal layer, and appears cyan on the NBI image.

Image: A comparison of white light to narrow band imaging (Photo courtesy of Olympus Medical Systems).

Neuro-Imaging Offers Potential For Determining the Underlying Pathology of Concussions hree-dimensional (3D) Magnetic Resonance (MRI) Diffusion-Tensor Images (DTI) of the brain are changing neurosurgical care of patients with Traumatic Brain Injuries (TBI), Mild TBI, or brain tumors, and could also be used for printing 3D functional models of the brain.

Two recent studies have found that MRI-DTI can be used to find the underlying pathology of concussion injuries, and provide prognoses for TBI and MTBI patients to help those most at risk for persistent, long-term problems. One of the studies found that women have a higher risk of negative long-term effects of head injuries than men. The researchers also found evidence of microstructural damage to white matter in the brains of women with concussion injuries and a worse cognitive performance than in men with similar injuries.

The researchers also found that MRIDTI can play a significant role in preoperative mapping of the brain of brain tumor patients, and change their neurosurgical care.

Researchers at the Albert Einstein College of Medicine and Montefiore Medical Center (New York, NY, USA; www.einstein.yu.edu/departments/

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medicine) and at the Medical College of Wisconsin (Milwaukee, WI, USA; www.mcw.edu/MCW) carried out the studies.

John. L. Ulmer, MD, Medical College of Wisconsin, said, “The mapping depicts individual white matter tracts, which aid surgeons in safely resecting and removing brain tumors.

Using standard imaging alone is insufficient in determining the relationship of the brain tumor to any of the given white matter networks around it. Because white matter is difficult to identify anatomically during surgery surgeons often cannot tell which white matter tract controls critical functional areas such as motor skills, language, vision and memory. DTI creates a color-coded image of the brain that establishes functional network resection boundaries around the tumor. Preoperative DTI helps the surgeon avoid injuring eloquent brain networks when taking tumors out. A next step in preoperative neurosurgery is adapting 3D functional brain printing to provide neurosurgeons with a 3D perspective of the critical functional white matter network relationships as well as an educational tool during consultations with brain tumor patients.

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CT SYSTEM

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C.R. Bard

Siemens Healthineers

Fujifilm

The Site-Rite Prevue+ is designed to assist in the successful placement of peripheral IV catheters. It aids the assessment of peripheral vasculature prior to attempted access, in order to help identify the vessel and anatomical location that needs to be accessed.

The Biograph RT Pro edition is built upon the Somatom Definition CT platform to provide temporal and high-contrast CT resolution for RT planning. It provides sharper clinical images with enhanced tumor boundary definition to allow physicians to visualize metabolically active areas of tumors.

The FDR D-EVO GL DR detector features a longlength field of view to enhance efficiency, image quality and dose for upright exams. The detector complements its single exposure acquisition with ISS technology and noise reduction circuitry to produce clear, sharp images at a low dose.

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Wrist MR Imaging System Receives European CE Mark novel hand and wrist Magnetic Resonance Imaging (MRI) system has received CE Mark (Conformité Européenne) approval for the European market.

The WristView imaging was developed by Aspect Imaging (Tel Aviv, Israel; www.aspectimaging.com). The company designs and develops compact MR imaging and Nuclear Magnetic Resonance (NMR) systems for preclinical and medical applications.

WristView does not require cooling systems, or a special shielding room, costs less, and requires less training than a full-body MRI scanner. WristView uses a 1-T permanent magnet, and is optimized for hand and wrist applications, in terms of its design and bore size. The system requires very little maintenance, and has an extremely low-level external magnetic field, allowing it to be used anywhere in a hospital or research center. The CE Mark now enables the company to sell the scanner in Australia, New Zealand, Eastern Europe, and some Asian countries.

Founder and CEO of Aspect Imaging, Uri Rapoport, said, “We are thrilled to bring our MR imaging solutions to a wider international audience. Europe makes up a large percentage of the global market for this product in particular, and we’re extremely excited to now have the ability to introduce our system there. We encourage all people suffering from rheumatoid arthritis and carpal tunnel syndrome to demand that their condition be diagnosed with MRI.”

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Image: The WristView MRI system (Photo courtesy of Aspect Imaging).

New High-Resolution Digital X-Ray Detectors Announced new 43 x 43 cm digital detector intended for use in room-based X-Ray systems is now available for general and pediatric dose-sensitive applications, and for use with gadolinium (GOS), and cesium (CsI) scintillators.

Carestream Health (Rochester, NY, USA; www. carestream.com) developed the detectors, which are intended for use with their DRX-Evolution Plus, DRX-Ascend digital X-Ray systems, the DRX-Revolution mobile imaging system, and for the tabletop.

The detectors feature rapid imaging, higher Detective Quantum Efficiency (DQE), a lower radiation dose, and adhere to the IPX Level 7 rating, and IEC standard 60529 for water resistance when submerged for up to 30 minutes in one meter of water.

The detectors are also lighter and have a thinner

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profile than previous versions, and feature bi-color LEDs for feedback on detector status, and a fast frame rate.

The detectors systems also feature a beam detect mode, intended for room retrofits that enables the use of the detector without a cable connection to the generator. Image capture begins automatically when the detector senses exposure to X-Rays.

Sarah Verna, Global Marketing Manager for XRay Solutions at Carestream Health, said, “We have modified the Buckys in our room-based systems to accept the larger-format DRX detectors. These detectors are ideal for chest X-rays, extremity exams

and general radiography imaging studies and also can be used for bariatric patients.”

Image: The wireless DRX Plus 4343 detector (Photo courtesy of Carestream Health).

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Medical Imaging International

Sentinel Lymph Node Tracer Maps Breast Cancer Metastasis new study describes how a novel sentinel lymph node (SLN) radiotracer helps determine breast cancer spread by targeting a specific antigen.

