Medical Imaging International March 2017 by Globetech

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Vol.27 No.1 2-3 /2017 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 3-28 PACS/ IT Update . . 29-32 Product News . . . . 10-32 Industry News . . . . . . 33 International Calendar . 34

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Study Suggests Teenage Obesity May Lead to Permanent Bone Loss esearchers have shown that obesity in adolescents affects bone density and could increase the risk of bone fractures in later life. Obesity is a major problem in many countries and is commonly associated with cardiovascular disease, and diabetes. The goal of the researchers is to try and find how obesity in adolescents affects bone structure. Twenty-three adolescents with a mean Body Mass Index (BMI) of 44 kg/m2, and with a mean age of 17 years took part in the study. The researchers used 3D High Resolution Peripheral Quantitative Computed Tomography (HRpQCT) exams to measure bone microarchitecture, and mineral density in the arms and legs of the study participants. The scans enabled the researchers to study the structure of a bone in the forearm called the distal radius. In addition, the study participants underwent dual-energy X-Ray Absorptiometry (DXA) exams to quantify lean mass, and visceral fat mass. The research was presented at the annual Radiological Society of North America (RSNA2016) meeting. The study results showed a positive association between BMI and cortical bone thickness and area, and cortical bone porosity. There was also a positive association between lean mass and trabecular density, bone volume, and integrity. The researchers concluded that a high amount of visceral fat combined with a low amount of muscle

mass, was a risk factor for weakened bone structure in adolescents. Lead author of the study, radiologist Miriam A. Bredella, MD, Massachusetts General Hospital (Boston. MA, USA; www.massgeneral.org), said, â&#x20AC;&#x153;While obesity was previously believed to be protective of bone health, recent studies have shown a higher incidence of forearm fractures in obese youths. Adolescence is the time where we accrue our peak bone mass, so bone loss during this time is a serious problem. We know from other chronic states that lead to bone loss in adolescence, such as anorexia nervosa, that increased fracture risk persists in adulthood, even after normalization of body weight. Therefore, it is important to address this problem early on. In addition, vitamin D, which is important for bone health, is soluble in adipose tissue and gets trapped within fat cells. The best way to prevent bone loss is a healthy diet that contains adequate amounts of calcium and vitamin D, along with sufficient exercise, as we have shown in our study that muscle mass is good for bone health.â&#x20AC;?

New Radiation-Free Screening Alternative in Development esearchers in the Netherlands are developing an alternative breast cancer screening method that can identify tumors by the blood vessels surrounding it. Mammograms are commonly used in many countries for the early detection of breast cancer, but the procedure is often unpleasant, and uses X-Rays that can themselves cause cancer. In addition, most of the findings are false-positives, and findings are not actually cancerous. The new technique that generates 3D images is being developed by researchers at the Technical University Eindhoven (TU/e; Eindhoven, the Netherlands; www.tue.nl). The proof of concept research study results was published in the October 2016 online issue of the journal Scientific Reports. The new technology involves a patient lying on a table, with their breast hanging freely in a bowl. The clinician then uses echography to create a 3D image of the breast. The technique uses dynamic contrast specific ultrasound tomography to reveal the microvessels associated with tumors. The researchers are currently assembling an international medical team to begin preclinical studies of the new technique. A similar technique, also developed at the TU/e, is already being used for radiationfree detection of prostate cancer. The method involves a clinician injecting harmless microbubbles into a patient, followed by imaging using an echoscanner to precisely monitor the microbubbles as they move through the blood vessels of the prostate gland. The technique reveals the network of chaotic microvessels that surround a tumor.

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MRI Study Shows Brain Disruption In Children with PTSD he results of a new study suggest that children suffering from Post-Traumatic Stress Disorder (PTSD) experience disruptions in the neural networks in their brains. The researchers used Magnetic Resonance Imaging (MRI) Diffusion-Tensor Imaging (DTI) to investigate the brain structure of pediatric patients who had been victims of the 2008 earthquake in Sichuan in which nearly 70,000 people died, and more than 370,000 were injured. Some of the patients were suffering from PTSD, while others were not. The images showed changes in the brains of the children with PTSD suggesting decreased network efficiency between linked regions of the brain. The study was published online in October 2016 in the journal Radiology and could help researchers find new treatments for PTSD, a condition that is often the result of one or several traumas. Children with PTSD may suffer from lasting changes in brain structure and brain function. The Chinese researchers used MRI imaging to compare the brain structure in 24 pediatric patients with PTSD, and another 23 children exposed to trauma but without PTSD. Lead author of the study, Qiyong Gong, MD, PhD, West China Hospital, Sichuan University (Chengdu, China; http://eng.cd120.com), said, “Generally speaking, the structural connectome and

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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 Hazel Tapia Reader Service Manager Arda Turac Production Director

the functional connectome are based on different types of raw images, which may be used to investigate the brain’s abnormalities through different views. In a previous functional and current structural connectome study of the same patient group, we found a shift toward regularization in the brain networks of the PTSD patients relative to controls. Thus, we speculate that this regularization process may be a general pattern of pediatric PTSD. These abnormalities suggest that PTSD can be better understood by examining the dysfunction of large-scale spatially distributed neural networks. Image: The image shows a pediatric PTSD-related sub-network of the brain (Photo courtesy of RSNA).

Researchers Use PET to Visualize Cardiac Amyloidosis esults of a study have shown that a new non-invasive technique using PET imaging and a radiotracer, can visualize abnormal protein deposits in the heart, in a condition called cardiac amyloidosis. The researchers used fluorine-18 (F-18)-florbetaben, a radioactive tracer, and Positron Emission Tomography (PET) to visualize and quantify the deposition of amyloid proteins in heart muscle. The technique could be used to diagnose cardiac amyloidosis accurately and non-invasively, and could also help clinicians the monitor disease burden. The study results were published in the November 2016 issue of The Journal of Nuclear Medicine. The researchers from the Princess Alexandra Hospital (Brisbane, Australia; https://metrosouth. health.qld.gov.aul) performed F-18-florbetaben PET in 14 subjects and compared patients who had thickened heart muscle, secondary to amyloid deposition, with those that had thickened myocardium as a result of hypertensive heart disease. The researchers found a higher target-to-background Standardized Uptake Values (SUV) ratio and percentage myocardial radiotracer retention in amyloid patients compared to the control subjects with heart disease. The results show that the new

PET technique can be used to identify and differentiate between patients with cardiac amyloidosis and those with hypertensive heart disease. Corresponding author of the study, Dr. W. Phillip Law, said, “The first signs and symptoms of the disease are non-specific and usually attributed to other conditions. Currently, there is no definitive test to diagnose cardiac amyloidosis other than an invasive biopsy of the heart muscle. Cardiac amyloidosis is often not diagnosed until late in the course of the disease, as the typical appearance of the infiltrated myocardium on echocardiography and MRI can be mistaken for other more prevalent disorders. Tailored molecular imaging with PET using florbetaben may significantly simplify the diagnostic algorithm for patients with suspected cardiac amyloidosis. Future studies investigating florbetaben uptake pattern in other [non-amyloid, nonhypertensive] causes of heart muscle thickening would further clarify the specificity of florbetaben. The relationship of PET quantification of florbetaben retention in the heart, with histological amyloid plaque burden, may provide another means of monitoring disease and could also be useful in monitoring response of cardiac amyloid to treatment, but further research needs to be undertaken to investigate this relationship.”

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New Dedicated CT Scanner Gets Clearance new Computed Tomography (CT) scanner with dedicated Radiation Therapy (RT) features, manufactured by of the largest international medical imaging equipment companies, has received US Food and Drug Administration (FDA) 510(k) clearance. RT images from the new scanner enable precise contouring and provide a personalized dose calculation, with a reduced number of workflow steps. A new imaging suite provides features such as integrated image assessment, patient marking, and contouring. The SOMATOM Confidence RT Pro CT scanner and the optional new syngo.via RT Image Suite soft-

ware are made by Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com). The new scalable syngo.via RT Image Suite software is intended to help radiation oncologists with integrated image assessment, contouring, and patient marking, and uses a flexible client-server based architecture. The syngo.via can also be used with 4D Positron Emission Tomography (PET)/CT, multi-parametric Magnetic Resonance (MR), and dual energy and perfusion CT images for example. Image: The SOMATOM Confidence RT Pro CT scanner with dedicated Radiation Therapy planning features (Photo courtesy of Siemens Healthineers).

MRI-DTI Shows Brain Connections Created by Musical Training esearchers from a children’s hospital in Mexico have used MRI-DTI imaging to show how learning music can improve brain connections in children. The researchers found fiber growth and new connections in the brains of the children after only nine months of musical training. The researchers used Magnetic Resonance (MRI) Diffusion-Tensor Imaging (DTI) and found that growth occurred in parts of the brain associated with ADHD, and autism spectrum disorders. The results could enable researchers find targeted strategies to treat these disorders. The researchers from the Hospital Infantil de México Federico Gómez (Mexico City, Mexico; http://himfg.com.mx) presented their research at the annual Radiological Society of North America (RSNA2016) meeting. Twenty-three healthy children, with no history of neurological, sensory, or perception disorders, took part in the study. The children, aged between five and six years old, were right-handed and had not had any training in an artistic discipline before. Pilar Dies-Suarez, MD, chief radiologist, Hospital Infantil de México Federico Gómez, said, “It’s been known that musical instruction benefits children with these disorders, but this study has given us a better understanding of exactly how the brain changes and where these new fiber connections are occurring. When a child receives musical instruction, their brains are asked to complete certain tasks. These tasks involve hearing, motor, cognition, emotion and social skills, which seem to activate these different brain areas. These results may have occurred because of the need to create more connections between the two hemispheres of the brain. Experiencing music at an early age can contribute to better brain development, optimizing the creation and establishment of neural networks, and stimulating the existing brain tracts.”

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Cardiac PET/CT Imaging Effective In Detecting Arterial Calcium new study shows that cardiac positron emission tomography/computed tomography (PET/CT) imaging is effective in measuring total coronary artery calcification. Researchers at Intermountain Medical Center Heart Institute (Murray, UT, USA; www.intermountainhealthcare.org) conducted a study of 658 patients (mean age 67.2 years) who passed a stress test, and who went on to have a clinically indicated regadenoson rubidium-82 PET/CT scan and concurrent coronary artery calcification quantification. Calcium presence and density were measured through an Agatston score, which was defined as mild for a score of 0-10, moderate for a score of 11-299 as moderate, and severe as a score of 3001,000 as severe. Scores higher than 1,000 were ruled as very severe. The results showed a significant correlation between the amount of calcium and the occurrence of cardiac events; 3.88% of the patients with moderate calcification, 5.26% of the patients with severe calcification, and 7.14% of the patients with very severe calcification had a cardiac event within a year. In all, 16.28% of patients with coronary artery calcification suffered a cardiac event during the study period. The 33 patients (5%) with no or mild calcification had no cardiac events. The study was presented at the American Heart Association (AHA) annual meeting, held during November 2016 in New Orleans (LA, USA). “People say ‘I’m good -they gave me a stress test’, but it doesn’t tell the whole story. The story it tells is that on that day your engine - your heart passed the test. Some of these people die within a year from a heart attack,” said lead author and study presenter Viet Le, MPAS. “Cardiac PET provides so much more for so much less radiation exposure, and with CT we can get anatomical

imaging on a scanner that also gives us functional imaging.” PET is a nuclear medicine imaging technique that produces a three-dimensional (3D) image of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide tracer. Tracer concentrations within the body are then reconstructed in 3D by computer analysis. In modern PET-CT scanners, 3D imaging is often accomplished with the aid of a CT X-ray scan performed on the patient during the same session, in the same machine. Image: Research shows cardiac PET/CT imaging is effective in detecting coronary calcium (Photo courtesy of Intermountain Medical Center Heart Institute).

Radiology Studies Provide Insight on Zika Effects hree now studies use computerized tomography (CT), ultrasound, and magnetic resonance imaging (MRI) to assess the impacts of Zika virus. The first study examines CT findings of the central nervous system (CNS) in 16 newborn babies with congenital Zika virus infection confirmed by tests in cerebral spinal fluid (CSF). The researchers, from Barão de Lucena Hospital (Recife, Brazil; http://portal.saude.pe.gov.br), identified a recognizable pattern of decreased brain volume, simplified gyral pattern, calcifications, ventricular dilatation, and prominent occipital bone in the CT images. The second study, by researchers at Federal Fluminense University (Niterói, Brazil; www.uff.br) analyzed the imaging results of three target groups affected by Zika: adults who developed acute neurological syndrome, newborns with vertical infection with neurological disorders, and pregnant

women with rash outbreaks suggestive of Zika. They found common MRI findings that included enhancement of certain spinal and facial nerves. In the newborns, MRI showed orbital injuries and anatomical changes in brain tissue. The third study, conducted at Clínica de Diagnóstico por Imagem (CDPI; Rio de Janeiro, Brazil; www.cdpi.com.br), used ultrasound and fetal MRI performed on pregnant patients with Zika virus at different gestational ages. Once the babies were born, they underwent ultrasound, CT and MRI. The researchers then created three-dimensional (3D) virtual and physical models of the skulls. They found that more than half the babies had microcephaly, brain calcifications, and loss of brain tissue volume, along with other structural changes. All studies were presented at the RSNA annual conference, held during November 2016 in Chicago (IL, USA). “The emergence of Zika virus in the Americas

has coincided with increased reports of babies born with microcephaly,” said study author Heron Werner Jr., MD, PhD, of the CDPI department of radiology. “An early diagnosis may help in treating these babies after birth. Moreover, the knowledge of abnormalities present in the central nervous system may give hints about the pathophysiology of the disease.” Zika virus is a member of the Flaviviridae family, and is transmitted by the daytime-active Aedes mosquitoes; in humans, the virus causes a mild illness known as Zika fever. Zika outbreak was first reported in Brazil in May 2015, and since then local health authorities estimate that around a million suspected cases have occurred. Brazilian health authorities also observed a significant increase in the number of detected cases of microcephaly and Guillain-Barré Syndrome affecting fetuses and newborns.

