Medical Imaging International March 2017 by Globetech

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Vol.28 No.1 2-3 / 2018 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 4-21 PACS/ IT Update . . 21-24 Product News . . . . . 6-24 Industry News . . . . . . 25 International Calendar . 26

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Personalized Radiotherapy Treatments Developed for Cancer Patients esearchers have revealed a new innovative radiation therapy approach, called the radiosensitivity index, which can improve outcomes of radiation therapy for patients with head and neck cancer. The researchers developed the new test to determine the sensitivity of tumors in a specific patientto-radiation therapy. The scientists validated the radiosensitivity index, which is based on gene expression in the tumor, in nine different patient groups, and with different types of tumors. Researcher team from the H. Lee Moffitt Cancer Center & Research Institute (Tampa, FL, USA; www.moffitt.usf.edu) published the results of their study in the May 2017 issue of the journal The Lancet Oncology. The researchers used the radiosensitivity index within a mathematical framework that enabled them to select the most appropriate radiotherapy dose, based on the individual tumor biology of each patient. As a next step the researchers are developing the first clinical trial for patients with squamous cell carcinoma, of the oropharynx. According to the authors, advances in the field of radiomics, which uses Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Positron Emission Tomography (PET) to scan and characterize tumors could

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also be used in the future to provide information for non-invasive and reproducible virtual 3-D biopsies of entire tumors. Associate member and section head at Moffitt Head and Neck Radiation Oncology, Jimmy J. Caudell, MD, PhD, said, “We propose to explore how we can move away from a one-size-fits-all approach to radiotherapy treatment for patients with head and neck cancer, and to develop evidence with which to guide personalization and biological adaptation of radiotherapy to improve outcomes and reduce toxicity.”

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Image: An example of radiation a therapy treatment for head and neck cancer patients (Photo courtesy of the Head and Neck Cancer Guide).

were administered to 95% of the patients, and there were no scan-related complications. Each ultrafast CMR scan took 18 minutes on average, and cost USD 150. The most common underlying diagnoses were hypertrophic cardiomyopathy (21%), non-ischemic dilated cardiomyopathy (17%), and ischemic cardiomyopathy (11%), plus 20 other diagnoses including tumors, congenital heart disease (CHD), myocardial iron overload, amyloidosis, vasculitis, and apical thrombus. The CMR had an impact on the clinical management of 33% of patients, and revealed a new, unsuspected diagnosis in 20% of patients, leading to a complete change in management. The study was presented at EuroCMR, held during May 2017 in Prague (Czech Republic). “Accurate diagnoses provided by CMR have reduced morbidity and mortality in Europe, and we hope to find the same in Peru,” said lead author Peruvian cardiologist Katia Menacho, MD, a PhD student at UCL. “If we show long-term benefits on prognosis we will seek support from the Peruvian government to provide ultrafast CMR at more hospitals in Peru. The accurate diagnosis provided by CMR should lead to more targeted patient care and better outcomes.”

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Cardiac Imaging Test Targets Developing Countries new cardiovascular magnetic resonance (CMR) imaging test designed for developing countries is three times faster and less than one-fifth the cost of standard CMR, according to a new study. Researchers at University College London (UCL, United Kingdom; www.ucl.ac.uk), in collaboration with international academic and political representatives from Peru, the United Kingdom, the United States, and Brazil, adapted a current UCL protocol initially developed to assess iron overload in patients with thalassaemia major with the aim of reducing average CMR scan time from 60 minutes to about 15. The original protocol was modified by adding gadolinium as a contrast agent, which is critical for detecting cardiac fibrosis and infarction in the diagnosis of various cardiovascular diseases. The ultrafast CMR protocol was tested over two days at two hospitals in Peru, accompanied by training for local cardiologists, radiologists, and technicians; the study involved 100 patients with suspected cardiomyopathy and 11 healthy controls. All scans were diagnostic, although two patients underwent a repeat scan, one due to failure of contrast delivery and one to confirm unexpected cardiac amyloidosis. Gadolinium-based contrast agents

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Medical Imaging International February-March/2018

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MUSCULOSKELETAL MRI

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The Accu-Gold Touch instruments incorporate the largest touch screen in the industry to make diagnostic x-ray QA even faster and easier. The series also provides access to the full lineup of Accu-Gold sensors, the most extensive line of x-ray QA sensors available.

The S-scan is a complete musculoskeletal MRI that uses eXP Technology to cover all musculoskeletal anatomy. Featuring a maintenance-free open permanent magnet with 0.25T field strength, the system can be installed in a single room of 18 square meters.

The Apogee 3500 Elite features versatile solutions and user-friendly workflow to ensure professional diagnosis. It uses MFI to reduce signal distortion and eliminate unwanted noises for rendering premium images with outstanding resolution and high contrast.

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Innovative Mammography System Improves Patient Comfort new digital breast tomosynthesis (DBT) system delivers diagnostic accuracy at the same low dose as a conventional mammography exam. The GE Healthcare (GE, Little Chalfont, United Kingdom; www.gehealthcare.com) Senographe Pristina system is a three-dimensional (3D) DBT mammography platform that allows for excellent visualization of breast lesions without increasing the radiation dose. Tomosynthesis is based on ASIRDBT, an iterative reconstruction algorithm with a calcification artifact correction that delivers off-plane images superior to the traditional filtered back projection (FBP) algorithm. In addition, a specific slabbing algorithm renders calcifications as if each were in its optimal plane, making the images easy to read. The Senographe Pristina was designed with technologist in mind. Space below the collimator is large, and wrap-over tube design makes it easier to position patients. The backspace is large enough to allow technologists to work without hitting their elbows when positioning the breast over the support. When po-

sitioning patients in medio-lateraloblique (MLO), the tube head can be moved to a parked position away from the technologist’s head, clearing the upper space so that patients can be positioned without physical strain. The console and gantry are ready to use within a few minutes of startup, without the need for complex calibration, and switching between 2D mammography and DBT can be made with just one click, thanks to pre-set default acquisition settings. The 2D image contrast can be modified on the fly, with a selection of six contrast levels available in order to accommodate user preferences. The acquisition console is also well aligned with other GE Healthcare products, so that the learning curve is minimal for those familiar with the GE Healthcare procedures. Designed to make the patient experience more comfortable, the system comes with gentle, rounded corners on the image detector help reduce patient discomfort under the arms. Comfortable armrests replace the conventional

handgrips that may cause tensing of the pectoral muscles, making it hard to properly position the tissue; in addition, the redesigned armrest allows women to gently support their arm during the exam in a relaxed position. And a self-compression tool helps give women a sense of control by allowing them to manually adjust the degree of breast compression. Image: The Senographe Pristina system (Photo courtesy of GE Healthcare).

