Medical Imaging International June 2016 by Globetech

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Vol.26 No.3 5-6/2016 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 2-29 PACS/ IT Update . . 30-31 Product News . . . . . 8-30 Industry News . . . . . . 33 International Calendar . 34

Medical Imaging International

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Intelligent Imaging System Assists Mammography Technologists novel mammography system with intelligent image processing supports healthcare professionals in the early detection and diagnosis of breast cancer. The Aspire Cristalle is an advanced digital mammography system that optimizes image contrast and dose across all breast types, thanks to a combination of hexagonal close pattern (HCP) capture technology and intelligent image processing, resulting in a reduced acquisition time of 15 seconds. Images are enhanced by intelligent automatic exposure control (iAEC) and image based spectrum conversion (ISC), which analyze the breast for glandular tissue characteristics, detect implants to optimize dose and processing, and precisely tune contrast to adapt for every breast type and to image implants. Simplicity of operation allows reliable exams quickly and easily, starting from a simple one-button

startup to a patented comfort paddle equipped with soft edges, a flexible composition, and a four-way pivot that contours to the individual shape of the breast, in order to apply a gentle, even compression that results in optimal tissue separation. The Aspire Cristalle system is a product of Fujifilm Medical Systems (Tokyo, Japan; www.fujifilm.com/products/ medical), and was designed to provide an upgrade path to future technologies. “Fujifilm is constantly innovating to develop the most advanced digital mammography systems to assist in the early detection of breast cancer,” commented Timothy Gustafson, RT, director of the imaging service at White Memorial Medical Center (Los Angeles, CA, USA). “Aspire Cristalle brings together Fujifilm’s extensive research, expertise, and experience. The technology allows us to continue our mission, providing comprehensive cancer care

for our community, combining sophisticated technology with a warm, caring touch.” HCP is based on hexagonal pixels distributed in the electrical field, which are more efficient than traditional, square pixels; this results in a strong, homogenous signal that provides images with high detective quantum efficiency (DQE) and modulation transfer function (MTF), which delivers exceptionally sharp images, even at low dose, with a small (50 micrometer) pixel size. Image: The Aspire Cristalle digital mammography system (Photo courtesy of Fujifilm).

New Drying Cloth For Transesophageal Ultrasound Probes novel irradiated cloth features a super adsorbent matrix and an ultra-smooth surface for enhanced drying following disinfection and rinse. The CS Medical (Creedmoor, NC, USA; www.csmedicalllc.com) QwikDry transesophageal echo (TEE) ultrasound probe drying cloth is designed to effectively remove moisture from probes at the conclusion of high-level disinfection and rinse with the TD 100 automated TEE probe disinfector, and prior to reuse or storage. Once the disinfected TEE probe is removed from the TD 100, the QwikDry cloth is applied to the insertion shaft to absorb any residual moisture. Each lint-free QwikDry is individually packaged in an easy to open Chevron pouch. The cloth was developed since a wet probe, stored in a plastic sheath or hung freely for drying, can allow airborne contaminates to foster growth of spores and bacteria, while other drying methods, such as a reusable sponge, paper towel, cotton cloth, or surgical gauze – though effective in the drying of a TEE probe – could introduce outside contaminates. A sponge, for example could foster spore and bacteria growth while a towel, cloth, or gauze could contain contaminates introduced during the manufacturing or handling process prior to being used. TEE is an alternative method to perform an echocardiogram, using a specialized probe containing an ultrasound transducer at its tip passed into the patient’s esophagus. Unlike standard echocardiography, the transducer is close to the upper chambers of the heart, and thus very clear images of the heart structures and valves can be obtained. TEE is often used in people with a thicker chest wall, in the obese, and to provide information during surgery to repair heart valves, a tear in the aorta, or congenital heart lesions.

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Optical System Reconstructs Virtual 3D Spinal Column novel diagnostic system offers stereo-radiographic imaging and three dimensional (3D) modeling tools particularly suited to orthopedic applications. The Biomod 3S system uses noninvasive optical information technology that is combined with classic two-dimensional (2D) radiographic images of the spine to yield a virtually reconstructed 3D model of the vertebral column that can provide clinicians with complete view of the patient’s spine. This allows a thorough and accurate evaluation of spinal deformities in diverse pathologies, such as scoliosis, kyphosis, vertebral compression, posture and balance anomalies, and dorsopathy, among others. The optical acquisition is realized simultaneously with frontal and sagittal full spine X-rays obtained from an existing radiological set-up, and therefore does not require any change in clinical routine or increased radiation exposure. Patented software performs an automatic correction of patient’s sway during acquisition, thus providing a complete evaluation of the spine and the posture in a minimum time input, with an average spinal reconstruction taking about five minutes. The Biomod 3S system was developed by AXS Medical, a division of Diagnostic Medical Systems (DMS; Mauguio, France; www.dms.com). The technology has also been adopted by Toshiba Medical Systems Europe (TMSE; www.toshibamedical.eu) for OrthoMod 3D spinal imaging technology in order to provide information on rotations

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Cover Image: Courtesy of Tera Recon Dan Gueron Publisher Andrew Deutsch News Editor Joseph Ciprut Assistant Editor Brenda Silva New Products Editor Theresa Herman Regional Director Dr. Jutta Ciolek Regional Director Parker Xu Regional Director Katsuhiro Ishii Regional Director Arda Turac Production Director

and twists in the spine that are not possible to evaluate in a traditional 2D setup. Before OrthoMod 3D, getting 3D information usually meant relying on a supplemental computerized tomography (CT) or magnetic resonance imaging (MRI) scan, which implied further radiation exposure. “The new spinal imaging solution is extremely accessible and it can be easily integrated into an existing R/F or RAD suite equipped with digital full spine,” said René Degros, business unit manager for X-Ray with TMSE. “It is particularly suited for practices focusing on radiology, pediatrics, orthopedics, and ambulatory surgery.” Image: The Biomod 3S system (Phoro courtesy of AXS Medical/DMS).

New MRI Technology Uses Krypton Gas as Contrast Agent new magnetic resonance imaging (MRI) scanning technology that uses Krypton gas as an inhalable contrast agent could provide insights on lung disease. Under development by researchers at the University of Nottingham (United Kingdom; www. nottingham.ac.uk), the novel technique uses lasers to hyperpolarize the nuclei of a noble gas, aligning them so that the inert gas becomes visible on an MRI scan. While traditional MRI uses hydrogen protons in the body as molecular targets, this does not give a detailed picture of the lungs, since they are full of air. The new technique will make three-dimensional (3D) imaging of the lungs possible, and could also be used with other inhaled, hyperpolarized, noble gases, such as helium and xenon-129. The new method is made possible via catalytic hydrogen combustion, a process associated with clean energy related sciences. In the process, krypton-83 gas is mixed with molecular hydrogen as the buffer in laser spin-exchange optical pumping (SEOP). After laser pumping, the hydrogen gas is mixed with molecular oxygen, “exploding” it away in a controlled fashion via catalyzed combustion, leaving behind high-purity, hyperpolarized krypton gas. The study describing the catalytic process was

published on March 9, 2016, in the Proceedings of the National Academy of Sciences of the United States of America (PNAS). “Remarkably, the hyperpolarized state of krypton-83 ‘survives’ the combustion event. Water vapor, the sole product of the ‘clean’ hydrogen reaction, is easily removed through condensation, leaving behind the purified laser-polarized krypton-83 gas diluted only by small remaining quantities of harmless water vapor,” said senior author Prof. Thomas Meersmann, PhD, chair of translational imaging. “This development significantly improves the potential usefulness of laser-pumped krypton-83 as MRI contrast agent for clinical applications.” The hyperpolarized state is very low spin temperature condition that is not in a thermal equilibrium with the temperature of the sample. Low spin temperature leads to high magnetization of the spin ensemble, which results in a very high nuclear magnetic resonance signal intensity. This eventually returns to the depolarized thermal equilibrium temperature. Of the quadrupolar noble gas isotopes, krypton-83 is most likely to serve as a surface sensitive MRI contrast agent, since it displays a slower relaxation compared to xenon as a result of its smaller electron cloud and its larger nuclear spin.

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Medical Imaging International May-June/2016

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Medical Imaging International

3D Extremity System Up for FDA Clearance leading imaging vendor has filed a 510(k) application with the US FDA for clearance of its Cone-Beam Computed Tomography (CBCT). The system is designed to capture weightbearing and other types of 3D diagnostic images of extremities including knees, legs, feet, arms, and hands. The images are intended for orthopedic and sports medicine practices and institutions, including hospitals, urgent care facilities, and imaging centers. Carestream Health (Rochester, NY, USA; www. carestream.com), a worldwide provider of dental and medical imaging systems and IT solutions, developed the OnSight 3D Extremity System and is conducting trials and research studies of the system in the US and Europe. Carestream is conducting a clinical study together with UBMD Orthopaedics & Sports Medicine (Williamsville, NY, USA; www.ubortho.com) and US Erie County Medical Center (ECMC; Buf-

falo, NY, USA; www.ecmc.edu) that is designed to help orthopedic surgeons diagnose the degree of instability of the patella more accurately, and objectively. In Europe, HUS Medical Imaging Center (Helsinki, Finland; www.biomag.hus.fi) is performing the first European clinical study of the system, and will investigate its use for imaging bone fractures, bone structure, and the level of metal artifacts. The results of the clinical studies will be used to help Carestream design new orthopedic imaging systems that use less radiation than standard CT scanners. Helen Titus, Marketing Director, Worldwide CT and Ultrasound Solutions, at Carestream, said, “Orthopedic imaging is a major focus for Carestream because of the prevalence of musculoskeletal conditions among people of all ages. Youth and adults often suffer sports-related injuries to their knees, ankles and feet while older adults experience arthritis,

joint instability, meniscus loss and other conditions. Our goal is to offer a compact, affordable imaging system that enables a variety of healthcare providers to produce extremely high-quality 3D images of extremities including weight-bearing exams.” Image: The OnSight 3D extremity system provides high-quality, low-dose 3D images for use by orthopedic, sports medicine and other healthcare providers (Photo courtesy of Carestream Health).

Functional Brain Scans May Help Detect Autism in Adults n innovative computer algorithm could be the key to implement brain scans as a means to identify autism spectrum disorder (ASD), according to a new study. Developed at Advanced Telecommunications Research Institute International (Kyoto, Japan; www. atr.jp), and Brown University (Providence, RI, USA; www.brown.edu), the neuroimaging-based algorithm can classify different subject sets using functional magnetic resonance imaging (fMRI) to analyze thousands of brain network functional connections (FCs). When the researchers examined the scans of people with and without ASD, the algorithm found 16 key interregional FCs that allowed it to identify with high accuracy those who had been diagnosed with autism, and those who had not. The neuroimaging classifier, which blends two machine-learning algorithms, was first developed with the aid of 181 adult volunteers at three sites in Japan, and was then applied to a group of 88 American adults at seven sites; all the study volunteers with autism diagnoses had no intellectual disability. The classifier worked well in each population, averaging 85% accuracy among the Japanese volunteers and 75% accuracy in the Americans. The researchers calculated that the probability of such a degree of cross-population performance purely by chance was 1.4 in a million. To further validate the classifier, the researchers examined how it related to the Autism Diagnostic Observation Schedule (ADOS), a clinical tool based not on markers of biology or physiology, but instead on a doctor’s interviews and observations of behavior. They found that the 16 FCs identified by the classifier related to attributes of importance in ADOS. They also found that 41% of the specific brain regions in which the 16 FCs resided were within the cingulo-opercular network, which participates in the conceiving of other people, face processing, and emotional processing. The study was published on April 14, 2016, in Nature Communications.

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White Matter Hyperintensities Precede Alzheimer’s Onset new study suggests that autosomal dominant Alzheimer’s disease (AD) is associated with increased white matter hyperintensities (WMH) on magnetic resonance imaging (MRI), evident well before symptom onset. Researchers at Columbia University (New York, NY, USA; www.columbia.edu), Washington University School of Medicine (WUSTL; St. Louis, MO, USA; www.medschool.wustl.edu), and other institution participating in the Dominantly Inherited Alzheimer Network (DIAN; St. Louis, MO, USA; www.dian-info.org), conducted a study involving 299 participants (median age 39 years), including 184 who had a mutation that results in AD, and 115 of their first-degree relatives who served as non-carrier controls. The researchers than calculated the estimated years to AD from expected symptom onset by subtracting the affected parent’s symptom onset age from the participant’s age. Baseline MRI data were

also analyzed for total and regional WMH. The researchers found that mutation carriers had greater total WMH volumes, which increased approximately six years prior to expected symptom onset. The effects were most prominent for the parietal and occipital lobe, which showed divergent effects as early as 22 years prior to estimated onset. The study was published on March 26, 2016, in Annals of Neurology. “Autosomal dominant Alzheimer’s disease is associated with increased WMH well before expected symptom onset,” concluded lead author Seonjoo Lee, PhD, of Columbia University, and colleagues. “The findings suggest the possibility that WMH are a core feature of Alzheimer’s disease, a potential therapeutic target, and a factor that should be integrated into pathogenic models of the disease.” The white matter of the brain contains the neu-

ronal fibers that transmit information around the living brain. Historically, the vast majority of neuroscience research effort has been invested in understanding and studying gray matter and neurons, while white matter has received relatively little attention, largely due to the lack of effective research tools to study it, even though it comprises about half the volume of the brain. Image: The WMH in the brain of patient with Alzheimer’s disease (Photo courtesy of Adam Brickman / Columbia University).

HIFU System Submitted for FDA Approval n application for a next-generation non-invasive High-Intensity Focused Ultrasound (HIFU) device was submitted to the US Food and Drug Administration (FDA) in conjunction with a therapeutic ultrasound system. HIFU treatment is minimally invasive, and is an effective treatment option for prostatic tissue ablation. The treatment has minimal side effects, and is normally recommended for treatment of localized stage T1 and T2 prostate cancer. The applicant, [company name and info] had received a similar US FDA clearance for another robotic HIFU prostate tissue ablation system in 2015. The new robot-assisted Focal One HIFU device, the EDAP TMS (Paris, France; www.edap-tms.com) Focal One system, is intended for focal therapy of prostate cancer. The system already has the CE Mark (Conformité Européenne) for the European market. The non-invasive Focal One robot-assisted prostate tumorectomy device combines imaging and treatment technologies. The device provides focal therapy, Magnetic Resonance (MR)-fused imaging, precise and efficient therapeutic HIFU energy, and validation imaging using contrast-enhanced ultrasound when treatment is complete. Marc Oczachowski, CEO of EDAP, said, “We are pleased to submit our Focal One HIFU device file to the FDA to further our goal of making EDAP’s full range of HIFU products available to both urologists and patients in the U.S. There is a clear, growing demand from the worldwide urology community for non-invasive options for the ablation of prostatic tissue, and we are well positioned to address this market with our complementary Ablatherm and Focal One devices. We believe that HIFU has the potential to become a standard of

care tool for prostate ablation. We are extremely excited by the progress of the U.S. commercial launch of Ablatherm Robotic HIFU and look forward to working with the FDA on the clearance process for Focal One.” Image: The robot-assisted Focal One HIFU device (Photo courtesy of EDAP TMS).

Advanced Oncology Workflow Offers Improved Reading and Reporting for Cancer Patients new upgrade to an enterprise image management system offers clinicians an improved oncology reading workflow. The workflow includes new native tools for Positron Emission Tomography/Computed Tomography (PET/CT) studies, and provides quantitative and qualitative information to speed up and improve image reading. The new Carestream (Rochester, NY, USA; www.carestream.com) CT Perfusion and Subtraction modules include interactive tools for analyzing and comparing 3D, CT Perfusion (CTP), and Digital Subtraction Angiography (DSA) images. The modules

provide tissue perfusion and tissue blood volume data from CT brain perfusion scans, and a DSA workflow that can analyze vessel blockages using X-ray angiography (XA) subtraction. PET segmentation enables users to examine tumor Standardized Uptake Values (SUV) traces on a PET image to help detect early stage cancers. The Vue Reporting module can present interactive hyperlinks to critical images, and can automatically include quantitative analysis results as tables and charts. Vue Reporting also offers bookmarks and lesion management reporting that can be shared using the Vue Motion universal viewer. Ron Muscosky, worldwide clinical solutions

product line manager, said, “The latest upgrade for our enterprise image management platform incorporates advanced tools to aid in tumor detection and tracking. This can help radiologists deliver more meaningful reports while also enhancing collaboration with clinicians and patients. Traditional oncology features cannot adequately address the increased demand we can expect for long-term monitoring of oncology patients as the world’s population ages. And the recent announcement of Medicare payments for CT lung cancer screening can be expected to boost imaging volumes for current and former smokers.” Medical Imaging International May-June/2016

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Medical Imaging International

Medtronic CRT-D Devices Now Compatible with MRI nnovative cardiac resynchronization therapy defibrillators (CRT-Ds) now provide patients with access to advanced 3-Tesla magnetic resonance imaging (MRI) devices. The Medtronic (Dublin, Ireland; www.medtronic.com) Claria MRI Quad CRT-D SureScan, Amplia MRI Quad CRT-D SureScan, and Compia MRI Quad CRT-D SureScan line of CRT-Ds have received the European Community CE marking for 3-Tesla MRI scans without positioning restrictions. In addition to the full line of CRT-Ds, Medtronic MR-conditional cardiac rhythm, heart failure devices and leads, deep brain stimulation (DBS) neurostimulators, and spinal cord stimulators, previously approved for 1.5 Tesla are now approved for full body scans in both 1.5- and 3-Tesla MRI machines in Europe. As many as 40% of CRT patients will need an MRI within four years after receiving a device, but until the availability of MR-conditional CRT-Ds, patients with these devices were contraindicated from

undergoing MRI scans because of the potential interaction between the MRI machine and device functions, which could result in risk to the patient. This has prevented thousands of heart failure patients from receiving an MRI scan. â&#x20AC;&#x153;Medtronic is committed to providing patients with the most advanced MR-conditional technology available in cardiac rhythm and heart failure devices so they can have full access to essential MRI scans,â&#x20AC;? said David Steinhaus, MD, medical director for the cardiac rhythm and heart failure division at Medtronic. The Claria MRI CRT-D features the EffectivCRT Diagnostic and the EffectivCRT during AF algorithm, which automatically adjusts pacing rates, without adversely affecting the average heart rate. Claria MRI and Amplia MRI CRT-Ds also feature the Medtronic-exclusive AdaptivCRT algorithm,

which improves CRT response rate by 12% and reduces risk of atrial fibrillation (AF) by 46%, as compared to echo-optimized biventricular pacing. They also enable multiple point pacing, which can stimulate two sites on the left ventricle simultaneously. Image: The Amplia MRI and Claria MRI CRT-Ds (Photo courtesy of Medtronic).