Symmetry Recognition System Detects Spinal Deformity novel imaging system scans the surface of the human back to three-dimensionally detect early stages of idiopathic scoliosis. Developed by researchers at Hokkaido University (Japan; www.oia.hokudai.ac.jp), the prototype device scans multiple points on the back, enabling the evaluation of the back’s symmetry from any angle in a few seconds to enable speedy and accurate detections of adolescent idiopathic scoliosis (AIS), a condition that can lead to a large curvature that is six times greater than normal, since their bodies are still in the process of developing, and hence are more vulnerable to curvature. The Japanese School Health and Safety Act stipu-

lates that elementary and junior high schools conduct physical check-ups aimed at detecting AIS. However, the act leaves it up to the respective medical associations or education boards in each municipality to decide how to conduct the checks, giving rise to regional gaps in the detection rate. Another related problem is the burden placed on doctors, who have to examine a large number of students within a limited time frame. To address these issues, associate professor Hideki Sudo, MD, of the Hokkaido University Graduate School of Medicine, and Professor Satoshi Kanai, PhD, of the Graduate School of Information Science and Technology developed the new system, which evaluates the level of asymmetry on the sur-

face of the back without requiring the presence of a physician. The device is expected to go through clinical testing so that it can be used in clinics and for physical examinations at schools. Scoliosis is a medical condition in which a person’s spine is curved from side to side. Although it is a complex three-dimensional deformity, on an Xray, viewed from the rear, the spine of an individual with scoliosis may look more like an “S” or a “C” than a straight line. Scoliosis is typically classified as congenital, idiopathic, or neuromuscular, when it has developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma. Medical Imaging International February-March/2017

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Specialized CT Scans Could Predict Stroke Risk he results of a new proof-of-concept study show that the blood flow in corkscrew-like eddies through the upper left chamber of the heart may help predict the chance of a patient suffering a stroke. The researchers used specialized Computed Tomography (CT) scans to compare the blood flow in the left atria of a 58-year-old woman with a healthy heart, and a 68-year-old man with heart disease and an enlarged heart, both had a history of atrial fibrillation. The results were published in the November 2016 print issue of Annals of Biomedical Engineering. The research team consisted of cardiologists and biomedical engineers from Johns Hopkins University School of Medicine (Baltimore, MD, USA; www.hopkinsmedicine.org). They created computer models and visualizations of blood flow in the atrium that showed that a diseased heart lacks the tight corkscrew-like “eddies” that move blood out

of the heart efficiently, and this increases the risk of developing a blood clot. According to the researchers, the new method could enable clinicians in the future to predict the stroke risk in people with enlarged and weakened heart muscle. Hiroshi-Ashikaga, MD, PhD, assistant professor of medicine, said, “By looking at blood flow through the atrium, we think we can accurately assess stroke risk better than such risk factors as heart size and pumping strength. Our study fills in a missing diagnostic link between heart function and fluid motion in our understanding of how each can affect stroke risk. As the blood comes in contact with the atrium’s surface, it slows down due to shearing forces similar to friction, and this appears to prevent the blood from exiting the chamber as smoothly as it might. The slower the blood moves and the more contact it has with the atrium, the more risk there is for a clot to form.”

Image: The trajectory of blood flowing into the left atrium from the pulmonary veins (Photo courtesy of Hiroshi Ashikaga).

Portable Spine Imaging System Improves Patient Outcomes

Study Suggests Fractures Not Improved by Post-Surgery Ultrasound Treatment

new advanced imaging technology helps surgeons confirm proper placement of spinal implants while saving time in the operating room (OR). The DePuy Synthes Spine (Raynham, MA, USA; www.depuysynthes. com/about/depuy-synthes-spine) KICK System is an image-guided surgery technology that enables real-time intraoperative viewing of instrumentation and implants relative to patient anatomy, in order to permit proper pedicle screw placement. The system is based on Brainlab (Munich, Germany; www.brainlab.com) optical tracking technology with laser guidance. Using a small, portable infrared camera with a computer and monitor, the system moves easily between ORs and works together with existing X-ray equipment to support surgical workflow. A full high definition (HD) touch monitor displays up to four different X-ray images at one time, making X-ray equipment repositioning in order to capture different views unnecessary, and thus ultimately reducing radiation exposure and surgery time. The system is compatible with the proprietary FluoroExpress software module. “Building on our commitment to enabling technologies, the KICK System enhances less invasive surgery for the clinician who may not have access to expensive 3D imaging systems, but recognizes the need for advanced imaging to support a successful fusion procedure and help improve patient outcomes,” said Dan Wildman, platform leader at DePuy Synthes Spine. “Through solutions such as the KICK System, we are improving access to care and creating and delivering clinical and economic value to healthcare systems worldwide.”

he results of a new clinical trial indicate that treatment using Low-Intensity Pulsed Ultrasound (LIPUS), following surgery to repair a bone fracture may not improve the chances of recovery, despite popular belief that it does. The US Food and Drug Administration (FDA) approved the use of LIPUS for the healing of fractures in 1994. LIPUS is often used for tibia fractures that heal slowly and that often require follow-up surgery. The results of the randomized controlled trial that included 501 patients from academic trauma centers in North America were published in the October 25, 2016, issue of the British Medical Journal (BMJ). The patients had undergone surgical repair for a lower leg (tibia) fracture between the years 2008 and 2012. The researchers from the McMaster University (Hamilton, ON, Canada; www.mcmaster.ca) concluded that there was no difference in the recovery time between those patients that received LIPUS treatment and those that received a placebo treatment. There was also no difference in the time it took for functional recovery including quality of life, leisure activities, return to work, or the time to full weight-bearing activities between the two patient groups. Xavier Griffin, associate professor, trauma surgery, the University of Oxford, said, “These authors report important patient-centered outcomes ... showing that low intensity pulsed ultrasound is of no benefit to adults with tibia fractures. It is time for us to make good use of their determination and abandon this ineffective treatment.”

Topical Therapy Reduces Radiation-Induced Skin Damage newly developed topical therapy applied before or after radiation exposure prevents potential skin damage due to oxidative stress, according to a new study. Developed by researchers at the University of Pittsburgh (Pitt; PA, USA; www.pitt.edu), the synthetic molecule, named JP4-039, is a mitochondrial targeted antioxidant designed to prevent accumulation of reactive oxygen species (ROS), thereby limiting oxidative damage and preserving mitochondrial function. According to the researchers, this is important as mitochondria are particularly susceptible to oxidative stress, and mitochondrial dependent apoptosis plays a major role in radiation induced tissue damage.

The researchers found that in both mouse and human skin models, topical application of JP4-039 prevented and mitigated radiation-induced skin damage, as characterized by clinical dermatitis, loss of barrier function, inflammation, and fibrosis. The damage mitigation also reduced apoptosis, helped preserve the skin’s antioxidant capacity, and reduced the irreversible DNA and protein oxidation associated with oxidative stress. The study was published on September 23, 2016, in the Journal of Investigative Dermatology. “During the course of radiation therapy, patients can develop irritating and painful skin burns that can lead to dangerous infections and diminished quality of life. Sometimes the burns are so severe

that patients must stop their treatment regimen,” said corresponding author Louis Falo, MD. “Our results show that topical treatment with this therapeutic agent prevents skin damage at the source.” Radiation-induced skin damage ranges from photoaging and carcinogenesis due to ultraviolet (UV) exposure, to treatment-limiting radiation dermatitis associated with radiation therapy (RT), and to cutaneous radiation syndrome, a frequently fatal consequence of exposures from nuclear accidents. The skin radiation leads to a complex pattern of direct tissue injury involving damage to cells of the epidermis and endothelial cells within the walls of blood vessels, as well as the inflammatory cell recruitment. Medical Imaging International February-March/2017

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Cardiac Mapping System Expands Electrophysiology Options new cardiac mapping system and sensorenabled catheter allow for more efficient treatment of various arrhythmias. The St. Jude Medical (SJM; St. Paul, MN, USA; www.sjm.com) EnSite Precision cardiac mapping system offers a dual-technology platform that provides highly detailed anatomical models and maps to enable more efficient treatment of a wide range of arrhythmias, including atrial fibrillation (AF) and ventricular tachycardia (VT). The cardiac mapping system is flexible, allowing physicians to map heart chambers with any electrophysiology catheter and with minimal fluoroscopy demands, thus reducing potential for risks associated with excessive radiation exposure. Based on the SJM EnSite Velocity cardiac mapping system, EnSite Precision adds the EnSite AutoMap Module, which enables the electrophysiologist to more quickly perform morphology matching that identifies the source of the irregular heartbeat, using automated cardiac rhythm mapping tools. The module includes the TurboMap feature, which helps the physician build a cardiac map 10 times faster than current systems using recorded data. The EnSite Precision cardiac mapping system has been approved by the U.S. Food and Drug Administration (FDA). “Our new EnSite Precision cardiac mapping system was designed to give the physician a means to precisely navigate within the heart, provide higher density diagnostic data to better inform their diagnosis, and allow them to use the tools that make sense for each individual patient and situation,” said Srijoy Mahapatra, MD, vice president of clinical, medical, and scientific affairs at SJM. “The system’s intelligent automation tools enable faster, more accurate high-density maps with greater consistency across cases, which are important factors in addressing the needs of today’s electrophysiology labs.” “The new EnSite Precision cardiac mapping system allows more mapping data to be collected in a shorter amount of time compared to today’s technologies,” said John Day, MD, of Intermountain Medical Center Heart Institute (Salt Lake City, UT, USA). “We look forward to implementing the EnSite Precision cardiac mapping system and the new SJM sensor enabled tools to help guide therapy and provide expanded procedural options to tailor care for patients in simple to complex ablation scenarios, as well as deliver a new level of accuracy and speed in our procedures.” Cardiac arrhythmia is a group of conditions in which the heartbeat is irregular, too fast, or too slow due to a malfunctioning electrical conduction system. The arrhythmias are comprised of extra heartbeats, which include premature atrial contractions and premature ventricular contractions; supraventricular tachycardias, which include AF, atrial flutter, and paroxysmal supraventricular tachycardia; ventricular arrhythmias, which include ventricular fibrillation and VT; and bradyarrhythmias.

Image: The EnSite Precision cardiac mapping system (Photo courtesy of St. Jude Medical).

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Micro-Ultrasound System Approved For Prostate Imaging and Biopsies high-resolution micro-ultrasound systems has received the CE Mark (Conformité Européenne) approval for its prostate imaging and biopsy guidance systems. The micro-ultrasound platform provides a real-time resolution down to 70 microns for prostate imaging and biopsies, and operates at a frequency of 29 MHz, much higher than that of conventional ultrasound systems. The increased resolution provides urologists with improved visualization of suspicious regions, and enables them to perform targeted biopsies of the prostate at the same time. The ExactVu system was developed

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by Exact Imaging (Toronto, Canada; www.exactimaging.com), a world leader in the development of high-resolution micro-ultrasound systems. Following the CE Mark approval the company plans to begin commercial sales and expand activity into Europe. Exact Imaging clinical applications, technical support, and direct sales will be based in Belgium. CEO and President of Exact Imaging, Randy AuCoin, said, “We are thrilled with the achievement of CE Mark approval for our ExactVu system, which is the culmination of many years of technical development. There is significant built-up demand for acquiring the ExactVu instrument

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and this approval will allow us to be able to commercialize our platform in Europe. With the ExactVu platform, urologists will have a new level of real-time resolution to facilitate actually targeting their prostate biopsies at suspicious regions. The goal is to provide the best tools to help the urologist make the most informed decisions and ultimately, to improve patient outcomes.”

Image: The ExactVu Micro-ultrasound system (Photo courtesy of Exact Imaging).

New Research Shows Aerobic Exercise May Improve Cognitive Function esearchers using MRI scans have shown that aerobic exercise may benefit people with Mild Cognitive Impairment (MCI) by increasing brain volume and improving cognitive function. The Magnetic Resonance Imaging (MRI) scans showed that six months of either aerobic or stretching exercises increased local gray matter volume in patients. The results were revealed at the annual Radiological Society of North America (RSNA 2016) meeting. Thirty-five adults, suffering from Mild Cognitive Impairment (MCI) participated in the randomized, controlled trial. All participants underwent high-resolution MR brain imaging before and after a six-month period of aerobic exercise. The results of the study showed that aerobic exercise led to a significant change in the brain, after a short period of time. Brain volume increased in the temporal lobe, and in most other gray matter regions, improving shortterm memory. The researchers also

compared the MRI results with conventional and biomechanical metrics. Co-investigator of the study, Jeongchul Kim, PhD, from the Wake Forest School of Medicine (WFSM; Winston-Salem, NC, USA; www. wakehealth.edu/school), said, “We used high-resolution MR images to measure anatomical changes within areas of the brain to obtain both volumetric data and directional information. Compared to the stretching group, the aerobic activity group had greater preservation of total brain volume, increased local gray matter volume and increased directional stretch of brain tissue. Directional changes in the brain without local volume changes could be a novel biomarker for neurological disease. It may be a more sensitive marker for the tiny changes that occur in a specific brain region before volumetric changes are detectable on MRI. Any type of exercise can be beneficial. If possible, aerobic activity may create potential benefits for higher cognitive functioning.” Medical Imaging International February-March/2017

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Medical Imaging International

or to make breathing easier when necessary. The system can be fitted with a comprehensive range of optional software applications to deal with complex cases. The robotic construction of the Siemens Healthineers table gives it a flexible isocenter, so that the angiography system can follow all table positions and provide imaging support for the patient’s treatment, while representing the target area of the body from virtually any angle. Artis pheno recognizes the position of the tabletop at all times, and automatically aligns itself. Memory positions let the system move the C-arm out of the operating area quickly if necessary, giving the surgeon and team free access to the patient, and then move it back to exactly the same position again for further imaging. A dedicated hygiene approach combines several factors: an antimicrobial coating prevents bacteria and viruses from multiplying on the system; the

wiring is routed inside the system to prevent cables from becoming dirty and potentially transmitting bacteria; and seamless surfaces with no recesses, and spaces that are easy to access, make the system easier to clean. And because the system is floor-mounted, it is easier to install in the OR, and the sterile airflow from the ceiling is interrupted during imaging only by the flat-panel detector. Additional optional application packages include software for extensive spinal fusion procedures using screws or needles; screw paths can be precisely planned, and an automatic path alignment function automatically aligns the C-arm to follow them. A laser integrated in the image detector shows the surgeon the planned path, which helps improve both accuracy and speed in the OR. A number of applications support tumor transarterial chemoembolization (TACE), rendering arterial vessels visible, with graphic overlaying of the selected vessel paths with the real-time X-ray images.

Novel Activity-Based Probes Detect Vascular Inflammation esearchers have shown that a combined optical and Positron Emission Tomography (PET)/Computed Tomography (CT) probe can be used to detect early signs of atherosclerotic plaques. The researchers published the study in the October 2016, issue of the Journal of Nuclear Medicine. Atherosclerosis is mostly asymptomatic and can develop over many years. Symptoms only become apparent when more than 70% of a vessel is blocked resulting in a significant risk of a stroke or myocardial infractions. The researchers from the Stanford University Medical Center (SUMC; Stanford, CA, USA; http://stanfordmedicine.org) used Activity-Based Probes (ABPs) and optical and PET/CT methods. The researchers were able to demonstrate that ABPs, which target cysteine cathepsins provide a fast and non-invasive technique to enable them to image the progression of atherosclerotic disease and the vulnerability of plaque. One of the lead authors of the study, Matthew Bogyo, PhD, said, “This collaborative study with Zhen Cheng, PhD, and Michael McConnell, MD, provides evidence that these probes have potential benefits for non-invasive imaging of atherosclerotic plaque inflammation, potentially leading to the application of this probe in the clinic to help identify patients at high risk of developing premature atherosclerosis. What’s novel about this is the fact that these probes provide accurate detection of lesions undergoing high levels of inflammatory activity and extracellular matrix remodeling. They not only enable early disease detection, they can provide realtime monitoring of therapeutic responses and clinical drug efficacy.”