Ultrafast Ultrasound System Introduced premium ultrasound system with new clinical innovations, such as a 200-times faster acquisition rate than existing systems, has been introduced. The system has a new architecture, a streamlined design, 4.5 times more computing power than previous versions, an improved user interface, and is easier to use especially for long working shifts. The Aixplorer Ultimate premium ultrasound system was developed by SuperSonic Imagine (Aix, France; www.supersonic imagine.com). The system uses the company’s new UltraFast Needle PL.U.S technology for

precise simultaneous visualization of anatomical structures and for the trajectory of biopsy needles. The Aixplorer Ultimate also features ShearWave Elastography (SWE), ultraFast Doppler with both Color Doppler and Pulsed Doppler in a single sweep, Angio PL.U.S for imaging microvascularization, and TriVu that combines three types of diagnostic information in a single exam. The system provides reliable and rapid access to diagnostic information for the assessment chronic liver disease, breast cancer, prostate cancers, and other diseases, and can also be used for pediatric and vascular examinations.

Co-Founder, and CIO at SuperSonic Imagine, Jacques Souquet, said, “Aixplorer Ultimate is the result of eight years of research and development. This is a much more reliable, faster and innovative ultrasound system, designed to meet new imaging needs when screening, diagnosing and monitoring major diseases. Discussed in more than 400 publications, the SWE technology employed in this system has demonstrated its clinical advantages associated with the detection and characterization of many different diseases across a broad spectrum of applications.” Medical Imaging International February-March/2018

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The Integris features wireless communication and a built-in 19-inch touch screen computer/monitor. Durable and built to move, it features a high degree of customization and functions as a complete DR lab, making it ideal for clinics and hospital settings.

The Magvue uses a permanent magnet to generate 0.33T magnetic field. It provides positioning convenience for patient comfort, while other features such as remote coil identification, automatic table movement and remote patient handling offer user convenience.

The Precision features advanced applications such as auto-stitching and tomography to create an efficient workflow and maximize patient throughput. It combines auto-positioning with an ergonomic design to provide an optimal solution for all imaging needs.

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Study Shows Learning Tasks with Music Can Change Brain Structure esearchers have shown that people who practiced basic movement tasks while listening to music showed increased structural connectivity in white matter pathways in parts of the brain. The researchers found that those brain regions associated with sound and control movement processing had improved structural connections as a result of the therapy. The findings were published online in the August 2017 issue of the journal Brain & Cognition by researchers from the University of Edinburgh (Edinburgh, Scotland; www.ed.ac.uk) and could be used for research into motor rehabilitation of patients with a disability, after a stroke for example. The study included 30 right-handed volunteers. They were split into two groups and were asked to learn a new physical task involving sequences of finger movements, with their left nondominant hand. One group learned the task with-

out music, while the second group learned it with musical cues. The researchers found that both groups learned the sequences equally well after 4 weeks of practice. The researchers then used Magnetic Resonance Imaging (MRI) to scan the volunteers’ brains. The scans showed that there was a significant increase in whitematter connectivity in the group working with music as opposed to the group working without music that showed no change. Research team leader Dr. Katie Overy, said, “The study suggests that music makes a key difference. We have long known that music encourages people to move. This study provides the first experimental evidence that adding musical

cues to learning new motor task can lead to changes in white matter structure in the brain.” Image: A new study shows that learning physical tasks while listening to music can change the structure of the brain (Photo courtesy of Shutterstock).

Artificial Intelligence X-Ray Analysis Equivalent to Orthopedic Surgeon Diagnosis new study suggests that artificial intelligence (AI) deep learning algorithms are on par with humans for diagnosing fractures from orthopedic radiographs. Researchers at Karolinska Institutet (KI; Solna, Sweden; www.ki.se), the Royal Institute of Technology (KTH; Stockholm, Sweden; www.kth.se), and Danderyd Hospital (Sweden; www.ds.se) extracted 256,000 wrist, hand, and ankle radiographs stored at Danderyd Hospital, classifying them by four variables - fracture, laterality, body part, and exam view. Five deep learning networks were then examined, with the most accurate network benchmarked against a gold standard for fractures. The deep learning networks were then

trained to identify fractures in two-thirds of the radiographs under the guidance of the researchers, and then independently analyzed the remaining images, which were completely new to the AI program. Analysis was then compared with that of two senior orthopedic surgeons who reviewed the images at the same resolution as the network. The results showed that all networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network, which was equivalent to that of senior orthopedic surgeons when they were presented with images at the same resolution as the network. According to the researchers, AI has

the potential to do even better with access to greater amounts of data, and they have therefore begun a follow-up study that will include Danderyd Hospital’s entire orthopedic archive of over a million high-resolution radiographs. The study was published on July 6, 2017, in Acta Orthopaedica. Deep learning is part of a broader family of machine learning methods that is based on learning data representations, as opposed to task specific algorithms. It involves artificial neural network (ANN) algorithms that use a cascade of many layers of nonlinear processing units for feature extraction and transformation, with each successive layer using the output from the previous layer as input to form a hierarchical representation. Medical Imaging International February-March/2018

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Medical Imaging International

Brain Mapping Tool Identifies Diseased Tissue new device to map the brain during surgery provides higher resolution neural readings than existing tools used in the clinic and could enable doctors to perform safer, more precise brain surgeries. Developed by researchers at the University of California, San Diego (UCSD, USA; www.ucsd.edu), Massachusetts General Hospital (MGH; Boston, USA; www.massgeneral.org), and other institutions, the device is an improved version of an electrocorticography electrode grid, which takes advantage of the electrochemical properties of poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS). Using PEDOT:PSS allows the new electrode grid to be about a thousand times thinner than current clinical electrode grids. The PEDOT:PSS microelectrode arrays is just 6 micrometers thick (versus several millimeters in current grids), which allows it to conform better to the intricately curved surface of the brain and obtain better readings. The new electrode grid also contains a much higher density of electrodes, since they can be spaced 25 times closer than those in current clinical electrode grids, enabling detection of changes in amplitude across pial surface distances as small as 400 μm, resulting in higher resolution recordings. The researchers also conducted several clinical tests. In one test, the researchers performed background readings of a patient’s brain waves both awake and unconscious. The PEDOT:PSS electrode grid identified normal functioning areas of the brain versus where the seizure areas with more detailed and higher resolution readings than

the clinical electrode grid. Other tests that monitored the brain activity of patients performing cognitive tasks showed that both the PEDOT:PSS and standard electrode grids could differentiate between visual and audio inputs. The study was published on May 12, 2017, in Advanced Functional Materials. Image: The PEDOT:PSS electrode grid (Photo courtesy of David Baillot / UCSD).

Radiosurgery Improves Quality of Life for Patients with Facial Pain new study suggests that stereotactic radiosurgery (SRS) can improve the quality of life (QOL) of patients with trigeminal neuralgia and also reduce their depression. Researchers at Case Western Reserve University (CWRU; Cleveland, OH, USA; www.case.edu) and the Cleveland Clinic (CC; OH, USA; www.my.clevelandclinic.org) conducted a study in 50 patients with TN treated with SRS. The researchers prospectively collected EuroQOL 5Dimension (EQ-5D) and Patient Health Questionnaire 9 (PHQ-9) data before and after the procedure, and pain response and treatment-related facial numbness were classified using Barrow Neurological Institute (BNI) scales. The patients’ answers were analyzed before treatment and at each follow-up appointment. The results showed that following SRS, 12-month freedom from pain was 92%, while 12-month freedom from facial numbness was 89%. Significant improvements in the EQ-5D index and PHQ-9 were observed. At 12 months following SRS, the actuarial rates of improvements in EQ5D, and PHQ-9 were 55% and 59%, respectively. Overall, patients reported improved QOL and lower rates of depression after SRS. The benefit of treatment was strongly driven by improvements in pain and discomfort, as well as self-care. “People go and see their neurologist and get the pain under control with medication, but they don’t realize how lousy this can make them feel. Pain and the medication to stop the pain make it difficult for people with TN to go outside and live life,” said corresponding author Samuel Chao, MD, of CC. “With radiosurgery, we can reduce pain, improve quality of life and decrease depression; people can go out and enjoy life without worrying they will have a random attack. Giving options empowers the patient to be more aware of themselves and manage their own condition.” Trigeminal neuralgia, also called tic douloureux, is a chronic pain condition that affects the trigeminal (5th) cranial nerve, one of the most widely distributed nerves in the head. Typical Type 1 neuropathic pain causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. The atypical form, Type 2, is characterized by constant aching, burning, stabbing pain of somewhat lower intensity. Both forms of pain may occur in the same person, sometimes at the same time.