Researchers at Beijing Cancer Hospital (BJC; Beijing, China; www. bjcancer.org) and Peking University Cancer Hospital & Institute (Beijing, China) conducted a retrospective study of 2,317 patients with primary breast cancer who underwent lymphoscintigraphy and sentinel lymph node biopsy (SLNB). Before imaging, all patients were administered a preoperative peritumoral injection of 37 MBq of 99mTc-rituximab, a new SLN radiotracer that binds to the antigen CD20, which is expressed extensively in lymph nodes.

Initial results in 100 randomly selected patients showed that the detection rate for SLN by injection of Tc99m-rituximab, as verified by lym-

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phoscintigraphy, was 100%. SLNs from the 100 patients were then harvested, guided by a hand-held gamma-detecting probe, and biopsied with a similar success rate of 100%.

When examining results of the other 2,217 patients in the study, the detection rate was 98.8% percent for lymphoscintigraphy and 99.9 % for SLN biopsy. The study was published in the August 2016 issue of The Journal of Nuclear Medicine.

“The advantage of Tc-99m-rituximab is its uniform molecular weight and molecular size. It does not escape easily from SLNs to the second echelon lymph nodes,” said senior author Zhi Yang, PhD, chair of the department of nuclear medicine at BJC. “This results in clear SLN imaging in patients and the high success rate of lymphoscintigraphy. In addition, technical factors, such as the injection dose, injection volume and injection

Nano-Based Masks Increase Radiation Therapy Comfort ew immobilization masks made from nano-enhanced thermoplastic sheets can reduce pressure on the face during radiation therapy (RT).

The Orfit (Wijnegem, Belgium; www.orfit.com) hybrid head masks are made by interweaving natural nano-clay into the inner layers of a proprietary thermoplastic material called Nanor to provide improved mechanical properties and thinner masks with less shrinkage, since the thermoplastic masks shrink when they cool on the patient during positioning.

This provides enhanced patient comfort, in particular since the patient tends to swell during the course of RT. The reduction of shrinkage provides the degree of comfort required to minimize patient movement during the delivery of the radiation dose.

Laboratory tests have shown a reduction of fixation force when using the hybrid immobilization head masks, making patient immobilization easier and contributing to patient comfort, and ultimately to the effectiveness of RT. The tests also revealed that the reinforced Nanor thermoplastics have a higher bending modulus, allowing for a reduction of the thickness of the immobilization masks to 1.2 and 1.6 mm instead of 2 and 3.2mm of regular masks, while maintaining identical mechanical properties.

Orfit also supplies the HP PRO So-

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lution, an immobilization device designed for brain and head and neck treatments in both photon and proton therapy, which makes use of ultra-thin Nanor masks. The solution includes a homogeneous low-density immobilization board with a narrow carbon fiber base plate in the head and neck area, allowing for closer range positioning of the RT device. The lightweight base plate also has good dosimetric properties. The Nanor masks are affixed with a patented mechanism that locks the mask profile onto the base plate.

“Ensuring patient comfort has always been and continues to be one of our major priorities. We firmly believe that theOrfit HP Pro Solution, used in combination with our nanotechnology-based masks, will help alleviate discomfort and anxiety, which is especially important when treating children,” said Steven Cuypers, CEO of Orfit.

Reproducible positioning of the patient over multiple rounds of RT demands reliable immobilization for an accurate and consistent treatment setup. The use of low-temperature thermoplastic materials molded over the patient’s head effectively immobilizes movement, reducing the amount of time that it may take to receive RT and minimizing unwanted side effects such as damage to the skin, the upper digestive tract, and rampant caries due to damage to saliva glands.

site, can be well controlled.”

Lymph nodes serve as biologic filters that contain immune cells to fight infection and clean the blood.

When cancer cells break away from a tumor, they can travel through the lymph system; sentinel node surgery allows the surgeon to remove the nodes to determine cancer spread.

Since human lymph nodes are only a half-centimeter in size, they are difficult to discern among the surround-

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ing tissue during surgery. Furthermore, even when surgeons are able to map the location of the nodes, there is no current technique that indicates whether or not the lymph nodes contain cancer, requiring removal of more lymph nodes than necessary.

Image: A sentinel node biopsy for breast cancer diagnosis (Photo courtesy of CancerQuest).

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ULTRASOUND SYSTEM

DR TABLET

CapeRay

Mindray

Canon

The Aceso dual-modality system combines fullfield digital mammography (FFDM) and 3D automated breast ultrasound (ABUS) for improved diagnostic accuracy of cancer in dense breast tissue. It offers lower radiation exposure for patients, as well as reduced breast compression.

The M6 is configured with the full range transducers, advanced clinical functions, and intelligent measurement tools for accurate scanning and diagnosis. It features automatic measurement, intelligent workflow, onboard software and flexible connectivity solutions for reducing repetitive steps.

The DR Tablet solution comprises a tablet, CXDI wireless DR System, and CXDI control software NE. The tablet's Wi-Fi capability allows end-users to communicate with the CXDI detector and the DICOM network, while simultaneously sending previous images to PACS.

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Ultrasound Method Could Increase Understanding of Cancer Cells and Metastases esearchers have discovered a new ultrasound method, called isoacoustic focusing, that can be used to analyze and separate cells from blood. The new method developed at Lund University (Lund, Sweden; www.lunduniversity.lu.se) and Massachusetts Institute of Technology (MIT; Boston, MA, USA; http://web.mit.edu) exposes cells to ultrasound as they flow through a micro-channel inside a chip, and causes them to separate. The lateral movement of the cells enables the researchers to identify their acoustic properties, and could be used to detect the cell type, and distinguish between cancer cells of different origins.

The study was published in the May 2016, issue of the online journal Nature Communications. The method could be used to measure the variation in the number of tumor cells in time and help determine whether medication can be effective in treatment or not.