Ultrasound System Provides Enhanced Elastography Functions n upgraded ultrasound system is now capable of providing both real-time tissue elastography (RTE) and point shear wave measurement (SWM) without changing probes. The upgraded ARIETTA V70 is a compact, lightweight ultrasound system with an ergonomic design that is equipped with multiple functions and a range of surgical transducers to support a variety of specific procedures in each diagnostic field. Multi-layered and single crystal technologies allow efficient transmission and reception of the ultrasound pulse with minimal energy loss, increasing both the sensitivity and clarity of the images. The use of symphonic technologies, from wave generation to image display, assures that all technologies are harmonized. The SWM feature automatically makes multiple shear wave propagation velocity (Vs) measurements within a region of Interest (ROI) with a single button press. An evaluation of the reliability of each Vs measurement is made, and the percentage of correctly detected measurements is displayed as the Vs efficacy rate (VsN). RTE relative tissue stiffness is measured by calculating tissue strain, which is induced by light vibration of the probe. An auto frame selection (AFS) algorithm and an assist strain ratio (ASR) function automatically locate the ROIs needed for fat lesion ratio, which enhances workflow and efficiency for breast elastography studies. The ARIETTA V70 also supports comprehensive diagnosis of diffuse liver disease via RTE, providing a liver fibrosis index measurement function (LF Index) which reflects the degree of fibrosis, and SWM, which reflect the degree of fibrosis, inflammation, congestion, and jaundice. RTE is also compatible with contrast-enhanced ultrasound, so that it can be used during surgery as a supplemental aid for the detection of additional lesions. The ARIETTA V70 is a product of Hitachi Aloka Medical (Tokyo, Japan; www.hitachi-aloka.co.jp).

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MEDICAL SHIELDING SYSTEM

MAMMOGRAPHY VIEWER

Aycan

ETS Lindgren

Fujifilm

The XRAY-PRINT is a plain paper print solution that is DICOM 3.0-compatible with PACS. The hardware and software have been optimized for medical images to achieve near-film quality prints, making it ideal for sharing radiological images with patients and referring physicians.

The SAFESCAN automated detection systems provide functional sensitivity to ferromagnetic material and come with both audio and visual indicators. They are ideal for detection in doorways and hallways inside an MRI area, and can be installed into any new or existing MRI suite.

The mammography viewer creates 3D images by using two high-resolution images taken from different angles with one being a conventional 2D image. The images are displayed on two high-definition monitors and a 3D image can be viewed by wearing polarized 3D glasses.

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Advanced Mobile Stroke Unit Offers CT Imaging Capabilities he world’s most comprehensive mobile stroke unit (MSU) has been equipped with a computerized tomography (CT) scanner capable of conducting and producing advanced quality imaging for stroke diagnosis and noninvasive imaging of blood vessels in the brain. The University of Tennessee (UT) College of Medicine (Memphis, USA; https://uthsc.edu/ Medicine) launched the MSU, the largest in the world, complete with an internal power source capable of matching regular electrical outlet access. Weighing in at more than 14 tons, it includes features and capabilities never before assembled for mobile deployment. These include a hospital-quality CT scanner with advanced imaging capabilities to not only allow brain imaging, but also high resolution CT-angiography, as it is equipped with a dedicated gantry that automatically moves the patient to obtain images. Due to the advanced imaging capabilities, the MSU can bypass hospital emergency departments (EDs) and take patients directly to an endovascular catheterization laboratory, the operating room, a hos-

pital stroke unit, or the neuro-intensive care unit. The MSU is staffed with fellowship-trained nurses certified as advanced neurovascular practitioners (ANVP-BC). The advanced CT capabilities will also help launch immediate treatment, including administration of tissue plasminogen activator (tPA) and the potent blood pressure drug nicardipine. “We are thrilled to have this medical first in Memphis. I want to stress that the Mobile Stroke Unit is a product of worldwide industry leaders brought together to create the first-of-its-kind vehicle,” said David Stern, MD, executive dean at the UT College of Medicine. “The goal of the mobile stroke unit is to minimize morbidity and mortality, to have more patients walk out of the hospital fully functional. Time is everything for stroke treatment; the quicker we are able to assess and attend to a patient, the better his or her chances are for recovery.” “The Mobile Stroke Unit will be based in the heart of a 10-mile, most critical needs areas of Memphis with the highest incidence of stroke, but can be deployed within the entire metro region,” said Andrei Alexandrov, MD, chairman of the de-

partment of neurology at The UT Health Science Center. “We estimate that 300 patients will need to be treated by the Mobile Stroke Unit to prove its effectiveness over the course of three years. Our goal is a sustainable model for future funding and an overall lowering of morbidity and mortality through early treatment.” Image: The interior of the MSU, with CT scanner (Photo courtesy of UT College of Medicine).

Innovation Initiative to Develop Artificial Intelligence X-Ray Engine newly-announced research initiative aims to develop an artificial intelligence engine that will be seamlessly incorporated into proprietary exam routing technology. The Singularity Healthcare initiative, launched in collaboration with the Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; http:// web.mit.edu) and Massachusetts General Hospital (MGH; Boston, MA, USA; www.massgeneral.org) will be used to instantly pre-read digital x-rays and identify potential areas of injury and disease, while continuously learning from IA’s expanding database of 7 billion images. The algorithm will be applied before X-Ray images are routed to one of the 500 board certified radiologists connected in the cloud to IA’s platform. “Inconsistency in testing and access to care con-

tribute significantly to one trillion of waste in the USD 2.8 trillion U.S. healthcare industry,” said Brian Hall, President and COO of Imaging Advantage. “If successful, Singularity will introduce a solution with potential to transform radiology by providing faster, more accurate and less expensive diagnostic testing, representing an indispensable innovation for radiologists.” “Given the advances in the field of artificial intelligence that have taken place at MIT and elsewhere, and Imaging Advantage’s scale, we are not only optimistic about a successful outcome, but expect it to be realized on an accelerated schedule,” said Professor SP Kothari, PhD, of the MIT Sloan School of Management. “The project is not only achievable, but also has potential to touch nearly every person in world. This is how we think artifi-

cial intelligence and deep learning should be developed and deployed.” “The proposed deep-learning solution combines all layers of machine learning into a single pipeline, and then optimizes and meshes with other machine-learning algorithms on top of it,” said electrical engineer Kalyan Veeramachaneni, PhD, of the MIT Institute for Data Systems and Society. “Starting this endeavor with the enormous trove of metadata in Imaging Advantage’s archives, we can learn how decisions made at the initial, raw representation stage impact the final predicted accuracy efficacy.” X-Ray exams constitute 50% of all radiology tests in healthcare, and radiology is the significant limiting factor in hospital emergency department (ED) patient flow and treatment. Medical Imaging International May-June/2016

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FDA Clearance for Three New Mobile C-Arms he US Food and Drug Administration (FDA; Silver Spring, MD USA; www. fda.gov) has cleared three new system models of an established family of mobile C-arms. The C-arm systems are made by a leading flatpanel detector manufacturer who also recently released a new upgraded version of another, premium mobile C-arm system. The Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com) Cios Fusion, Cios Select, and Cios Connect mobile C-arms use the same flat panel detectors as the existing Cios Alpha system. The Cios Fusion can use 30 cm x 30 cm, and 20 cm x 20 cm detectors and has most of the software and hardware features of the Cios Alpha, such as a touchscreen remote that can be used to control the C-arm inside

the sterile work area. All members of the Cios family of C-arms feature automatic dose-performance adjustment. The Cios Connect weighs just over 248 kilos, and can display individual images simultaneously in subtracted, and X-ray views to enable physicians to optimize the presentation of contrast and bone. The Cios Select is a new entry-level system with a push button interface for a simplified workflow, and uses the Intelligent Dose Efficiency Algorithm (IDEAL) image-processing algorithm for continuous contrast and brightness adjustments. The systems also feature updated software that provides a large preview image to help operating room staff select image settings, and a single-touch

metal correction function that enables the user to compensate for metal image components, and provides improved contrast for the representation of surrounding tissue. Martin B. Silverman, vice president X-ray Products, Siemens Healthcare, said, “With the addition of these three new mobile Carms to the Cios family, Siemens Healthcare is proud to build on our tradition of C-arm leadership. Our Cios family offers customers a complete product portfolio that meets their needs, regardless of facility type or budget. These expanded mobile C-arm offerings represent another example of how Siemens innovates to solve the daily real-world challenges facing hospitals and surgical centers.”

Rapid HDR Prostate Brachytherapy Treatment Requires Minimal Radiation Exposure new innovative radiation treatment for prostate cancer called High Dose Rate (HDR) prostate brachytherapy can deliver a precise radiation dose within several minutes, and is then removed immediately afterwards, minimizing potential side effects and damage to surrounding healthy tissue. The HDR brachytherapy treatment is a one-hour long outpatient procedure that includes a preliminary Computed Tomography (CT) scan, in-depth radiation treatment planning, and a personalized radiation dose delivered by a robotic system. The procedure is performed by a radiation oncologist together with an urologist. HDR brachytherapy can be combined a short course of external beam radiation, for more aggressive prostate cancers, so that a higher radiation dose can be delivered to the prostate gland. The Loyola University Medical Center (Maywood, IL, USA; http://loyola medicine.org) offers the new HDR procedure as well as radical prostatectomy, proton therapy, Image- Guided Intensity-Modulated Radiation Therapy (IMRT), and LDR brachytherapy. While each of the treatment methods has its advantages and disadvantages, and has been shown to be safe and effective, HDR brachytherapy is a cutting-edge treatment that is convenient, reliable, and customizable. Loyola radiation oncologist Abhishek Solanki, MD, said, “What sets HDR brachytherapy apart is the ability to sculpt the radiation dose to reliably avoid healthy organs, such as the bladder, rectum and urethra. Since the radiation source is removed immediately after completion of treatment, patients do not have to take radiation precautions after they leave the hospital.”

Medical Imaging International May-June/2016

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PRODUCT NEWS TOMOSYNTHESIS SYSTEM

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ULTRASOUND SYSTEM

CT SCANNER

GE Healthcare

Mindray Medical Imaging

Hitachi Aloka Medical

The SenoClaire 3D system uses a low-dose short X-ray sweep around the compressed breast with nine exposures to separate tissues and reduce the overlapping of structures. It delivers high DQE at low dose for visualizing microcalcifications without binning and its images are PACS-compatible.

The TE7 touch-enabled system supports rapid and confident evaluation in multiple point-of-care settings. The intuitive tablet-like operation, superior image quality with one-touch image optimization, and exam presets improve both diagnostic confidence and efficiency.

The SCENARIA scanner features a 0.35-second rotation speed which reduces kinetic artifact, exam time and contrast volume, while maintaining diagnostic imagery. It offers a maximum field of view of 500mm, up to 5660 view/rot high-speed data acquisition and a gantry aperture of 75cm.

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World’s First UHF Clinical Ultrasound System Receives Clearance

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Image: The Vevo MD ultrasound system (Photo courtesy of FUJIFILM VisualSonics)

first-of-a-kind UHF clinical ultrasound system has received FDA clearance after ten years of successful preclinical research.The system, which uses much higher frequencies than standard ultrasound systems in use today, and was first commercialized in Europe. The system provides image resolution down to 30 micrometers, and can use UHF transducers that work at frequencies up to 70 MHz. The FUJIFILM VisualSonics (Toronto, Canada; www.visualsonics. com) Vevo MD UHF system is compatible with FUJIFILM VisualSonics UHF series of transducers. UHF technology is intended for imaging small parts in the first 3 cm of the body, in fields such as neonatology, musculoskeletal and vascular imaging, and dermatology, and provides much higher resolution than conventional ultrasound systems. The company expects that the new technology will lead to new medical discoveries, and improved patient care.” Renaud Maloberti, VP and GM of FUJIFILM VisualSonics, said, “As the recognized leader in ultra-high frequency imaging systems, FUJIFILM VisualSonics is proud to be the first to market with unparalleled technology. With the Vevo MD, clinicians can observe the tiniest, most highly detailed anatomy that has never been seen before, which means greatly enhanced potential for diagnoses.”

Advanced 3D X-Ray Imaging Provides Insight into Progression of Idiopathic Pulmonary Fibrosis esearchers have used a novel and advanced 3D Computer Tomography (CT) imaging technique to follow the development of an aggressive deadly lung disease called Idiopathic Pulmonary Fibrosis (IPF). IPF is currently diagnosed using 2D CT scans or by taking a lung biopsy in hospital for investigation under an optical microscope. The new technique, originally designed for aircraft engineering, is used to carry out 3D scans of lung biopsy samples at a resolution similar to that of an optical microscope. The team from the UK National Institute for Health Research Southampton Respiratory Biomedical Research Unit (BRU), University of Southampton (Southampton, UK; www.uhs.nhs.uk/home.as-

px) used CT equipment at the μ-VIS Centre for Computed Tomography (Southampton, UK; www.southampton.ac.uk/muvis/index.page) to perform the Microfocus CT scans. The scan technique involves rotating the biopsy sample 360 degrees while making numerous 2D images, which are rendered into detailed 3D images. The results of the research were published in the April 21, 2016, issue of the journal JCI Insight. The incidence of IPF in the UK is increasing by 5% every year. In 2015 more than 5,000 new cases were diagnosed in the UK. One of the symptoms of patients with IPF, an interstitial lung disease, is difficulty breathing. The disease causes inflammation, and scarring of lung tissue, and patients have a life

expectancy of between three and five years. Lead author of the study, Dr. Mark Jones, University of Southampton, said, “Whilst accurate diagnosis of IPF is essential to start the correct treatment, in certain cases this can be extremely challenging to do using the tools currently available. This technology advance is very exciting as for the first time it gives us the chance to view lung biopsy samples in 3D. We think that the new information gained from seeing the lung in 3D has the potential to transform how diseases such as IPF are diagnosed. It will also help to increase our understanding of how these scarring lung diseases develop which we hope will ultimately mean better targeted treatments are developed for every patient.” Medical Imaging International May-June/2016

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Upgraded Ultrasound System Features Deep Learning Algorithm newly-introduced ultrasound upgrade raises the efficiency of radiologists by providing a deep learning algorithm and other imaging enhancements including CEUS (Contrastenhanced ultrasound) and fusion diagnostic imaging functions. The Samsung Medison (Seoul, Korea; www. samsungmedison.com) S-Detect for Breast upgrade for the premium RS80A with Prestige ultrasound system uses big data from many breast exams to provide the characteristics of displayed lesions and an analysis of whether a lesion is malignant or benign. The deep learning algorithm can improve the accuracy of diagnostic image analysis results by providing lesion characteristic analysis, seg-

mentation, and assessment. The RS80A with Prestige upgrade also includes an improved S-Fusion tool, CEUS+ with VesselMax and FlowMax tools for vessel and blood flow visualization, S-3D arterial analysis for 3D vessel imaging and simplified artery plaque volume. The new RS80A with Prestige upgrade is currently available in Europe, and the Middle East, and will be launched in China, Russia, and the Americas at a later date. Image: The RS80A with Prestige ultrasound system (Photo courtesy of Samsung Medison).

Highly-Sensitive Tracer to Assist MRI Scanners esearchers have revealed a new fluorine-based Magnetic Resonance Imaging (MRI) tracer that can efficiently track cells and molecules. The tracer will enable clinicians to track cells and visualize their behavior in living patients, and speed up the development of emerging treatments using stem cells and immune cells. The discovery was announced by researchers at the University of California, San Diego School of Medicine, (UCSD; San Diego, CA, USA; http://som.ucsd.edu), and published in the March, 14, 2016, online issue of Nature Materials. The researchers were able to synthesize a new cell-labeling probe using fluorine-19 that was taken up by targeted cells. The fluorine agent was then detected using an MRI scanner and allowed researchers to observe the movement of cells. The researchers increased the sensitivity of the agent by combining highly fluorinated nano-emulsions with magnetic properties of metals, and discovered that iron was effective at enhancing the signal of the fluorine MRI tracer. Iron is biologically friendlier and cheaper than gadolinium, a rare-earth metal used in proton MRI today. Senior author of the study, Eric T. Ahrens, PhD, professor of radiology, said,â&#x20AC;&#x153;Fluorine19 tracer agents are an emerging approach that produces positive signal hot-spot images with no background signal because thereâ&#x20AC;&#x2122;s virtually no fluorine concentration in tissues. We have made a major leap in sensitivity. We have figured out how to dissolve and encapsulate metals inside the fluorine-based droplets. The net effect is to greatly amp up the MRI signal. 19F MRI aided by iron represents a significant advance in tracking cells in many emerging therapeutic areas, such as immunotherapy, stem cells and treating inflammationâ&#x20AC;?.