Medical Imaging International February-March/2018

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MOBILE RADIOGRAPHY UNIT

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The PanoRad features maximum exam flexibility packaged in the smallest footprint. It easily fits in work areas with a ceiling of 2.4 meters as compared to 2.9 meters required for other systems, making it ideal for use in locations with ceiling height restrictions.

The SAXO 4T unit is controlled by a microprocessor and designed for emergency rooms, as well as intensive care and pediatric applications. Using a portable WIFI detector with its tablet, it is possible to easily switch to digital across the mobile fleet.

The Amadeo Cis ceiling-mounted system features a newly designed spring counterbalance system for effortless manual positioning of the X-ray tube.The floating tabletop of the height-adjustable Bucky table is perfectly suited for routine examinations.

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Abnormal White Matter Connectivity May Point to Long-Term Effects in Athletes bnormal changes in white matter connections found in the brains of people suffering from concussion could provide sports lawyers with evidence of brain trauma in concussion lawsuits. The abnormal connections may indicate that the brain is compensating for damage caused by the concussion as well as degeneration of brain tissue. This diagnostic signature, with the help of Artificial Intelligence (AI) could be used to detect long term detect brain trauma. The new tool was developed by researchers at the Université de Montreal (www.umontreal.ca/en), the Montreal Neurological Institute and Hospital (The Neuro; www.mcgill.ca), and the Ludmer Center for NeuroInformatics (http://douglas.research.mcgill.ca), all located in Montreal, QC, Canada. The study was published in the May 16, 2017, issue of the European Journal of Neuroscience. The researchers recruited former university ice hockey and American football players aged 51 to 75 for the study. The researchers selected a cohort of 15 athletes who had suffered from concussion during their sports careers, and 15 athletes without concussion. The researchers performed Magnetic Resonance Spectroscopy (MRS) and Diffusion Weighted Imaging (DWI) scans, and other tests, pooled the data, and used AI software to distinguish a healthy athlete’s brain with those with concussion. The researchers found abnormal connectivity in several brain regions of concussed athletes and were able to accurately detect concussion in 90% of the cases. First author of the paper, Dr. Sebastien Tremblay, postdoctoral researcher at The Neuro, said, “With 1.6 to 3.8 million concussions per year in the US alone, the prevalence of this injury is alarming. It is un-

acceptable that no objective tools or techniques yet exist to diagnose them, not to mention the sheer lack of scientifically valid treatment options. With our work, we hope to provide help to the vast population of former athletes who experience neurological issues after retiring from contact sport.” Image: Researchers found that white matter connections between several brain regions of concussed individuals showed abnormal connectivity that might reflect both degeneration and the brain’s method of compensating for damage (Photo courtesy of Dr. Sebastien Tremblay).

Full-Body Mobile CT Provides Enhanced Functionality newly upgraded 32-slice computed tomography (CT) scanner offers superior image quality and advanced features. The Samsung NeuroLogica (Danvers, MA, USA; www.samsungneurologica. com) BodyTom Elite is a self-shielded, multi-departmental imaging solution that can transform any room into an advanced imaging suite. The system can accommodate patients of all sizes, offering a combination of rapid scan time, flexible settings, and immediate image viewing. The system includes four key features for optimization of radiation dose delivery: dose structured reporting, CT dose check, automatic exposure control (AEC), and pediatric and adult reference protocols. System software features include intuitive customization, such as the ability to change the slice width and gap, oblique the dataset, and render maximum intensity projection, minimum intensity projection, and mean

value projection; 30 new custom kernels that enable the technologist to choose sharpness, tissue contrast, and smoothing for each scan type; a metal artifact reduction (MAR) feature to improve metal implants and trauma cases; and the aforementioned AEC, which minimizes the amount of radiation by factoring in the thickness and density of a patient. Additional features include low dose lung cancer screening (under 3mGy) to detect abnormalities; contrast capability, which allows use of CT angiography and perfusion imaging utilizing bolus tracking and manual start; linear and step calibration for navigation accuracy during axial and helical scanning; a step correction feature that automatically adjusts for slight movements; a lift system that reduces setup time, aligns with tables easier, and allows for faster transition to scanning, and a translate system that reduces vibrations. Medical Imaging International February-March/2018

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Medical Imaging International

First Humans Tested with New MRI Technology new metamaterial-enhanced MRI technique has been tested for the first time on humans. The technique enhances the local sensitivity of Magnetic Resonance Imaging (MRI) scanners and could be used to acquire higher-resolution MRI images, reduce image acquisition time, improve patient comfort, and improve the diagnosis of disease. The new technology was designed and tested by scientists from the Leiden University Medical Center (Leiden, the Netherlands; www.lumc.nl) and ITMO University in (Saint Petersburg, Russia; en.ifmo.ru), and was published in the May 2017 issue of the journal Scientific Reports. Current MRI technology suffers from an intrinsically lower signal-tonoise ratio, and longer acquisition time than Computed Tomography (CT), or ultrasound. However, the new MRI technique enhances local sensitivity and enhances the signal-to-noise ratio. The technique uses a thin metasurface of conducting copper strips attached to a thin flexible substrate, and integrated this into close-fitting receive coil arrays inside an MRI scanner. Rita Schmidt, researcher at the Department of Radiology, Leiden University Medical Center, and first author of the study, said, “We placed such a metasurface under the patient’s head, after that, the local sensitivity increased by 50 percent. This allowed us to obtain higher image and spectroscopic signals from the occipital cortex. Such devices could potentially reduce the duration of MRI studies and improve its comfort for subjects. Our technology

can be applied for producing metamaterial-inspired, ultra-thin devices for many different types of MRI scans, but in each case, one should first carry out a series of computer simulations, as we have done in this work. One needs to make sure that the metasurface is appropriately coupled.” Image: A patient inside an MRI scanner with metasurface-enhanced coil arrays (Photo courtesy of ITMO University).