Per Augustsson, Department of Biomedical Engineering, Lund University (Lund, Sweden; www.lunduniversity.lu.se), said, “The vision is that our innovation will eventually be used in healthcare facilities, for example, to count and distinguish different types of cells in patients’ blood. It may seem odd that we are interested in the acoustic properties of blood cells and cancer cells. But we have been searching for new methods to separate cells in order to study them

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Image: New ultrasound iso-acoustic technology could help increase awareness about the spread of cancer cells and metastases (Photo courtesy of Nature Communications / Lund University).

in more detail. Since we are looking for individual cells in a blood sample which contains billions of cells, the smallest overlap in size between the cancer cell and other blood cells will lead to thousands of blood cells ‘contaminating’ the cancer cells extracted through the separation. This is why we have now developed iso-acoustic focusing.”

Cardiac MRI Can Predict Future Heart Failure new study suggests that magnetic resonance imaging (MRI) can be used after a heart attack to monitor heart muscle bleeding, which happens in phases. Researchers at the University of Glasgow (United Kingdom; www.gla.ac.uk) used MRI and computer techniques to generate three-dimensional (3D) images of models of both healthy and injured beating hearts. They used the same methods to scan heart-attack patients two days, three months, and one year after the attack. The data was then used to create computer models that can predict potential bleeding in the heart, based on information from MRI scans.

The models showed that the bleeding in the heart occurs in two phases, the first 12 hours after a heart attack and the second 2-3 days later. Essentiality, the researchers claim that an MRI scan following a heart attack could be used to monitor

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bleeding from the heart, providing a window of opportunity to introduce treatments to stop the second phase, which can help to reduce or even prevent later heart failure. The study was presented at the British Cardiovascular Conference, held during June 2016 in Manchester (United Kingdom).

“This research has provided us with a new understanding of heart muscle injury and how it develops. We can now focus our research on developing new treatments to reduce the level of this injury following a heart attack,” said lead author Professor Colin Berry, MD. “The study has also presented a new way of identifying those at a higher risk of heart failure before the condition develops.

This knowledge can be used to identify those most in need of interventions and monitoring earlier.”

“Heart failure is an incurable condition which is associated with a reduced quality of life and a lower

life expectancy. This exciting research has found a new characteristic related to heart attacks which could be used to treat people following a heart attack, to cut their risk of developing heart failure,” said Professor Jeremy Pearson, MD, associate medical director at the British Heart Foundation (Birmingham, United Kingdom; www.bhf.org.uk), which funded the study. “The British Heart Foundation is committed to funding research to cure heart failure, but this study represents a promising new opportunity to develop new treatments to prevent the onset of heart failure and reduce the burden of the disease.”

Bleeding (or bruising) in the heart affects more than 40% of heart-attack patients, and is associated with a 2.6 times greater risk of adverse remodeling, which is a precursor to heart failure. It is also linked to a six times greater risk of either death or heart failure following a heart attack.

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Small Novel MRI Scanner Unveiled US partnership has unveiled a new compact 3T Magnetic Resonance Imaging (MRI) scanner intended for investigational research.

The scanner, the only one of its kind, was developed as part of a US National Institutes of Health (NIH) Bioengineering Research Partnership.

General Electric (GE) Global Research (Niskayuna, NY, USA; www. geglobalresearch.com) and the Mayo Clinic (Rochester, MN, USA; www. mayoclinic.org) developed the scanner. The scanner was designed specifically for imaging of the head, wrists, ankles, and feet, and other small extremities. Approximately 45% of the MRI scans at the Mayo Clinic are for the imaging of the head and small ex-

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tremities. The system is installed at the Mayo Clinic Rochester, Minnesota, campus in the USA. One aim of the new design was to improve the MRI experience for patients. The scanner allows patients undergoing a scan to keep their arms and torso completely outside of the MRI magnet. A scan in an existing whole-body scanner requires the patient to lie on a table that enters the magnet of the MRI machine, and patients, especially those with claustrophobia, are not comfortable with the procedure.

The new system also features a new prototype magnet that is around one-third the size of magnets in existing MRI scanners. In addition, the compact scanner requires only a

small fraction of the helium cooling liquid required today. Because of its size, the new scanner needs less floor space for installation, has lower electrical power consumption, and a sig-

Medical Imaging International

nificantly faster scanning speed. Initial imaging has shown that it can be used for advanced applications such as functional MRI, diffusion MRI, and MR Elastography.

Study Reveals Link Between Biomarkers and Heart Disease in Male HIV Patients esults of a new Computed Tomography (CT) imaging study of male Human Immunodeficiency Virus (HIV) patients show a link between an increased prevalence of Coronary Artery Disease (CAD), and higher inflammatory biomarkers.

The results of the study were published in the June 27, 2016, issue of the Journal of the American Heart Association (JAHA). The study included 925 men, including 575 men with HIV. The researchers used CT angiography imaging to look for signs of subclinical CAD, and for the presence of seven inflammatory biomarkers. CAD includes narrowed arteries, and various changes in the characteristics of plaque deposits. The study was carried out by researchers at the Keck School of Medicine, University of California (UC; Los Angeles, CA, USA; www. universityofcalifornia.edu), Johns Hopkins University (Baltimore, MD, USA; www.jhu.edu) and five additional institutions. CT imaging enabled researchers to detect subclinical CAD, before clinical symptoms became apparent and provided more inflammatory markers than in previous studies.

Research team leader Hossein Bahrami, MD, PhD, said, “We found that men infected with HIV had higher levels of inflammatory biomarkers than men who were not infected.

There was a strong, independent association between the presence of these inflammatory biomarkers and

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Image: The compact 3T, a research prototype, is intended for imaging the head and small extremities (Photo courtesy of the Mayo Clinic).

subclinical CAD detected by CT scan.