Medical Imaging International February-March/2017

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Medical Imaging International

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Pushing the Boundaries with CEUS and US Elastography By Becky McCall, Contributing Editor ltrasound elastography and contrast enhanced ultrasound (CEUS) are among the latest advances in ultrasound (US) technology that offer improved spatial and temporal resolution in the detection and characterisation of abnormal tissues. SonoScape is leading the field in developing this technology that is improving outcomes for patients. Leader in the field, Andrej Lyshchik, M.D., Ph.D., Assistant Professor at the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia, US, is enthusiastic for SonoScape’s US elastography. He welcomed the nature of US elastography as a noninvasive technique that allows detection and characterisation of tissues with abnormal biomechanical properties.

US Elastography Currently, there are three main types of US elastography: transient elastography, compression elastography and Acoustic Radiation Force Impulse (ARFI) imaging. Transient elastography uses an external device that generates mechanical displacement of tissues and a built-in US transducer to register shear wave that propagates within the examined tissues. ARFI imaging uses acoustic radiation forces to generate tissue displacement and map its elastic properties based on the speed of sheer wave propagation. To date, liver, kidney, breast and prostate are among the organs that show most benefit from these technologies. In particular, Dr Lyshchik explained that one of the most commonly used clinical applications of ARFI and transient elastography is for the evaluation of patients with chronic liver disease. CEUS in the Evaluation Of Tumor Blood Flow Likewise, CEUS also promises improvements in patient management with its high resolution, real-time visualisation of new blood vessels within tumours that increases diagnostic accuracy. CEUS can be used on SonoScape’s scanners. CEUS uses US contrast agents that are composed of a gas microbubbles, encapsulated by an outer protein or lipid shell. These microbubbles are of a diameter (1-8 μm) that enables passage through the pulmonary capillar-

ies, but restricts the microbubbles to the vasculature, making them excellent intravascular blood pool agents. Unlike contrast agents for MRI and CT, US contrast agents are not nephrotoxic and have no renal contraindications, making them an exceptionally safe to use. Detecting such changes in tumour vascularity (including blood flow kinetics and microvascular density) is a recognised indicator of treatment response via visualisation of the perfusion of US contrast agents. Parameters such as the time required from injection to contrast arrival, rate of US contrast agent inflow, rate of US contrast agent washout, and cumulative US contrast agents signal over time (an indicator of net blood flow) have all been shown to be potentially useful indicators of treatment response. CEUS also provides the opportunity to create 3D parametric maps of tumour perfusion to illustrate the differences in intra-tumoural blood flow kinetics. Dr Lyshchik explained that within oncology, CEUS can detect changes in tumour vascularity that provide an indicator of treatment response to certain therapies. He remarked that due to the real time nature of ultrasound and the blood pooling properties of US contrast agents, visualisation of UCA perfusion provides an indicator of the blood flow kinetics and microvascular density of the tumour. CEUS of Liver Nodules and Hepatocellular Carcinoma Of note, CEUS is also a potentially safer, less expensive and more readily available technique for characterising focal liver nodules in patients at risk for hepatocellular carcinoma, compared to the current clinical standard. This significant cancer, rated as the fifth most common cancer worldwide with an annual incidence of over 550,000, predominantly affects patients with cirrhosis and chronic hepatitis. But imaging to diagnose hepatocellular carcinoma can be challenging, especially in patients with advanced cirrhosis, in which structural and physiological alterations of the liver can impair detection of the cancer. However, studies of CEUS, which is available on SonoScape’s scanners in this capacity, have demonstrated safety, high specificity and positive predictive value for

Figure: Compression elastogram of thyroid demonstrated a very hard nodule, highly concerning for thyrosis cancer.

Figure: Indeterminate liver lesion in patient with cirrhosis (arrow) demonstrating avid arterial phase hyper-enhancement, suspicious for HCC.

Figure: The American College of Radiology Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS)

diagnosis of hepatocellular carcinoma compared to hepatobiliary agent gadoxetate-enhanced MRI. In an effort to facilitate the clinical use of CEUS, the American College of Radiology recently introduced the CEUS Liver Imaging Reporting and Data System (CEUS LI-RADS), which provides standardisation of CEUS examination and reporting, and allows liver nodule classification based on their like-

lihood to be hepatocellular carcinoma. Finally, worth a mention is CEUSguided biopsy, which is another application of SonoScape’s technology that targets and biopsies lesions, normally invisible or hard to detect, for example, the small nodules of hepatocellular carcinoma on cirrhosis or adenocarcinoma’s areas in the prostate. It can also target viable areas of large, necrotic tumours. Medical Imaging International February-March/2017

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Medical Imaging International

Capsule Endoscope System Images Small Bowel nnovative technology provides a novel 360º panoramic lateral image of the small bowel to assist in the detection of subtle abnormalities. The CapsoVision (Saratoga, CA, USA; www. capsovision.com) CapsoCam Plus system consists of the capsule endoscope, a capsule retrieval kit, a data access system, and proprietary software that all work together to provide a streamlined examination of the small bowel, with comprehensive 360 degree imaging. In contrast to end-facing cameras that only provide a limited view of the mucosa, the CapsoCam Plus uses four laterally oriented cameras to provide a full 360° panoramic image of the mucosa. CapsoCam Plus uses a large-capacity onboard storage system that eliminates the need for external receiver equipment. The onboard storage design makes capsule administration faster and easier,

Radiation-Free Alternative to Mammogram on the Horizon

while eliminating risks associated with radio frequency (RF) signals. To extract the images and other data collected during a CapsoCam Plus examination, users simply place the retrieved capsule into the CapsoAccess system, and click download. The data is then easily accessed using the CapsoView software, available for both Microsoft Windows and Mac OSX operating systems. “Without the need for capital equipment, the barriers to entry are significantly reduced, and physicians can perform more capsule endoscopy procedures more flexibly while minimizing expenses related to staffing and exam room time,” said Johnny Wang, President of CapsoVision. “We’re hopeful that our unique technology is able to make a positive impact in the United States, for both patients and clinicians.” Capsule endoscopy uses a tiny camera inside an ingestible capsule to take pictures and videos of the

gastrointestinal (GI) tract. As the capsule travels through the digestive tract, the camera takes thousands of pictures that are usually transmitted wirelessly to a recorder. Capsule endoscopy is preferred for screening the small intestines, or when traditional colonoscopy or upper endoscopy are difficult or contraindicated. Image: The CapsoCam Plus offers 360¬∫ imaging technology (Photo courtesy of CapsoVision).

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new, accurate, ultrasonic mammography method could help identify cancerous tumors by blood vessels structure, without radiation, according to a new study. Under development at the Eindhoven University of Technology (TUE; The Netherlands; www.tue.nl), dynamic contrast specific ultrasound tomography (DCS-UST) builds on a patient-friendly prostate cancer detection method called cumulative phase delay imaging (CPDI) which images and quantifies ultrasound contrast agent (UCA) kinetics. The technology is based on harmless microbubbles injected into the patient’s bloodstream; the microbubbles vibrate in the blood at the same frequency as the ultrasonic echo, as well as at twice that frequency - the so-called second harmonic. This second harmonic is delayed by the gas bubbles; the more bubbles are encountered by the sound on its route, the bigger the delay compared to the original sound. By measuring this delay, the researchers can thus localize the air bubbles without any disturbance, since the second harmonic generated by the body tissue is not delayed, and is therefore discernible. This difference, however, can only be seen if the sound is captured on the other side. So the method is perfectly suited to organs that can be approached from two sides, like the breast. An ultrasound scanner can thus be used to precisely track the microbubbles as they flow through the blood vessels. Since cancer growth is associated with the formation of chaotic microvessels, the presence and location of cancer become visible. What also makes the technique different to current mammography is the patient’s position. Instead of standing, the patient lies on a table, with the breast hanging freely in a bowl. The proof-of-concept study was published in the November 2016 issue of Scientific Reports. “For breast imaging, DCS-UST will lead to a more practical, faster, and less operator-dependent imaging procedure compared to standard echo-contrast, while preserving accurate imaging of contrast kinetics,” concluded lead author Libertario Demi, PhD, of the TUE biomedical diagnostics laboratory.

Medical Imaging International February-March/2017

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PRODUCT NEWS DR SYSTEMS

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DR DETECTOR

MRI INFUSION PUMP

Italray

Agfa HealthCare

IRadimed

The X-Frame range of DR rooms features high device positioning automation, anatomical programs, and pre-defined working positions for significantly increasing productivity. They are ideal for immediate, RT diagnosis with substantial dose reduction in general radiography and emergency.

The DX-D 60 provides virtually instant image access, improving image acquisition speed and workflow. It allows migration of mobile and stationary X-ray systems, including Bucky tables, floor stands and neonatal incubator trays, to DR technology without the cost of room replacement.

The MRidium 3860+ non-magnetic pump offers the ability to infuse medications in the MRI room and has been cleared by the FDA for use with up to 3T MR scanners. It allows clinicians to safely and reliably run both volumetric and syringe dosed infusions by way of syringe, bags, and bottles.

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Novel Technique Uses Lasers To Image Living Tissues new imaging technique uses tiny embedded particles to illuminate cellular structures in deep tissue and other dense and opaque materials. Developed by researchers at the Massachusetts Institute of Technology (MIT, Cambridge, MA, USA; web.mit.edu), Massachusetts General Hospital (MGH; Boston, USA; www.massgeneral.org), and the Jožef Stefan Institute (Ljubljana, Slovenia; www.ijs.si/ijsw), the particles are made from lead iodide perovskite, a material that absorbs and traps light efficiently. When a laser beam is projected at the particles, they emit a normal, diffuse fluorescent light. But if the incoming laser’s power is tuned to certain threshold, the particles will instantly generate laser light. The tiny, 6-micron-long particles have a rodshaped geometry – much like chopsticks – and can allow a specific wavelength of light to bounce back and forth along the particles’ length, resulting in images that can be captured at resolutions six times higher than current fluorescence-based microscopes. According to the researchers, the optical technique, called LAser particle Stimulated Emission (LASE) microscopy, could be used to im-

age a specific focal plane, or a particular layer of biological tissue. The study was published on November 4, 2016, in Physical Review Letters. “Theoretically, scientists can shine a laser beam into a three-dimensional sample of tissue embedded throughout with laser particles, and use a lens to focus the beam at a specific depth,” said lead author MIT graduate student Frederick Sangyeon Cho, MSc. “Only those particles in the beam’s focus will absorb enough light or energy to turn on as lasers themselves. All other particles upstream of the path’s beam should absorb less energy and only emit fluorescent light.” “Our idea is, why not use the cell as an internal light source? We can collect all this stimulated emission and can distinguish laser from fluorescent light very easily using spectrometers,” concluded Mr. Cho. “We expect this will be very powerful when applied to biological tissue, where light normally scatters all around, and resolution is devastated. But if we use laser particles, they will be the narrow points that will emit laser light. So we can distinguish from the background and can achieve

good resolution.” Perovskite, named after Russian mineralogist Lev Perovski (1792–1856), is composed of calcium titanate, and was discovered in the Ural Mountains by Gustav Rose in 1839. Perovskites have excellent light-emitting properties, and have been used to make light-emitting diodes and optically pumped lasers. They may also be used to design solution-processed lasers that can be tuned across the entire visible and near infrared (NIR) spectrum by changing the chemical composition of the perovskite film. Image: Researchers found embedded nanoparticles could improve regular microscopes six-fold (Photo courtesy of MIT).

New Technique Generates 3D Fetal Models for VR Viewing esearchers have developed a new technology that uses fetal MRI and ultrasound data to build 3D virtual reality models of human fetuses. The models recreate the entire internal structure of the fetus, and very closely match the appearance of the baby when it is born. By using a virtual reality headset clinicians and parents can view and study the anatomy of the baby, and even hear its heartbeat. The researchers from the Clínica de Diagnóstico por Imagem (CDPI; Rio de Janeiro, Brazil; www. cdpi.com.br/ui) presented the new technique at the annual Radiological Society of North America

(RSNA2016) meeting. Magnetic Resonance Imaging (MRI) is often used for imaging a fetus and placenta when higher-resolution and higher contrast images are required, that ultrasound cannot provide. The researchers used sequentially mounted MRI slices, followed by segmentation of the required anatomy and reconstruction in 3D. The accurate 3D model includes the fetus and placenta, the umbilical cord, and the womb. The researchers used the Oculus Rift 2 headset that provides an immersive environment including sound, and navigation using head movements. Co-author of the study, Heron Werner Jr., MD,

PhD, said, “The 3D fetal models combined with virtual reality immersive technologies may improve our understanding of fetal anatomical characteristics and can be used for educational purposes and as a method for parents to visualize their unborn baby. The physicians can have access to an immersive experience on the clinical case that they are working on, having the whole internal structure of the fetus in 3-D in order to better visualize and share the morphological information. We believe that these images will help facilitate a multidisciplinary discussion about some pathologies in addition to bringing a new experience for parents when following the development of their unborn child.” Medical Imaging International February-March/2017

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Medical Imaging International

Echography Studies Examine How Air Pollution Impairs Lung Function wo transthoracic echocardiography studies including more than 16,000 individuals in Brussels, Belgium have shown the effect of air pollution on the hemodynamic functioning of the lungs. The studies were carried out between 2009 and 2013, and were presented at the EuroEcho-Imaging 2016 conference in Leizig, Germany. One study examined whether echocardiography parameters used to determine pulmonary circulation, and right ventricular function were affected by common levels of outdoor air pollution. In the second study, ten healthy male volunteers were exposed to either ambient air or to dilute diesel exhaust pollutants. Pulmonary vascular resistance was assessed using echocardiography at rest, as well as during a cardiac stress test. The results showed a reduced pulmonary acceleration time as well as increased pulmonary acceleration slope from pollutants, on the same day, over five days, and ten days exposure. There was also a deterioration of right ventricle function. Lead author of the study, Dr Jean-Francois Argacha, cardiologist at the University Hospital (UZ; Brussels, Belgium; www.uzbrussel.be), said, “This is the first human study to report an influence of air pollution on pulmonary vascular function. This is a major public health issue for people living in polluted urban areas where exercise could damage the lungs and potentially lead to decompensated heart failure. Such studies are important because if air pollution causes narrowing of the blood vessels in the lungs (vasoconstriction), this combined with the systemic effects of pollution could cause decompensated heart failure. Air pollution was associated with increased pulmonary vascular tone, which makes it more difficult for blood to flow to the lungs. Longer exposure to air pollution exposure seems necessary to impair right ventricular systolic function. Patients with obstructive sleep apnea were at greater risk. This suggests that pollution is more harmful to the lung circulation during exercise. Our main advice is to limit physical activities during heavy air pollution.”