Photoacoustic Imaging Ensures Complete Cancer Removal novel technology that combines light and sound can scan tissue samples to produce images detailed and accurate enough to determine whether a tumor has been completely removed. Developed by researchers at Washington University School of Medicine (WUSTL; St. Louis, MO, USA; www.medschool.wustl.edu), and the California Institute of Technology (Caltech; Pasadena, USA; www. caltech.edu) photoacoustic microscopy (PAM) can scan an unprepared sample of breast tissue in the operating theater, producing images of sufficient quality to detect tumor features and margins. PAM takes advantage of the intrinsic optical contrast of breast tissue in order to achieve multilayered, histology-like imaging of the tissue surface. According to the researchers, the high correlation of the PAM images to conventional histologic images allows rapid computations of diagnostic features such as nuclear size and packing density, potentially identifying small clusters of cancer cells. And since PAM does not require tissue processing or staining, it can be performed promptly and intraoperatively, enabling immediate directed re-excision, reducing the number of second surgeries. The study was published on May 17, 2017, in Science Advances. “Overall, the photoacoustic images had a lot of the same features that we see with standard staining, which means we can use the same criteria to interpret the photoacoustic imaging. We don’t have to come up with new criteria,” said co-senior author Deborah Novack, MD, PhD, of WUSTL. “It’s the pattern of cells – their growth pattern, their size, their relationship to one another – that tells us if this is normal tissue or something malignant.” “All molecules absorb light at some wavelength; this is what makes photoacoustic imaging so powerful. Essentially, you can see any molecule, provided you have the ability to produce light of any wavelength,” said co-senior author biomedical engineering Lihong Wang, PhD, of Caltech. Photoacoustic imaging uses non-ionizing laser pulses delivered into biological tissues. Some of the delivered energy is absorbed and converted into heat, leading to transient thermoelastic expansion, and thus wideband ultrasonic emission, which can be detected by ultrasonic transducers and analyzed to produce images. The magnitude of the photoacoustic signal is proportional to local energy deposition, which can be demonstrated by optical absorption contrast on the images of the targeted areas.

Medical Imaging International February-March/2018

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The Model 604 is designed for the assessment of MRI distortion caused mainly by the non-linearity of magnetic gradients. It can help quantify image distortion due to chemical shifts and susceptibility owing to density differences common in treatment planning.

The CYBERBLOC FP allows for quick positioning and workflow speed, and delivers optimized acquisition rate and distortion-free images. A view station with touch screen allows touch operations, while the control panel offers touch interface and live display.

The DRX-Revolution Nano with fully-integrated digital workflow features a sleek design with enhanced visibility along with a compact footprint. These enhancements make it easier to maneuver and position even in tight spaces and cramped critical care areas.

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Novel PET Tracer Developed for Imaging Prostate Tumors new PET tracer, called Carbon-11 labeled sarcosine (11C-sarcosine) has been used for the first time to image prostate cancer in a human being. According to the researchers the tracer could also be used to monitor targeted treatment of other cancers in the future. The researchers from the Division of Nuclear Medicine at the University of Michigan (Ann Arbor, MI, USA; https://umich.edu) compared the effectiveness of the new 11C-sarcosine tracer with an existing widely-used tracer called 11C-choline in two mouse models, and also carried out the first PET/CT (Computed Tomography) scan with 11Csarcosine for imaging a human prostate cancer patient. The results of the study were published online in the August 1, 2017, issue of the Journal of Nuclear Medicine. Sarcosine is partly responsible for the aggressiveness and progression of prostate cancer and enters cells via Proton-coupled Amino acid Transporters (PAT). The results of the study showed that in preclinical models 11C-sarcosine could produce high-contrast images of a human prostate cancer, and that 11C-sarcosine PET tumor-to-background ratios were significantly higher than those for 11C-choline. The researchers concluded that 11C-sarcosine has potential benefits over 11C-choline, and is a viable prostate cancer imaging tracer. Professor of radiology at the University of Michigan Division of Nuclear Medicine, Morand Piert, MD, said, â&#x20AC;&#x153;Given the link between 11Csarcosine cell uptake and PAT transport, the study provides first evidence that PAT expression can be elevated in prostate cancer. To our

knowledge, this is the first radiotracer to interrogate the activity of PATs, which play a role as multi-purpose carriers with distinct roles in different cells. In the brain, these transporters are involved in the neuronal amino acid transport. In the intestinal tract, certain PATs play a role as nutrient and drug transporter.â&#x20AC;? Image: A and B show trans-axial 11C-sarcosine hybrid PET/CT images of an adenocarcinoma. Image C shows a separately obtained T2weighted MR sequence, and Image D shows the resulting PET/MRI registration (Photo courtesy of M. Piert et al., University of Michigan).

New OCT Technique Images Cellular Structure of Eye new study describes how linear optical coherence tomography (OCT) allows clinicians to resolve individual photoreceptors, capillary blood vessels, and nerve fibers in the same image. Developed at the Medical University of Vienna (MedUni; Austria; www.meduniwien.ac.at) Line Field OCT uses noniterative digital aberration correction (DAC) to achieve aberration-free cellular-level resolution in OCT images of the human retina in vivo. The system is based on a linefield spectral-domain OCT system with a high tomogram rate. The researchers also applied DAC on functional OCT angiography data in order to improve lateral resolution and compensate for defocus. Functionally, the Line Field OCT is similar to a scanner, focusing a thin linear beam of light onto the internal structures of the eye. With speeds reaching up to 2.5 kHz, DAC can be applied not only to image human

cone photoreceptors, but also to obtain an aberration- and defocus-corrected three-dimensional (3D) volume. DAC speed necessities were measured by examining the axial motion of the OCT system in 36 subjects, with the aim of appropriately quantifying motion analysis. The study was published in the August 2017 issue of Optica. OCT is based on low-coherence interferometry, typically employing nearinfrared (NIR) light. The use of relatively long wavelength light allows it to penetrate into the scattering medium. Depending on the properties of the light source, OCT can achieve sub-micrometer resolution. OCT, being an echo imaging method, is similar to ultrasound imaging, but is limited to 1-2 mm below the surface in biological tissue, as at greater depths the proportion of light that escapes without scattering is too small to be detected. Medical Imaging International February-March/2018

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Medical Imaging International

Innovative MRI Device Images Neonatal Head n innovative neonatal magnetic resonance imaging (MRI) system incorporates a temperature-controlled incubator that minimizes movement of the baby. The Aspect Imaging (Shoham, Israel; www.aspectimaging.com) Embrace Neonatal MRI System is designed specifically for imaging neonates with a head circumference up to 38 centimeters and weight between one and 4.5 kilograms. The system can be placed inside a neonatal intensive care unit (NICU) environment, since it does not require a safety zone or a radiofrequency (RF) shielded room. And since the system is fully enclosed, medical device implants in close proximity to the system are not required to be “MR Conditional” or “MR Safe.” System features include a simplified workflow to allow prep and scan in less than an hour; a dedicated head coil that enables diagnostic quality brain imaging; continuous monitoring of the infant’s vital signs parameters during scan; a 5-Gauss line within the magnet covers, allowing select NICU equipment to be placed near the system; three size swaddles to reduce infant movement and allow routing of tubing and monitoring leads; a non-cryogenic technology that does not require a cooling system; and PACS/HIS/RIS connectivity with DICOM compatibility. The system is contraindicated for all infants with metallic or electronically active implants. “Although we can use traditional MRI scanners to image neonates, taking babies outside of the neonatal intensive care unit to MRI suites

presents great challenges,” said Vasum Peiris, MD, MPH, chief medical officer for the pediatrics and special populations at the FDA Center for Devices and Radiological Health (CDRH). “Having a system in the neonatal intensive care enables safer imaging for this vulnerable patient population.” Image: The Embrace neonatal MRI system (Photo courtesy of Aspect Imaging).