Although this study does not definitely prove the causal relationship between these markers and heart disease, it is suggestive of a possible role that persistent inflammation (even in HIV infected patients that are under appropriate treatments) may play in increasing the risk of heart disease in these patients. Inflammation has only recently been studied as a possible reason for chronic heart disease. Confirming the relationship between HIVrelated inflammation and the marked increase of CAD among men infected with HIV allows us to move forward in our attempts to better manage the health of these patients according to their specific medical needs.�

Image: Cardiac CT scans have revealed a link between higher inflammatory biomarkers and heart disease in male HIV Patients (Photo courtesy of the Multicenter AIDS Cohort Study).

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DIGITAL X-RAY SYSTEM

POC ULTRASOUND

Vinno Technology

Fujifilm

SonoSite

The VINNO M80 ob/gyn system uses a powerful 3D/4D rendering engine for fast and accurate volume data acquisition and rendering. It offers a wide suite of 3D/4D tools and comes with an extended-range control panel and monitor featuring tablet-like touch interface for smart navigation.

The FDR Visionary Suite combines a wide range of applications targeted to improve diagnostic capability, and a precise design to facilitate imaging.

Its unique image processing functions enhance quality while reducing dose rate, offering ease of operation with minimal impact for patients.

The iVIZ features a lightweight design with onehanded fit and control for easy maneuvering at the patient’s side, in transport with the patient, or for home visits. It comes with a 7-inch high-resolution touch screen, thumb-operated user interface, and integrated Wi-Fi and Bluetooth connectivity.

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High-Capacity Cyclotron System Introduced new compact high-capacity cyclotron system has been launched at the annual meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI 2016) in San Diego, CA, USA. Cyclotrons are used for the production of radionuclides for Positron Emission Tomography (PET) imaging procedures. The new cyclotron has an increased production capacity, and is more compact than previous models, with a footprint of less than 100 square meters. The system was designed for high-performance and reliability, and has a self-shielding option.

The Cyclone KIUBE 18MeV cyclotron was developed by Ion Beam Applications (IBA; Louvain-La-Neuve, Belgium; www.iba-worldwide.com), the world’s largest proton therapy and radiopharmacy solutions provider.

The production capacity of the new Cyclone KIUBE can be increased in steps to 20 curie of 18F in a two hour run. The first Cyclone KIUBE system is being installed at the University Hospital of Brussels (UZ Brussel; Brussels, Belgium; www.uzbrussel.be/u/view).

Bruno Scutnaire, president of IBA RadioPharma Solutions, said, “It has been demonstrated that 18 MeV is the optimal particle energy for the highest production of most of PET radioisotopes. The Cyclone KIUBE is producing the widest range of PET radioisotopes and covers all the needs of PET radiopharmacies, including 68Ga liquid (IBA process patented) and also made for production of SPECT 99mTc”.

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Image: The Cyclone KIUBE 18MeV cyclotron (Photo courtesy of IBA).

Sonoporation Could Double Survival Time for Pancreatic Cancer Patients esearchers have shown that ultrasound can enhance the ability of tumor cells in pancreatic patients to absorb chemotherapeutics, nearly double the median survival time from diagnosis, and cause recession of tumors.

The researchers in Norway combined ‘sonoporation’, an ultrasound technique, with the Gemcitabine chemotherapy. Sonoporation increases the porosity of pancreatic cells using microbubbles, and this enables the chemotherapy drug to enter into cancer cells.

The research results were presented at the May 2016 meeting of the Acoustical Society of America (Salt Lake City, Utah, USA; http://acousticalsociety.org) by researchers from the Haukeland University Hospital (Bergen, Norway; www.helse-bergen.no). The phase I clinical trial included 10 pancreatic cancer patients currently undergoing treatment. The microbubbles undergo inertial cavitation and this creates minute pores in a cell allowing a higher concentration of drugs to enter.

The researchers found that the new technique could nearly double the median survival time of the patients from seven to 18 months, using the same chemotherapy dosage, without any additional toxicity or side effects. As a next step the researchers plan to perform a larger-scale phase I/II clinical trial, and develop a microbubble compound for targeted drug-delivery with low acoustic intensities.

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Image: In the new technique, an ultrasound wave excites a microbubble and this increases drug uptake (Photo courtesy of S. Kotopoulis / Haukeland University Hospital, Norway).

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Medical Imaging International

Faster Mid-Range Ultrasound System Launched n innovative ultrasound system that features a new user interface, faster exam workflows, improved performance and image quality, and many additional features compared to previous system from the same family, has been launched.

The system was designed to provide advanced imaging solutions and shared services for general ultrasound imaging, internal medicine, and ob-

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stetrics & gynecology (OB/GYN) and cardiology specializations. The system features a high frame rate, new adaptive post-processing with an increased signal-to-noise ratio, more gray scales, and HD digital beamforming from near to far-field zone.

The E-CUBE 11 is the latest system in the E-CUBE family and was developed by Alpinion Medical Systems (Seoul, Korea; www.alpinion.com), a global ultrasound manufacturer that

Multi-Contrast MRI Technique Reduces Scan Times n innovative multi-contrast magnetic resonance imaging (MRI) technique can manipulate scans retrospectively, leading to significant timesaving and fewer rescans.

The MAGnetic resonance image Compilation (MAGiC) acquisition technique allows clinicians to modify image contrast after scanning has been completed, which is not possible with conventional imaging. While with conventional MR imaging, a radiologist may need to order a rescan if the proper contrast was not acquired, MAGiC allows the radiologist to view multiple different contrasts acquired from just a single scan, enhance differential diagnosis at a fraction of the scan time, improving patient throughput and comfort.