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Medical Imaging International

PRODUCT NEWS FLAT PANEL DETECTOR

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X-RAY SYSTEM

CT SCANNER

Italray

Konica Minolta Medical Imaging

Philips Healthcare

The X-FRAME DR-EZ features an acquisition station, a battery-powered detector, and an access point that allows Wi-Fi communication between the two. It can be used inside traditional buckys and any analog X-ray room, and is mainly used as a DR upgrade for traditional analog X-ray.

The AeroDR X70 system with tilting wall stand and table bucky provides a flexible digital X-ray imaging solution. Featuring a cassette-sized, wireless flat panel detector, the system is designed to increase patient throughput in X-ray rooms.

The Ingenuity Flex32 offers thin reconstruction with improvement in Z-axis visualization and fast acquisition times. It improves image quality through artifact prevention and increased spatial resolution, and offers personalized image quality based on the patient’s needs at low dose.

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Functional Imaging Helps Test Spine Stability new functional imaging test called vertebral motion analysis (VMA) enables patients to demonstrate evidence of spinal instability. Developed by Ortho Kinematics (OKI; Austin, TX, USA; www.orthokinematics. com) VMA testing involves standard surgical C-arms to capture moving “video x-ray” images using fluoroscopy. The images are uploaded to online servers, where they are processed to yield motion measurements that can be used to assess spinal instability. The cloud-based system also provides access to the images and test results via any internet-connected computer, tablet, or smartphone, providing an online tool that makes consulting with patients and interacting with insurance companies much easier. The VMA lumbar spine quantitative fluoroscopy test takes about five minutes more than the standard 15-minute flex-ex test, but offers more robust data with less radiation exposure for both the patient and technologist. In peer-reviewed studies, VMA has been shown to be more accurate, repeatable, and five times more sensitive in detecting lumbar radiographic instability as compared to flexex testing, but just as specific. OKI has received U.S. Food and Drug Administration (FDA) and the European Community (CE) mark of approval for the VMA. Since the 1940s, traditional flex-ex testing has been the standard of care for assessing instability based on spine motion analysis. Flex-ex testing requires physicians to measure spine motion from x-rays by hand. The results are high-

ly variable, but because flex-ex data is so important, it is still ordered over five million times every year in the United States, more than spine computerized tomography (CT) and magnetic resonance imaging (MRI) imaging combined. Image: A patient undergoing vertebral motion analysis testing (Photo courtesy of Ortho Kinematics).

Radiation/Chemotherapy Combination Ups Glioma Survival Rates atients with a low-grade glioma who received radiation therapy (RT) plus chemotherapy experienced a longer progression-free survival and overall survival than patients who received RT alone, according to a new study. Researchers at the Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org), Emory University (Atlanta, GA, USA; www.emory.edu) and other institutions conducted a study involving 251 patients with grade 2 astrocytoma, oligoastrocytoma, or oligodendroglioma who were younger than 40 and had undergone subtotal resection or biopsy, or who were 40 years or older and had undergone biopsy or resection of any of the tumor. The patients were randomly assigned to RT alone or to radiation therapy followed by six cycles of a combination chemotherapy that included procarbazine, lomustine, and vincristine (PCV).

The results showed that at a median follow-up time of 11.9 years, 67% of all enrolled patients were identified as having tumor progression, and 55% of the patients had died. Patients in the RT plus PCV chemotherapy arm had longer median survival times, compared with those who received RT alone (13.3 versus 7.8 years, respectively). Median progression- free survival time for patients receiving RT plus PCV chemotherapy was longer as well (10.4 years), compared to RT alone (four years). In addition, 10-year progression-free survival rates for patients in the RT plus PCV chemotherapy arm were 51%, compared to 21% percent in the RT alone arm. For both progression-free survival and overall survival distributions, a difference between treatment arms became apparent only after two to four years following randomization. The favorable prognostic variables identified for survival included

being in the radiation plus PCV chemotherapy arm and oligodendroglioma histology. The study was published on April 7, 2016, in the New England Journal of Medicine (NEJM). “Our results indicate that initial radiation therapy followed by PCV is necessary to achieve longer survival in patients with grade 2 glioma, and that salvage therapy at relapse after radiation therapy alone is less effective,” said lead author oncologist Jan Buckner, MD, chair of the department of oncology at the Mayo Clinic Cancer Center. “Radiation therapy plus PCV appears to represent the most effective treatment identified to date for the majority of patients with grade 2 glioma.” Grade 2 gliomas are relatively uncommon, constituting 5%–10% of all primary brain tumors in adults. They occur most commonly in young adults, and cause progressive neurologic deterioration and premature death. Medical Imaging International May-June/2016

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Medical Imaging International

New Reagent Helps Map Neural Connections in Brain n improved rabies virus tracer visualizes neural circuitry in the brain, helping to understand more about motor diseases and neurodevelopmental disorders. Researchers at the Salk Institute for Biological Studies (La Jolla, CA, USA; www.salk.edu) have engineered an optimized glycoprotein (OG) variant of the monosynaptic rabies virus (MRV) system that improves transsynaptic efficiency. The new approach is based on a genetic modification of the virus that allows infection to be targeted to specific types of neurons, thus allowing virus spread to be controlled. The result is that while neurons are illuminated across the entire brain, the tracer reagent illuminates only those that are directly connected to neurons of interest. The oG variant is a codon-optimized chimeric glycoprotein that merges the transmembrane-cytoplasmic domain of the B19G rabies virus, and the extracellular domain of the Pasteur virus strain glycoprotein. The resulting oG variant increases tracing efficiency for long-distance input neurons by up to 20-fold – when compared to B19G alone – allowing more

complete study of monosynaptic input neural networks in the brain. The study describing the improved technique was published on April 14, 2016, in Cell Reports. “To truly understand brain function, we have to understand how different types of neurons are connected to each other across many distant brain areas. The rabies tracing methods we have developed made that possible, but we were only labeling a fraction of all of the connections,” said senior author Professor Edward Callaway, PhD, who developed MRV. “Such a dramatic improvement in a critical tool for neuroscience will help researchers illuminate aspects of brain disorders where connectivity and global processing goes awry, such as in autism and schizophrenia.” “With this new rabies tracer, we can visualize connectivity neuron by neuron, and across long distance input neurons better than with previous rabies tracers,” said lead author Euiseok Kim, PhD, of the Salk systems neurobiology laboratories. “Although this improved version is much better, there are still opportunities to improve the rabies tracer fur-

ther as we continue to examine other rabies strains.” The MRV system, developed in 2007 and refined by Professor Callaway and other researchers for targeting specific cell types in 2010, uses a modified version of the rabies virus to infect a brain region. When the system is applied in genetic mouse models, researchers can see specifically how sensory, motor, and reward structures in the brain connect to

medium spiny neurons (MSNs) in the basal ganglia. There are two major projection cell types in the striatum of neurons that target downstream basal ganglia and have opposing effects on motivated behavior, but the differential innervation of these neuronal subtypes is not well understood. Image: MRV tracing in a mouse thalamus (Photo courtesy of the Salk Institute for Biological Studies).

First MR Angiography Contrast Agent for Supra-Aortic Arteries he US FDA has approved a contrast agent injection intended for the evaluation of suspected or known cases of supra-aortic, or renal artery disease in neonates, children, and adults. The US Food and Drug Administration (FDA) approved the agent for use with Magnetic Resonance Angiography (MRA), based on the results of two clinical studies. The Phase 3 multi-center openlabel studies included patients who were suspected of having, or know to suffer from vascular disease of the supra-aortic arteries, as well as patients with

suspected or known renal artery disease. The Bayer (Whippany, NJ, USA; www.bayer.us) Gadavist (gadobutrol) injection was used in the Gadavist-Enhanced MRA of the Supra-Aortic Vessels (GEMSAV) study that included 457 patients with suspected or known supra-aortic artery disease, and in the Gadavist-Enhanced Renal Artery MRA (GRAMS) study of 292 patients with suspected or known renal artery disease. In both studies gadobutrol was found to be able to visualize more vessel segments, and had non-inferior sensitivity and specificity compared to MRA without a contrast

agent. The agent also showed significantly higher visualization compared to non-contrast MRA images. Dr. Elias Melhem, MD, University of Maryland, and principal investigator for the GEMSAV study, said, “Until now, no contrast agents were FDA approved for use with MRA of the supra-aortic arteries. With FDA’s action, radiologists now have an approved MRA contrast agent to help visualize supra-aortic arteries in patients with known or suspected supra-aortic arterial disease, including conditions such as prior stroke or transient ischemic attack (TIA).”

Machine Learning Initiative to Develop Artificial Intelligence X-Ray Engine n initiative has been set up between a cloud-based radiology service provider, a technology institute, and a medical school to develop an Artificial Intelligence (AI) X-Ray engine that can pre-read digital X-Ray exams and find potential injuries and disease. The research team plans to integrate the system into the cloud-based service provider’s exam routing technology and apply an AI algorithm to all X-Ray images before they are routed to a radiologist. The system will use machine learning to continuously improve outcomes. The system will use the cloud provider’s imaging database of 7 billion images. The Singularity Healthcare initiative will be launched in the second quarter of 2016 by Imaging Advantage (IA; Santa Monica, CA, USA; www.

Medical Imaging International May-June/2016

imagingadvantage.com), and includes leading researchers from the Massachusetts Institute of Technology (MIT; Boston, MA, USA; http://web. mit.edu) and Harvard Medical School/Massachusetts General Hospital (HMS/MGH; Boston, MA, USA; http://hms.harvard.edu). More than 500 radiologists and 450 facilities in the US and around the globe are connected to the Imaging Advantage cloud. X-Ray exams still account for 50% of healthcare radiology tests in the US, and this makes them a significant limiting factor in hospital emergency departments. The Singularity initiative aims to make the patient workflow more efficient and improve treatment. SP Kothari, PhD, MIT Sloan School of Management, said, “We have a number of opportunities for

research and innovation at MIT, but were particularly intrigued by the bold initiative proposed by Imaging Advantage. Given IA’s platform approach to healthcare delivery, national scale and significant imaging data set, and the contribution of Dr. Saini from MGH, one of the leading global radiology teaching and research institutions, the project is not only achievable, but also has potential to touch nearly every person in world. This is how we think artificial intelligence and deep learning should be developed and deployed. Given the advances in the field of artificial intelligence that have taken place at MIT and elsewhere, and Imaging Advantage’s scale, we are not only optimistic about a successful outcome, but expect it to be realized on an accelerated schedule.”

PRODUCT NEWS MRI SYSTEM

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ULTRASOUND SYSTEM

MAMMOGRAPHY SYSTEM

Mindray Medical Imaging

Siemens Healthineers

Neusoft Medical Systems

The MagSense 360 features Inscan technology consisting of a dual operating mode, which allows scanning inside the shielding and console rooms. Its Affinity C-shaped magnets provide maximum openness and 330-degree OPEN feature offers more space for MR intervention surgery.

The ACUSON NX3 Elite features a control panel with more user-customizable settings, along with a 10.4-inch high-resolution touch screen for faster selection of imaging protocols. It also features a 220-degree endocavity transducer for expanding the field of view by up to 75%.

The NeuCare Mammo DR is a full-field digital mammography unit that increases exposure precision, and features whole-panel AEC detection for diagnostic precision. It also features automatic exposure and filter mode for optimizing exposure parameters without making manual adjustments.

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MRI Scans for Back Pain Can Be Augmented By New Seismic Vibration Treatment he need for costly MRI scans to diagnose patients with back pain could be reduced significantly by the use of a simple, inexpensive and safe new technology, and could also decrease the incidence of over-treatment. The technique was demonstrated by teams of researchers in Canada, and Denmark who studied the lumbar spine of twins and showed that structural changes in the spine affect its vibration response significantly. The two teams from the University of Alberta (Edmonton, Alberta, Canada; www.ualberta.ca), and the University of South Denmark (Odense, Denmark; www.sdu.dk/en) used gentle seismic vibration to find the vibration responses in identical twins, and the location of the back-pain. The study was published online in the March 11, 2016, issue of the journal Scientific Reports. The biomechanical study showed that in twins with similar spines, the seismic vibration responses were statistically similar. If one of the twins had suffered an accident or injury for example, the vibration responses were significantly different. Denmark has the largest and most comprehensive twin registry in the world, and this contributed to the research.

According to the researchers the results of the study show that the seismic vibration technique can be used as a diagnostic tool and improve the use of Magnetic Resonance Imaging (MRI) in the short term. In the long term, the new technique could also provide new diagnoses that can supplement imaging tests in use today. Currently MRI scans for back pain are over-used, often unnecessary, and a cost burden and strain on healthcare resources. Cameron Schuler, president and CEO, VibeDx (Edmonton, Alberta, Canada; http://vibedx.com), the company that licensed the new technology, said, “Back problems are a significant cause of disability world-wide. For 90 percent of these patients, current diagnostic methods are not able to identify their problems. Our hope is VibeDx will help improve our ability to identify the cause of the patient’s back problem, which will then assist clinicians in matching a patient to the best course of treatment for their specific situation.”

Image: An example of seismic vibration technology being used for diagnosis of back pain in a patient (Photo courtesy of the University of Alberta).

Radiation and Chemotherapy Improve Survival Rates of Glioma Patients he results of a phase III trial to find an improved treatment for grade 2 glioma patients show that patients receiving radiation therapy together with a chemotherapy regimen experienced longer progression-free survival, and longer and overall survival than patients receiving only radiation therapy. The results of the Radiation Therapy Oncology Group (RTOG) 9802 clinical trial were published in the April 7, 2016, issue of the New England Journal of Medicine. The trial involved 251 patients suffering from low-grade glioma, and tool place between October 1998 and June 2002.

Preliminary results of the trail show that at a median patient follow-up of 5.9 years, radiation therapy together with the procarbazine, lomustine and vincristine (PCV) chemotherapy regimen, resulted in a statistically significant prolongation of median progression-free survival. The initial results did not show an improved overall survival rate, but this was demonstrated in an additional follow-up. While only 5% to 10% of all brain tumors are Grade 2 gliomas, they are still responsible for progressive neurologic symptoms, and premature mortality in nearly all afflicted patients. Jan Buckner, MD, lead author of the study, De-

partment of Oncology, Mayo Clinic Cancer Center (Rochester, MN, USA; www.mayoclinic.org), said, “Our results indicate that initial radiation therapy followed by PCV is necessary to achieve longer survival in patients with grade 2 glioma and that salvage therapy at relapse after radiation therapy alone is less effective. It has also been hypothesized that other genetic alterations may be responsible for a small subset of patients whose glial brain tumors are chemotherapy-resistant. However, radiation therapy plus PCV appears to represent the most effective treatment identified to date for the majority of patients with grade 2 glioma.” Medical Imaging International May-June/2016

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Medical Imaging International

Ultrahigh-Frequency Fine Tunes Ultrasound Imaging n innovative ultrahigh-frequency (UHF) ultrasound system offers exceptional detail with resolution as fine as 30 micrometers, the equivalent of less than half the size of a grain of sand. The Fujifilm VisualSonics (Toronto, ON, Canada; http://vevomd.com) Vevo MD system is designed to play a role in a range of specializations, including neonatology, vascular, musculoskeletal, dermatology, and other clinical applications that pertain to the first three cm of the body. The system is capable of operating in a range of UHF frequencies of up to 70 MHz, when used with the Fujifilm VisualSonics UHF series of transducers. “As the recognized leader in ultra high frequency imaging systems, Fujifilm VisualSonics is proud to be the first to market with unparalleled technology,” said Renaud Maloberti, vice president and general manager of Fujifilm VisualSonics. “With the Vevo MD, clinicians can observe the tiniest, most highly detailed anatomy that has never been seen before, which means greatly enhanced potential for diagnoses.”

“The Vevo high frequency ultrasound systems and linear array transducers are ideal for fast, high resolution imaging,” said assistant professor Craig Goergen, PhD, of Purdue University (Lafayette, IN, USA). “The ease of use and unmatched image quality allow for visualization of fine structures, opening up numerous biomedical applications for us to explore.” While the UHF ultrasound frequency (100 MHz – 1 GHz) has been used in non-destructive evaluation of materials and biomedical imaging for many years, its applications in biology and medicine have so far been limited. With the advent of UHF ultrasound, the width of the ultrasound beam is of only a few microns, approaching the dimensions of many cells, which allows the detection of structure

too small for conventional ultrasound, such as pseudoaneurysms in artery walls. Image: A superficial hemangioma with color created with the Vevo MD (Photo courtesy of Fujifilm VisualSonics).

NE DES W IGN

Standard Phantom for Breast Cancer MRI he US National Institute of Standards and Technology (NIST; Gaithersburg, MD, USA; www.nist.gov) has developed a standardized phantom to help test the performance of magnetic resonance imaging (MRI) devices used to identify and monitor breast cancer. The NIST phantom will help standardize and ensure quality control of breast tissue MRIs when comparing images within and between medical research studies, comparing MRI scanner performance, and the training of operators. The phantom is composed of a flexible, soft 15 cm × 12.5 cm silicone shell, with internal components made of rigid polycarbonate to ensure regular geometry. The phantom also supports quantitative MRI, which is increasingly being used for breast cancer diagnosis, staging, and treatment monitoring. The phantom has two basic types of internal arrangements, which can be paired for MRI scans. One unit, designed for conventional MRI scans, is based on the magnetic properties of hydrogen atoms. It contains four layers of small plastic spheres filled with solutions that mimic tissue, including corn syrup in water to represent fibroglandular tissue, and grapeseed oil to represent fat; the spheres can be customized to meet special clinical needs. Potential options include solutions that would mimic either benign cysts or calcium microcalcifications, which can signal cancer. The second phantom unit is designed for the newer technique of diffusion MRI, which measures the motion of water molecules within breast tissue. The second unit contains plastic vials filled with varying concentrations of a polyvinylpyrrolidone (PVP), a nontoxic polymer, which is tuned to mimic the differing diffusion properties of malignant and benign tumors. Both units have a modular design to help fit them into different MRI systems. The development process of the new phantom was published on March 6, 2016, in JMRI.