Reading to Children Leads to Cognitive Improvement new international study into the cognitive development of preschool children has shown that reading stories while engaging with the children results in significantly greater brain activity, and suggests resulting improvements in engagement and understanding. The researchers used functional Magnetic Resonance Imaging (fMRI) for the study, which reinforces previous research showing the value of dialogic reading during the early development of children. The study was led by researchers from the Cincinnati Children’s Hospital Medical Center (Cincinnati, OH, USA; www.cincinnatichildrens.

Imaging Technique Treats AF With Less Radiation Exposure he results of a review article suggest that clinicians could use a new ultrasound-based image technique for guided catheter ablation instead of fluoroscopy, when treating patients with atrial fibrillation. Fluoroscopy exposes patients and the medical care team to high doses of radiation. The researchers advocate the use of the new Intracardiac EchoCardiography (ICE) technique to replace flouroscopy and reduce or even eliminate radiation exposure. The researchers and cardiologists from the Weill Cornell Medicine (New York, NY, USA; http://weill.cornell.edu), and the New York-Presbyterian (New York, NY, USA; www.nyp.org) published the results of their review article online, and in the June 2017, print issue of the journal Heart Rhythm. Co-author of the study, associate professor Dr. Jim Cheung, said, “Although the concept of fluoroless catheter ablation was introduced several years ago, it has yet to gain wide adoption, mostly because many electrophysiologists were trained to rely on X-ray imaging and are reluctant to trust ICE. This concern can be remedied with experience. For some, the learning curve can be steep, but generally, the skill set can be readily acquired. By thoughtfully modifying the way the procedure is performed, we can significantly reduce the radiation risk in the process. We are currently training our fellows to utilize this technique in an effort to guide the next generation of cardiologists to become well-versed in fluoroless ablation.”

Medical Imaging International February-March/2018

org) and was published in the May 31, 2017, issue of the journal PLOS ONE. The aim of the study was to investigate how engagement and verbal interactivity during reading affected neural activation and brain connectivity in 22, four year-old girls. The researchers found that those children who showed more interest in the stories read also had greater activation in the right-sided cerebellar areas of their brains. Lead author of the study, pediatrician John Hutton, MD, said, “The takeaway for parents in this study is that they should engage more when reading with their child, ask questions, have them turn the page, and interact with each other. In turn, this could fuel brain activation – or “turbocharge” the development of literacy skills, particularly comprehension, in preschool aged children. Our findings underscore the importance of interventions explicitly addressing both parent and child reading engagement, including awareness and reduction of distractions such as cell phones, which were the most common preventable barrier that we observed.”

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PRODUCT NEWS ULTRASOUND SYSTEM

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DR ROOM

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Alpinion Medical Systems

Control-X Medical

Philips Healthcare

The E-CUBE 8 uses a flagship model-grade platform to provide improved resolution, contrast and uniformity of 2D images. With the addition of the Dual pulser, clear and accurate Doppler data can be displayed without compromising the 2D image quality.

The Perform-X HF General DR Room is available in various system configurations to allow for a completely customized X-ray system. It is available with a variety of flat DR panels in a single or a dual cassette size detector which fits into existing cassette trays.

The Ingenia 3.0T CX MR system has been designed to help clinicians perform advanced clinical imaging that supports referrals and conducts routine imaging efficiently. It provides fast imaging, superb motion and fat suppression in almost all procedures.

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Researchers Develop Faster Cardiovascular MR Protocol he results of an international study show that a new cardiovascular MR imaging protocol can reduce costs by 80%, and is three times as fast as current tests. The new protocol also changed clinical management in 33% of the patients scanned. Cardiovascular Magnetic Resonance (CMR) imaging exams are regularly used to diagnose cardiovascular diseases, to assess cardiac function and structure, and to investigate the likelihood of heart attacks. Researchers from Peru, the UK, the US, and Brazil collaborated on the Impact of Non-invasive CMR Assessment (INCA)-Peru study. The goal of the research was to develop a new cost-effective and faster imaging protocol specifically for use in developing countries. The initial CMR protocol was developed by researchers from University College London (UCL; London, UK; www.ucl.ac.uk) and was tested in Thailand. Next, the researchers modified the protocol by adding gadolinium,

a CMR contrast agent, and tested it in a pilot INCAPeru study involving 50 patients. In the current study the researchers again tested the CMR protocol with the contrast agent for two days in Peruvian hospitals. One hundred patients with suspected cardiomyopathy, and 11 healthy controls took part in the study. Each scan cost USD150, and took only 18 minutes on average. Lead author of the study, cardiologist Dr. Katia Menacho, University College London, said: “In Peru just two public hospitals offer CMR - each performs 12 scans on one day a week. Five private hospitals provide CMR at USD $600-800 per scan. Public hospitals without CMR refer to the private sector and it takes up to three months to approve the paper-

work, delaying diagnosis and treatment. We showed that this ultrafast CMR protocol can be used to accurately diagnosis patients leading to changes in clinical management.” Image: A new generation 1.5-T adaptive cardiac and general MRI scanner (Photo courtesy of Siemens Healthineers).

MRI Calculates Kidney Scarring without Biopsy oninvasive magnetic resonance imaging (MRI) elastography can measure kidney damage and predict future kidney function within one year, according to a new study. Researchers at St. Michael’s Hospital (Toronto, Canada; www.stmichaelshospital.com) conducted a study in 16 patients (mean age 55 years) who underwent MRI elastography following a kidney transplant in order to determine if MRI-based elastography could measure organ stiffness to help estimate fibrosis in the allografts, and predict progression of allograft dysfunction. All participants first underwent free-breathing, flow-compensated elastography on a 3.0-T MRI scanner. They

subsequently underwent serial estimated glomerular filtration rate (eGFR) measurement after the elastography scan for a followup period of up to one year. The mean stiffness value of the kidney allograft was compared with both the histopathologic Banff fibrosis score and the rate of eGFR change during the follow-up period. The results revealed that whole-kidney mean stiffness ranged between 3.5 and 7.3 kPa, and correlated with the biopsy-derived Banff fibrosis score. The researchers also found negative correlations between whole-kidney stiffness and both baseline eGFR and eGFR change over time; but irrespective of baseline eGFR, increased kidney stiffness was associated with a greater eGFR

decline. The study was published on August 30, 2017, in Clinical Journal of the American Society of Nephrology. “Clinicians are hesitant to send patients for a test that has risks such as internal bleeding, unless a diagnosis can’t be made without it. With this new MRI test, doctors can gather valuable information in the many patients for whom the risks of a biopsy are too high,” concluded senior author nephrologist Darren Yuen, MD. “This new MRI test may help facilitate the testing of new anti-scarring treatments. By providing a needle-free way to measure kidney scarring, we may create more opportunities for this crucial research into finding an effective anti-scarring treatment.” Medical Imaging International February-March/2018

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Medical Imaging International