Image: A transthoracic echocardiogram being performed in a patient (Photo courtesy of Specialist Cardiology).

Study Maps the Impact Of Aging on White Matter Connections in the Brain cientists have carried out the most comprehensive study ever undertaken to investigate how connections in the brain weaken, as a person ages. The results of the study were published in the December 2016 issue of the journal Nature Communications. The researchers from the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE; Edinburgh, Scotland; www. ccace.ed.ac.uk) studied Magnetic Resonance Imaging (MRI) brain scans of more than 3,500 individuals between 45 and 75 years of age. The study participants were part of the UK Biobank study. The results of the study suggest that those connections involved in complex thinking skills are worst affected by aging, while areas in the brain involved in hearing, and movement are relatively well preserved. According to the researchers the results of the study will help clinicians understand the process of mental aging, as well as the healthy brain, and will help them understand other related conditions and diseases as well. Study leader, Dr. Simon Cox, from the CCACE, said, “By precisely mapping which connections of the brain are most sensitive to age, and comparing different ways of measuring them, we hope to provide a reference point for future brain research in health and disease.”

Medical Imaging International February-March/2017

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PRODUCT NEWS BREAST CT SYSTEM

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DIGITAL RF SYSTEM

DF/DR SYSTEM

Koning

Wandong Medical Equipment

Stephanix

The Koning 3D produces real 3D images with exceptional resolution, and no painful compression. Designed specifically to image from the chest wall to the nipple, it consists of a horizontal gantry and a patient table where the woman lies prone, with the breast positioned in the imaging area.

The DRF-1 features the fully upgraded Invary 2.0 image-processing platform for improved workflow speed. It offers a high acquisition speed and powerful image processing function, and is available for both digital radiography and fluoroscopy applications.

The D2RS is equipped with the latest generation of Canon Flat Panel Detector (FPD) and single touch, remote-controlled interface and table autopositioning facility. It allows for routine exams, radiography procedures and direct radiographic projections, making it a fully integrated solution.

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Multi-Purpose X-Ray Room Enhances Diagnostic Flexibility new direct radiography (DR) solution provides enhanced flexibility in diagnostics through direct digital dynamic remote-controlled fluoroscopy and radiography. The Agfa Healthcare (Mortsel, Belgium; www. agfahealthcare.com) DR 800 is a high-productivity, robust, and reliable radiography solution that integrates innovative features and direct image capture capabilities with versatile panel formats to offer high quality radioscopy and fluoroscopy in supine and upright positions. The highly customizable DR 800 can be equipped with high-frequency fluoroscopy generator options of 50, 65 or 80 kW, and with advanced cesium iodide (CsI) detector panel technology for high-speed, high-resolution, imaging at low dose. Smooth operation is achieved with the aid of ZeroForce Technology, which enables manual movement of the tube head in all directions quickly, and with almost zero effort; the tube head also holds a touch screen display. Other feature include a 180 cm image-receptor distance (SID) and auto positioning presets for chest imaging; an automated, fully motorized wall stand bucky with vertical tracking with the tube; a console for patient-side posi-

tioning; and a wireless console for remote control, a compressor cone, and an auto-switching anti-scatter grid. The DR 800 offers the option of full leg full spine (FLFS) with EasyStitch technology that applies fully automated single focus technology to minimize distortions. Angular tracking is available for use in dedicated exams, while motorized movement of the wall stand and tube head provides accurate stitching capabilities for high precision in images. An optional overlay for the height-adjustable table and floating top allows FLFS right on the table. The DR 800 comes with Multi-Scale Image Contrast Amplification (MUSICA) high-speed, multi-scale image processing, which can also process moving images. Along with enhanced noise suppression and superb brightness control, Dynamic MUSICA enhances both image quality and workflow for radiographers and radiologists in skeletal, thorax, abdomen, weight bearing x-ray exams, as well as fluoroscopy exams, such as barium studies, arthrograms, cystograms, myelography, and catheter placement. “High-quality imaging supports informed diag-

nosis and treatment decisions, critical for valuebased care,” said Louis Kuitenbrouwer, vice president imaging division of Agfa HealthCare. “With the DR 800, we are using our experience and innovation to create a versatile solution – a ‘jack of all trades’ that can be configured to match the user’s specific needs. Playing a key role in assuring optimum patient care, the DR 800 supports radiology within the care continuum.” Image: The DR 800 direct radiography solution (Photo courtesy of Agfa Healthcare).

Young American Football Players May Develop White Matter Changes without Concussion ew research shows that young American football players may suffer from changes in the white matter of their brain despite the fact that they were not diagnosed with concussion. The changes in the youth football players’ brains may even develop during only one season. The researchers also found a significant relationship between the white matter changes and the exposure of the players to head impacts. The results of the study were published online in October 2016 in the journal Radiology. The researchers studied 25 male football players eight to 13 years of age, and recorded head impact data us-

ing the Head Impact Telemetry System (HITs). The participants were tested using Magnetic Resonance Imaging (MRI) Diffusion-Tensor Imaging (DTI) and other multimodal neuroimaging scans to find microstructural changes in the white matter of the brain. The researchers showed that there was a significant relationship between head impacts and decreased Fractional Anisotropy FA in the tissue where white and gray matters meet. None of the players had any symptoms, or signs of concussion. Lead author of the study, Christopher T. Whitlow, MD, PhD, MHA, Wake Forest School of Medicine (Winston-Salem, NC, USA; http://school.

wakehealth.edu), said, “Most investigators believe that concussions are bad for the brain, but what about the hundreds of head impacts during a season of football that don’t lead to a clinically diagnosed concussion? We wanted to see if cumulative sub-concussive head impacts have any effects on the developing brain. We found that these young players who experienced more cumulative head impact exposure had more changes in brain white matter, specifically decreased FA, in specific parts of the brain. These decreases in FA caught our attention, because similar changes in FA have been reported in the setting of mild TBI.” Medical Imaging International February-March/2017

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Medical Imaging International

New Next-Generation Mobile DR System Unveiled new highly mobile and compact premium Digital Radiography (DR) system with enhanced usability features and improved image quality has been unveiled at the International Society of Radiographers and Radiological Technologists (ISRRT) congress in Seoul, Korea. The new system has a collapsible column, is only 55.5cm wide, and weighs 349 kg, making it highly mobile, including transport in elevators. Another mobility feature is the addition of adaptive soft driving control and a front bumper sensor. The Samsung (Seoul, Korea; www. samsungmedicalsolution.com) GM85 DR is already available in Korea, and will be launched globally according to the regulatory schedules in each country. New workflow and usability features include a Source to Image Distance (SID) guide for detailed positioning, S-Align that shows the angle of the detector compared to the Tube Head Unit (THU), precise body positioning using click buttons on

the THU, and a battery that can be charged in two to four hours. The GM85 unit also offers the SVue advanced imaging engine, the SimGrid that reduces radiation scatter effects without using a conventional grid, and tube and line enhancement for improved clarity of the tube and line in chest images. Dongsoo Jun, president, Health & Medical Equipment Business, Samsung Electronics, said, “We are excited to introduce the new mobile digital X-ray at the ISRRT, being held first-ever here in Korea. Driven by Samsung’s relentless spirit of innovation the GM85’s enhanced mobility and streamlined workflow will enable users to experience a new level of efficiency with a mobile DR system without jeopardizing image quality. Leveraging Samsung’s deep expertise in user-friendly functions and advanced imaging technology, Samsung will take the lead in providing a spectrum of diagnostic and patient-centric tools to meet the various needs of both care provider and patient.”

Image: The new GM85 DR unit (Photo courtesy of Samsung Medical).

PET Imaging Could Improve Cancer Treatment ositron emission tomography (PET) tracking of liposomal nanomedicines could be used to validate drug delivery, according to a new study. Developed by researcher at King’s College London (KCL; United Kingdom; www.kcl.ac.uk) Shaare Zedek Medical Center (Jerusalem, Israel; www.szmc.org.il), and other institutions, the PET radio-labeling method exploits the metal-chelating properties of certain drugs – bisphosphonates such as alendronate, and anthracyclines such as doxorubicin – and widely used ionophores in order to achieve excellent radio-labeling yields, purities, and stabilities with 89Zr, 52Mn, and 64Cu, and without needing to modify the nanomedicine components. Imaging with PET in mouse models of breast and ovarian cancer showed that the drugs accumulate in tumors and metastatic tissues in varying therapeutic concentrations, and in most cases, at levels well above those in normal tissues. According to the study, in one mouse strain the nanomedicines unexpectedly showed up in the uterus, a result that would not have been detected without the PET imaging

Medical Imaging International February-March/2017

study. The study was published on October 26, 2016, in ACS Nano. “This technique allows quantification of the biodistribution of a radio-labeled stealth liposomal nanomedicine containing alendronate that shows high uptake in primary tumors and metastatic organs,” concluded senior author Rafael Torres Martin de Rosales, PhD, of KCL, and colleagues. “The versatility, efficiency, simplicity, and GMP compatibility of this method may enable submicrodosing imaging studies of liposomal nanomedicines containing chelating drugs in humans, and may have clinical impact by facilitating the introduction of imageguided therapeutic strategies.” Chelation involves the formation or presence of two or more separate coordinate bonds between a polydentate (multiple bonded) ligand and the single central atom of a metallic ion. The ligands are usually organic compounds, known as chelants or chelating agents. Chelation is useful for delivering nutritional supplements, in chelation therapy to remove toxic metals from the body, as contrast agents in MRI and PET scanning, in manufacturing using homogeneous catalysts, and in fertilizers. LINKXPRESS COM

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CT SCANNER

MRI SYSTEM

Wandong Medical Equipment

Siemens Healthineers

Swissray International

The DM-1 mammography system features an advanced 24cm x 30cm full field FPD detector and high frequency 4.8kW generator. It combines high image quality with low radiation dose, and offers comfort and safety during examinations.

The SOMATOM go.Now delivers low-dose scanning, and allows scans of long ranges while maintaining a high spatial resolution. Built around a new mobile workflow, it allows the user to check patient information as soon as the data is collected, and prepare the scan directly at the gantry.

The SR Pulse 710 whole body 1.5T system is for head to toe imaging with 5-50cm FOV and a 71cm bore diameter. It is equipped with multi-element coil arrays selected through programmed protocols, thus reducing the need for time-consuming repositioning.

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Cost-Effective DR System Provides High-Quality Imaging new digital radiography (DR) system combines reliability with cost-reduction solutions to support a full range of clinical applications. The Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) Multix Fusion Max radiography system is a midrange, ceiling-suspended x-ray room designed to perform general, trauma and emergency, chest screening, ontable examinations and high-throughput general Xray scans. An ergonomic Bucky wall stand enables imaging of patients from head to toe while standing, sitting, or on a mobile table. Adjustment of the table or the Bucky wall stand is synchronized automatically with the system’s X-ray tube tracks to retain the correct source-imaging-distance (SID). The organ programs (OGPs) on the system’s syngo FLC workstation allow users to predefine all important imaging parameters, including kV, mAs and

collimation size, so that facilities can cover much of their patient mix without manual adjustments. An innovative MAXcharge feature prevents battery-related workflow interruptions, since the MAX wi-D detector automatically charges whenever it is inside the table or its Bucky wall stand tray, as well as when it is stored inside the mobile detector holder. As the Multix Fusion Max is a member of the Max family of radiography systems, users can efficiently swap its X-ray detectors with all other Max systems. The ability to share expensive detector technology across the entire Max portfolio can help a facility boost detector uptime and utilization within the department, while having a backup solution available at any time, providing small and mediumsized hospitals with the scalability necessary to obtain the right configuration for their patient mix. “The digital flat detector makes image acquisition

much faster than CR cassettes; it is easy to use and enables flexible patient positioning,” said radiographer Anna Cahalin of Congleton Memorial Hospital (United Kingdom; www.eastcheshire.nhs.uk). Image: The Multix Fusion Max radiography system (Photo courtesy of Siemens Healthineers).

Residual Gadolinium May Persist in Brain for Years ew studies reveal that gadolinium based contrast agents (GBCA) used in magnetic resonance imaging (MRI) exams may remain in the brain for years, but the long-term effects are unknown. A series of three recent studies raise new questions about residual gadolinium concentrations in the brains of patients with no history of kidney disease. The first, conducted at Teikyo University (Tokyo, Japan; www.teikyo-u.ac.jp), examined brain tissues from five autopsied patients who had undergone multiple GBCA MRI exams and five patients with no gadolinium history. The study, published in the November 2016 issue of the Japanese Journal of Radiology, found that even in patients without severe renal dysfunction, gadolinium accumulated in the brain. The findings of the Japanese study lend support to the results of a study at the Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org), published in the March 2016 issue of Radiology, which

showed residual gadolinium deposits present in the postmortem brains of 13 patients who had undergone at least four GBCA contrast MRI exams. Neither the Teikyo University nor the Mayo clinic study was able to identify whether the residual gadolinium was in free or chelated form. A third study, by the University of Heidelberg (Germany; www.uni-heidelberg.de), published in the June 2015 issue of Radiology, retrospectively looked at two groups of 50 patients who had undergone at least six MRI exams, suggests that the molecular structure of the gadolinium contrast agent may play a role in retention. There are two structurally distinct categories of GBCA: linear and macrocyclic. In the macrocyclic structure, the gadolinium is bound more tightly to the chelating agent and, therefore, less likely to release free gadolinium into the body. “We now have clear evidence that the administration of various gadolinium-based contrast agents results in notably varied levels of accumulation of residual gadolinium in the brain. What we still don’t know

is the clinical significance, if any, of this observation,” commented professor of radiology and neuroradiology Emanuel Kanal, MD, director of magnetic resonance services at University of Pittsburgh Medical Center (UPMC, PA, USA; www.upmc.com). “We cannot unnecessarily deprive our patients of crucial, even life-saving medical data from gadolinium contrast-enhanced MRI. Nor can we ignore these new findings and continue prescribing them as we have until now, without change.” Gadolinium – a rare earth heavy metal – is used for enhancement during MRI. Neurotoxic effects have been seen in animals and when a GBCA is given intrathecally in humans. On its own, gadolinium can be toxic; therefore, when used in contrast agents, gadolinium is bonded with a molecule called a chelating agent, which controls the distribution of gadolinium within the body. In July 2015, the U.S. Food and Drug Administration (FDA) stated that it was unknown whether gadolinium deposits in the brain were harmful. Medical Imaging International February-March/2017

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Medical Imaging International

Linen Tags Tested and Approved for MRI Scanners uccessful tests on a new UHF RFID linen tag has confirmed that the tag and related families of tags can be labelled MR Conditional for use with all types of 1.5T and 3T Magnetic Resonance Imaging (MRI) systems. Testing included various MRI exposures, and MRI related issues such as magnetic field interactions, artifacts, and heating, at an renown MR safety testing facility that also evaluates other materials, implants, and various devices. The Fujitsu Frontech (Foothill Ranch, CA, USA; www.fujitsu.com) WT-A533 Ultra-High Frequency (UHF) Radio Frequency Identification Device (RFID) linen tag was tested by the Magnetic Resonance Safety Testing Services (MRSTS) MRI test facility. The test results were posted on the MRIsafety.com website (www.mrisafety.com). The MR

Conditional rating is also for the WT-A53x and WTA52x families of UHF RFID linen tags. The linen tags are used in healthcare garments, flat lines, and scrubs and are designed for industrial laundry applications. Following the MR Conditional approval the linen tags can now also be used in sheets. Frank G. Shellock, PhD, Keck School of Medicine, University of Southern California, said, “We were very impressed with the Fujitsu Linen RFID Tab. The construction of the tag and selection of internal components make it ideal for use in hospital garments and linens used in and around MRI systems. We were also surprised by the relatively small image artifact generated by the tag. The measured maximum image artifact of 2 millimeters under worst case MRI conditions will substantially reduce the impact on the diagnostic use of MRI.”