Clinicians will be able to generate multiple image contrasts in T1, T2,

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STIR, T1 FLAIR, T2 FLAIR, Dual IR, Phase Sensitive IR, and Proton Density weighted images of the brain, all in a single acquisition. To change contrast, users simply move a cursor on the interface to change parameters, such as repetition time (TR), echo time (TE), and inversion time (TI).

MAGiC can also generate parametric maps for further analysis of patientspecific tissue values like T1, T2, and proton density (PD). MAGiC was developed by GE Healthcare (Waukesha, WI, USA; www.gehealthcare. com), in collaboration with SyntheticMR (Linköping, Sweden; www. syntheticmr.com).

“MAGiC is a terrific clinical innovation…this technique can improve the way clinicians conduct neuro scans and diagnose their patients,” said Eric Stahre, president and CEO of MRI at GE Healthcare.

provides innovative medical ultrasound transducers, therapeutic and diagnostic ultrasound systems (US-guided HIFU), as well as complete ultrasound solutions.

The new 10.4-inch touch screen and programmable keys provide a 28% shorter exam time, and an average of 35% less keystrokes. Another usability feature of the E-CUBE 11 is that it requires less repetitive movements to operate than previous versions. The system includes an Intel Core i7 Central Processing Unit (CPU) and an integrated Solid-State Drive (SSD). The system uses Alpinions’ Crystal Signature Technology, a new adaptive imaging algorithm, and has enhanced digital signal processing capabilities. The new features provide improved detail including clearer border definitions, and an improved ability to discern tissue details.

Image: The user controls and display of the E-Cube 11 ultrasound system (Photo courtesy of Alpinion Medical Systems).

Annual Screening Adequate for Follow-Up of Non-Solid Lung Nodules esearchers have shown that an annual low-dose Computed-Tomography (CT) scan may be sufficient for follow-up for non-solid lung nodules.

Current follow-up procedures for Non-Solid Nodules (NSN) include biopsies or surgery. NSN are mostly asymptomatic lung growths and are only rarely life-threatening. The nodules are being found more frequently in the US because of recent national guidelines that recommend annual lung-cancer screening exams for longtime smokers.

The study was published on July 5, 2016, in the online issue of the journal Radiology. The researchers used data from the large-scale International Early Lung Cancer Program (I-ELCAP) and tried to validate findings from an earlier study with data from the US National Lung Screening

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Medical Imaging International November-December/2016

Trial (NLST). The NLST trial compared lung cancer detection using chest X-Rays and low-dose CT. Co-author of the study, Claudia I. Henschke, MD, PhD, Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital (ISMMS; New York, NK, USA; http://icahn. mssm.edu), said, “When you biopsy a nonsolid nodule, it’s usually pre-malignant, noninvasive, or due to some other cause like infection or fibrosis.

We think that we have enough data now to say that these nodules can safely be followed by annual CT scans and do not have to be biopsied or treated right away. Survival remains 100 percent as long as the nodules remain nonsolid, and for those that ultimately do progress, the oneyear follow-up interval is short enough that they still remain entirely curable.”

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MR Imaging Technique Promises More Reliable Cancer Screening and Diagnosis

MRI Data Shows Human Brain Can Reverse Effects of Schizophrenia

project to develop a novel advanced medical imaging technology is intended to enable earlier detection of cancer, increase survival rates, and allow for a patients’ full recovery. The new imaging technology is intended to provide more reliable and less invasive cancer diagnosis based on a novel Magnetic Resonance Imaging (MRI) technique that could lead to gamechanging diagnostic tools for cancer imaging, and enable personalized cancer treatment.

The European Union (EU)-funded GlucoCEST Imaging of Neoplastic Tumours (GLINT) project began in January 2016, and makes use of a technique called glucose-based Chemical Exchange Saturation Transfer (glucoCEST). The technique can be used to detect the massive native glucose uptake in tumors as they grow.

Scientific Coordinator of GLINT, and inventor of the glucoCEST method Professor Xavier Golay, University College London (London, UK; www.ucl.ac.uk), said, “GLINT offers for the first time a possibility to bring to the clinics a muchtouted new imaging technique, allowing to directly image by MRI native, nonlabeled glucose the way PET does it using the expensive radio-labeled sugar analogue fluorodeoxyglucose (FDG). This represents among others a huge hope for pediatric patients and for everyone required to undergo continuous surveillance of cancer progression. It also carries the hope to reduce or at least significantly limit the costs of diagnostic cancer imaging.”

he results of an international study indicate that the brains of schizophrenia patients can heal, and can reorganize and fight the disease.

Schizophrenia is associated a widespread reduction in the volume of brain tissue, but there is also a small increase in brain tissue in other regions.

The researchers were able to record this increase using Magnetic Resonance Imaging (MRI) covariance analysis. The researchers enrolled 98 schizophrenia patients, and 83 control patients without the disease.

The research was published in a study entitled ‘Dynamic cerebral reorganization in the pathophysiology of schizophrenia: a MRI-derived cortical thickness study’ that was published online on May 26, 2016, in the journal Psychological Medicine. The research was carried out by scientists at the Robarts Research Institute, Western University (London, ON, Canada; www.robarts.ca) University of Nottingham, (Nottingham, UK; www.nottingham.ac.uk), and in universities and institutes in China, and one institute in Canada.

The results showed that a reduction in cortical thickness in the brain was accompanied by increased thickness in distributed regions of the brain, and that there was reduced deviation from the control patients with increasing duration of the illness.

The researchers concluded that subtle reorganization of the cerebrum indicates that the brain has an inherent plasticity that may occur in parallel with tissue reduction in adult schizophrenia patients.

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Research Suggests A Better Approach to Breast Cancer Screening esearchers are unhappy with current models for determining mammography screening risk/benefit ratios, and suggest that the measurement of Quality-Adjusted Life-Years (QALYs) gained, when breast cancer is prevented, could be more accurate.