Medical Imaging International May-June/2016

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PRODUCT NEWS CBCT SYSTEM

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ANGIO-CT SYSTEM

MAMMOGRAPHY SYSTEM

Newtom

Siemens Healthineers

Planmed

The NewTom 5G XL features a motor-driven patient table and an open gantry. Designed for the patient to be positioned lying down, the system offers 3D exams with multiple FOVs, and allows 2D and X-ray video imaging with low emission scan protocols to minimize dose.

The MIYABI allows users to quickly switch between angio and CT modalities without the need for patient transfer. It is ideal for minimally-invasive interventions in patients requiring a combination of MDCT and angiography such as with interventional oncology, stroke, and trauma.

The Clarity 3D provides both 2D and 3D imaging, with an intuitive dual-touch screen that adapts to each of the available imaging modes. It eliminates motion blur and artifact intrusion to offer clear tomosynthesis images with higher visibility of microcalcifications and delicate tissue structures.

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3D Noninvasive Virtual Autopsies Link Forensics and Radiology irtual autopsies that create 3D Computed Tomography (CT) models of the body, while leaving it intact, represent the future forensic medicine. The new method does not interfere with forensic evidence, and 3D models can easily be shared for obtaining a second opinion. The cost of virtual autopsies is still a barrier, but they are expected to come down with the introduction of new technology, and increased acceptance of the new method. Virtual autopsies were pioneered by Dr. Thali, Institute of Forensic Medicine at the University of Zurich (Zurich, Switzerland; www.irm.uzh.ch/ en.html), who also co-founded The Virtopsy Project. The new method is already standard procedure in Switzerland, and is gradually being accepted around the world. The Virtobot, a robotic system used for virtual autopsies, works with a CT scanner to create automated, high-resolution 3D surface images, and performs CT-guided post-mortem tissue sampling for documentation of an injury. Bite marks, for exam-

ple, can be modeled in 3D for comparison with the dental records of a suspect for use as evidence. Virtual autopsies also take less time because imaging can be performed quickly. They are observer-independent enabling objective data archiving, and can be used in situations where conventional autopsies are not possible for religious or other reasons. Dr. Thali, said, “With virtual autopsy, imaging becomes the gold standard in the future examination of forensic evidence. At the moment, we cannot see everything with imaging, but judging by the (technology) on display at RSNA 2015, I think the direction is absolutely clear. Our customer (the court system) often has no real knowledge of the body’s internal structures, so having 3D visualiza-

tion is a good tool to show what really happened to the body.” Image: The robotic Virtobot system performs various tasks together with a CT scanner to produce high-resolution 3D surface documentation, and enable CT-guided postmortem tissue sampling (Photo courtesy of RSNA).

Forensic Researchers Set Standards for X-Ray Identification new study establishes science-based standards for identifying human remains, based on X-rays of an individual’s spine, upper leg, or the side of the skull. Researchers at North Carolina State University (NCSU; Raleigh, USA; www. ncsu.edu), Middle Tennessee State University (Murfreesboro, USA; www.mtsu.edu), and the University of South Florida (USF; Tampa, USA; www.usf.edu) compared ante-mortem and postmortem lateral craniofacial X-rays in 41 cases, X-rays of the vertebral column in 100 cases, and X-rays of the proximal femur in a further 49 cases. The X-rays were then scored for number of concordant features, analyzed using classification decision trees, and evaluated using a receiver operating characteristic. The researchers then used the data to develop specific standards for each skeletal region. They

used additional, unmatched X-rays to test the accuracy of the standards in accurately identifying a body, and how likely were false-positive or falsenegative results. The outcome showed a wide spectrum of consistencies; for example, two or more points of concordance are required in lateral cranial X-rays for a 97% probability of a correct identification, with a 10% misclassification rate. And just a single concordant feature is needed on cervical vertebrae for a 99% probability of correct identification, with a 7% misclassification rate. And if there are one or more femoral head and neck concordant features, the probability of a correct identification is 94% and 97%, respectively. However, at the other end of the spectrum, four or more concordant features are required for a 98% probability of correct identification, and even there

is a 40% misclassification rate. The study also established the minimum number of concordant areas needed to confirm positive identifications in the three standard radiographic views. The study was published on March 17, 2016, in the American Journal of Forensic Medicine and Pathology. “In the past, forensic experts have relied on a mixed bag of standards when comparing antemortem and post-mortem X-rays to establish a positive identification for a body, but previous research has shown that even experts can have trouble making accurate identifications,” said lead author Professor of Anthropology Ann Ross, PhD, of NCSU. “We’ve created a set of standards that will allow for a consistent approach to identification that can be replicated, and that allows experts to determine probabilities for an identification.” Medical Imaging International May-June/2016

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Medical Imaging International

Nanostim Leadless Pacemakers Approved for MRI ll European patients with a Nanostim leadless pacemaker, as well as new patients implanted with the device, can now safely undergo full body magnetic resonance imaging (MRI) scans. The St. Jude Medical (SJM; St. Paul, MN, USA; www.sjm.com) Nanostim leadless pacemaker is just 10% the size of a conventional pacemaker, and is designed to be implanted directly in the heart, reducing or eliminating common complications associated with leads, chest incisions, and surgical pockets. It is implanted via a percutaneous coronary intervention (PCI) through the femoral vein into the heart, using a miniature delivery system, and is designed to be fully retrievable for repositioning throughout the procedure, and later retrieved if necessary. The device is supported via the proprietary Merlin Programmer, which is also used to interrogate and

program the company’s other pacemakers and implantable cardioverter defibrillators (ICDs). Eliminating the visible lump and scar at a conventional pacemaker’s implant site, in addition to the removal of patient activity restrictions that may prevent the dislodgement or damage to a conventional lead, could potentially improve the quality of life for patients and allow most to continue living active, uninhibited lifestyles. “The Nanostim leadless pacemaker is one of the most important advances in the history of pacemaker technology,” said Mark Carlson, MD, vice president of global clinical affairs and chief medical officer of St. Jude Medical. “The freedom from leads and now the ability for patients with the Nanostim leadless pacemaker to undergo MRI scans are important factors for physicians as they consider treatment options.” “It’s important that my patients in

MRI-Guided Ultrasound Procedure Ablates Entire Prostate Gland real-time, magnetic resonance imaging (MRI) guided ultrasound system provides a continuous volume of thermal energy to ablate the prostate gland from the inside out. The transurethral ultrasound ablation (TULSA) PRO system is based on an ultrasound applicator (UA) that houses 10 transducers, which can be individually turned on or off, depending upon the size of the prostate gland. During treatment, the UA is inserted into the urethra and rotated 360 degrees while emitting highly accurate and precise ultrasound energy. The energy thermally coagulates the prostate gland outwards from the urethra towards the prostate boundary, thus destroying the prostate tissue (including the cancerous tissue), but sparing surrounding healthy tissue. An auxiliary endorectal cooling device provides further protection. The procedure takes place within an MRI scanner, during which a software-controlled algorithm measures MRI temperature data to adjust the energy intensity and rate of rotation of the UA, resulting in precise conformal targeting and temperature feedback. The minimally invasive procedure takes about 40 minutes, and can be performed on an outpatient basis, with the same (or better) quality out-

Medical Imaging International May-June/2016

need of pacemakers also have the freedom to undergo MRI diagnostic scans for other conditions, if needed,” commented cardiologist and electrophysiologist Tom Wong, MD, of Royal Brompton Hospital (London, United Kingdom). “This new labeling

provides that flexibility and will be of great benefit to patients to ensure peace of mind for the future.” Image: The Nanostim leadless pacemaker (Photo courtesy of St. Jude Medical).

comes than surgery or radiation. The TULSA PRO system is a product of Profound Medical (Toronto, ON, Canada; www.profoundmedical.com), and has received the European Community (EC) mark of approval. “Our preclinical data observed that 83% of urethral tissue was preserved after treatment, along with no damage to urethral sphincters, bladder neck, or rectal wall, resulting in good quality of life outcomes,” said Steven Plymale, CEO of Profound Medical. “Twelve-month follow-up of 30 patients demonstrated virtually no incidence of incontinence and GI toxicity. We’re also now seeing rates of erectile dysfunction at around 16% with TULSA-PRO, well below rates following surgery.” The TULSA system works differently to another innovative prostate ablation procedure, high intensity-focused ultrasound (HIFU), which uses a rectal probe to emit a HIFU beam through the rectal wall to the prostate, creating a rice-sized lesion. While HIFU needs to lays down hundreds of rice-sized lesions, one on top of the other, ablating 40 cubic centimeters of prostate tissue in three hours, the transurethral TULSA-PRO probe does a single sweep in 40 minutes, covering an area as large as 100 cubic centimeters. LINKXPRESS COM

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PRODUCT NEWS FLAT PANEL DETECTOR

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DR SYSTEM

ULTRASOUND SYSTEM

Protec

Samsung

The RAPIXX 4343M1/2F DR system features a portable 43 x 43 cm DR flat panel for flexibility in handling and patient positioning. Its high-end detector with CONAXX 2 DR software, automatic dose detection, and standard cassette format makes it ideal for DR upgrade solutions.

The GC85A DR system comes with S-Detector, SVue, and S-Align imaging technologies. It features S-Share compatibility for reduced downtime, and auto positioning for faster operation.

The WS80A with Elite features a hybrid imaging engine evo that combines 2D and color image quality with a fast frame rate for powerful data processing and noise reduction. Its S-Vue transducer technology for enhanced vision of scanned areas makes it ideal for women's health exams.

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Multisite Ultrasound Study to Help Improve Pregnancy Outcomes esearchers are using microvascular ultrasound imaging equipment to study the microvascularization of the placenta, the elasticity of placental tissue, and its calcification content. The multisite study is part of an initiative to improve the understanding of the function of the placenta, and is being funded by a USD 2.725 million grant from the US National Institutes of Health (NIH). The researchers will use Toshiba America Medical Systems (Tustin, CA, USA; www.medical. toshiba.com) Aplio 500 Platinum microvascular ultrasound systems for the study, which is taking place at the Eastern Virginia Medical School (EVMS; Norfolk, Virginia; www.evms.edu) Fetal Cardiovascular Center. The Aplio 500 Platinum system provides advanced visualization imaging, quantification and intervention, and will be used by EVMS for Superb Micro-Vascular Imaging (SMI) for noninvasive visualization of small blood vessels, and low-velocity microvascular blood flow. The researchers at EVMS

will use Toshiba’s Shear Wave Elastography (SWE) for noninvasive measurements of tissue stiffness, and Toshiba’s MicroPure visualization of microcalcifications, instead of gray scale imaging. The study is intended to help find new methods to predict, and minimize difficulties later in pregnancy, by studying the placenta during the early stages. Dr. Alfred Abuhamad, Chairman of Obstetrics and Gynecology, and Vice Dean of Clinical Affairs, EVMS, said, “Through our research study, we hope to develop an algorithm that can potentially help predict late pregnancy complications in early gestation by using new, high-tech ultrasound software, provided by Toshiba. Our study is designed to identify which ultrasound tools are best at determining women who will develop poor pregnancy outcomes and those who will not. If we have the ability to identify

which pregnancies will have complications in the future through ultrasound, then we can address it early with interventions and therapies.” Image: The Aplio 500 Platinum ultrasound system (Photo courtesy of Toshiba Medical Systems).

Detection Method Spares Unnecessary Prostate Cancer Treatments novel three-dimensional (3D) cell model that mimics the morphogenesis of acini, the glandular units that constitute the prostate, could help study how prostate cancer (PC) progresses. Developed by researchers at St. George’s University of London (SGUL; United Kingdom; www. sgul.ac.uk), the 3D cellular model monitors the morphogenesis of the glandular structures using microscopy and imaging techniques, which can help identify the intraluminal hyperproliferation of the acini. By identifying the factors that alter the epithelial organization of acini that lead to the intraluminal proliferation, the researchers hope to develop a strategy that can help determine the causes of PC progression.

Using the 3D acini model, the researchers are developing methods that will provide objective measures for patient stratification and disease grading, which could thus complement current clinical classification of patients diagnosed with PC. By doing so, they hope to be able to consistently distinguish aggressive PC from indolent disease, a distinction currently difficult to identify, which often leads to inappropriate treatment and high morbidity and mortality. “Based on these cell culture models, we believe a test could be developed to assess how invasive a prostate cell could become when taken from a patient,” said principal investigator Ferran Valderrama, PhD, of the SGUL PC cell biology laboratory. “We believe that this information would help to de-

termine the appropriate treatment for the patient, reducing the burden derived from unnecessary over treatment, and overall having a positive outcome in patient survival.” “The currently available prognostic tests for prostate cancer cannot conclusively tell us whether a tumor will rapidly progress and spread to other tissues, or instead will remain confined to the limits of the prostate,” added Dr. Ferran Valderrama. “Improving current procedures for predicting the outcome of a prostate that presents with ‘suspicious’ characteristics of prostate cancer are necessary. If we were able to determine that outcome in a consistent and conclusive manner, it would be easier to define the best approach for treatment for each individual case.” Medical Imaging International May-June/2016

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Fusion Biopsy Helps Urologists Detect Most Dangerous Prostate Cancers ew MRI technologies, such as fusion biopsy, are helping urologists locate malignant prostate cancer lesions more accurately. Fusion biopsy enables physicians to perform biopsies with the help of direct guidance of the needle, using real-time ultrasound imaging, to the suspicious lesion. The patient first undergoes a Magnetic Resonance Imaging (MRI) exam of the prostate gland. The images are then evaluated by a radiologist for suspected lesions. Next, a device called UroNav, made by Invivo (Gainesville, FL, USA; www. invivocorp.com), uses the information from the MRI exam, and live ultrasound imaging to enable urologists to more accurately perform the prostate biopsy procedure. The procedure is especially effective for men who have undergone a traditional biopsy without cancer being found, despite PSA blood tests indicating a risk for prostate cancer. In the US, approximately 1.2 million men undergo a biopsy each year, and around 20 million Prostate-Specific Anti-

Minimally Invasive Procedure Can Freeze Phantom Limb Pain esearchers have presented the results of a study investing the use of cryoablation to reduce Phantom Limb Pain (PLP) in patients with chronic pain in amputated limbs. The researchers showed that interventional radiologists can apply cryoablation to specific nerves of patients suffering from PLP, significantly reducing their level of pain from phantom limbs. The researchers also investigated the safety and effectiveness of the PLP treatment. According to the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA; www.cdc.gov) there are nearly 185,000 limb amputations every year in the US, including military veterans wounded in war, and amputations performed to treat disease. The new findings of the clinical trial, entitled, “Percutaneous Image Guided Cryoablation for the Treatment of Refractory Phantom Limb Pain” were presented by researchers at the Emory Interventional Radiology and Image Guided Medicine Emory University School of Medicine (Atlanta, Georgia; www.med.emory.edu), at the 2016 Annual Scientific Meeting of the Society of Interventional Radiology. Prologo, director of Interventional Radiology, Emory Johns Creek Hospital, and assistant professor, Emory School of Medicine, said, “More veterans than ever are returning from war with amputations, because of improved body armor and extraction techniques. At the same time, veterans who fought in the Vietnam War still suffer from phantom limb pain. Until now, they’ve had few medical interventions available to them with the potential to reduce significant pain. We insert a cryoablation probe into the nerves causing pain and drop the temperature to negative 40 degrees centigrade for 25 minutes.”

Medical Imaging International May-June/2016

gen (PSA) tests are performed. Trans-Rectal UltraSound (TRUS) biopsy and other traditional techniques only sample the lower part of the prostate gland, while nearly 30% of cancers are outside this area. The result has been that traditional biopsy methods have led to only 30%–40% results positive for prostate cancer, out of 1.2 million biopsies performed each year. The fusion-guided prostate biopsy is especially useful for monitoring any change in the clinical status of low-risk patients, and can also help find more aggressive cancers faster, preventing metastasis. Dr. David Samadi, David Samadi Prostate Cancer Center (New York, USA), said, “The MRI guided fusion biopsy allows for more accuracy, less repeat biopsies, and less pain. It is expected to eventually become standard of practice.” Image: The UroNav uses information from an MRI exam and live ultrasound imaging to enable urologists to more accurately perform the prostate biopsy procedure (Photo courtesy of Invivo).

Medical Imaging International

PRODUCT NEWS CR SYSTEM

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MRI SYSTEM

ROBOTIC SCANNER

Konica Minolta Medical Imaging

GE Healthcare

Siemens Healthineers

The REGIUS 110 HQ is a single-bay CR system that can process up to 76 plates per hour. It supports a high-resolution read function for mammography, and comes with a touch screen control station, along with intuitive software tools for easy operation.

The SIGNA Pioneer system delivers faster body imaging by enabling shorter breath-holds and faster scans. Its intelligent design automatically adapts protocols to varying patient profiles, and allows for real-time 3D prospective motion correction.

The Multitom Rax twin robotic X-ray scanner allows for the integration of multiple X-ray capabilities in one room. It features a scanner that revolves around the patient, reducing transfers and repositioning, and making it ideal for pediatric, geriatric, bariatric, immobile, and trauma cases.