Technique Boosts the Quality of MRI Scans esearchers have uncovered a new way to boost the quality of Magnetic Resonance Imaging (MRI) brain scans for use in largescale studies and analyses of stroke outcomes. Stroke victims often undergo an MRI brain scan when they reach hospital, but these scans do not have a high enough resolution for research analysis. Now a team of researchers at the Massachusetts Institute of Technology (MIT; Cambridge, MA, USA; http://web.mit.edu) in collaboration with doctors at the Massachusetts General Hospital (Boston, MA, USA; www.massgeneral.org), and many other institutions, has discovered a way to boost the quality of standard MRI scans for future research. Clinical MRI scans of emergency stroke patients are taken in low-resolution with image slices only every 5-7mm however researchers require higher-resolution images with slices only 1mm apart. To fill in the missing data in the scans from the stroke patients the researchers took information from the entire scan set and used algorithms to recreate the missing anatomical features. Senior author of the paper, MIT electrical engineering and computer

science professor, Polina Golland, said, “These images are quite unique because they are acquired in routine clinical practice when a patient comes in with a stroke. The key idea is to generate an image that is anatomically plausible and to an algorithm looks like one of those research scans, that is completely consistent with clinical images that were acquired. Once you have that, you can apply every state-of-the-art algorithm that was developed for the beautiful research images and run the same analysis, and get the results as if these were the research images.” Image: Researchers have devised a new technique to boost the quality of low-resolution MRI scans and make them suitable for use in largescale studies (Photo courtesy of MIT).

MRI Finds Breast Cancer Following Conservation Surgery he results of a new study have compared the outcomes of two different combined screening methods for detecting new breast cancers in women after breast conservation surgery and radiotherapy. The researcher compared screening using both mammography and Magnetic Resonance Imaging (MRI), and screening using mammography and ultrasound, for patients whose breast cancer was first diagnosed at an age of 50 or less. The results of the multi-center study in which 754 women were enrolled, were published online in the June 22, 2017, issue of the journal JAMA Oncology by researchers from the Seoul National University College of Medicine (Seoul, the Republic of Korea; http://jwleecenter.org/eng). The researchers performed annual mammography, breast MRI, and breast ultrasonography, for both contralateral (opposite) and conserved breasts during the three-year study. During the study 17 cancers were diagnosed, of which 13 were stage 0 or stage 1 cancers. The authors of the study, conclude, “After breast conservation therapy in women 50 years or younger, the addition of MRI to annual mammography screening improves detection of earlystage but biologically aggressive breast cancers at acceptable specificity [correctly identifying people who don’t have disease]. Results from this study can inform patient decision-making on screening methods after breast conservation therapy.”

Medical Imaging International February-March/2018

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The Mammo FFDM Phantom allows testing of image quality, artifact detection, uniformity and contrast-to-noise ratio using the same window width and window level. It simulates characteristics of compressed tissue, which are essential for early detection of cancer.

The FDR Go PLUS features a collapsible column for maximum visibility, and an extralarge display for previewing at the bedside. Other options include user-adjustable drive handle, wireless barcode reader, an RFID card reader and extensive storage areas.

The VIVIX-D 1717G has been designed for RF systems with an active area of 17-inches x 17-inches and short booting time of one minute. The fast TFT detector with 10fps image acquisition speed (30fps in 2x2 binning mode) ensures high image quality.

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Clinical Trial to Test Whole-Breast Ultrasound Technology cancer center in the US is set to begin a clinical trial, part of research project to test the effectiveness of a new whole-breast ultrasound technology. The researchers recruited women with dense breast tissue, and intend to examine the effectiveness of the new breast ultrasound device that could help clinicians distinguishing normal breast tissue from cancerous tumors. The new technology is also more comfortable than current mammography scans. The new SoftVue, the first 3D whole-breast ultrasound system ever developed, was made by Delphinus Medical Technologies (Novi, MI, USA; www.delphinusmt.com). The research project and clinical trial are run by the University of Southern California Norris Comprehensive Cancer Center (USC; Los Angeles, CA; USA; https://uscnorriscancer.usc.edu). The new ultrasound technology consists of a 360-degree ring transducer that can scan the whole breast in one pass, from the front of the breast, to the chest wall, and takes only between two and four minutes to scan each breast. The SoftVue software also shows a number of distinct tissue qualities that could help radiologists differentiate cancers from benign growths. Assistant professor of clinical radiology, the national principal investigator of the research project Mary Yamashita, MD, said, “While mammography is the best screening tool for women, we have known for

years that breast cancers are much more difficult to see in women with dense breasts. Our hope is that this technology will enable us to detect cancers much sooner in women with dense breast tissue so that we can provide better outcomes for those with cancer and peace of mind for those with a negative study.” Image: The new SoftVue software can perform rapid scans of dense breast tissue (Photo courtesy of Delphinus Medical Technologies).

Mobile Phone Analysis Helps Reveal Radiation Exposure n analysis of mobile phones and other objects in close proximity with the body could be used in retrospective dosimetry, according to a new study. Researchers at Lund University (Sweden; www.lu.se) conducted a study that examined a number of objects and materials held close the body, and which therefore have a potential to provide information on whether the carrier has been exposed to ionizing radiation in the absence of dosimeters. Among the objects examined were mobile phones, teeth and dental fillings, household salt, and desiccant drying agents. The study showed that several of the materials contained very promising properties, not least of them mobile phones. Mobile phones contain resistors made from aluminum oxide (AlO), which can provide information about radiation as late as six years after the time of exposure. During analysis, the phone is dismantled and the resistor is examined using a light-sensitive measuring technique called optically stimulated luminescence (OSL), with results in two hours. The researchers also developed initial estimations of conversion factors

for the transition between radiation dose and dosemeter material using an anthropomorphic phantom. The study was presented as a doctoral thesis at Lund University. “In case of a nuclear power plant disaster, many people are worried, even when only a small number of people have been exposed to harmful levels of radiation,” said lead author medical physicist Therése Geber-Bergstrand, MSc, a doctoral student at Lund University. “The results from the mobile phones were very promising. Even though further studies are required, the phones can be used right away.” OSL involves the stimulation of trapped electrons performed using light of a specific wavelength. The stimulation with light can be performed using different modes: continuous wave (CW-OSL), linearly modulated (LM-OSL), and pulsed (POSL). The CW-OSL mode is the most frequently used, with the intensity of the stimulation light kept constant and the luminescence recorded during stimulation. This involves using filters to discriminate between the stimulation light and the luminescence. Medical Imaging International February-March/2018

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Medical Imaging International

Low BMI May Increase Risk of Stress Fractures esearchers have shown that underweight female runners have a higher risk of injury from stress fractures and take a longer time to heal, than women with a normal Body Mass Index (BMI). While lower body weight may be an advantage for runners, the new research shows that a BMI of less than 19 increases the risk of women runners developing stress fractures compared to those with a BMI of 19 or higher. The recovery time after suffering such fractures also took longer in underweight women runners. The researchers from the Ohio State University Wexner Medical Center (Columbus, OH, USA; https://wexnermedical.osu.edu) published the results of the study in the May/June 2017 issue of the journal Current Orthopaedic Practice. The researchers followed injuries of dozens of college athletes for three years. The researchers used the Kaeding-Miller classification system that ranks injuries on a scale between 1 and 5. The system takes into account the symptoms of the patient, bone scans, and imaging findings from Computed Tomography (CT), X-Ray, and Magnetic Resonance Imaging (MRI) scanners. The researchers recommend that female athletes keep to a BMI of 2024, close to the recommended BMI score of 26, so that they have enough lean muscle mass to dissipate impact forces while running on hard surfaces. Assistant professor of clinical orthopedic surgery and sports medicine at Ohio State, Dr. Timothy Miller, said, “We found that over time, we were able to identify the factors that put female runners at an increased risk of developing a stress fracture. One of the most important factors we identified was low body weight, or low body mass index. When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of run-

ning to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture. It’s imperative that women know their BMI and work to maintain a healthy level. They should also include resistance training in their training regimen to strengthen the lower leg to prevent injury, even if that means adding weight from additional muscle mass.” Image: Research shows underweight female runners have a higher risk of injury from stress fractures (Photo courtesy of the Ohio State University Wexner Medical Center).