Image: An example of a Fujitsu Ultra-High Frequency (UHF) Radio Frequency Identification Device (RFID) linen tag (Photo courtesy of Fujitsu Frontech North America).

MRI Analysis Software Quantifies Cardiac Flow echnologies used to develop three-dimensional (3D) video games can now be used to noninvasively quantify cardiac flow and measure heart function in clinical settings. The technology, the result of a collaboration between GE Healthcare (GE, Little Chalfont, United Kingdom; www.gehealthcare.com) and Arterys (San Francisco, CA, USA; www.arterys.com), analyzes multislice, multiphase, and velocity-encoded magnetic resonance imaging (MRI) scans in four dimensions (4D) in order to assess blood flow to the heart and its major blood vessels. The software, dubbed ViosWorks, has applications that range from congenital heart disease (CHD) and aortic and valvular disease to shunts and collateral vessels. ViosWorks simultaneously provides key elements of a cardiac MRI exam, including anatomy, function and flow, thus helping to solve several cardiac MRI challenges at once. By operating in a virtual seven dimensions (three in space, one in time, and three in velocity direction), the datasets captured at each time point during the cardiac cycle allow the software to yield high resolution, time-resolved images of the beating heart, supplying a measure of the speed and direction of blood flow at each location. A key element of ViosWorks is the Arterys cloud-based, machine-learning platform that is designed to deliver ultra-fast visualization and quantification with automatic image analysis.

Medical Imaging International February-March/2017

Arterys uses software as a service (SaaS) analytics powered by potent algorithms that allow large datasets to be evaluated in real-time via the cloud-based software, significantly reducing the time spent on data processing and helping promote the new visualization routines. The system is compatible with images from both 1.5-tesla and 3-tesla MRI scanners. “We believe that our 4D Flow software represents a significant advance in medical imaging, making scans more accessible, useful, and practical for patients and medical professionals,” said Fabien Beckers, CEO of Arterys. “It’s not possible for physicians to process all this data themselves. We take advantage of neural networks to process all this data. We have reached the limit on how much a single computer and a single doctor can do with data.” In the future, GE Healthcare and Arterys hope that machine learning can be used to extract insights from aggregate MRI data analyzed from large numbers of scans taken from different (anonymous) individuals. The Arterys analytics software would search for image features that can be used to predict the advance of a heart condition, and the likelihood that a certain treatment will be successful. Both Arterys and GE Healthcare also plan to extend the use of their technologies to illnesses beyond heart disease, such as imaging brain and musculoskeletal structure, and gaining diagnostic insights in the treatment of diseases such as cancer and multiple sclerosis.

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The Medrad Stellant with Certegra workstation is a scalable informatics-ready solution offering dose management and contrast dose management options. Its interface gives technologists POC tools for enhanced visualization in complex CT angiography and cardiac CT studies.

The MyLab Twice hybrid includes two units: a POC tablet-style portable device, as well as a premium console machine. Featuring a 19-inch full touch screen TFT LCD color monitor, it offers the complete range of advanced transducers and superior image quality with high-frequency range.

The G-Arm B6 Duo fires two X-ray beams asynchronously to provide bi-lateral video and images, giving the user a more comprehensive picture than a traditional C-arm. It uses the smallest dose of radiation, and is compatible with all surgical tables.

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Adding Color to Ultrasound Helps Differentiate Structures new study describes how novel algorithms incorporate color identification into grey ultrasound (US) images, helping to differentiate fine details. Developed by University of Rochester (NY, USA; www.rochester.edu) researcher Professor Kevin Parker, PhD, the mathematical model is used to characterize US scattering behavior and visualize the results as color-coding of the B-scan image. The methodology, which uses a set of mathematical functions devised in 1890 by the great mathematician Charles Hermite of France, approximates the pulseecho formation in typical situations. Professor Parker recognized that the Gaussian weighted Hermite functions closely approximated ultrasound pulses. Currently, medical US imaging scanners typically display the envelope of the reflected signal on a log scale in shades of grey. But the properties of this image and speckle patterns result in an inability to differentiate between different scattering sources that may have fundamentally different frequencydependent scattering cross sections. The new class of images, termed H-scan, can reveal information otherwise hidden in the conventional envelope display. The study was published in the June 2016 issue of Physics in Medicine & Biology.

“If you look at an ultrasound image of the liver, there are so many things in there – veins, arteries, biliary ducts, liver cells, perhaps some scar tissue – and they’re all just displayed as black and white blobs,” said Professor Parker, of the department of electrical and computer engineering. “If there’s a large artery, it’s easy to see the wall and the blood inside. But at the finer levels of detail, it is often impossible to tell if you’re looking at a smaller artery or 10 little cells.” “By letting us see things we can’t see now, it could be very important to individual patients. I realized if we used these, it would make our analyses of ultrasound scattering easier,” concluded Professor Parker. “So now, instead of ultrasound images showing all of these tissue structures as black and white objects, we can now classify them mathematically (by their size) and assign unique colors to unique types of scatterers.” Ultrasound uses pulses of high-frequency sound waves that bounce back echoes when they strike cells or arteries; these echoes are also known as scattered waves. With few exceptions – such as

Doppler-enhanced ultrasound imaging of blood flow – those features consist of varying shades of black, white, and gray reflecting different densities. Image: An increase in fatty lipids in liver tissue is shown in blue using the H-scan format, compared to normal tissue (Photo courtesy of Professor Kevin Parker).

MRI Study Finds Muscles Supporting Spine May Weaken in Space esearchers have found that long missions in space result in atrophy of the muscles supporting the spine of astronauts. The study included six crew members of the International Space Station (ISS). The astronauts underwent one Magnetic Resonance Imaging (MRI) scan of the spine before the mission to the ISS, one upon their return to Earth, and a third scan one to two months after their return. The research study funded by the National Aeronautics and Space Administration (NASA; Washington, DC, USA; www.nasa.gov) was published online in the October 2016, issue of the journal Spine, and

provides insights into the connection between prolonged space flights, spinal disc disease and back pain. The NASA astronauts spent between four and seven months in the ISS in microgravity. The aim of the study was to find which factors affect lower back pain and the strength of the lumbar spine during long-duration spaceflight, and what happens when the astronauts returning to Earth. More than half of ISS crew members reporting spinal pain. The researchers did not find any change in the spinal disc height of the astronauts but found an increased risk of spinal disc herniation, around four times higher than that in matching controls. The as-

tronauts gained approximately two inches in height during their time in space. Dr. Douglas G. Chang, University of California, San Diego, said, “This could provide helpful physiological information to support a manned mission to Mars. These measurements run counter to previous hypotheses about the effects of microgravity on disc swelling. Whether new exercise countermeasures can prevent in-flight paraspinal muscle atrophy, improve spinal pain and function, shorten recovery time, and how such exercise might be performed in a microgravity environment with available exercise equipment need further study.” Medical Imaging International February-March/2017

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MRI Reveals Changes in Brains of Pregnant Women agnetic resonance imaging (MRI) scans reveals that the brains of pregnant women show significant reductions in grey matter in regions associated with social cognition. Researchers at Universitat Autònoma de Barcelona (UAB, Spain; www. uab.cat), Fundació IMIM (Barcelona, Spain; www.imim.cat), Leiden University (The Netherlands; www. universiteitleiden.nl), and other institutions conducted a study that compared MRI scans of 25 first-time mothers before and after their pregnancy, of 19 of their male partners, and of a control group formed by 20 women who were not and had never been pregnant and 17 of their male partners. The data was gathered during a period of five years and four months.

The results of the study showed a symmetrical reduction in the volume of grey matter in the medial frontal and posterior cortex line, as well as in specific sections of, mainly, prefrontal and temporal cortex in pregnant women. The reductions in grey matter were practically identical variations in both women who underwent fertility treatments and women who became pregnant naturally. In MRI scans taken two years later, the gray matter loss remained, except in the hippocampus, where most volume had been restored. The changes were so consistent that a computer algorithm could predict with 100% accuracy whether a woman had been pregnant from her MRI scan. According to the researchers, the grey matter areas corresponded with a neural network

Printed Kidney Phantoms Aid Radiation Dosing Calibration new study suggests that three dimensional (3D) printed kidney phantoms could help determine calibration constants in quantitative single-photon emission computed tomography/ computerized tomography (SPECT/CT) imaging. Researchers at the University of Würzburg (Germany; www.uni-wuerzburg. de) created a set of four one-compartment kidney dosimetry phantoms and their spherical counterparts, with filling volumes ranging from 8 mL (for newborns) and 123 mL (for adults). The phantom designs were based on the outer kidney dimensions, as provided by medical internal radiation ddose (MIRD) guidelines. Based on the designs, the four refillable, waterproof, and chemically stable models were manufactured using fused deposition polylactide (PLA) modeling on a Conrad (WernbergKöblitz, Germany; www.conrad.com) Renkforce RF1000 FFF 3D printer. The researchers then applied nuclide-dependent SPECT/CT calibration factors for technetium-99m (Tc99m), lutetium-177 (Lu-177), and iodine-131 (I-131) to assess the phantoms accuracy when used in quantitative imaging for internal renal dosimetry. The results showed that for the largest phantom, the volumes of interest had to be enlarged by 1.2 mm for 99mTc, 2.5 mm for 177Lu, and 4.9 mm for 131 in all directions to obtain calibration factors comparable to reference. In decreasing phan-

Medical Imaging International February-March/2017

tom volumes, the difference between corresponding sphere–kidney pairs was small, at less than 1.1% for all volumes. The study was published on December 1, 2016, in The Journal of Nuclear Medicine. “This research shows a way of producing inexpensive models of patient-specific organs/lesions for providing direct and patient-specific calibration constants. This is particularly important for imaging systems suffering from poor spatial resolution and ill-defined quantification, such as SPECT/CT,” said lead author Johannes Tran-Gia, PhD. “With comparably low costs and submillimeter resolution, 3D printing techniques hold the potential for manufacturing individualized anthropomorphic phantoms in many clinical applications in nuclear medicine.” An imaging phantom is designed to respond in a similar manner to how human tissues and organs would act in order to evaluate, analyze, and tune performance of a specific imaging modality. Phantoms made for radiography may therefore hold various quantities of x-ray contrast agents with absorbing properties similar to normal tissue, so as to tune image contrast or modulate radiation exposure. For ultrasound, on the other hand, a phantom with similar rheological and ultrasound scattering properties to real tissue would be essential, but x-ray absorbing properties would not be needed.

that is associated with processes involved in social cognition and self-focused processing, with a similar decline in gray matter volume occurring during adolescence. The study was published on December 19, 2016, in Nature Neuroscience. “We certainly don’t want to put a message out there along the lines of ‘pregnancy makes you lose your brain’. Gray matter volume loss can also represent a beneficial process of maturation or specialization, an adaptive process of functional specialization towards motherhood,” said lead author neuroscientist Elseline Hoekzema, PhD, of UAB and Leiden University. “These changes may reflect, at least in part, a mechanism of synaptic pruning, where weak synapses are eliminated giving way to more efficient and specialized neural networks.” “The loss of grey matter does not imply any cognitive deficits, but

Medical Imaging International

rather points to an adaptive process related to the benefits of better detecting the needs of the child, such as identifying the newborn’s emotional state,” added senior author Oscar Vilarroya, PhD, of the UAB cognitive neuroscience research unit. “Moreover, they provide primary clues regarding the neural basis of motherhood, perinatal mental health, and brain plasticity in general.” Image: Grey matter reduction in pregnant women (orange), compared to controls (Photo courtesy of UAB).

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The Vscan Extend dual-probe ultrasound offers smooth integration with hospital DICOM systems. Featuring an intuitive touch screen and weighing just 406 grams, it offers applications with a range of capabilities, such as assessing heart failure patients and measuring bladder volume.

The DR 600 combines direct image capture capabilities with versatile panel formats. Key features include MUSICA image processing, quicker preview on the MUSICA workstation and tube head, touch screen display and user interface, and seamless migration to direct radiography.

The AMULET Innovality offers both 2D and advanced applications, and delivers sharper, clearer images that allow the radiologist to see breast tissue detail. It automatically optimizes the X-ray dosage for each breast type, and offers an extremely fast image time of just 15 seconds.

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Microscopic Sensor Helps Tailor Radiology Treatments new sensor measures radiation doses at the individual cell level, enabling clinicians to obtain a complete picture of how much damage each cell has incurred following treatment. Developed by researchers at SINTEF (Trodheim, Norway; www.sintef.no), the University of Wollongong (UOW; Australia; www.uow.edu.au), and other institutions, the new sensor is as small as a cancer cell, a feat achieved by using a technology called semiconductor processing. The measuring instrument thus contains a sheet of microsensors placed side-by side, all mounted on a silicon base. The sensors are also encapsulated in a plastic material that mimics human tissue, so that the radiation dose measured by the sensors is almost identical to that absorbed by real cancer cells. The dispersal of mixed radiation fields across a given area enables the sensors to provide an image of the location within the cell that absorbs the highest levels of radiation. The sensor was recently tested at the European Synchrotron Radiation Facility (ESRF; Grenoble, France; www.esrf.eu), and was found to be capable of measuring true radiation doses absorbed by tissue, and with a better spatial resolution than existing equipment. The researchers are now working to provide more precise quantification of the radiation doses absorbed by cancer tissue, and reduce the damage incurred by healthy tissue. “The most important component of the new sensor is the element silicon, which is a semiconductor with radiation detection properties. When radiation counteracts with silicon the energy is converted into a measurable electrical signal. The magnitude of the signal indicates the intensity of the radiation,” said SINTEF researcher physicist Angela Kok, PhD. “This technology means that doctors can monitor and control radiation doses to make sure that only cancer cells are destroyed, with only minimal damage to surrounding healthy tissue.”