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Novel Molecular Tags Permit More Versatile Bioimaging new study describes a class of molecular tags that enhance magnetic resonance imaging (MRI) signals, and could enable widespread real time monitoring of metabolic processes in cancer and heart disease. Researchers at Duke University (Durham, NC, USA; www.duke.edu) have succeeded in developing a cost-efficient method to directly hyperpolarize long-lived nuclear spin states on universal 15N2-diazirine molecular tags. Named SABRESHEATH, the technique results in a higher than 10,000-fold enhancement in the generation detectable nuclear MR signals, that can also last much longer. The 15N2-diazirines are biocompatible, inexpensive to produce, and can be incorporated into a wide range of biomolecules without significantly altering molecular function. Current hydrogen-based hyperpolarization techniques result in agents visible for only seconds, and thus cannot monitor the majority of biological processes. The 15N2-diazirine molecular tags, on the other hand, are composed of two nitrogen atoms bound together in a ring, a geometry that

traps hyperpolarization in a state that does not relax quickly, thus greatly enhancing magnetic resonance signals for over an hour. An added advantage is that it can be tagged on small molecules, macromolecules, and amino acids, without changing the intrinsic properties of the original compound. The study was published in the March 25, 2016, issue of Science Advances. “This represents a completely new class of molecules that doesn’t look anything at all like what people thought could be made into MRI tags,” said senior author Professor Warren S. Warren, PhD, chair of Physics at Duke. “We envision it could provide a whole new way to use MRI to learn about the biochemistry of disease. In a minute, you’ve made the hyperpolarized agent, and on the fly you could actually take an image. That is something that is simply inconceivable by any other

method.” The hyperpolarized state is a very low spin temperature state that is not in a thermal equilibrium with the temperature of the sample. Low spin temperature leads to high magnetization of the spin ensemble, resulting in very high nuclear MRI signal. This spin state eventually returns to the thermal equilibrium temperature (depolarization). Image: Duke scientists have discovered a new class of inexpensive and long-lived molecular tags that enhance MRI signals by 10,000-fold (Photo courtesy of Thomas Theis, Duke University).

Imaging Method Facilitates Gall Bladder Removal eal-time near-infrared fluorescence cholangiography (NIRFC) can help image the bile ducts during gallbladder removal surgeries, according to a new study. Researchers at the University of California Los Angeles (UCLA; USA; www.ucla.edu) conducted a prospective study involving 37 patients undergoing laparoscopic biliary and hepatic operations who were administered intravenous indocyanine green (ICG) for NIRFC. The patients were administered with different doses and times – ranging from 10 to 180 minutes – from ICG injection to visualization. The porta hepatis vein and biliary structures were then examined using a dedicated laparoscopic system equipped to detect NIRFC, and quantitatively analyzed using a scoring system.

The results showed that visualization of the extrahepatic biliary tract improved with increasing doses of ICG, and was also significantly better with increased time after ICG administration; quantitative measures also improved with both dose and time. The results suggest that a dose of 0.25 mg/kg administered at least 45 minutes prior to visualization is optimal for intraoperative anatomical identification of the extrahepatic biliary anatomy. The study was published on March 10, 2016, in Surgical Innovations. “Injuries to the bile ducts, which carry bile from the liver to the intestines, are rare; but when they do occur, the outcomes can be quite serious and cause life-long consequences,” said lead author Ali Zarrinpar, MD, PhD. “Gallbladder removals are one of the

most litigated cases in general surgery because of these injuries. Any technique that can reduce the rate of bile duct injury and increase the safety of the operation is good for patients and for surgeons.” The gallbladder and liver can be hard to access and visualize when the areas around them are inflamed or surrounded by fat. Using a conventional imaging technique, in which the bile ducts are not clearly delineated, injuries to the ducts can occur. But when ICG is taken up by the liver and excreted into the bile, laparoscopic devices can detect the fluorescence in the bile ducts and superimpose that image onto a conventional white light image. The augmented image improves the surgeons’ visualization, making it easier for them to identify the appropriate bile duct anatomy. Medical Imaging International May-June/2016

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Medical Imaging International

Novel Technology Provides Dynamic Respiratory Imaging nnovative Structured light plethysmography (SLP) imaging technology helps construct a 3-dimensional (3D) image that displays regional breathing correlations and lung symmetry. The Thora-3Di system projects a structured image that covers the patient’s chest and abdomen to record movement in four dimensions; the recorded image can be replayed in real time, while allowing the clinician to manipulate the view using proprietary SLP software to create a 3D image. The software also provides the operator with the ability to divide the image into defined regions, so as to compare the upper chest and abdomen or the left and right sides of the chest, as a means to identify potential asymmetries indicative of respiratory-related issues. By comparing the patient’s sym-

metry of breathing and measuring the chest wall, Thora-3DI can illustrate the dynamics of lung function in real time, reflecting respiratory function and providing a deeper understanding of the patient’s lungs, without the need or forced manoeuver testing or moving the patient to a measurement site. The patient can be sitting, lying, conscious, or unconscious, as the Thora-3DI is noninvasive and does not require any direct interaction with the patient. Thora-3Di is a product of Pneumacare (Cambridgeshire, United Kingdom; www.pneumacare.com). “The measurement of lung function changes in children with respiratory diseases is essential if we are to accurately assess the benefit of treatments. Noninvasive, simple methods have been sought for decades, and the technique developed by Pneumacare is exciting and novel,” said

DTI Study Finds Damaged Brain Networks Possible Cause of Insomnia esearchers discover link between insomnia and altered integrity of the white matter tract in regions of the brain that regulate alertness, consciousness, and sleep. The study included 23 patients suffering from insomnia, and 30 healthy control subjects who were examined using a special Magnetic Resonance Imaging (MRI) sequencing technique called Diffusion Tensor Imaging (DTI). The patients and control subjects were also given questionnaires to evaluate their mental status, and sleep patterns. The questionnaires included the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, and the Self-Rating Anxiety Scale. The researchers published their findings in the April 2016, online issue of the journal Radiology. The researchers used MRI-DTI to analyze the white matter tracts in the insomnia patients and studied the relationship between abnormal white matter integrity and the duration and nature of the sleep disorder. The results of the study showed the insomnia patients had significantly reduced white matter integrity in several regions of the right brain, including the thalamus, compared to the healthy controls. The duration of

Medical Imaging International May-June/2016

patients’ insomnia, and the score they gave on the self-rated depression scale, was associated with abnormalities in the thalamus, and body corpus callosum. The cause of white matter integrity abnormalities in the insomnia patients could have been caused by loss of the protective myelin coating around nerve fibers. Shumei Li, MS, Researcher at the Department of Medical Imaging, Guangdong No. 2 Provincial People’s Hospital (Guangzhou, China; www. gd2h.com), said, “Insomnia is a remarkably prevalent disorder. However, its causes and consequences remain elusive. White matter tracts are bundles of axons – or long fibers of nerve cells – that connect one part of the brain to another. If white matter tracts are impaired, communication between brain regions is disrupted. We used a new method called TractBased Spatial Statistics that is highly sensitive to the microstructure of the white matter tract and provides multiple diffusion measures. These impaired white matter tracts are mainly involved in the regulation of sleep and wakefulness, cognitive function and sensorimotor function The involvement of the thalamus in the pathology of insomnia is particularly critical, since the thalamus houses important constituents of the body’s biological clock.

Prof. Warren Lenney, MD, of the University Hospital of North Staffordshire (Stoke on Trent, United Kingdom). “If accurate, reproducible, and sensitive results can be obtained, I can foresee the technique having

wide application in all centers specializing in the management of pediatric respiratory illnesses.” Image: The Thora-3Di system (Photo courtesy of Pneumacare).

PRODUCT NEWS ULTRASOUND SYSTEM

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DIGITAL IMAGING SYSTEM

CONTRAST MEDIA INJECTOR

SonoScape

Varian Medical Systems

Ulrich Medical

The S12 color Doppler system features a 15-inch LED monitor with articulating arm, and a user-oriented multi-language input keyboard. Four active transducer sockets are available for applications in cardiology, ob/gyn, and anesthesiology/emergency medicine/musculoskeletal.

The Nexus-DRF system combines RF and DR capabilities in one imaging platform using various flat panel detectors. It runs on Windows 7 with an intuitive graphic user interface, and features an NVDIA K2000 series video card with Direct-X technology for image display.

The CT Motion uses roll pump technology in combination with a two-piece tubing system for lower costs and less waste per patient. It ideally adjusts to the exam requirements while safe injection protects both the patient and the user, making it ideal for use in computed tomography.

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Prone Biopsy System Offers 3D Imaging-Guided Breast Biopsy novel prone biopsy system allows radiologists to better target lesions found during three dimensional (3D) guided mammography exams, as well as other screening modalities. The Hologic Affirm Prone Biopsy System combines minimally invasive, stereotactic breast biopsy with 3D guidance technology to provide true 360degree access to lesions, with the aid of a fully integrated C-arm that rotates around the patient, who is lying in a prone position. As a result, approach angles can be varied with minimal movement on the patient’s part, as she is supported throughout the procedure. The system also features a streamlined workflow with increased automation to raise patient satisfaction and eliminate a direct view of the biopsy needle. The Affirm prone biopsy system, a product of Hologic (Bedford, MA, USA; www.hologic.com), is the first dedicated prone system to offer both 2D and 3D imaging-guided breast biopsies. The system also expands the company’s breast biopsy portfolio, complementing the Genius 3D mammography exam and the Affirm upright biopsy system, and has

been approved by the U.S. Food and Drug Administration (FDA), as well as receiving the European Community Ce mark of approval. “We challenge ourselves to advance medical technology so that healthcare professionals and patients can benefit from innovative solutions that significantly improve outcomes and patient experience, while also creating a powerful economic model for our customers,” said Pete Valenti, division president Image: The Affirm prone biopsy of breast and skeletal health solu- system (Photo courtesy of Hologic). tions at Hologic. “The launch of our Tejerina (Madrid, Spain). “As an early testing site Affirm prone biopsy system is the most significant for the Affirm prone biopsy system, we’ve had the advancement in prone biopsy technology since we opportunity to perform many biopsies using this introduced the first system more than 20 years ago.” technology, and are pleased to report that this new “Until now, we’ve been struggling to handle biopsy table has helped to solve our challenges. We complex biopsies for subtle lesions or faint calcifiare able to visualize more tissue and have access to cations that we are only able to identify using 3D challenging lesion locations, and the procedures are mammography exams,” said Alejandro Tejerina, very fast.” MD of Centro Patologia de la Mama Fundación

Pediatric Pneumonia Can Be Diagnosed via Lung Ultrasound ung ultrasound (LUS) may offer a safer, yet equally effective, alternative to chest Xrays (CXR) for diagnosing pneumonia in children, according to a new study. Researchers at Mount Sinai School of Medicine (New York, NY, USA; www.mssm.edu) and Vanderbilt University (Nashville, TN, USA; www. vanderbilt.edu) conducted a randomized control trial comparing LUS to CXR in 191 children from birth to 21 years of age with suspected pneumonia in an emergency department (ED). Patients in the investigational arm received a LUS; if there was clinical uncertainty after ultrasound, clinicians had the option to obtain CXR. Those in the CXR group had a chest X-ray, followed by lung ultrasound. The

primary outcome was the rate of CXR reduction. The results showed that the patients in the investigational group had a 38.8% reduction in chest X-rays, with no missed cases of pneumonia and no increase in complications, adverse events, or subsequent unscheduled healthcare visits. Novice and experienced clinicians achieved a 30% and 60.6% reduction in CXR use, respectively. The reduction in chest X-rays led to overall cost savings of USD 9,200 per patient, and an average decrease in time spent in the emergency department of 26 minutes. The study was published in the March 2016 issue of Chest. “Ultrasound is portable, cost-saving, and safer for children than an X-ray because it does not expose them to radiation. In the era of precision med-

icine, lung ultrasound may also be an ideal imaging option in children who are at higher risk for radiation-induced cancers or have received multiple radiographic or CT imaging studies,” said lead author James Tsung, MD, MPH. “Our study could have a profound impact in the developing world where access to radiography is limited.” Pneumonia is the leading cause of death in children worldwide, according to the World Health Organization (WHO, Geneva, Switzerland; www. who.int). Symptoms include fever, cough, and rapid breathing. CXR is considered the test of choice for diagnosing pneumonia in children, but the WHO estimates three-quarters of the world’s population does not have access to radiography. Medical Imaging International May-June/2016

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Medical Imaging International

Breast Tomosynthesis System Improves Image Accuracy nnovative digital breast tomosynthesis (DBT) systems provide enhanced diagnostics, especially for patients with denser breast tissue. The Planmed Oy (Helsinki, Finland; www. planmed.com) Clarity 3D DBT system resolves the challenge of overlapping tissue structures by producing sharp 3D reconstructions of breast tissue that permit higher visibility of small microcalcifications and delicate tissue and blood vessel structures, using a patented Continuous Sync-and-Shoot method that eliminates both motion blur and artifact intrusion. The product family also includes the Planmed Clarity 2D digital mammography system, which can be easily upgraded to DBT at any time. Both systems allow imaging with a low effective patient dose, and feature a durable digital detector for mobile screenings, as well as touch controls on dual touchscreens that adapt to each of the available imaging modes. The system has a compact footprint and can be installed in small rooms, and runs from a standard wall outlet. The eye-catching design, which won the prestigious Red Dot (Essen, Germany;

www.red-dot.org) Design Award, can be tailored to suit a variety of color schemes, providing a personal touch and helping to reduce patient anxiety. “We can reduce patient anxiety with the design of the systems, and consequently encourage more women to participate in breast cancer screenings,” said Jan Moed, managing director of Planmed. “The Red Dot jury especially valued their eye-catching and functional design, which also enhances ergonomics. The adaptive touch control of the systems will provide an unforeseen user experience.” DBT mammograms use low dose x-rays to create a 3D image of the breast, which can then be viewed the in narrow slices, similarly to CT scan images. While in conventional 2D mammography overlapping tissues can mask suspicious areas, 3D images eliminate the overlap, making abnormalities easier to recognize. Experts estimate that 3D DBT mammography will replace conventional mammography within 10 years. Image: The Clarity 3D DBT system (Photo courtesy of Planmed).

First Injectable Intravenous Suspension for Contrast-Enhanced Liver Ultrasonography

MRI System Helps Plan Prostate Cancer Radiation Treatment

n a first for liver imaging as well as pediatric patients, the FDA has approved the contrast agent, “sulfur hexafluoride lipid-type A microspheres,” for use in adults with suboptimal echocardiograms, and also for children. The agent is expected to improve the sensitivity, and specificity of ultrasonography, and help surgeons differentiate between focal hepatic lesions that are benign and those that are malignant. The LUMASON agent, also called SonoVue, was developed by Bracco Imaging (Monroe Township, NJ, USA), and is already being used in Europe and Asia. The agent consists of gas-filled microspheres, which reflect sound waves, and enhance the ultrasonographic images. The system has a proven safety, and efficacy profile for liver ultrasonography, and echocardiography, and is packaged in a three-part kit that does not need mechanical agitation, or refrigeration. Alberto Spinazzi, MD, senior VP, global medical and regulatory affairs, in the Bracco group, said, “We are proud to be the first company to obtain FDA approval for this important clinical use of ultrasound contrast both in adults and children. This new indication for LUMASON reflects our efforts and investments to expand the range of approved clinical indications for contrast-enhanced ultrasound in the United States. We are very pleased with the collaborative work with the FDA whose review is critical to ensuring the safety and efficacy of any use of imaging products to the healthcare community.”

n innovative imaging system helps plan radiotherapy (RT) treatment of prostate cancer using magnetic resonance imaging (MRI) alone, without the need for computerized tomography (CT). The Royal Philips (Amsterdam, The Netherlands; www.philips.com) Magnetic Resonance for Calculating Attenuation (MRCAT) system, designed for the Ingenia MR-RT imaging platform, will support those who choose to use MRI as their single-modality imaging approach to prostate cancer RT treatment planning. The MRCAT system provides high-quality, soft-tissue contrast for target delineation, as well as density information for dose calculations via robust imaging protocols that allow the system to obtain CT-like workflow, and potentially reduced provider costs, as compared to MR-CT workflow. “Where CT solutions have played a leading role in past radiotherapy treatments, MR takes an innovative approach by providing physicians with increased soft-tissue visualization and functional imaging capabilities to help improve treatment plans,” said Lizette Warner, PhD, manager of clinical science MR therapy at Philips North America.” “Successful cancer treatment depends on the quality and accuracy of the radiation therapy plan, making imaging a critical piece in determining course of treatment. The real power of MR-only simulation is that it enables us to develop personal treatment plans,” said Rodney Ellis, MD, vice chairman of radiation oncology at the Seidman Cancer Center (Cleveland, OH, USA; www.uhhospitals.org/seidman).

PET/CT Links Activity in Stress Center of Brain to Risk of Future Heart Problems esearch results have shown that increased activity of the stress center of the brain is linked to a higher risk for cardiovascular events such as heart attacks, stroke, and death, and increased evidence of arterial inflammation. The goal of the study is to make an initial investigation into the mechanisms behind stress response and the risk of cardiovascular events using Positron Emission Tomography/Computed Tomography (PET/CT) imaging. The results were presented at the 65th Annual Scientific Session of the American College of Cardiology. The study is the first to use imaging to find a link between atherosclerotic disease and biochemical

Medical Imaging International May-June/2016

activity in the brain. The researchers at the Massachusetts General Hospital (MGH; Boston, MA, USA; www.massgeneral.org) used PET/CT scans of 293 patients with an average age of 55 years, to objectively measure activity in various brain regions, in the bone marrow, and arteries. The scanning procedure included the use of a radioactive tracer to find areas of increased metabolic activity. Coauthor of the study, Ahmed Tawakol, MD, Massachusetts General, said, “Our study illuminates, for the first time, a relationship between activation of neural tissues – those associated with fear and stress – and subsequent heart disease

events. There is a need to develop greater knowledge in terms of the mechanism that translates stress into cardiovascular disease risk, given the prevalence and potency of stress as a risk factor. Over the past several years, it’s become clear that stress is not only a result of adversity but may itself also be an important cause of disease. The risks of heart disease linked to stress is on par with that for smoking, high blood pressure, high cholesterol and diabetes, yet relatively little is done to address this risk compared to other risk factors. We are hopeful studies like this bring us closer to understanding how stress may lead to heart disease.”