Imaging Technique Assists Breast Surgery esearchers in the UK have shown that a combined optical and molecular imaging technique can be used to assess tumor margins during breast-conserving surgery. The researchers used Cerenkov Luminescence Imaging (CLI) together with a Positron Emission Tomography (PET) radiotracer F-18-fluorodeoxyglucose (F-18-FDG) for this first-in-human trial of the technique. The study was carried out by researchers from King’s College (London, UK; www.kcl.ac.uk) and published in the June 2017 issue of The Journal of Nuclear Medicine. Clinicians injected F-18-FDG tracer 45-60 minutes before surgery and then intraoperatively imaged tumor specimens in an investigational CLI imaging system immediately following tumor excision, for 22 patients suffering from invasive-breast cancer. The results showed that F-18-FDG CLI was a useful low-risk tool for the intraoperative assessment of tumor margins during breast-conserving

surgery. Professor at King’s College, Arnie D. Purushotham, MD, said, “Currently, approximately 1 in 5 women who undergo breast-conserving surgery, also known as lumpectomy, require repeat surgery due to inadequate excision of the tumor during the initial surgical procedure. By accurately assessing tumor resection margins intraoperatively with CLI, surgeons may be able to completely clear the cancer with a single operation, thereby reducing the number of breast cancer patients requiring a second, or even third, surgical procedure. The feasibility of intraoperative CLI as shown in this study, in combination with the wide applicability of F-18-FDG across a range of solid cancers, provides a stepping stone for clinical evaluation of this technology in other solid cancer types that also experience incomplete tumor resection due to close or involved margins.”

Single RT Treatment Relieves Spinal Compression Symptoms new study suggests that a single radiation therapy (RT) treatment is as effective as a full week of RT for treating spinal cord compression (SCC), a common complication of metastatic cancer. The phase III clinical trial, conducted at Mount Vernon Cancer Centre (Northwood, United Kingdom; www.enherts-tr.nhs.uk/our-hospitals/ mount-vernon-cancer-centre), enrolled 688 patients (median 70 years, 73% male) with metastatic prostate (44%), lung (18%), breast (11%), and gastrointestinal cancers (11%). The researchers randomly assigned the patients to receive external beam spinal canal radiation therapy either as a single dose of 8 Gy or as a 20 Gy dose split in five doses over five days. The primary endpoint of the study was ambulatory status, measured on a four-point scale. The results showed that at eight weeks, 69.5% of patients who received single-dose RT and 73.3% of those who received five doses had ambulatory status 1 (normal walking) or 2 (able to walk with walking aid), showing that both shorter- and longer-course RT treatments helped patients stay mobile. The median overall survival was similar in both groups, as were side effects, but mild side effects were less common in

Medical Imaging International February-March/2018

the single-dose group. The study was presented at the American Society of Clinical Oncology (ASCO) annual meeting, held during June 2017 in Chicago (IL, USA). “Our findings establish single-dose radiotherapy as the standard of care for metastatic spinal canal compression, at least for patients with a short life expectancy. For patients, this means fewer hospital visits and more time with family,” said lead author and study presenter oncologist Peter Hoskin, MD. “Longer radiation may be more effective for preventing regrowth of metastases in the spine than single-dose radiation. Therefore, a longer course of radiation may still be better for patients with a longer life expectancy, but we need more research to confirm this.” Metastatic SCC is a spinal cord or cauda equina compression by direct pressure and/or induction of vertebral collapse or instability, which leads to irreversible neurological damage such as paraplegia or tetraplegia, depending on the level of the lesion. Up to 10% of all cancer patients will have metastatic SCC, and early diagnosis and treatment are essential to prevent permanent neurological damage.

PRODUCT NEWS PORTABLE CT SCANNER

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MAMMOGRAPHY SYSTEM

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Samsung

Siemens Healthineers

Beekley Medical

The OMNITOM delivers the highest quality non-contrast CT, CT angiography, and CT perfusion scans at the POC. Its rapid scan time, ultra-small footprint, and immediate image viewing make it suitable for collecting real-time data of critically ill patients.

The Mammomat Revelation performs automated breast density measurement to allow for immediate risk stratification and personalized imaging workflows. The unique 50-degree 3D HD breast tomosynthesis allows targeting suspicious areas with one click.

The MRI markers identify areas of interest with a bright and consistent image on all sequences. They are available for orthopedic, pediatric, or breast imaging, as well as for soft tissue masses and larger areas of concern, and are ideal for small field of view imaging.

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Wireless Scanners Unveiled for Emergency Medicine digital healthcare company has unveiled a new line of smartphone-based, point-and-shoot, handheld ultrasound systems for emergency medicine. The scanners are protected with a magnesium case, and can be submersed in water for disinfection and cleaning. The scanners have a user-replaceable rechargeable battery. The Clarius C3 and Clarius C7 scanners were developed by Clarius Mobile Health (Burnaby, BC, Canada; www.clarius.me). The Clarius C3 is a multipurpose ultrasound scanner and is designed for ultrasound imaging of the lungs, heart, and abdomen and features a virtual phased array to enable clinicians to perform quick scans of the heart. The Clarius L7 model is designed for imaging superficial structures in the body, and for guiding procedures. Both scanners feature automated gain and frequency settings, and are designed to help clinicians diagnose triage emergency patients suffering from abdominal bleeding, collapse, bleeding lung, dislocated joints or broken bones. To begin using the scanner the clinician launches the smartphone application (app), selects the scanner, and the part of the body that needs to be scanned. The application enables the clinician to zoom in, freeze and save the image. Clarius ultrasound scanners have been cleared by regulatory authorities for sale worldwide in more than 20 countries. Neena Rahemtulla, VP Marketing, Clarius Mobile Health, said, “Clarius has many qualities that make it the ideal ultrasound system for challenging environments outside the hospital. We’re looking for-

ward to receiving feedback on our wireless scanners from experts in the specialized field of disaster response.” Image: The Clarius C3 handheld ultrasound scanner (Photo courtesy of Clarius Mobile Health).