Researchers in Norway found that there were large uncertainties in the evaluation a long running breast cancer screening program in the country, especially in the estimates of over-diagnoses.

The researchers from the Department of Screening at the Cancer Registry of Norway (Oslo, Norway; www.kreftregisteret.no/en) studied the benefit/detriment ratio estimates of the Norwegian Breast Cancer Screening Program (NBCSP) in 2015, and presented the results at the annual meeting of the Radiological Society of North America

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(RSNA 2015). The results were published in the March 2016, issue of the Journal of Medical Screening. Under the program, all women aged 50 to 69 receive an invitation for screening every two years. The Research Council of Norway also evaluated the screening program between 2007 and 2015.

According to the researchers, the range of estimates varies widely and needs to be interpreted carefully before publication. In addition the estimates include two different variables that are not comparable – lives saved and cases of over-diagnosis. The researchers found that the program saved about one life per 1-2 women with epidemiologic over-diagnosis. The researchers suggest that using a simple risk/benefit ratio could be misleading. Instead, they propose the use of Quality-Adjusted

Life-Years (QALYs) gained when breast cancer is prevented, compared to QALYs lost in cases of over diagnosis.

Solveig Hofvind, PhD, researcher, Department of Screening, Cancer Registry of Norway, said, “Our research demonstrates that it’s very difficult to find clear numbers to show the risk/benefit ratio of mammography screening. The range is so wide and it depends on so many different factors, that it’s important to understand the screening logistics and the epidemiology in order to choose the right model to estimate such a ratio. In any event, if a patient asks for information about risk/benefit ratios, that information should be shared and interpreted with substantial. I know women may ask about this ratio and we have to be prepared to give them information with the best knowledge we have today.”

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IT/PACS Update

Computer Program Bests Radiologists at Analyzing Brain MRI new study that matched two physicians against a computer algorithm in analysis of magnetic resonance imaging (MRI) brain scans found the program was nearly twice as accurate.

Researchers at Case Western Reserve University (CWRU; Cleveland, OH, USA; www.case.edu) and the University of Texas Southwestern Medical Center (Dallas, TX, USA; www.utsouthwestern.edu) conducted a study to determine the feasibility of using computer-extracted texture features to differentiate between radiation necrosis and recurrent brain tumors on post-radiochemotherapy MRI scans. In all, 58 patient scans were used, with 43 forming the training cohort for the algorithm and 15 forming the test cohort.

A set of radiomic features was extracted for every lesion on each MRI sequence – gadolinium T1WI, T2WI, and FLAIR. Feature selection was used to identify the top five most discriminating features for every MRI sequence on the training cohort. These features were then evaluated on the test cohort by a support vector machine classifier.

The classification performance was compared against diagnostic reads by two expert neuroradiologists, who had access to the same MRI sequences as the classifier. Finally, clinical histologic findings were confirmed by an experienced neuropathologist.

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The results revealed that in the direct comparison, one neuroradiologist diagnosed seven patients correctly, and the second physician correctly diagnosed eight patients. The computer program, on the other hand, was correct on 12 of the 15 MRI scans. The researchers are now seeking to validate the algorithms’ accuracy using a much larger collection of images from across different sites, so that it could eventually be used as a decision support tool to assist neuroradiologists in improving their confidence in identifying a suspicious lesion. The study was published on September 15, 2016, in the American Journal of Neuroradiology.

“One of the biggest challenges with the evaluation of brain tumor treatment is distinguishing between the confounding effects of radiation and cancer recurrence; on an MRI, they look very similar,” said lead author biomedical engineer Pallavi Tiwari, PhD, of CWRU. “What the algorithms see that the radiologists don’t are the subtle differences in quantitative measurements of tumor heterogeneity and breakdown in microarchitecture on MRI, which are higher for tumor recurrence.”

“While the physicians use the intensity of pixels on MRI scans as a guide, the computer looks at the edges of each pixel; if the edges all point to the same direction, the architecture is preserved,”

added senior author professor of biomedical engineering Anant Madabhushi, PHD, director of the CWRU Center of Computational Imaging and Personalized Diagnostics. “If they point in different directions, the architecture is disrupted – the entropy, or disorder, and heterogeneity are higher.”

In a recent competition at the 2016 International Symposium of Biomedical Imaging (ISBI), held during April in Prague (Czech Republic), a machine-learning computer algorithm that was trained to recognize breast cancer metastasis in lymph nodes identified correctly 92% percent of the time, nearly matching the 96% success rate of a human pathologist.

Image: A computer program beats radiologists in MRI analysis (Photo courtesy of CWRU).

Oncology Management Platform Reaches International Milestone n enterprise-wide image management Vendor Neutral Archive (VNA) has reached an important sales milestone, with the installation of over 300 systems at oncology sites around the world. The VNA manages all DICOM (Digital Imaging and Communications in Medicine) and non-DICOM clinical oncology department data used in the treatment of cancer patients. The data includes radiology diagnostic images, radiation treatment plans, and other clinical data. The oncology facilities that use the Synapse VNA interface more than 800 linear accelerators (linacs).

Fujifilm Medical Systems U.S.A. (Stamford, CT, USA; www.fujifilmusa. com) developed the Synapse VNA technology interface. The company is also a leading worldwide provider of diagnostic imaging products, and medical informatics solutions, including digital X-Ray systems, Radiology Information Systems (RIS), the Synapse PACS (Picture Archiving and Communication System), cardiovascular products, and advanced imaging systems for the women’s health market.

VP of Fujifilm Medical Systems

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TeraMedica Division USA, Greg Strowig, said, “Fujifilm truly dominates the oncology VNA space both for our innovative technology and also our knowledge of what it takes to deliver better cancer care. Cancer centers across the globe have turned to us because of our unparalleled experience with the management of cancer treatment data.”