Medical Imaging International

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DTI Study Reveals Neurological Differences in Children with Sensory Processing Disorder he results of a new study have shown that children (male and female) affected by the Sensory Processing Disorder (SPD) have different brain connectivity than children without SPD. The study used a Magnetic Resonance Imaging (MRI) technique called Diffusion Tensor Imaging (DTI) to study the children, and found that the changes in brain connectivity predicts challenges with tactile and auditory processing. The researchers from the University of California San Francisco (UCSF; San Francisco, CA, USA; www.ucsf.edu) published the results in the January 26, 2016, issue of the journal Frontiers in Neuroanatomy. The study included 40 right-handed children with SPD, and 41 right-handed children without an SPD diagnosis. The researchers compared white matter tracts in the brain of both groups of children. SPD can cause hypersensitivity to sound, touch, and sight, a lack of fine motor skills, attention challenges, and great difficulties with regulating emotions.

The children’s Sensory Profile and Acoustic Index of the Differential Screening Test were characterized, and part of the Sensory Integration Praxis Tests was carried out to measure auditory and tactile processing. The researchers then used DTI to measure the structural connectivity of both groups of children. DTI measures the movement of water molecules in the brain, and maps the structural connections between regions of the brain by visualizing the direction of white matter fibers, and their integrity. The results showed that the DTI scans were strongly correlated with the direct measurements of tactile and auditory processing during the neurological testing. This will allow clinicians to use DTI to calculate sensory challenges, assess patients objectively using quantifiable biomarkers, and provide personalized treatments. Senior author of the study, Pratik Mukherjee, MD, PhD, professor of radiology, biomedical imaging, and bioengineering at UCSF, said, “By comparing the white matter in the brain of

kids with SPD and typically developing kids, we were able to relate them to direct measurements of auditory and tactile function and find strong correlations between the white matter and sensory functioning. The children with SPD and the typically developing kids form a continuum, with the children with SPD at one extreme and sensory-typical at the other. This builds on the idea that SPD is a spectrum dis-

order and for the first time we have direct measurements, rather than solely relying on parent reports. Image: The diagram shows areas of the brain that can be affected by sensory processing disorders (SPD). Using an advanced form of MRI, researchers have identified abnormalities in the brain structure of children with SPD primarily in the back of the brain (Photo courtesy of UCSF).

MRI-DTI Useful in Predicting Long-Term Effects of Combat-Induced MTBI esearchers in the US have found that MRIDTI measurements correlate with clinical outcomes such as symptom severity and healthcare utilization in veterans with Mild Traumatic Brain Injury (MTBI). Diffusion Tensor Imaging (DTI) is a Magnetic Resonance Imaging (MRI) technique that can be used to measure the integrity of white matter in the brain’s signal-transmitting nerve fibers. The researchers studied 57 military veterans, diagnosed with MTBI after their return from combat, and with an average period of 3.8 years between injury and post-deployment evaluation. The average follow-up duration was 1.4 years. The study was published in the March issue of the journal Radiology and was carried out by researchers at the Philadelphia VA Medical Center

(Philadelphia, USA; www.philadelphia.va.gov). There has been a dramatic rise in the number of cases of combat-related MTBI in US service members. According to the US Armed Forces Health Surveillance Center more than 300,000 soldiers were diagnosed with MTBI between 2000 and 2015. The diagnosis of MTBI remains challenging, and it can be confused with other conditions such as Post-Traumatic Stress Disorder (PTSD). The results of the study show significant correlations between initial post-deployment DTI measurements and neuro-behavioral symptoms. The measurements also correlated with the timing of injury, subsequent functional outcomes, and the frequency of healthcare visits made by veterans with MTBI. According to the researchers, loss of white matter integrity is directly related to clinical out-

comes in veterans who suffered concussion or Mild Traumatic Brain Injury (MTBI) during combat. Jeffrey B. Ware, MD at the Philadelphia VA Medical Center, said, “All conventional MR images were interpreted as normal. We retrospectively analyzed the data from the DTI sequence to derive measures of white matter integrity, which we compared to clinical measures and subsequent outcome measures 6 months to 2.5 years after the initial evaluation. Our findings suggest that differences in white matter microstructure may partially account for the variance in functional outcomes among this population. In particular, loss of white matter integrity has a direct, measurable effect. It was illuminating to see the association between measures of white matter integrity and important outcomes occurring months to years down the road in our study population.”

3D Imaging Technique Provides Tool for Detecting Advanced Liver Fibrosis esearchers have found that a new innovative 3D Magnetic Resonance Elastography (MRE) technique is a highly accurately, and less invasive method to diagnosis advanced liver fibrosis, instead of liver biopsies used today. Non-Alcoholic Fatty Liver Disease occurs when large droplets of fat are deposited in the liver (hepatic steatosis), and can progress to liver fibrosis, cirrhosis, and cancer. NAFLD is widespread around the globe, and affects 33% or more of the general population in the US, and 50% of obese people. The research was carried out at the UC San

Diego School of Medicine NAFLD Research Center (San Diego, CA, USA; http://gastro.ucsd.edu/ fatty-liver/Pages/default.aspx) and published in the March 22, 2016, issue of the American Journal of Gastroenterology. The researchers conducted a prospective study that included 100 patients, 56% of them women, that had proven NAFLD. The researchers then assessed the effectiveness of 2D, and the new 3D MRE method. MRE is an Magnetic Resonance Imaging (MRI) technique that propagates mechanical shear waves in liver tissue. Tissue stiffness, an indicator of fibrosis, is measured quan-

titatively using an algorithm in MRE images. Rohit Loomba, MD, director of the NAFLD Research Center, and first author of the study, said, “3D MRE is probably the most accurate noninvasive method to detect advanced fibrosis. The prospective study is the first to evaluate 3D-MRE for diagnosing advanced fibrosis in NAFLD patients. Both 2D and 3D were highly accurate. These findings suggest that MRE could be used to enroll patients with advanced fibrosis into screening programs for cirrhosis as well as enrollment into clinical trials aimed at reversing fibrosis in the setting of advanced fibrosis.” Medical Imaging International May-June/2016

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Medical Imaging International

Lung Ultrasound Effective Substitute for Chest X-Rays in Diagnosis Of Pneumonia in Children he results of a randomized controlled trial in the pediatric emergency department of a leading medical school in the US suggest that lung ultrasound is highly effective, and safe, for diagnosing pneumonia in children, and could potentially be used as a substitute for standard chest XRay exams. According to the World Health Organization (WHO) pneumonia is the leading cause of death in children worldwide. While chest X-Rays exams are currently the standard choice for diagnosis, the WHO estimates that 75% of the world’s population does not have access to radiography. The results of the study were published in the March 2016 issue of the journal Chest. The study included 191 children aged 0 to 21 years. The children were randomly assigned to receive either a lung ultrasound and if necessary also a chest X-ray, and a control group that underwent a chest X-ray followed by a lung ultrasound. The study was conducted by researchers at the Mount Sinai hospital Icahn School of Medicine (ISMMS; New York, NK, USA; http://icahn.mssm.edu).

The researchers found that 38.8% less chest X-Rays were performed in the group that underwent an initial ultrasound exam, compared to no reduction in the control group. No pneumonia cases were missed and there was no increase in any other adverse events. The replacement of X-Ray exams by ultrasound resulted in overall cost savings of USD 9,200, and reduced the time the children spent in the emergency ward by an average of 26 minutes. The results suggest that lung ultrasound could become the best option for the diagnosis of pneumonia in children, although further research is required. Dr. Tsung, associate professor at Mount Sinai, and leader of the research team, said, “Ultrasound is portable, cost-saving and safer for children than an X-ray because it does not expose them to radiation. Our study could have a profound impact in the de-

veloping world where access to radiography is limited. In the era of precision medicine, lung ultrasound may also be an ideal imaging option in children who are at higher risk for radiation-induced cancers or have received multiple radiographic or CT imaging studies. Image: Lung ultrasound may be a safe substitute for chest x-ray when diagnosing pneumonia in children (Photo courtesy of Mount Sinai Hospital).

Large-Scale CT Study: Increased Cancer Risk For Patients with High Coronary Calcium Score esearchers investigating heart CT scans of more than 6,000 people have found that a high coronary artery calcium score may result in a greater risk for cancer, chronic kidney disease, and COPD, besides increasing the risk for heart and vascular disease. Heart Computed Tomography (CT) scans are used for finding mineral density levels, or calcium scores, in blood vessels feeding into coronary arteries. Coronary calcium scores are a good predictor for the risk of stroke, and coronary heart disease. The study was not intended to look for, measure, or find cause/effect relationships between non-cardiovascular diseases and coronary calcium levels. The study was conducted by researchers at the Johns Hopkins University School of Medicine (Baltimore, MD; www.hopkinsmedicine.org) and other universities, and was published online on March 9, 2016, in the journal Cardiovascular Imaging. The researchers made use of the Multi-Ethnic Study of Atherosclerosis (MESA) that included data from subjects in six different centers. The 6,814 people in the study were 45 to 84 years old, and without any signs of cardiovascular disease when the first heart CT scan and coronary calcium score calculation were made. Over a period of 10 years, through to 2012, the people returned for annual or more follow-up visits. At the end of the 10-year period 1,238 of the original participants were diagnosed with a variety of non-cardiovascular diseases, such as cancer, kidney disease, pneumonia, blood clot, dementia, hip fracture, and lung disease. The results found that among participants with coronary calcium scores higher than 400, 36.9% were diagnosed with a

Medical Imaging International May-June/2016

non-cardiovascular disease. In contrast, only 11% of participants with no coronary artery calcium had such a disease. Chronic kidney disease was found in 395 participants, and Chronic Obstructive Pulmonary Disease (COPD) in 161 participants. Michael Blaha, MD, MPH, from the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine, said, “Plaque in the arteries is the result of cumulative damage and inflammation, and vulnerability to injury and chronic inflammation likely con-

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tributes to diseases like cancer, kidney and lung diseases, as well as cardiovascular disease. So it makes sense that the coronary calcium score – a measure of arterial aging – is predictive of non-cardiovascular diseases too. The reason the coronary calcium score may work so well at identifying vulnerability to a variety of chronic diseases is because it’s a direct measurement of the cumulative effect of all risk factors, rather than a consideration of a single risk factor, like obesity, smoking or high blood pressure.”

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Mountable Ultrasound System Empowers Clinical Efficiency new ultrasound system developed for regional anesthesia, vascular access, and trauma applications provides a smart user interface that adapts to the user’s imaging needs. The SonoSite SII is a portable, mountable system that can be used across multiple hospital environments for ultrasound-guided procedures on a daily basis, including a zero footprint option for constrained rooms. The system features a touch screen user interface that provides a logic-driven clinical menu that adaptively adjusts to the individual case. An embedded dual connector allows quick switching between ultrasound transducers with two simple taps of the screen, ensuring that the right transducer is always readily available. To further accelerate end-to-end workflow, the SII comes with elevated transducer holders, a tray with a lockable drawer, large storage baskets,

and a dedicated location for a gel bottle, all while minimizing device footprint. The SII also features proprietary DirectClear technology, which enhances rP19 and rC60 transducer performance by increasing penetration depth and contrast resolution for better visualization of nerves and vessels. The SonoSite SII is a product of Fujifilm SonoSite (Seattle, WA, USA; www.sonosite.com), and has been approved by the U.S. Food and Drug Administration (FDA). “The new SII ultrasound system expands on the design goals of our mountable legacy system by offering more functionality, and an even better user experience from start to finish,” said Brian Leck, VP of global direct sales at Fujifilm SonoSite. “We listened to clinicians, and delivered a product designed to maximize the efficiency of their ultrasound use. The SII captures the epitome of the SonoSite brand, allowing clinicians to confidently use the

system from day one.” “Clinicians wanted a system to drive better overall efficiency, whether it be less button presses on the system or more utility in the stand,” added Brian Noyes, VP of global marketing at Fujifilm SonoSite. “The SonoSite SII features a newly designed user interface that adapts to the imaging state, and brings the con-

trols that are needed to the forefront. When you are scanning, you will see controls that are relevant to scanning. When you are in the frozen state, you will see controls related to measurements and calculations.” Image: The SonoSite SII portable, mountable ultrasound system (Photo courtesy of Fujifilm SonoSite).

PET-Guided Chemotherapy Can Increase Hodgkins Disease Remission he first large-scale trial of its kind in the US has shown that PET-guided chemotherapy can significantly increase disease remission and reduce toxic side effects of treatment for patients with advanced Hodgkin lymphoma. The research was conducted by the Southwest Oncology Group (SWOG), and two other US National Cancer Institute research groups, and was published in the April 11, 2016, issue of the Journal of Clinical Oncology. Hodgkin’s disease affected approximately 9,050 Americans in 2015. The researchers recruited 358 Hodgkin patients for the trial, and evaluated 331 of them. The patients received two rounds of a four-drug Hodgkin’s chemotherapy treatment regimen ABVD (Adri-

amycin, Bleomycin, Vinblastine, Dacarbazine) followed by a Positron Emission Tomography (PET) scan to assess treatment response. Patients with a negative PET scan received another four cycles of ABVD. Patients with a positive scan result, received six cycles of eBEACOPP, a seven-drug Hodgkins chemotherapy treatment regimen used in Europe. The results showed that 15% to 30% of patients’ PET scan still showed signs of cancer after two rounds of ABVD treatment, were cancer-free after two years. On the other hand 64% of patients, who also received eBEACOPP treatment, after PET scanning, were cancer-free after two years, double the expected remission rate. In addition, the study results showed that 82% of patients whose PET scan

was negative, and underwent the additional ABVD treatment, were cancer-free after two years. Dr. Jonathan Friedberg, director, James P. Wilmot Cancer Institute, University of Rochester Medical Center (Rochester, NY, US; www.urmc. rochester.edu/cancer-institute.aspx), said, “What’s also important is that only 20 percent of the patients in our trial were exposed to eBEACOPP – which means they weren’t exposed to its bad effects,” said “That’s important because many people diagnosed with Hodgkin lymphoma are in their 20s and 30s and want to have children. This response-adapted therapy would ensure that the people who need the more toxic drugs receive them – and would spare others from infertility and serious toxicities.”

Minimally Invasive Catheterization Techniques and New Imaging Tools for Treatment of Pediatric Plastic Bronchitis he results of a retrospective study show that a novel minimally invasive procedure consisting of a Magnetic Resonance (MR) lymphangiogram and lymphatic embolization, can help relieve airway blockages that can occur in children as a result of congenital heart defect surgery. Pediatric physicians-researchers found that the main cause of plastic bronchitis is abnormal lymphatic flow into lung tissue, which is often undiagnosed. Plastic bronchitis is a rare complication in about 5% of children who survive heart surgery for single-ventricle disease. Abnormal circulation can cause lymph to leak into a child’s airways and dry, forming a cast. To treat this the researchers developed a new imaging technique called dynamic contrast enhanced MR lymphangiogram that enabled them to visualize

the anatomy and flow in the lymphatic system, and locate sites where lymph leaks into the airways. After identifying the leakage site in a lymph vessel, the team used lymphatic embolization and iodized oil, coils, or covered stents, based on the specific case, to block the abnormal flow of lymph. The retrospective study included 18 children with plastic bronchitis at the Children’s Hospital of Philadelphia (CHOP; Philadelphia, PA, USA; www.chop.edu). The researchers published the results of the study online, ahead of print, on February 10, 2016, in the journal Circulation. The team performed lymphatic embolization in 17 patients, aged between two and 15 years, with a median age of 8.6 years. Fifteen patients showed significantly improvements in cast formation, lasting for more than two years in some cases. Transient side effects

included abdominal pain and low blood pressure, but the authors reported that the procedure appeared safe in the patients treated. According to the researchers the treatment has can offer long-term improvement, or even a cure in patients with plastic bronchitis, avoiding the need to perform a heart transplant. The techniques have also been successfully used to treat patients with idiopathic plastic bronchitis that does not have a known cause. Maxim Itkin, MD, associate Radiology professor, Perelman School of Medicine, University of Pennsylvania, (PENN Medicine; Philadelphia, PA, USA; www.upenn.edu), said, “We have expanded on that study to report short-term outcomes in a larger group, and to share insights into the development of plastic bronchitis, which has been poorly understood.” Medical Imaging International May-June/2016

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Medical Imaging International

Guidance Engine Software Simplifies Fusion Imaging Stent Placement Workflow novel software application package provides automated procedure support for minimally invasive treatment of aortic aneurysms. The software application package automates the stent placement workflow, reduces the radiation dose that a patient is exposed to, and reduces the amount of contrast media required for the precision placement of stents. In addition, intra-operative 3D imaging allows surgeons to check the results of the procedure as soon as surgery is complete. Siemens Healthcare (Erlangen, Germany; www. healthcare.siemens.com) presented the Evar Guidance Engine software application package at the Charing Cross International Symposium (CX;

London, UK) on April 26 to 29, 2016. The Evar Guidance Engine provides automated workflows to support the surgical process including analysis of pre-procedural Computed Tomography (CT) images, image-supported intervention, and intra-operative monitoring using 3D imaging. The Evar Guidance Engine software can recognize aorta vessel walls, find the main branching vessels, and determine the best angle for the C-arm equipment. The software prepares the CT image for overlay with the 2D X-Ray image, and this enables anatomical markings from the CT image to be displayed on the X-Ray image to help the surgeon position the stent precisely, and reducing the duration of surgery.