“It appears that proton therapy produces better outcomes for some types of cancer than traditional radiotherapies. There currently exist no sensors capable of measuring radiation of this kind, but we realized that our technology could be adapted to develop sensors with the right specifications,” added SINTEF research scientist Marco Povoli, PhD. “The fabrication process required more development to optimize the reliability of the results, but we overcame this challenge within a few months.” Image: Researchers Marco Povoli and Angela Kok with the microscopic radiation sensor (Photo courtesy of SINTEF).

Researchers Provide Suggestions to Avoid Errors in Pediatric Chest Radiography he authors of a new study into the challenges of pediatric chest radiography have come up with new guidelines that include a better understanding of the development, and anatomy and children, and a more systematic approach to image interpretation. The guidelines are necessary because when imaging children it is often difficult to get their cooperation and keep them in the optimal position. The paper lists the common problems that occur during pediatric chest radiography and describes how these can be overcome. The results of the study were published in the October 2016 issue of the American Journal of

Roentgenology. The title of the study is: “Pediatric Chest Radiographs: Common and Less Common Errors.” To keep the radiation dose for children as low as possible radiologists are careful in recommending additional projections, follow-up radiographs, or additional cross-sectional imaging. In addition, a systematic approach for image interpretation, and an awareness of common errors and their causes, can help clinicians reduce errors, and provide more accurate interpretations. Co-author of the study A. Luana Stanescu, Seattle Children’s Hospital, University of Washington School of Medicine (UW Medicine; Seat-

tle, Washington, USA; www.uwmedicine.org), said, “Having a thorough understanding of normal pediatric anatomy and developmental changes along with a good command of the entities unique to children is essential for the pediatric and general radiologist to avoid significant interpretive errors,” said paper “Errors in interpretation may lead to inappropriate further imaging, incurring additional radiation exposure and cost, as well as psychologic effects on the patients and their families. In our study, we highlight some common and less common pitfalls in pediatric chest radiography, in addition to discussing some tools for avoiding potential mistakes.” Medical Imaging International February-March/2017

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Medical Imaging International

Portable Imaging System Offers Easy Upgrade to Digital Radiography compact, lightweight system enables small to mid-size hospitals and other healthcare providers to easily transition from computed radiography (CR) to digital radiography (DR) technology. The Carestream Health (Rochester, NY, USA; www.carestream.com) Motion mobile X-ray system is a highly affordable mobile and economical bridge between analog, CR, and DR imaging. The integrated DR version

includes a 19-inch touch screen monitor; an interface that automatically acquires DAP and technique information, which eliminates manual data entry; DirectView software that provides faster image display and delivery to a PACS or printers; and support for Carestream DRX Core, DRX Plus, and DRX 2530C detectors that allow detector sharing with other DRX imaging systems. CR features include a choice of

Robot-Supported Angiography System Advances Hybrid ORs novel angiography system offers personalized, minimally invasive surgery (MIS) for multimorbid patients with changing disease patterns. The Siemens Healthineers (Erlangen, Germany; www.healthcare. siemens.com) Artis pheno provides patients with multiple health issues the option to undergo MIS and interventional radiology and interventional cardiology procedures, despite the additional risks associated with chronic disease. Artis can scan the body up to 15% faster (compared to prior systems Siemens Healthineers systems), and produce three-dimensional (3D) images that need less contrast agent; if the patient is sensitive to the contrast agent, Artis pheno can also support CO2 imaging of the extremities. The C-arm is 13 centimeters wider and has a free inner diameter of 95.5 centimeters, offering more space for handling adipose patients and longer instrument use that can be used without added difficulty. The multi-tilt table is designed to accommodate patients weighing up to 280 kilograms, with edge of the table capable of tilting to stabilize the patient’s blood pressure, for example, or to make breathing easier when necessary. The system can be fitted with a comprehensive range of optional software applications to deal with complex cases. The robotic construction of the Siemens Healthineers table gives it a flexible isocenter, so that the angiography system can follow all table positions and provide imaging support for the patient’s treatment, while representing the target area of the body from virtually any angle. Artis pheno recognizes the position of the tabletop at all times, and automatically aligns itself. Memory positions let the system move the C-arm out of the op-

Medical Imaging International February-March/2017

erating area quickly if necessary, giving the surgeon and team free access to the patient, and then move it back to exactly the same position again for further imaging. A dedicated hygiene approach combines several factors: an antimicrobial coating prevents bacteria and viruses from multiplying on the system; the wiring is routed inside the system to prevent cables from becoming dirty and potentially transmitting bacteria; and seamless surfaces with no recesses, and spaces that are easy to access, make the system easier to clean. And because the system is floor-mounted, it is easier to install in the OR, and the sterile airflow from the ceiling is interrupted during imaging only by the flat-panel detector. “We see a high number of multimorbid patients with impaired kidney function in the angio suite,” said Professor Frank Wacker, MD, director of the institute for diagnostic and interventional radiology at Hanover Medical School (Germany; www. mh-hannover.de). “Shorter scan times help reduce the amount of iodinated contrast agent during 3D angiography in the thorax and abdomen by up to fifteen percent.” Additional optional application packages include software for extensive spinal fusion procedures using screws or needles; screw paths can be precisely planned, and an automatic path alignment function automatically aligns the C-arm to follow them. A laser integrated in the image detector shows the surgeon the planned path, which helps improve both accuracy and speed in the OR. A number of applications support tumor transarterial chemoembolization (TACE), rendering arterial vessels visible, with graphic overlaying of the selected vessel paths with the realtime X-ray images.

manual or anatomical programmed radiography (APR) mode for quick selection of exam technique; an 8-inch touch screen; a choice of push button or hand switch exposure control; a manual light beam collimator; and a 30kW capacitor discharge generator. An optional dose-area product (DAP) meters information needed for monitoring dose. The CR system also has a storage bin for cassettes or detectors, a tube head and column that are designed to fold down for excellent visibility, and a tilt step designed to facilitate moving the system over small obstacles, such as access points to elevators. The system can initially be used with film or CR cassettes, and then converted to a DR system to streamline image capture, viewing, and wireless communication to picture archiving and communication systems (PACS). “We designed this new portable

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system to equip imaging facilities of all sizes with the ability to efficiently capture images using film, CR, or DR technology,” said Sarah Verna, worldwide marketing manager for X-ray Solutions at Carestream. “This system addresses each user’s current imaging needs while providing an easy transition to DR technology when desired.” Image: The Motion mobile X-ray system (Photo courtesy of Carestream Health).

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The X5 features a slim laptop design and utilizes single crystal technology for more efficient scanning, improved imaging and easier enhancement. It has a 15.6-inch high definition LCD monitor, a quick boot up time of 24 seconds, and a built-in battery for three hours of continuous use.

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

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

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Next Generation Endoscopy System Provides Superior Visualization state-of-the-art image-enhanced endoscopy system allows differentiation of mucosal surfaces and vessel structures within the gastrointestinal (GI) tract. The Fujifilm (Tokyo, Japan; www.fujifilm.com) ELUXEO endoscopy system is powered by unique 4-LED multi light technology that combines different wavelengths and specific intensified light spectra created by an integrated light source. This allows healthcare professionals to easily switch between three imaging modes: white light (WL), blue light imaging (BLI) and linked color imaging (LCI). Each light mode utilizes a unique light spectrum to improve the visualization of specific structures in the GI tract. For example, BLI, which has a shorter wavelength than WL, is better absorbed by hemoglobin; this increased absorption makes it easier to detect blood vessels and differentiate between tissue layers, without having to use a real-time filter. The ELUXEO also offers X135 multi zoom technology to optimally magnify structures and further aid in diagnosis and treatment planning. It also comes equipped with a flexibility adjuster, and has a smaller bending radius to enhance maneuverability and maximize patient comfort. In addition, a new training module which instructs users on the application of BLI for detecting Barrett’s oesophagus (BO) provides an interactive training tool that enables endoscopists to see how well they detect and delineate early neoplasia, how they perform compared to other experts in the field, and how technologies like BLI may further improve their clinical practice. “ELUXEO system and its outstanding 4-LED Multi Light technology was developed in cooperation with healthcare experts to achieve optimal results when choosing imaging modes such as BLI”, said Nadja Scheuringer, marketing manager of the endoscopy systems division at Fujifilm. “The new endoscopy series was built on Fujifilm’s heritage and long-standing expertise in medical imaging, and underlines our commitment of being a trusted partner for healthcare professionals in hospitals, clinics, and private practices.”

“During the procedure, the BLI mode is particularly beneficial for making an immediate treatment decision,” said Professor Alessandro Repici, MD, director of the endoscopy unit at the Humanitas Research Hospital (Milan, Italy) one of the first users of the system in clinical practice. “It facilitates the identification of lesions, inflammations and early stages of colorectal cancers, makes diagnosis easier and more precise and thus contributes to improve patient outcomes.” Image: The 4-LED light source of the ELUXEO endoscopy system (Photo courtesy of Fujifilm).

Three New Studies Detail Effects of Zika Virus on Brain

he results of three new studies into the effects of the Zika virus disease in Brazil revealed multiple types of congenital brain

damage. The research was presented at the annual Radiological Society of North America (RSNA2016) meeting in Chicago, USA. One of the studies investigated Computed Tomography (CT) findings of the Central Nervous System (CNS) of 16 newborn babies that suffered from a congenital Zika virus infection. The CT brain findings showed decreased brain volume, calcifications, ventricular dilatation, simplified gyral pattern, and prominent occipital bone.

In the second study researchers analyzed scans of adults, and newborn babies with various neurological disorders, and of pregnant women with rashes indicative of a Zika infection. There were common Magnetic Resonance Imaging (MRI) findings that included enhancement of certain spinal and facial nerves. In addition, the researchers found orbital injuries and changes in the anatomy of brain tissue in the MRI scans of the newborn babies. A third study consisted of ultrasound, and fetal MRI scans in pregnant women suffering from a Zika infection. After the babies were born, ultrasound, CT and MRI scans revealed that more than

half of them had lost brain tissue volume, or suffered from microcephaly, brain calcifications and other structural changes. The researchers used 3D virtual and physical skull models for their research. Author of the first study, Natacha Calheiros de Lima Petribu, MD, Department of Radiology, Barão de Lucena Hospital (Recife, Brazil; http://cnes2. datasus.gov.br), said, “We live in Pernambuco, a state in northeastern Brazil, which had the highest number of patients with microcephaly during the Zika outbreak in our country. Our study proves that Zika virus infection can cause congenital brain damage in babies with and without microcephaly.” Medical Imaging International February-March/2017

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Portable Terahertz Scanner Images the Human Body novel portable terahertzscanning device uses arrays of carbon nanotubes (CNT) to better image three-dimensional (3D) objects and tissues. Developed at the Tokyo Institute of Technology (TITECH; Japan; www.titech.ac.jp), the flexible terahertz scanner integrates 23 CNT detector elements into a single CNT film array with a mechanical strength that enables it to be readily bent over a wide range of angles, unlike other

semiconductor materials that are fragile and break under stress. In addition, the CNT films absorb electromagnetic radiation over a broad terahertz band range, which eliminates the need for planar antennas in order to scan objects. As a result, the scanner is wearable, portable, and can scan 3D objects without requiring complex optics or equipment. The terahertz scanner was successfully used for active imaging of flat and curved samples; multi-view

Experts Recommend Personalized Approach to Breast Cancer Screening xperts in the US have recommended a risk-based personalized approach to breast cancer screening to ensure improved, safer and less expensive cancer care. Current 5-year breast cancer survival rates have reached 90% as a result of both improved treatment and screening, but this could still be improved further by taking into account the differences between women with dense breasts, those with a personal history of breast cancer, and carriers of the BRCA1 and BRCA2 gene mutations for example. The recommendations presented by the experts from the George Washington University (Washington DC, USA; https://smhs.gwu.edu) and the Memorial Sloan Kettering Cancer Center (New York, NY, USA; www.mskcc.org) include annual screening using both mammography and ultrasound modalities for

women aged 40 and older who have a lifetime risk of breast cancer. In addition, since mammography screening alone is unable to find a third of all cancers in women with dense breast tissue, they could benefit from the addition of ultrasound screening, as revealed in a recent study of 15,000 women. Mammography screening is not suitable for women under 40 years of age who carry the BRCA1 mutation. As an alternative, annual or biannual Magnetic Resonance Imaging (MRI) scans could increase cancer detection and reduce radiation exposure for BRCA1 carriers aged 25 to 40. For BRA1 carriers older than 40, alternating MRI and mammography screening every six months could be suitable. Contrast-Enhanced Digital Mammography (CEDM) is another possible alternative for routine mammography screening.

scanning of cylindrical samples; and passive wearable imaging of a human hand. In the future, the researchers expect their terahertz scanner will enhance the capability of noninvasive inspections in pharmaceutics, food quality control, and medical monitoring, including noninvasive inspection of medical equipment and for imaging cancer cells, blood clots, sweat glands, and teeth. The study describing the new scanner was published in the November 2016 issue of Nature Photonics. The terahertz band resides between the infrared (IR) and microwave bands of the electromagnetic spectrum, with rays that can pass through a wide variety of materials without damaging them; they therefore have great potential for noninvasive, high-resolution imaging of solid objects and soft tissue of the human body. But current terahertz devices used for whole body scans must ro-

Medical Imaging International

tate 360 degrees around the human body, and thus they are large, bulky, and inflexible. Image: The terahertz scanner imaging a human hand (Photo courtesy of TITECH).

New Diagnostic Imaging and Radiation Oncology Topics Released he American College of Radiology (ACR) has announced updated appropriateness criteria for 227 topics with more than 1,100 clinical indications for radiology professionals. The evidence-based guidelines help healthcare providers select the most suitable medical imaging exam for a clinical condition, and are continuously reviewed and updated. The ACR (Reston VA, US; www. acr.org) is a professional medical society that supports radiology professionals and radiological care. The guidelines, also referred to as specified Appropriate Use Criteria (AUC), are part of the US Protecting Access to Medicare Act (PAMA) legislation,

Medical Imaging International February-March/2017

and an expert panel of clinicians from each medical specialty develops the criteria. Chair of the ACR Diagnostic Imaging and Interventional Radiology Appropriateness Criteria Committee, E. Kent Yucel, MD, FACR, said, â&#x20AC;&#x153;Use of these guidelines in exam ordering ensures that the right patient gets the right scan for the right indication and has been shown to improve quality, reduce unwarranted scans and lower imaging costs. The guidelines allow providers to educate themselves regarding the latest evidence-based approach to medical imaging for a given procedure without disrupting the doctor-patient relationship or delaying needed care.â&#x20AC;? LINKXPRESS COM

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The OEC Elite can be managed single-handedly and is easy to maneuver and position. Its large field of view allows the user to simultaneously view full-size primary and reference images, as well as focus on the clinically relevant anatomy.