Image: The Synapse VNA is provides medical image and information management for enterprises (Photo courtesy of Fujifilm).

Medical Imaging International November-December/2016

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The lifeIMAGE 5.0 platform allows clinicians to quickly gain access and compare data from a number of locations internal and external to the hospital. It allows physicians in multiple locations to simultaneously review and annotate diagnosticquality images.

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Google DeepMind to Explore Streamlining Radiotherapy Planning collaboration between Google DeepMind (London, UK; https://deepmind.com) and England’s National Health Service (NHS, London; www.nhs.uk) will evaluate the potential for machine learning in making radiotherapy (RT) planning more efficient.

The collaboration will be through a partnership with University College London Hospital (UCLH; United Kingdom; www.uclh.nhs.uk), and will involve analysis of many as 700 former head and neck cancer patients, with the hope that artificial intelligence (AI) machine learning could decrease segmentation process time from four hours to just one. According to DeepMind, the project could also lead to the development of a RT segmentation algorithm with potential applications beyond head and neck cancers.

“Developing machine learning which can automatically differentiate between cancerous and healthy tissue on radiotherapy scans will assist clinicians in planning radiotherapy treatment,” said Yen-Ching Chang, MD, clinical lead for radiotherapy at UCLH. “This has the potential to free up cli-

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nicians to spend even more time on patient care, education and research, all of which would be to the benefit of our patients and the populations we serve.”

“This real-world application of artificial intelligence technology is exactly why we set up DeepMind. We’re incredibly excited to be working with the radiotherapy team at UCLH to explore how AI can help to reduce the time it takes to plan radiotherapy treatment for head and neck cancer patients,” said Mustafa Suleyman, co-founder and head of applied AI at Google DeepMind. “We hope this work could lead to real benefits for cancer patients across the country and for the clinicians who treat them.”

DeepMind is a AI company founded in September 2010 which created a neural network that can able to access an external memory like a conventional Turing machine, resulting in a computer that mimics the short-term memory of the human brain;

it was acquired by Google in 2014. In July 2016, Google DeepMind partnered with Moorfields Eye Hospital (London, United Kingdom; www. moorfields.nhs.uk) in a project designed to use AI for the early detection and treatment of preventable eye diseases by analyzing retinal scans.

Image: Google’s DeepMind has the capacity to build an artificial intelligence computer that mimics the human brain (Photo courtesy of Google DeepMind).

Radiation Dose Management System Improves Patient Care novel web-based management system uses Microsoft cloud technology to track, analyze, and report practice-level radiation dose data.

The GE Healthcare (GE, Little Chalfont, United Kingdom; www.gehealthcare.com) DoseWatch Explore is a cloud-based radiation dose management software suite that tracks, analyzes, and reports practice-level radiation dose data for GE computed tomography (CT) systems. Using Microsoft (Mountain View, CA, USA; www.microsoft.com) Azure cloud technology and GE’s InSite connection, DoseWatch Explore collects radiation data directly from the CT scanner; no additional hardware integration, infrastructure, or installation is required.

The dose management solution helps clinicians

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quantify the CT systems’ practice-level radiation dose using protocol parameters determined per exam/per device, enabling the development of individual dose management practices, while at the same time improving patient radiation dose levels during diagnostic imaging procedures. The solution this offers clinicians a new level of data analysis, utilizing familiar, browser-based tools and technology with the scale, cost-efficiency, and ease-of-deployment provided by cloud infrastructure.

“Patient safety is at the heart of dose management and is a big driver for why we created this solution,” said Agnes Berzsenyi, VP and general manager of product management for global services at GE Healthcare. “For healthcare clinicians interested in managing radiation dose for CT,

DoseWatch Explore is a perfect entry-level dose management solution that harnesses the power of data, analytics, and software to help clinicians achieve optimal dose levels and provide better patient care.”

“DoseWatch Explore is a great example of how integrated device, software and cloud platform solutions seamlessly work together to deliver practical, actionable insights to health organizations,” said Neil Jordan, general manager of worldwide health at Microsoft. “Azure provides industry-leading security features and complies with a number of global, regional, and industry-specific standards and regulations, enabling providers using DoseWatch Explore to focus on their primary objective – improving patient health.”

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Industry News

Global Imaging Equipment Market to Exceed USD 45 Billion by 2023 he global medical imaging equipment market is expected to grow at an average annual rate of 5.6% from USD 29.4 billion in 2015 to USD 45.3 billion by 2023, driven by developments in computer-aided detection (CAD) and 3D imaging technologies. These are the findings of Persistence Market Research Pvt. Ltd. (New York, NY, USA; www.persistencemarketresearch.com), a supplier of market intelligence reports and consulting services. Increased global demand for diagnosis and diagnostic equipment owing to rising incidences of respiratory, orthopedic, and cardiovascular diseases will further drive the market growth.

Based on product type, the global medical imaging equipment market is divided into X-ray devices, ultrasound devices, magnetic resonance imaging (MRI) equipment, computed tomography (CT) scanners and nuclear imaging equipment. In 2015, X-ray devices and ultrasound devices together accounted for around 50% of the total market share. There has been an increase in the demand for technologically advanced X-ray systems due to growing demand for bedside monitoring and a higher number of patients being treated through urgent care centers and emergency medical services. The growth in the sluggish mature X-ray imaging equipment segment has been further aided by digital X-ray systems, which have revolutionized X-ray imaging.

In 2015, the global portable X-ray devices market held a share of more than 40% in the X-ray devices market. Portable X-ray devices have high adoption rates, especially in emergency departments and ICUs, and are rapidly replacing stationary X-ray equipment due to the shift in user preference towards bedside imaging.

Moreover, the rising trend of home healthcare is also leading to sales of stationary X-ray equipment slowing down.