Laser Technology Could Advance Thyroid Cancer Screening new, low-cost device could enable enhanced information and better diagnosis during thyroid nodule screening. A multidisciplinary team that includes The Institute for Photonic Sciences (ICFO; Barcelona, Spain; www. icfo.eu), Politecnico di Milano (Milan, Italy; www.polimi.it), the University of Birmingham (United Kingdom; www. birmingham.ac.uk), along with five other European institutions, are collaborating on the laser and ultrasound coanalyzer for thyroid nodules (LUCA) project, which combines two photonics systems, near-infrared (NIR) diffuse correlation spectroscopy and time-resolved spectroscopy, along with a ultrasound system and a probe that enables multimodal data acquisition. The project, launched to enhance screening of thyroid nodules for thyroid cancer, brings together clinical endocrinologists, radiologists, physicists, engineers, and industry players with the intention of developing a low-cost, point-of-care clinical device. According to the project partners, LUCA represents an innovative new tool for cancer diagnosis, screening, and therapy, and as such could have a significant impact not only in the field of thyroid cancer, but also in additional areas of the body accessible to both techniques. “The device combines ultrasound and near-infrared diffuse optical technologies in a single device and a probe. By combining information about tissue hemodynamics, chemi-

Medical Imaging International May-June/2016

cal constitution as well as anatomy, it will overcome the shortcomings of present techniques while screening for malign thyroid nodules,” said Prof. Turgut Durduran, PhD, of the ICFO, scientific coordinator of LUCA. “If successful, this will save millions of euros over the coming decades and improve the lives of millions of Europeans.” “A new tool made concomitantly with thyroid ultrasound may provide additional information to help us distinguish between benign and malignant nodules,” said Mireia Mora, MD, of the August Pi i Sunyer Biomedical Research Institute (IDIBAPS; Barcelona, Spain), responsible for the clinical application of the tool. “This would allow a reduction in the number of surgeries for these reasons, and would have an important socio-economic impact, diminishing the number of surgeries and the associated comorbidities, as well as improving the quality of life of the patients affected.” Thyroid nodules are a common pathology, with a prevalence of around 5% in women and 1% in men, which increases to 19%–76% with diagnostic neck ultrasound. To exclude thyroid cancer when screening – which occurs in 5%–15% of cases – ultrasound is followed by fineneedle aspiration biopsy of suspicious nodules. In thyroid cancer, the sensitivity and specificity of this process are limited, with a large number of non-diagnostic and false positive results that lead to unnecessary surgery.

Siemens Healthcare will make the Evar Guidance Engine available as part of the Pure platform on the Artis Q, Artis zeego, Artis zee, and Artis Q.zen angiography systems. Dr. Philipp Geisbuesch, vascular surgeon, Heidelberg University Hospital, said, “The optical system is an absolute winner, since you always have all the key orientation points in view. I can always see where the renal artery is, and which angulation I need to select. Fusion imaging enables us to place the endograft with maximum accuracy and the

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correct angulation. All with minimum use of contrast media. Using this contrast-enhanced cone beam CT, we discovered associated endograft or other complications in seven percent of patients that we could immediately repair on the table. Now we can be sure: once we bring our patient out of the operating room, everything that could be done has been done.” Image: The EVAR-3D Guidance for endovascular repair of the aorta (Photo courtesy of Siemens Healthcare).

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ULTRASOUND SCANNER

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The X2 offers sensors for R/F, MAM, CT, Survey, and light applications that are orientation-independent, removing the need for selecting ranges or special modes. Most sensors also measure waveforms that can be analyzed on the base unit and come with a built-in, self-test system.

The ExaPad portable ultrasound scanner comes with Echo interface and Echo Voice embedded software, which allows its main functions to be controlled by voice. Its 15-inch high-resolution touch screen and extended battery life makes it suitable for ambulatory and for sedentary use.

The Aplio 500 Platinum expands the range of visible blood flow, provides visualization of low velocity microvascular flow, and reveals cardiac function in detail. It features an adjustable console and a high-resolution 19-inch LED monitor for better image quality across clinical applications.

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Ablation Balloon Catheter Treatment for Barrett’s Esophagus Launched leading biomedical healthcare provider has launched a new express Radio-Frequency Ablation (RFA) catheter that can reduce the risk of lowgrade dysplasia by treating a precancerous condition called Barrett’s esophagus. The incidence of esophageal cancer is increasing faster than prostate cancer, breast cancer, and melanoma in the US. Barrett’s esophagus, a result of chronic injury from Gastro-Esophageal Reflux Disease (GERD), affects more than 12 million adults in America today. The Medtronic (Dublin, Ireland; www.medtronic.com) Barrx 360 Express catheter is a self-adjusting circumferential RFA catheter that enables gastroenterologists and surgeons to provide targeted precision therapy for treating Barrett’s esophagus. The RFA treatment removes diseased tissue with minimal damage to healthy tissue in the esophagus. The RFA therapy can reduce the risk of low-grade dysplasia progressing to cancer of the esophagus, by around 90%. The new design of the Barrx 360 Express catheter can reduce procedure times by 20% by simplifying workflow steps and increasing the efficiency of Barrett’s tissue ablation. The Barrx 360 Express RFA balloon catheter is being launched first in the US, but is also expected to be on sale in New Zealand, Australia, and the EU in 2016.

Image: The Barrx 360 Express Radio-Frequency Ablation (RFA) catheter can be used to treat Barrett’s esophagus (Photo courtesy of Medtronic).

Vafa Jamali, president Early Technologies, Medtronic Minimally Invasive Therapies, said, “In reducing the progression of dysplastic Barrett’s esophagus to esophageal cancer, the launch of the Barrx 360 Express RFA balloon catheter underscores our commitment to patients. We believe patients and physicians will benefit from the easier-to-use technology of the Barrx 360 Express catheter, which provides a more precise delivery of RF energy to the targeted area.”

Image-Guided PET-CT Surveillance Effective as Neck Dissection for Advanced Head and Neck Cancer he results of a recent study show that the survival rates of patients with advanced head and neck squamous-cell carcinoma, was similar for those diagnosed using PET-CT guided surveillance, and those who underwent a planned neck dissection. The use of the different techniques for the treatment of patients with advanced head and neck squamous-cell carcinoma nodal disease (stage N2 or N3) who have undergone chemoradiotherapy for primary treatment, is unclear and under debate. The primary end point of the prospective, randomized, controlled trial was to assess overall survival rates, and the non-inferiority of Positron-Emis-

sion Tomography-Computed Tomography (PET-CT) guided surveillance when compared with planned neck dissection for patients with stage N2 or N3 carcinoma nodal disease. The researchers used data gathered by the UK Warwick Clinical Trials Unit. Tissue samples were collected and stained for the p16 protein at the University of Birmingham (Birmingham, UK; www. birmingham.ac.uk). The study lasted from 2007 to 2012, and included 564 patients from 37 centers in the UK. Seventeen percent of the patients had nodal stage N2a disease, while 61% had stage N2b disease. The results showed that the use of PET-CT guided surveillance resulted in significantly less neck

dissections (54) compared to planned dissection surgery (221). Surgical complications were similar in both groups. The 2-year overall survival rate was 84.9% for those patients undergoing PET-CT surveillance, and 81.5% for those that underwent planned-surgery. In addition, savings of UKP 1,492 per patient were realized per patient, for the duration of the trial, when PET-CT guided surveillance was used instead of neck dissection. The researchers concluded that survival rates for patients who underwent planned neck dissection were similar to those that underwent PET-CT guided surveillance, and that imaging surveillance resulted in significantly less operations than neck dissection, and was more cost-effective. Medical Imaging International May-June/2016

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Medical Imaging International

Miniature Transponder Guides Radiation Therapy Procedures new implanted transponder can help enhance the precision of radiotherapy (RT) and radiosurgery treatments for cancer by providing real-time, continuous information on tumor position. The Calypso 17G soft tissue Beacon transponder emits a non-ionizing electromagnetic signal that is tracked in real-time by the Calypso system, guiding treatment beams to target tumors during treatment with medical linear accelerators. The size of a grain of rice, the 17G Beacon has a smaller cross-section area than the current, 14G version, and can be implanted within the soft tissue throughout the body, with the exception of the lung. The Calypso System can then deliver real-time, continuous three-dimensional (3D) tumor position information, improving clinician confidence that the prescribed dose has

been delivered to the tumor. Based on the transponder signals, the Calypso System can track even the slightest movement of the tumor without using ionizing radiation, and can precisely target even tumors that exhibit respiratory motion, as the system allows the beam to be gated on only when the tumor is in the planned position. The increased precision can enable treatment margin reduction, protecting healthy tissue and reducing side effects. The Calypso 17G soft tissue Beacon transponder and the Calypso System are products of Varian Medical Systems (Varian, Palo Alto, CA, USA; www.varian.com). Organ motion is variable and unpredictable, posing challenges during delivery of external beam RT treatments for cancer. The ability to track target motion in real time during treatment and gate the

Ultrasound System Receives US Defense Health Agency Approval n ultrasound system has received Authorization to Operate (ATO) approval from the US Defense Health Agency (DHA) by complying with strict US Department of Defence (DoD) cybersecurity guidelines. The approved series of ultrasound systems met the DHA’s Patient Health Information (PHI) network security guidelines, which mitigate security risks and ensure protection against viruses, malware, and other malicious software. To meet the PHI guidelines, the manufacturer enhanced their ultrasound platform to include the Microsoft Windows 7 Operating System (OS) and security software that proactively identifies and prevents malicious attacks and viruses. Cybersecurity is also an increasing problem for healthcare institutions outside of the military that are increasingly connected on online networks. The ultrasound systems that were approved were the Aplio 500 Platinum and Aplio 300 Platinum series. The systems are manufactured by Toshiba America Medical Systems (Tustin, CA, USA; http://medical.toshiba.com), and received ATO approval for use in the US Air Force. In the past Toshiba also received ATO approval for its Computed Tomography (CT), Magnetic Resonance (MR), and cardiovascular X-Ray systems. Satrajit Misra, VP, Marketing and Strategic Development, at Toshiba, said, “We understand that medical imaging safety goes beyond radiation dose and extends to other areas, including cyber threats where medical imaging technology could be targeted. Cyber threats present a significant risk to not only healthcare provider’s data, but to patient safety when personal health and financial information is stolen, and the confirmation of ATO status will help our customers mitigate those risks.”

delivery beam can enable reduction in the margins between the clinical target volume (CTV) and the planning target volume (PTV). Image: The Calypso 17G soft tissue Beacon transponder (Photo courtesy of Varian Medical Systems).

PET Imaging Agent Promises Improved CAD Detection and Reduced Dose for Obese Patients he results of a first Phase 3 study of a new PET imaging agent were announced at the American College of Cardiology (ACC) Annual Scientific Session, in April 2016, in Chicago. In the study, the new investigational Positron Emission Tomography (PET) imaging agent was compared to Myocardial Perfusion Imaging (MPI) using Single Photon Emission Computed Tomography (SPECT) to assess Coronary Artery Disease (CAD) in patients with a BMI of 30 or higher. Obesity can lead to an increased risk of stroke, heart disease, high blood pressure, or diabetes. The flurpiridaz F 18 PET imaging agent was developed by Lantheus Medical Imaging (LMI; North Billerica, MA, USA; www.lantheus.com), a company which develops, manufactures, and commercializes diagnostic imaging agents. The results of the study showed that flurpiridaz F 18 could improve the detection of coronary artery disease in obese patients, compared to SPECT MPI, while at the same time reducing radiation exposure for the patients. Cesare Orlandi, MD, CMO, Lantheus Medical Imaging, said, “The Phase 3 data sub- analysis presented at ACC show the advantages of flurpiridaz F 18 PET imaging for coronary artery disease detection in obese patients. Flurpiridaz F 18 PET imaging shows superiority over SPECT in an obese population and provides images with better quality, and less attenuation, which can lead to increased diagnostic certainty by physicians. We believe the improved diagnostic accuracy, utility in stress imaging, reduced radiation exposure and potential for quantification of coronary flow reserve provide great promise for flurpiridaz F 18 to become the diagnostic imaging tool of choice for evaluating coronary artery disease in obese patients.”

2D FFD Mammography System and 3D DBT System Receive CE Certification new digital breast tomosynthesis system and a full field digital mammography system from the same manufacturer are now approved for sale in the EU after receiving the CE (Conformité Européenne) mark. Digital Breast Tomosynthesis (DBT) imaging technology is used to create 3D volume reconstructions of the breast, resolve micro-calcifications in blood vessels in overlapping breast tissue, and eliminate motion blur and artifact intrusion, resulting in enhanced diagnostics for patients with denser breast tissue. DBT improves the accuracy of images, by providing increased detail and precision.

Medical Imaging International May-June/2016

The systems that received the CE Mark are the Planmed (Helsinki, Finland; www.planmed.com) Clarity 3D DBT system, and the Clarity 2D Full Field Digital (FFD) mammography device. Planmed develops, manufactures, and markets advanced mammography and orthopedic imaging equipment, and accessories, including stereotactic biopsy devices, and breast positioning systems. The Clarity 2D digital mammography system can also be upgraded to DBT. Both systems are capable of delivering a low effective patient dose, have a digital detector for mobile operation, and feature Planmed Clarity Flow touch control for dual touch screens.

The systems can be used for screenings, diagnostic imaging, and biopsies. Jan Moed, managing director, Planmed, said, “We are very excited about the CE clearance, as it permits us to launch a new and improved method to combat breast cancer. We are convinced that both systems will be well accepted. The Red Dot jury especially valued their eye-catching and functional design, which also enhances ergonomics. The adaptive touch control of the systems will provide an unforeseen user experience. We can reduce patient anxiety with the design of the systems and consequently encourage more women to participate in breast cancer screenings.

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PACS SOFTWARE

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The Buzz digital O.R. is a central multi-touch information hub that routes, displays, interacts, streams, records, and enhances medical images, software content and videos. It includes a 42-inch HD touch display, industrial-grade workstation, and integrated sound system.

The Unity PACS is designed for automating diagnostic imaging and data management, and can be controlled by speech command. It imports indications, measurements, technologist’s findings, hemodynamic data, risk assessment, radiation / contrast dose, and guidelines directly into reports.

The iClarity allows healthcare professionals to securely utilize PACS and Clarity Practice software via the iPhone or iPad. Its search facility can sort by name, ID number, modality, and date, and it utilizes tools like zoom, pan, window/level, cine, and measurements to manipulate images.

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Virtual Reality Technologies Can Dramatically Reduce Surgical Planning Times, Increase Accuracy ew virtual-reality technologies that use medical images and data from various sources have the potential to dramatically improve patient outcomes. One recent clinical trial carried out by pediatric surgeons at Stanford University Medical Center (SUMC; Stanford, CA, USA; http:// stanfordmedicine.org), has enabled surgeons and radiologists to develop more accurate surgical plans in 40% less time. The trial also changed the role of the radiologists who became more involved in treatment planning, and prepared data sets for the surgeons. Surgeons in the SUMC trial used a virtual-reality platform developed by EchoPixel (Mountain View, CA, USA; www.echopixeltech.com). Other trials have also shown that surgical accuracy can be increased by 10%. The new technologies will enable doctors to interact with 3D Magnetic Resonance Imaging (MRI) and ultrasound rendered images of an organ. Smart styluses and other hardware can even provide resistance and tactile feedback similar to an actual operation. Virtual reality could be especially useful in medical training, although widespread adoption of such technology will take several more years, as medical professionals are not willing to make abrupt changes in their way of working. Sandeep Gupta, manager of Biomedical Image Analysis, GE Global Research, said, “VR gives a very immersive way of looking at all this data, which is working to integrate virtual reality into its existing imaging equipment. Doctors may be able to see which brain regions are affected by a neurodegenerative disease, for example, or which neural pathways information and signals are flowing through.”

Image: Doctors used a virtual-reality tool to plan surgeries on newborns missing pulmonary arteries (Photo courtesy of Stanford University).