The SOMATOM Confidence RT Pro generates personalized images for all patients that are optimized for both contouring and dose calculation. It reduces unnecessary workflow steps and potential sources of errors, and features advanced technology for improved visualization.

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

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Mobile C-Arms Fitted with New CMOS Flat-Panel Technology new generation of full-sized C-arm imaging solutions is now available fitted with CMOS Flat-Panel (FP) technology. This latest generation of C-arms provides both improved image quality, and minimized radiation dose. The new FP CMOS technology replaces current amorphous silicon detectors, and closes the gap between the cost efficiency of image intensifiers, and quality of images from flat-panel technologies. The Ziehm Solo FD, and Ziehm Vision RFD, systems are both available with the new Flat Panel (FD) CMOS detectors, and are produced by Ziehm Imaging (Nuremberg, Germany; www.ziehm.com). Ziehm Imaging develops, and manufactures innovative mobile X-Ray imaging solutions, including mobile C-arm systems. The Ziehm Solo FD mobile C-arm is intended for use in trauma, orthopedic, and pain management interventions, and provides improved contrast for imaging soft tissue, and bone. The Ziehm Vision RFD system can be used for vascular procedures, and includes a 25 kW power generator. This system will be available commercially with CMOS technology, in the beginning of 2017. The Ziehm Vision RFD Hybrid Edition is a mobile hybrid solution that is intended for cardiovascular procedures. Ziehm Imaging has also released the new Ziehm NaviPort 3D interface that is intended for image-guided navigation, and can improve the precision, and reliability of surgical procedures. The new interface connects navigation systems with the Ziehm Vision RFD 3D C-arm providing intraoperative 3D imaging and navigation.

Image: The Ziehm Solo FD C-arm imaging system fitted with CMOS FlatPanel (FP) detectors (Photo courtesy of Ziehm Imaging).

MRI Scans Can Detect Chemical Imbalance in Brain agnetic resonance imaging (MRI) can be used to measure the higher levels of oxidative stress present in patients with schizophrenia, according to a new study. Researchers at Harvard Medical School (HMS; Boston, MA, USA; www.harvard.edu) and McLean Hospital (Belmont, MA, USA; www.mcleanhospital. org) used a novel magnetic resonance spectroscopy technique to identify oxidative stress in 21 patients with chronic schizophrenia by measuring the brain concentrations of two molecules, nicotinamide adenine dinucleotide (NAD+) and nicotinamide adenine dinucleotide hydrogen (NADH), that give a readout of how well the brain is able to buffer out excessive oxidants. The researchers found a 53% elevation in NADH

in the chronic schizophrenia patients, as compared to healthy individuals of similar age. A similar degree of NADH elevation was also seen in newly diagnosed schizophrenia, suggesting that oxidation imbalance is present even in the early stages of illness. Modest NADH increases were also seen in bipolar disorder, which shares some genetic and clinical overlap with schizophrenia. The study was presented at the American College of Neuropsychopharmacology annual meeting, held during December 2016 in Hollywood (FL, USA). “Intensive energy demands on brain cells lead to accumulation of highly reactive oxygen species, such as free radicals and hydrogen peroxide. However, measuring this process in the living human brain has remained challenging,” said lead author Fei Du,

PhD, an assistant professor of psychiatry at HMS. “In addition to offering new insights into the biology of schizophrenia, this finding also provides a potential way to test the effectiveness of new interventions.” Schizophrenia is a mental disorder characterized by abnormal social behavior and failure to comprehend reality. Common symptoms include false beliefs, unclear or confused thinking, hearing voices, reduced social engagement and emotional expression, and a lack of motivation. People with schizophrenia often have additional mental health problems such as anxiety disorders, major depressive illness, or substance use disorders. Schizophrenia does not imply a split or multiple personality disorder, conditions with which it is often confused in public perception. Medical Imaging International February-March/2017

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Medical Imaging International

3D Printed Lenses Provide Sharper Ultrasound Images n innovative ultrasound probe is equipped with superior resin transducer lenses manufactured using three-dimensional (3D) printing technology. Developed by researchers at Nanyang Technological University (NTU; Singapore; www.ntu. edu.sg), the technology allows the printing of complex lens shapes for ultrasound probes that can be used to focus the resulting waves at multiple sites, or to shape waveforms with complex temporal and spatial shapes to a specific target. Current ultrasound design is limited by the optical characteristics of glass, which dictate cylindrical or spherical shaped lenses, thereby restricting the clarity of the imaging. The arbitrarily shaped surfaces are made of polymers and printed with 3D printers, using three different polymer materials and a simplified deposition technique. The process involves painting layers of carbon-nanotube powder and polydimethylsiloxane. Together with a clear resin, pressure amplitudes of 300 bar peak positive can be obtained, and the flexibility of the polymer substrates allows complex waveforms to be generated. The study describing toe fabrication process and testing was published on October 29, 2016, in Applied Physics Letters. “In most medical surgeries, precision and noninvasive diagnosis methods are crucial. This novel device not only determines the focus of the wave but also its shape, granting greater accuracy and

control to medical practitioners,” said lead author Claus-Dieter Ohl, PhD, of the NTU School of Physical and Mathematical Sciences. “3D printing reinvents the manufacturing process, enabling the creation of unique and complex devices. In turn, the way medical devices are created needs to be rethought. This is an exciting discovery for the scientific community as it opens new doors for research and medical surgery.” An ultrasonic probe consists of a piezoelectric element, backing material, an acoustic matching layer and an acoustic lens. The piezoelectric element generates the ultrasonic waves by repeatedly expanding and contracting; the backing material prevents excessive vibration in order to improve axial resolution; the acoustic matching layer improves impedance; and the acoustic lens prevents the ultrasonic waves from spreading and focuses them in the slice direction to improve the resolution.

Image: A 3D printed resin lens for ultrasound overcomes the limitations of glass (Photo courtesy of NTU).

Researchers Investigate Cause of Contrast Agent Deposits in MS Patients he results of a new study involving multiple sclerosis patients, show how performing repeated MRI scans on the patients with gadolinium-based contrast agents leads to the deposition of the agents in the brains of the scanning subjects. The researchers from the Charité - Universitätsmedizin Berlin (Berlin, Germany; www. charite.de/en) and the Max Delbrück Center for Molecular Medicine (Berlin, Germany; www. mdc-berlin.de) compared the use of linear and macrocyclic gadolinium-based MRI contrast agents, and how their use led to the deposition of the agents in multiple sclerosis patients’ brains. The results of the study, published in the December 2016 issue of the journal Multiple Sclerosis, suggest that the use of ‘macrocylcic contrast agents’ reduces the risk of accumulation of the agents in the brain. Study leader PD Dr. Michael Scheel, said, “Patients who received a different type of MRI contrast agent – one that is referred to as a macrocyclic contrast agent – showed no evidence of gadolinium brain deposition. Available data currently suggest that the risk of deposits is considerably higher with contrast agents that have a linear molecular structure. This effect appears to be absent, or much reduced, when using contrast agents with a ring-shaped, macrocyclic structure.”

Medical Imaging International February-March/2017

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Medical Imaging International

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Mammograms Contribute to Over-Diagnosis of Breast Cancer new study casts further doubt on the value of universal mammogram screening for breast cancer in women over the age of 40. Researchers at the Dartmouth Institute for Health Policy and Clinical Practice (DTI; Lebanon, NH, USA; tdi.dartmouth.edu), the Geisel School of Medicine (Hanover, NH, USA; www.geiselmed.dartmouth.edu), and the U.S. National Cancer Institute (NCI, Rockville, MD, USA; www.cancer.gov) used data from the Surveillance, Epidemiology, and End Results (SEER) program from 1975 to 2012 to calculate the tumor-size distribution and size-specific incidence of breast cancer among women 40 years of age or older. The researchers then calculated size-specific cancer case fatality rate for two time periods: a baseline period before the implementation of widespread screening mammography (1975-1979), and a period encompassing the most recent years, for which 10 years of follow-up data were available (2000-2002). The data was used to track how many cancers were found when small (under two centimeters), versus large, when they are presumably more life-threatening, assuming that if the true number of breast cancer cases is stable, an increase would indicate over-diagnosis. The results showed that after the advent of screening mammography, detected breast tumors that were small increased from 36% to 68%, while detected tumors that were large decreased from 64% to 32%. The researchers concluded that if disease burden was stable, only 30 of the 162 additional small tumors per 100,000 women that were diagnosed were expected to progress to become large, implying that the remaining 132 cases were over-diagnosed, and would never have led to clinical symptoms. The study was published on October 13, 2016, in the New England Journal of Medicine (NEJM). “The magnitude of the imbalance indicates that women were considerably more likely to have tumors that were over-diagnosed than to have earlier detection of a tumor that was destined to become large,” concluded lead author H. Gilbert Welch, MD, MPH, of DTI, and colleagues. “However, with respect

to only these large tumors, the decline in the size-specific case fatality rate suggests that improved treatment was responsible for at least two thirds of the reduction in breast cancer mortality.” “We get credit for curing disease that would never have harmed the patient. We receive positive feedback from patients thanking us for ‘saving my life,’ alarming feedback from patients with ‘missed diagnoses,’ and no feedback at all from patients whose cancer was over-diagnosed,” wrote Professor Joann G. Elmore, MD, MPH, in an accompanying editorial. “The mantras ‘all cancers are life-threatening’ and ‘when in doubt, cut it out’ require revision.” Image: Mammograms in women over 40 may contribute to over-diagnosis of breast cancer (Photo courtesy of Getty Images).

Innovative Transducer Expands Emergency Cardiac Ultrasound new portable transducer frees physicians in emergency care situations of time and mobility restrictions incurred by locating an available ultrasound cart. The Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) S4-1 is a pocket-sized and lightweight point-of-care (POC) cardiac transducer for the Lumify platform, the Philips smart-device portable diagnostic ultrasound solution. Smaller than a smartphone, the S4-1 transducer and cable together weigh just 152 grams. The introduction of the S4-1 expands Lumify into ambulatory use, with clinical applications expanded to include a full offering of in-demand cardiac, abdominal, thoracic, and OB/GYN imaging. The S4-1 transducer offers Lumify advanced high-sensitivity and high-resolution, two-dimensional (2D) image quality, along with new exam pre-sets, which allow clinicians to triage and assess their patients for faster, informed decisions. And beyond integrating with everyday technology, such as off-the-shelf compatible smart devices, Lumify uses cloud-enabled technology to connect with picture archiving and communication systems (PACS), shared networks, and system directories. Data is accessible on the Philips HealthSuite Digital Platform, an open and secure, cloud-based IT infrastructure. “Our vision for smart-device ultrasounds is focused on putting high-quality devices in the hands of more professionals to serve more patients in more locations,” said Randy Hamlin, POC business leader for Philips Ultrasound. “With the S4-1 transducer and clinical pre-sets, Lumify is further extending the reach of ultrasound by delivering exceptional image quality, now for routine cardiac exams, and creating better connections between clinicians and their patients.” “Lumify is a game-changing innovation,” said emergency ultrasound physician John Bailitz, MD, of the American College of Emergency Physicians (ACEP; Irving, TX, USA; www.acep.org). “The affordability, flexibility, and versatility of Lumify make it appealing to those working in emergency settings, and now with the S4-1 cardiac probe and FAST exam pre-sets, we can conduct crit-

ical exams at the point-of-care, resulting in more efficient triage of patients.” The Philips Lumify is a complete, portable ultrasound system intended for a range of specialties and settings. The system is supplied with two transducers and a scanning app that controls several types of ultrasound scans under a monthly subscription plan that includes not only the device and app, but also an entire healthcare ecosystem dedicated to care delivery. Real-time automatic app updates include rollout of new features as soon as they are developed. Image: The S4-1 POC cardiac transducer and Lumify system (Photo courtesy of Philips Healthcare). Medical Imaging International February-March/2017

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New Functionality Announced for Advanced Visual Analysis and Quantification Platform medical imaging systems company has showcased new multimodality functionality and expanded neurological tools for its advanced visual analysis and quantification platform. The analysis platform can now be used for neurological diagnosis to track and compare brain images and disease progression in patients, and features machine learning to improve the clinician workflow, and improved 3D printing options. Royal Philips (Amsterdam, the Netherlands; www.philips.com) announced the IntelliSpace Portal 9.0 at the annual Radiological Society of North America Annual Meeting (RSNA2016) meeting. IntelliSpace Portal 9.0 includes new machine learning capabilities and can help radiologists detect, diagnose and follow the progression of patients with brain injuries, stroke, dementia, Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS). The platform includes CT Brain Perfusion, and MR T2 Perfusion enhancements, the Longitudinal Brain Imaging (LoBI)1 application for neuro reading, and the CorTech Labs (San Diego, CA, USA; www. cortechslabs.com) NeuroQuant measurement application for the quantification of brain volume loss. IntelliSpace Portal 9.0 applications can be accessed from anywhere in the hospital network, and can integrate with Picture Archive and Communications Systems (PACS), and Hospital Information Systems (HIS) for information sharing and collaboration. Senior VP and GM of Philips Healthcare IT, Yair Briman, said, “Radiology has a unique ability to influence and improve outcomes, and intelligent tools enable us to empower radiologists with the right information. With advances in machine learning, IntelliSpace Portal 9.0 will now be able to continually learn the usage patterns of users to enhance the important daily functions of a radiologist such as prepreprocessing of images, encouraging faster and more streamlined diagnosis.”

Image: The IntelliSpace Portal 9.0 includes the NeuroQuant application for objective quantification of brain atrophy (Photo courtesy of Royal Philips).

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The KT-D213V5E monitor is equipped with a high density LCD panel and innovative image controller for accurate performance. Using technologies such as subdivision uniformity, the monitor guarantees high-quality images for increased diagnostic confidence.

The ChromaPaxx 17C2D4G160 HD integrates a 17-inch display and digital recorder to capture video/images via S-Video or Composite and record in three formats. It is suitable for recording/displaying videos and images for endoscopy, surgical applications, and X-ray procedures.

The Digital Room Upgrade Kit for is meant for upgrading existing rooms with compatible X-ray systems from CR to DR without having to upgrade the entire room. It offers a choice of wireless, tethered, or fixed Canon CXDI DR system to suit different budgets.