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Mallinckrodt to Sell Nuclear Imaging Business for USD 690 Million allinckrodt plc (Dublin, Ireland; www. mallinckrodt.com) has entered into a definitive agreement to sell its nuclear imaging business to IBA Molecular (IBAM) (Sterling, VA, USA; www. ibamolecular.com) for approximately USD 690 million.

Mallinckrodt develops, manufactures, markets and distributes specialty pharmaceutical and biopharmaceutical products and therapies, while its nuclear imaging business includes diagnostic imaging products. The company is a global producer of the key medical isotope molybdenum-99, from which technetium-99m is derived for use in roughly 80% of all nuclear medicine procedures worldwide. IBAM is a global manufacturer and distributor of radiopharmaceutical products with a product portfolio and pipeline of diagnostic and therapeutic

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tracers, and is active in the PET and SPECT segments.

"Mallinckrodt's Nuclear Imaging operation has a long history going back 50 years, and has been a strong cash-generating business over time. Our team has made significant progress in driving profitability over the past few years," said Mark Trudeau, President and Chief Executive Officer of Mallinckrodt.

Renaud Dehareng, Chief Executive Officer of IBAM, said, "We are very excited about this acquisition. IBAM's and Mallinckrodt's Nuclear Imaging business' complementary footprint and capabilities will substantially broaden our ability to serve patients globally. We are very pleased to welcome our new colleagues to IBAM upon closing and look forward to working together in this next chapter of our company's development."

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

JANUARY 2017 IRIA 2017 - 70th Annual Conference of Indian Radiological & Imaging Association (IRIA). Jan 5-8; Jaipur, India; Web: www.iria.in/index.php Breast Imaging in the Caribbean. Jan 912; Punta Mita, Mexico; Web: www. pennmedicine.org 2017 Gastrointestinal Cancers Symposium. Jan 19-21; San Francisco, CA, USA; Web: http://gicasym.org Arab Health 2017. Jan 30-Feb 2; Dubai, UAE; Web: www.arabhealthonline.com

FEBRUARY 2017 SPIE Medical Imaging 2017. Feb 11-16; Orlando, FL, USA; Web: http://spie.org/ medical-imaging.xml 9th German Cardio Diagnostics Days with 10th Noninvasive Cardiovascular Imaging Symposium. Feb 23-25; Leipzig, Germany; Web: www.kardiodiagnostik.de

MARCH 2017 ECR 2017 – European Congress of Radiology. Mar 1-5; Vienna, Austria; Web: www.myesr.org SIR 2017 - 42nd Annual Scientific Meeting - Society of Interventional Radiology. Mar 4-9; Washington, DC, USA; www.sirweb.org KIMES 2017. Mar 16-19; Seoul, Korea; Web: www.kimes.kr AIUM 2017 – The American Institute of Ultrasound in Medicine. Mar 25-29;

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MAY 2017 SPR 2017 – Society for Pediatric Radiology. May 16-20; British Columbia, Canada; Web: www.pedrad.org

JUNE 2017 19th Annual International Symposium on Multidetector-Row CT. Jun 4-7; San Francisco, CA, USA; Web: http://isct.org Swiss Congress of Radiology 2017. Jun 8-10; Bern, Switzerland; Web: www.radiologiekongress.ch UK Radiological Congress 2017. Jun 12-14; Manchester, UK; Web: www. ukrc.org.uk 2017 World Congress Thoracic Imaging Meeting. Jun 15-16; Beverly, MA, USA; Web: http://fleischnersociety.org 4th World Congress of Thoracic Imaging 2017. Jun 18-21; Boston, MA, USA; Web: www.myesti.org ESGAR 2017 - European Society Of Gastrointestinal And Abdominal Radiology. Jun 20-23; Athens, Greece; Web: www.esgar.org CARS 2017 - Computer Assisted Radiology and Surgery. Jun 20-24; Barcelona, Spain; Web: www.cars-int.org Nordic Congress of Radiology. Jun 29-Jul 1; Reykjavík, Iceland; Web: www.ncr2017.is

AUGUST 2017 FIME 2017. Aug 1-3; Miami, FL, USA; Web: www.fimeshow.com ESC 2017 - European Society of cardiology Congress. Aug 26-Sep 30; Barcelona, Spain; Web: www.escardio.org 44th Annual Meeting and Muscu-

loskeletal Imaging Course: Fundamentals to Advanced Concepts. Aug 30-Sep 1; New York, NY, USA; Web: http://internationalskeletalsociety.com

SEPTEMBER 2017 ESUR 2017- European Symposium on Urogenital Radiology. Sep 14-17; Bordeaux, France; Web: www.esur.org 27th World Congress on Ultrasound in Obstetrics and Gynecology. Sep 1720; Vienna, Austria; Web: www.isuog.org Euroson 2017 – Congress of the European Federation of Societies for Ultrasound. Sep 22-25; Antalya, Turkey; Web: www.efsumb.org

OCTOBER 2017 WFUMB 2017- World Federation for Ultrasound in Medicine and Biology. Oct 13-17; Taipei, Taiwan; Web: www.wfumb.org ESMRMB 2017- Annual Scientific Meeting. Oct 19-21; Barcelona, ES; Web: www. esmrmb-eventcalendar.org 6th International Conference on Radiology and Imaging. Oct 23-25; Chicago, USA; Web: www.radiology.conferenceseries.com Society of Radiologists in Ultrasound (SRU) Annual Meeting. Oct 27-29; Chicago, IL; Web: http://www.sru.org 25th UEG Week – United European Gastroenterology. Oct 28-Nov 1; Barcelona, Spain; Web: www.ueg.eu

NOVEMBER 2017 RSNA 2017 – 103rd Meeting of Radiology Society of North America. Nov 26-Dec 1; Chicago, IL, USA; Web: www.rsna.org

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35

Medical Imaging International November-December/2016

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Vol. 26 No.6 11-12/ 2016

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