First-of-Its-Kind Neurosurgery Visualization Platform novel neurosurgery Virtual Reality (VR) visualization platform has been demonstrated at the NVIDIA GPU Technology Conference (GTC) 2016 in California (USA). The enterprise-wide solution is intended to help clinicians plan, prepare, and perform neurosurgery, and enable the surgeon to empower and engage their patients throughout the care cycle, from the examination room, to the operating room. The platform was developed by Surgical Theater (Mayfield Village, Ohio, USA; www.surgical theater.net), a world leader in medical virtual reality systems. The platform includes NVIDIA (Santa Clara, CA, USA; www.nvidia.com) Graphics Processing Units (GPU) also used in VR gaming, flight

simulation, and artificial intelligence. The Surgical Theater platform combines data from different imaging modalities including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) to build a virtual reconstruction of a patients’ anatomy. The user of the new platform wears an HTC (Xindian; New Taipei City, Taiwan; www.htc.com) Vive VR headset, and can perform a VR “fly through” of a patient’s anatomy, before and during the operation. This enables the neurosurgeon to navigate the unique anatomy of each patient and treat neurological disorders, and cerebrovascular diseases. The platform enables the neurosurgeon to show the patient the planned surgery in VR, and

helps them understand the procedure. Dr. Neil Martin, chairman of the University of California, Los Angeles (UCLA; Los Angeles, CA, USA; www.ucla.edu) Department of Neurosurgery, said, “Surgical Theater provides an immersive and memorable situational awareness when navigating through the inner space of the patient’s brain. Flying through the patient’s brain and having the ability to circumnavigate the tumor to see how the surrounding tissue, arteries or the optic nerve could be connected is critical to planning the removal procedure. It stays with you. So the terrain of the patient’s brain is familiar in surgery, which can enhance performance, reduce risk, and improve the overall outcome and timing of the surgery.” Medical Imaging International May-June/2016

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IT/PACS Update

Wireless Handheld Ultrasound Comes to iOS and Android novel mobile ultrasound scanner works with a mobile app, providing physicians with the freedom to perform ultrasound exams anywhere, anytime. The Clarius handheld ultrasound scanner is designed to be carried around for quick exams and to guide point-of-care procedures, such as nerve blocks and targeted injections. The device is constructed with a tough magnesium shell to withstand hospitals and other unpredictable environments, and is provided with a high quality, “pointand-shoot” simplicity similar to that of a mobile phone. Other features of the Clarius handheld scanner include automated gain and frequency settings and an intuitive user interface. The wireless device uses a secure point-to-point network to connect to the app on the selected de-

FDA Approves New Cloud PACS and Zero-Footprint Diagnostic Viewer he manufacturer of a leading cloud-based medical image management suite, has announced US FDA 510(k) approval of a next generation cloud PACS and HTML5 zero-footprint diagnostic viewer tools, with new features for image viewing, management, and interpretation. A global network of 70,000 users and 750+ providers exchange medical images using the platform that can eliminate the need for Virtual Private Networks (VPN), manual storage devices, and error-prone manual workflows. DICOM Grid (Phoenix, AZ, USA; www.dicomgrid.com), a healthcare Software as a Service (SaaS) company, announced the new DG PACS (Picture Archiving and Communications Systems) and DG Viewer that can be integrated into existing Health Information Exchanges (HIE), and Electronic Health Record (EHR) systems saving time, preventing redundant radiology exams, and minimizing radiation exposure for patients. The DG PACS uses configurable workflow rules for routing, a modality worklist, and integrated reporting tools, enabling organizations to manage medical images on-site, and off-site. The DG PACS has a cloud-based architecture enabling full diagnostic read-at-home mobile access, with teleradiology capabilities, using only a web browser. The DG Viewer enables fast diagnosis of trauma, and tele-stroke cases in an operating room during cardiovascular, orthopedic, and neurosurgery procedures. The viewer also facilitates collaboration, and consultation between clinicians. Tyler Martin, executive director of Ambulatory Network Operations at the New England Baptist Hospital (NEBH; Boston, MA, USA; www.nebh.org), said, “Because both NEBH and outside studies are available in DICOM Grid, the physicians can easily hang priors performed at other facilities next to more recent studies done within the hospital. This streamlines their workflow, allowing them to more rapidly arrive at a treatment plan for the patient.”

Medical Imaging International May-June/2016

vice (or devices), and is compatible with most iOS and Android smartphones and tablets. According to the developers, the affordable ultrasound solution will be able to bring ultrasound inside ambulances; will enable better women’s health in rural places; will reduce infection rates during procedures; and will enable physicians to solve health issues sooner. The Clarius handheld ultrasound scanner is a product of Clarius Mobile Health (Burnaby, BC, Canada; www.clarius.me), and is pending worldwide approval. “Physicians have been asking for a portable ultrasound system that works with their iPhone for some time. The challenge has been to make an affordable device that is small enough to carry around and that also produces great images,” said Laurent

Pelissier, chairman and CEO of Clarius Mobile Health. “We chose the name Clarius because it’s a combination of ‘Clear’ and ‘Ultrasound’. It also happens to be the name of a roman God of medicine.” Image: The Clarius handheld ultrasound scanner (Photo courtesy of Clarius Mobile Health)

World Imaging Center News

European Consortium of Hospitals Aims to Replace Painful Liver Biopsies With Non-Invasive MRI Scans consortium of hospitals in Europe has been awarded a multi-million Euro grant to use a new non-invasive MRI technique for the early detection of diseases such as Non-Alcoholic Fatty Liver Disease (NAFLD). The new Magnetic Resonance Imaging (MRI) technique for diagnosing NAFLD is faster, less expensive, less painful, and safer than the existing method of liver biopsy. Current liver biopsies only sample 1/50,000th of the liver. The MRI technology called LiverMultiScan, was developed by Perspectum Diagnostics (Oxford, UK; www.perspectum-diagnostics.com) and was showcased at the International Liver Congress in Barcelona, Spain, on April 13th to 17th, 2016. LiverMultiScan is non-invasive and can be used by clinicians to accurately measure metrics such as liver fat for the early detection of NAFLD. The LiverMultiScan MRI scan takes 15 minutes. LiverMultiScan has been used in Europe and US for research since 2014. NAFLD is fuelled by the obesity epidemic and affects nearly 25% of Europeans. NAFLD can lead to complications such as cirrhosis, and liver failure. LiverMultiScan MRI is manufactured by Mirada Medical (Oxford, UK; www.mirada-medical.com), and has been received the CE Mark (Conformité Européenne), and US Food and Drug Administration (FDA) clearance. Dr Rajarshi Banerjee, CEO of Perspectum Diagnostics, says “We are delighted that the H2020 funding body recognises the enormous potential for LiverMultiScan to replace unnecessary biopsies. There is a real opportunity here, not

only to make significant economic savings at a time when all health services are under pressure, but also to reduce the number of patients having to undergo what can be a stressful and painful procedure.” Image: The LiverMultiScan MRI technology for diagnosing NAFLD (Photo courtesy of Perspectum Diagnostics).

US Cancer Center to Acquire Multiple Radiotherapy Solutions nderson Cancer Center has agreed to acquire four HDR brachytherapy afterloaders, an Oncology Information System (OIS), active breathing coordinator, comprehensive treatment planning software, and service for both hardware and software. The internationally recognized cancer center provides cancer care at various locations in the US state of Texas, and collaborates with community hospitals and health systems across the US. The MD Anderson Cancer Center (Houston, Texas, USA; www.mdanderson.org) will acquire

Elekta’s (Stockholm, Sweden; www.elekta.com) Infinity comprehensive image-guided radiation therapy system with Volumetric Modulated Arc Therapy (VMAT). The deal includes High-Dose-Rate (HDR) afterloaders, Oncentra Brachy treatment planning, the MOSAIQ OIS, and the Active Breathing Coordinator. Elekta is a human care company that develops tools and treatment planning systems for radiation therapy, radiosurgery, brachytherapy, and brain disorders, as well as workflow enhancement software for cancer care. Elekta will book the new order in the fourth quarter of fiscal year 2015-16.

Bill Yaeger, executive VP, North America region at Elekta, said, “As a world-renowned cancer center, MD Anderson has been a technology leader in managing the disease. In addition to being one of the first U.S. medical centers to acquire Elekta’s new Leksell Gamma Knife Icon brain radiosurgery system, MD Anderson is also part of the consortium to develop the world’s first high-field MR-guided linear accelerator. We are proud that it has chosen us again in the expansion of its facilities in Texas. Both organizations share a commitment to quality and the best care possible for patients.”

Advanced Enterprise Imaging Solution In Africa Powered by Imaging Platform

PET/CT Nuclear Medicine System to Improve Cancer Detection and Treatment in Tunisia

ntriHEALTH has selected an award-winning enterprise imaging platform as the first scalable and integrated enterprise image management to be deployed across the continent. The new platform will be used for enterprise-level medical image management, and will include workflow management, mobile image capture, reporting, and referral functionality. The platform provides a solution for the growing problem of healthcare delivery in Africa, a continent with a critical shortage of radiologists. The solution will include the centralization of medical imaging management, and communication of image data across the continent. IntriHEALTH (Fourways, Johannesburg, South Africa; www.intriHEALTH.com) selected Mach7 Technologies’ (South Burlington, VT, USA; www.mach7t.com) Enterprise Imaging Platform (EIP) based on requirements such as privacy, security, storage, and image availability. IntriHEALTH provides end-to-end solutions for longterm clinical exam data storage across imaging platforms. The Mach7 EIP can be used in various locations from remote imaging centers to academic hospitals. The scalable platform can be used for image capture in the field, access and sharing of patient imaging data from any geographic location, and features a simplified Graphical User Interface (GUI). Mike Simpson, CEO of IntriHEALTH, said, “Mach7 provides superior technology to solve the critical needs of our customers and patients in Africa. Advancing enterprise imaging by leveraging best-of-breed technology across a clinical ecosystem is gaining rapid adoption among providers across Africa. Our integration and implementation experience with Mach7 has been both swift and seamless, a testament to the technology and support teams at Mach7.”

he delivery of the first combined Positron Emission Tomography Computed Tomography (PET/CT) advanced imaging system to Tunisia is set to benefit cancer patients in the country. The system combines CT technology, which can accurately localize a tumor, with nuclear medicine (PET), which provides radiologists with information about the behavior of the cancer. Cancer mortality is increasing in Tunisia, and it is already the second most common non-infectious disease in the country. The GE Healthcare (Chalfont St Giles, Buckinghamshire, UK; www3. gehealthcare.co.uk) PET/CT machine was installed at the CERU Nuclear Medicine Center (Tunis, Tunisia; www.ceru-medecinenucleaire.com/en). CERU is Tunisia’s largest private center providing clinical radiology, and nuclear medicine treatments. Oncologists are using the new system to monitor and assess therapeutic responses to cancer treatments. GE Healthcare has committed USD1 billion globally to advance oncology solutions in 2016. The PET/CT system received regulatory authorization by the Tunisian authorities in September 2015, and has already treated more than 100 patients. PET/CT also enables oncologists to track how a patient is responding to treatment, in the early stages of the disease, and change the treatment regime if necessary. Farid Fezoua, president, and CEO, GE Healthcare in Africa, said, “GE is proud to have been selected by CERU as the key technology provider by for this important program. GE Healthcare is committed to serving its customers through partnerships and solutions offerings aimed at accelerating the development of sustainable healthcare in Tunisia.”

Medical Imaging International May-June/2016

Industry News

Upcoming Olympic Games Expected to Boost Brazil’s Healthcare System s part of the preparations for the Rio 2016 Olympic Games, a leading healthcare equipment and services provider will donate more than USD 2 million worth of new medical devices to a hospital in Rio de Janeiro. The donation will include four robotic surgical arms, six surgery monitors, six anesthetic machines, one Computed Tomography (CT) scanner, three digital X-Ray scanners, three ultrasound devices, and software for secure storage and management of patients’ scans. The high-tech medical equipment will be donated to the Souza Aguiar Hospital (Rio de Janeiro, Brazil) by GE Healthcare (Chalfont St Giles, Buck-

inghamshire, UK; www.gehealthcare. co.uk). Souza Aquiar is the second largest emergency care center in Latin America, and has over 600 beds, and receives more than 7,500 patients every month. The surgical arms are intended help doctors at the hospital perform 30% more surgeries, and reduce waiting times. The imaging equipment is also intended to reduce the radiation dose while doubling the number of XRay, CT, and ultrasounds exams carried out in the hospital. The new anesthetic equipment and surgical monitors can help clinicians provide optimized doses of anesthesia and shorten the time patients have to stay in the hospital by up to two days.

UK Health Service to Spend GBP 21.5 Million Upgrading Radiotherapy Resources he UK’s National Health Service has agreed to acquire linear accelerators, and software from a healthcare company in a deal valued at GBP 21.5 million. The order includes linear accelerators (linacs), multileaf collimators, and a system for improving the speed and reducing the radiation dose of radiation therapy treatment. The equipment and software will be delivered over the next two years. The deal was signed between the UK National Health Service Supply Chain (NHSSC) and Elekta (Stockholm, Sweden; www.elekta. com). Elekta develops tools and treat-

ment planning systems for radiation therapy, radiosurgery, brachytherapy, and brain disorders, and workflow enhancement software for cancer care. The deal includes Synergy linacs, Agility multileaf collimators for high speed beam shaping, and Elekta’s Volumetric Modulated Arc Therapy (VMAT) to improve the speed of radiation therapy treatment and reduce the radiation dose the patient is exposed to. During VMAT treatments radiation therapy is delivered in one or several uninterrupted arcs. This reduces the patient treatment time compared to curre

Turkish Group to Purchase Equipment Worth EUR 10 Million for Cancer Treatment healthcare company has announced a EUR 10 million deal with one of Turkey’s largest private healthcare networks for the procurement of sophisticated cancer treatment equipment and related software. The healthcare network includes 7 general-purpose hospitals, 2 dental care hospitals, as well as private healthcare facilities. The new equipment will include linear accelerators, treatment planning systems, and oncology information systems that can improve the accuracy and speed of cancer care. Medicana Health Group (Istanbul, Turkey; www.medicanainternational. com), selected Elekta’s (Stockholm, Sweden; www.elekta.com) Versa HD radiotherapy system and Synergy Platform linear accelerators, Monaco treatment planning systems, and MOSAIQ oncology information systems.

Medical Imaging International May-June/2016

Elekta is a healthcare company that develops tools and treatment planning systems for radiation therapy, radiosurgery, brachytherapy, and brain disorders, as well as workflow enhancement software for cancer care. Equipment deliveries are expected to begin in May 2016. The equipment will be installed in hospitals in the Turkish cities of Ankara, Bursa, Istanbul, and İzmir. Hüseyin Bozkurt, chairman of Medicana, said, ‘’We plan to open five new hospitals in the coming three years and to increase our presence in the radiation therapy segment with top of the line, latest technology linear accelerators, and fully integrated oncology information systems. We will continue to provide the latest developments in cancer treatment and the highest quality health services in all our hospitals.”

Varian Plans to Spin Off Imaging Components Business arian Medical Systems (Varian, Palo Alto, CA, USA; www. varian.com) intends to turn its imaging components unit into an independent publicly traded company, which will be spun off by means of a tax-free distribution to Varian stockholders. The new Varian Imaging Components spin-off will be a global supplier of components, software, and engineering services for imaging equipment manufacturers and system integrators in the medical diagnostics, dentistry, veterinary care, security, and industrial inspection industries. Among the products manufactured will be X-ray tubes, flat panel detectors, connectors and accessories for imaging, and workstations and software for computer-aided diagnostics and image processing. According to the company, the spin-off will give the two fundamentally different businesses the independence to optimize their strategies and operations to pursue growth strategies in their unique core markets, and sharpen the focus of each business and align their employee in-

centives and performance more closely with serving the specific needs of their respective markets. Upon completion of the transaction, Varian Medical Systems will continue to operate as one of the largest medical device companies focused on cancer treatment, with about USD 2.5 billion in annual revenues. It will concentrate on systems for treating and managing cancer, with distinct businesses in radiation oncology and proton therapy that will provide hospitals, clinics, and healthcare systems around the world with equipment, software, and services for radiotherapy, radiosurgery, brachytherapy, and proton therapy. “The spin-off will create two strong, independent companies. It will enable Varian to focus on expanding its position as a global cancer company with leading technology and services,” said Dow Wilson, CEO of Varian Medical Systems. “It will empower the new company to grow as a global leader in components, software and services for expanded imaging applications and markets.”

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

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

AUGUST 2016 38th Annual International Conference Of The IEEE Engineering In Medicine And Biology Society (EMBC). Aug 17-20; Orlando, FL; Web: http://embc.embs.org The 16th Asian Oceanian Congress of Radiology. Aug 19-21; Beijing, China; Web: www.theaosr.org FIME 2016 – Florida International Medical Exhibition. Aug 20-24; Miami, FL, USA; Web: www.fimeshow.com ESC 2016 – European Society of Cardiology. Aug 27-31; Rome, Italy; Web: www.escardio.org

SEPTEMBER 2016 ISS 2016 - International Skeletal Society Annual Meeting and Musculoskeletal Imaging Course. Sep 6-9; Paris, France; Web: www.internationalskeletalsociety.com CIRSE 2016- Cardiovascular and Interventional Radiological Society of Europe. Sep 10-14; Barcelona, Spain; Web: www.cirse.org 5th International Conf. on Radiology and Imaging. Sep 19-20; Las Vegas, NV, USA; Web: www.radiology.conferenceseries.com ASTRO 2016 - 59th Annual Meeting American Society for Therapeutic Radiology and Oncology. Sep 25-28; Web: https://www.astro.org 26th World Congress on Ultrasound in Obstetrics and Gynecology. Sep 25-28;

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International Calendar Davos. Mar 26-30; Web: www.idkd.org

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, United Arab Emirates; 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; Lake Buena Vista, FL, USA; Web: www.aium.org 49th International Diagnostic Course

APRIL 2017 12th European Molecular Imaging Meeting. Apr 5-7; Cologne, Germany; Web: www.emim.eu Society of Breast Imaging (SBI) / American College of Radiology (ACR) Breast Imaging Symp. Apr 6-9; Los Angeles, CA, USA; Web: Web: www.sbi-online.org Medical Fair India 2017. Apr 6-8; New Dehli, India; Web: www.medicalfair-india.com International Symposium on Biomedical Imaging (ISBI). Apr 18-21; Melbourne, Austrailia; Web: http://biomedical imaging.org/2017 80th Annual Scientific Meeting. Apr 2023; Montreal, QC, Canada; Web: www. car.ca ASNR 2017 - 55th Annual Meeting American Society of Neuroradiology. Apr 22-27; Long Beach, CA, USA; Web: www.asnr.org ISMRM 2017 - 25th Annual Meeting ofThe International Society for Magnetic Resonance in Medicine. Apr 22-28; Honolulu, HI, USA; Web: www.ismrm.org ECIO 2017 - 8th European Conference on Interventional Oncology. Apr 23-26; Bilbao, Spain; Web: www.ecio.org Radiology in Venice. Apr 23-29; Venice, Italy; Web: www.radiologyintl.com 2017 ARRS - Annual Meeting of American Roentgen Ray Society. Apr 30-May 5; New Orleans, LA, USA; Web: www.arrs.org

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

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Medical Imaging International May-June/2016

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