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New Version of Imaging Platform Offers Advanced VNA Capabilities new version of an award-winning enterprise imaging platform that supports additional specialties, provides improved collaboration, and offers advanced Vendor Neutral Archive (VNA) capabilities, has been announced. The platform features new workflow rules, intelligent image and archive management, live-streaming capabilities, ophthalmology and dental imaging workflows, and business Intelligence reports. The new Enterprise Imaging platform version was announced by Agfa HealthCare (Mortsel, Belgium; www.agfahealthcare.com), and includes workflows for academic, research, teaching, multi-site, and other medical imaging specialties. The platform can be used for virtual conferences using a browser and the universal XERO viewer. Remove viewing and live streaming during surgery and endoscopies, real-time audio, and video consultation are made possible using the Agfa Orpheus system. A report published in November 2015, by peer60, based on an industry survey including more than 500 healthcare providers, and entitled “Trends in Medical Imaging Technology” selected the Enterprise Imaging platform as the Number 1 Enterprise Imaging solution.

James Jay, VP, Agfa HealthCare Imaging IT solutions, said, “With this latest Enterprise Imaging release, Agfa HealthCare confirms its focus on delivering a highly integrated platform to improve the management and sharing of images across the healthcare enterprise.” Image: A new version of the Enterprise Imaging platform has been announced (Photo courtesy of Agfa HealthCare).

Platform Combines Imaging Scans and Clinical Information Systems for Decision Support new software platform brings together Electronic Health Record (EHR) and imaging information for analytics and clinical decision support for radiology and oncology specialties. The platform combines imaging data, and clinical information sources such as Electronic Medical Records (EMR) and Radio Therapy (RT) data into the primary reading workflow. The platform is designed to improve clinical productivity and has been cleared by the US FDA. The Quantitative Imaging Decision Support (QIDS) software platform was showcased at the annual Radiological Society of North America (RSNA2016) meeting by HealthMyne (Madison, WI, USA; www.healthmyne.com). The software provides curated medical content, evidence-based analysis, and reporting for clinical collaboration and

improved patient management, as well as data mining for research purposes. The platform is built around an image analysis engine that generates lung cancer screening information such as tumor size, and Lung-RADS categories, amongst other advanced quantitative metrics. HealthMyne plans to expand the platform to other specialties in the future. President and CEO of HealthMyne, Arvind Subramanian, said, “Radiologists who efficiently leverage existing clinical systems information and generate new quantitative metrics within the primary read will thrive in the Value-Based world. By automatically providing quantitative data not currently available in the routine clinical workflow, Health-

Myne is significantly enhancing collaboration between radiologists and oncologists to deliver precise patient management.” Image: The Quantitative Imaging Decision Support (QIDS) software platform (Photo courtesy of Healthmyne). Medical Imaging International February-March/2017

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IT/PACS Update

Custom Displays Deliver 4K HD Image Quality new series of custom monitors deliver 4KX2K resolution (3,840 × 2,160 pixels), four times that of full high definition (HD). The Canvys (LaFox, IL, USA; www.canvys.com) 4K2K custom display series deliver sharp, precise, detailed images with enhanced depth and color representation. In addition to displaying high-quality HD images, the monitors are also capable of delivering multi-modality; depending on the screen size and inputs, up to eight windows from eight different sources can be displayed on one screen at the same time. In addition, only one calibration and gamma set-

ting are needed when utilizing a single screen for multiple images. Picture-in-picture (PIP) functionality is used to compare two images side-by-side on a single screen in 2KX2K resolution without losing image quality, allowing users to view fine image details, a feature that is especially useful in applications such as minimally invasive surgery and endoscopy. Another innovative feature offered is optional projected capacitive touch (PCap), which allows the monitor to be operated by 10 fingers or latex gloves. With the 4K2K series, Canvys also deliver a range of custom options

Approval for 3D Total Knee Arthroplasty Surgical Planning Software

he US FDA has cleared a new 3D total knee arthroplasty surgical planning software that is part of a portfolio of apps for online weight-bearing 3D surgical planning for common orthopedic treatments. The online 3D planning software uses weight-bearing 3D images and other data from a 2D/3D orthopedic imaging system and provides surgical planning for total knee arthroplasty procedures. The EOS Imaging (Paris, France; www.eosimaging.com) KneeEOS online software planning tool received 510(k) clearance from the US Food and Drug Administration (FDA; Silver Spring, MD USA; www.fda.gov) for marketing in the US. KneeEOS is designed for use with the EOS Imaging 2D/3D orthopedic imaging system and is the part of a portfolio of EOSapps for common orthopedic surgeries. KneeEOS creates an initial proposal for size and position of implants to help surgeons pre-

Medical Imaging International February-March/2017

pare and optimize the alignment of the implants in 3D, and also displays relevant clinical data in real time. EOSapps use 2D images, and 3D digital anatomical datasets taken using the EOS imaging system for diagnosis, pre-operative surgical planning, post-operative assessment of the patient, and for follow-up imaging. Marie Meynadier, EOS Imaging CEO, said, “The kneeEOS FDA clearance is an important milestone that allows us to offer our full set of software solutions to the U.S. market. It will support the growing adoption of EOS images, 3D models and patientspecific datasets at each step of the care continuum, helping healthcare providers bring the value of personalized treatments to their patients without the high dose and cost of CT imaging.” Image: A clinician using the KneeEOS total knee arthroplasty surgical planning software (Photo courtesy of EOS Imaging).

and services, including needs assessment, custom engineering, and prototyping; touch and protective shield integration; various housing designs, including open frame, panel, chassis, or rack mount; rugged to slim and light weight designs; a wide range of controller solutions with inputs in many combinations; and single board controller and PC integration. The monitors are available in seven screen sizes: 23.8, 27, 31.5, 55, 58, 65, and 84 inches. 4K resolution refers to a horizontal resolution of 4,096 pixels.

The use of width to characterize the overall resolution marks a switch from previous video standards such as 480i and 1080p, which categorize media according to its vertical dimension. Using that same convention, 4K would be named 2160p. As 4K is becoming standard, manufacturers are working on the next step, 8K, which forms an image dimension of 7,680×4,320 pixels. Image: The Canvys 58-inch 4K2K display (Photo courtesy of Canvys).

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The RadiForce RX660 allows an image to be displayed that is true to the original source data, even at high brightness levels. Its wide viewing angles allow the user to view the screen from the side with minimal color shift, as well as view a variety of medical images at the same time.

The AeroDR Portable Retrofit turns an existing portable X-ray unit into a digital wireless solution. It has a very small footprint, which allows for installation and storage inside the cassette storage bin, and is completely self-contained and includes two long-life batteries.

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

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New High-Speed PACS Released new version of a web-based HTML5-based zero footprint PACS, that provides faster viewing of large and complex datasets, from various modalities, has been announced. The 5th generation of the Picture Archiving and Communication System (PACS) includes significant improvements in image display speed, and enhanced and optimized workflows that facilitate collaboration. The new PACS can launch images directly in a browser, without caching the files first, and does not need to download the images to a desktop client beforehand. The new FujiFilm Europe (Duesseldorf, Germany; www.fujifilm.eu) Synapse PACS version is also optimized for remote viewing at multiple locations, and uses server-side caching to reduce bandwidth requirements by 50%. The Synapse PACS is the most installed PACS worldwide and can be used for DICOM and non-DICOM data, in structured and unstructured formats. The Synapse family includes 3D, Mobility, and Vendor Neutral Archives (VNA) solutions, and a Clinical Workflow Manager. Opey Olorunlero, Synapse Product Manager, Fujifilm, said, “Synapse 5 pushes the boundaries of traditional PACS with its sub-second speed, fresh look, inbuilt data analytics tools and native support for display and processing of Digital Breast Tomosynthesis images. It has the potential to save organizations sig-

nificant resources through reduced desktop management, as there are no clients to install. The Global Worklist feature provides solutions for federated image and report sharing across any-vendor PACS system.” Image: The new 5th-Generation Synapse PACS was announced at the EHI Live 2016 meeting in the UK (Photo courtesy of Fujifilm).

New Software to Correct Metal Artifacts in CT Images esearchers in the US have compared the ability of iMAR, dual-energy virtual monochromatic imaging, and a combined technique, to correct imaging artifacts resulting from metal orthopedic and dental implants. Iterative Metal Artifact Reduction (iMAR), and dual-energy virtual monochromatic imaging, are two software techniques that clinicians use to compensate for artifacts created by metal implants during Computed Tomography (CT) imaging scans. The researchers from the Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org) also used a third technique that combines iMAR and virtual monochrome imaging. The metal artifact reduction software can be used directly from the CT scanner console. Each implant type causes different artifacts. For example, the metal in tooth fillings and artificial joints can block CT from imaging surrounding tissue, and can cause beam hardening, beam scattering, non-linear partial volume effects, and photon starvation. The results are severe

streaking and shadows on the CT scans that prevent radiologists from accurately reading the images. The results were presented at the annual Radiological Society of North America (RSNA2016), and showed that iMAR was better at eliminating artifacts for implants of the hip and knee, while for dental implants dual-energy virtual monochromatic imaging was more effective. In dental imaging iMAR actually introduced additional artifacts. A combination of both techniques was found most effective for spinal implants. Medical physicist Lifeng Yu, PhD, at the Mayo Clinic, said, “Metal artifacts are the most challenging unsolved problem in the 40-year history of CT scans. While the processed images are a great improvement over the originals, the techniques are still not perfect, and the final outcome is case by case.”

Image: An example of the application of iterative Metal Artifact Reduction (iMAR) in CT imaging (Photo courtesy of University Erlangen Radiologie, Erlangen, Germany). Medical Imaging International February-March/2017

Industry News

Hitachi to Expand Healthcare Businesses in Americas itachi, Ltd. (Tokyo, Japan; www.hitachi. com) has announced that it will combine Hitachi Aloka Medical America, Inc. (Wallingford, CT, USA; www.hitachi-aloka.com) into Hitachi Medical Systems America, Inc. (Twinsburg, OH, USA; www.hitachimed.com) on April 1, 2017, which will then change its name to Hitachi Healthcare America Corporation. Hitachi's healthcare business provides diagnostic

and clinical solutions ranging from diagnostic/clinical systems, such as particle therapy systems, to testing/reagents such as clinical analyzers and informatics that include IT services and integrated community care systems. The newly formed company will function as the regional headquarters providing sales and maintenances services while driving a customer-focused strategy for growing its current medical modality segments. The company also plans to

Top 6 Trends in the Global CT Systems Market he global medical computed tomography (CT) systems market is valued at USD 4.9 billion for 2016 and should continue to grow about twice as fast as other medical devices, driven by product improvements, growing clinical applications, an aging population with significant diagnostic needs, and rising incidence of chronic disease. These are the latest findings of Kalorama Information, (New York, NY, USA; www. kaloramainformation.com), an independent medical market research firm, which has identified the top six trends shaping the global CT systems market. Adoption of high slice-count systems: Amidst the increased focus on cutting healthcare and hospital costs, spending twice as much on 256- or 320-slice CT systems for clinical applications such as cardiac imaging when a 64-slice system is sufficient for a cardiac diagnosis may appear unnecessary. However, users of 256- or 320-slice systems can vouch for their superior image quality and better diagnostic capability in CT angiography. Software-aided dose reduction: Since CT exams add to a patient's lifetime exposure to ionizing radiation, dosing remains an issue for the increased use for these systems. Currently, CT systems feature various technologies, such as iterative reconstruction software, intra-operativity, and dose-tracking software to reduce the amount of emitted radiation as well as the number of unnecessary scans. Clinical application in pediatrics: Over the past few years, there has been a decrease in the clinical application of CT in pediatrics. Apart from the difficulty in deciding the extent of further reduction in the rates due to limited evidence about the appropriateness of most CT procedures, radiation doses from pediatric CT also vary widely in clinical practice. However, this presents an opportunity to reduce doses through standardized protocols and other processes. By implementing readily available dose-re-

Medical Imaging International February-March/2017

duction strategies, as well as eliminating unnecessary imaging, it will be possible to significantly reduce future radiation-induced cancers caused by the use of CT in pediatrics. High-speed systems: The increase in clinical utilization of CT has been drive by improvement in image quality and speed, and robustness and utility of the CT technique. There has been a significant improvement in the speed with which 3D volume can be imaged, as well as in routine spatial resolution in the slice direction, owing to helical scanning and multi-detector row CT. This, coupled with various other technological advances, has resulted in CT imaging speed increasing by more than seven orders of magnitude since it was first introduced in the early 1970s. The increase in speed, combined with improvement in low-contrast detectability and image quality, has resulted in the technique becoming more robust and allowing CT to become mainstream in medical care. Improved resolution with smart photons: CT systems are limited by "crosstalk" based on their use of reflectors. Direct conversion photon counting detectors, each photon creates a number of charge carriers in the semiconductor in proportion to the energy deposited. Charge carriers produced in the semiconductor follow electric field lines to prevent crosstalk, as a result of which, these detectors avoid the geometric inefficiencies in scintillator-photodiode detectors currently used in commercial systems and help achieve better spatial resolution. Portable CT units: Portable CT is expected to become a standard of care in the next decade as rapid diagnosis and treatment play an increasingly important role in improving the health outcomes for patients and reducing health care costs. Portable head CT imaging is particularly gaining importance in aiding diagnosis and treatment of patients with cranial pathology, as bringing the modality to the patient increases imaging speed and safety, which is critical in neurologic emergencies.

integrate its Innovation and Informatics Division, which currently belongs to Hitachi America, Ltd. into the new Hitachi Healthcare America Corporation. The company will focus on collaborative creation with its Americas-based key partners and customers to realize advanced medical technology and Informatics solutions, such as using radiation therapy treatment data and artificial intelligence to support creating better treatment plans, for example.

Siemens and Biogen in Alliance To Develop New MRI Tools new joint project has been agreed between two companies for the development of quantitative MRI metrics to improve decision making for the treatment of Multiple Sclerosis. The companies announced that they will develop applications for Magnetic Resonance Imaging (MRI) scanners that can help quantify key Multiple Sclerosis (MS) disease, and disease progression markers. The agreement is between Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) and Biogen (Cambridge, MA, USA; www.biogen.com). Biogen is a lead-

ing biotechnology company and develops therapies for neurological, autoimmune disease, and other conditions. Siemens will contribute its expertise in the field of neurology, and in medical imaging. MRI is used by clinicians for diagnosing MS, to measure disease activity, and to monitor the response to therapy by comparing sets of MRI scans made over a period of time. Automated MRI applications are now available for quantifying key MS markers such as new T2 lesions and brain atrophy, and enhanced data at the point-of-care could benefit patients with this MS.

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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 2529; Lake Buena Vista, FL, USA; Web: www.aium.org 49th International Diagnostic Course Davos. Mar 26-30; Web: www.idkd.org

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