Technique Restores Fertility to Patients with Fibroids esearchers have shown that Uterine Fibroid Embolization (UFE) treatments can enable women suffering from uterine fibroids to become pregnant again. Uterine fibroids often cause infertility and complications during pregnancy, and current standard treatments consist of surgery to remove the fibroids that may cause complications such as hysterectomy, and is not always effective. UFE treatments on the other hand are not yet fully accepted for fertility-preserving treatment in women with symptomatic fibroids. The researchers from the Department of Interventional Radiology at the Saint Louis Hospital (Lisbon, Portugal; www.hslouis.pt) registered the pregnancy rates of 359 women with fertility problems who suffered from uterine fibroids, for a period of nearly six years. All of the women had undergone either partial or conventional UFE treatment. The study was published online in the June 2017 issue of the journal Radiology.

The results of the research showed that 149 women (41.5%) in the study group became pregnant at least once during the 6-year study period. The clinicians used Magnetic Resonance Imaging (MRI) scans and digital subtraction angiography imaging to visualize partial UFE. Study co-author João Martins Pisco, MD, PhD, from the Department of Interventional Radiology at Saint Louis Hospital in Lisbon, Portugal, said, “Our findings show that UFE is a fertility-restoring procedure in women with uterine fibroids who wish to conceive, and pregnancy following UFE appears to be safe with low morbidity. Women who had been unable to conceive had normal pregnancies after UFE and similar complication rates as the general population in spite of being in a high-risk group. In our study there are now almost 200 newborns following UFE. Our next step will be a randomized study comparing the results of partial and conventional UFE.” Medical Imaging International February-March/2018

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Medical Imaging International

CT Analysis Technology Uncovers Disease Indicators ovel medical image analyzing algorithms help identify evidence of fatty liver, coronary artery calcium, and other indicators from computerized tomography (CT) scans. Zebra Medical Vision (Shefayim, Israel; http://zebra-med.com) has developed five algorithms designed to detect fatty liver, excess coronary calcium, emphysema, low bone density, and vertebral compression fractures; another ten algorithms will be released in the near future. The algorithms are based on anonymous databases of medical images and clinical data, which helped train them to detect certain markers in medical images. The fatty liver algorithm, for example, segments and calculates the average density of the liver using CT scans of the chest and abdomen. The platform helps discover chronic diseases earlier by automating CT and magnetic resonance imaging (MRI) scan analysis, which are overwhelming overstretched radiology departments. Earlier detection can give healthcare organizations the opportunity to establish preventative care programs, improving care while reducing the overall patient treatment costs. The Zebra algorithm engine can be deployed in both cloud and on-site configurations, and is designed to integrate into picture archiving and communication systems (PACS), radiological information systems (RIS), and electronic medical record (EMR) systems. “Regulatory approvals allow us to continue driving adoption of our analytics engine globally, where we see significant interest in countries that have a problematic ratio of radiologists per capita. Providing tools that assist them in delivering better care is critical and is the driving force behind our mission,” said Elad Benjamin, CEO of Zebra Medical Imaging. “We have already begun working with luminary university hospitals in Europe, and will continue to expand our footprint across the region.” “Machine Learning will change the way radiology is practiced in the coming years,” said Professor Gabriel Krestin, MD, chairman of the department of radiology and nuclear medicine at Erasmus University Medical Centre (Rotterdam, the Netherlands). “I believe it will make radiologists more productive, and I also believe that new use cases and value propositions will emerge as the technology is implemented widely. It is a very exciting time for radiology.” The Royal College of Radiologists has reported that growth of CT and MRI scans in the United Kingdom is outstripping the increase in available radiologists. While the number of radiologists increased by just 5% between 2012 and 2015, the number of CT and MRI scans increased by 29% and 26% (respectively) over the same time period.

Medical Imaging International February-March/2018

Image: Medical image algorithms help identify evidence of disease (Photo courtesy of Zebra Medical Imaging).

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ICRco

The ARiX RAD offers automated movements and electronic follow up of the wall and table Bucky that allows studies to be performed more rapidly. Its panel control has an anatomic programmer by region, projection and patient’s complexion.

The bk5000 delivers high-res images quickly and efficiently with a 20-second boot time and transducers that can be connected/removed using a simple locking mechanism. It offers a suite of innovative technologies, advanced controls and adjustments.

The iDR34 is the only DR solution capable of both regional scanning and long length spinal imaging studies. Its 17 inch x 34 inch field of use allows for replacing or supplementing the existing RAD room environment and provides the ability to do all anatomy regions.

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Triple Vascular Screening Reduces Mortality for Older Men he results of a large screening trial have shown that the overall mortality of men aged between 65 and 74 could be reduced by 7%, as a result of using combined Peripheral Artery Disease (PAD), hypertension, and Abdominal Aortic Aneurysm (AAA) screening, compared with no screening at all. The goal of the randomized controlled trial was to examine the effect, and cost-effectiveness of the combined screening, compared to current cardiovascular screening of AAA disease alone. Combined screening consisted of Doppler-based ankle brachial index for PAD, and abdominal ultrasound for AAA. The primary outcome was allcause mortality, while the secondary outcomes included cause-specific mortality, renal failure, cancer, diabetes, and other factors. The results of the Viborg Vascular (VIVA) Trial that included 50,168 men from the cen-

ter of Denmark, were published in the August 28, 2017, issue of the journal The Lancet, by researchers from the Odense University Hospital (Odense, Denmark; http://en.ouh.dk), and Aarhus University (Aarhus, Denmark; www. au.dk/en). The results indicated that combined vascular AAA, PAD and hypertension screening resulted in an observed reduction of mortality risk in the study population without serious negative side effects. The researchers recommend that the combined screening method could be used as a good and cost-effective mortality prevention strategy for older men. Chadi Ayoub, MBBS, and M. Hassan Murad, MD, said, “The VIVA trial presents thought-provoking findings. However, implementation of this triple screening intervention requires more proof than presented in this

study. The 10 criteria developed in the 1960s by WHO13 remain a valid framework for establishing whether screening should be implemented or scarce resources should be directed at individuals with increased risk of morbidity and mortality.” Image: The results of a large screening trial have shown that the overall mortality of men aged between 65 and 74 could be reduced by triple screening (Photo courtesy of iStock).

New 3T MRI Scanner Cleared by US FDA he US FDA has approved a new widebore 3.0T MRI system, developed as part of a four-year collaboration between the US National Football League, mTBI researchers, and a medical imaging device manufacturer. The new Magnetic Resonance Imaging (MRI) system offers improved clinical performance, and both neurology and oncology research-focused capabilities to help researchers find new biomarkers for diagnosing mild Traumatic Brain Injury (mTBI). The SIGNA Premier MRI system is made by GE Healthcare (Chalfont St Giles, Buckinghamshire, UK; www3.gehealthcare.co.uk), and features GE’s newest short-bore, high-homogeneity 3T superconductive magnet, a new digital RF transmit and receive architecture, and

GE’s SuperG gradient technology. The SuperG gradient coil provides improved performance and stability. The scanner also features machine-learning software with cloud analytics. The Radio Frequency (RF) technology of the scanner provides 146 independent receiver channels for faster scanning, improved performance, and improved image quality. The SIGNA Premier scanner also includes a fitadaptable 48-channel Head Coil with good image quality, and a high Signal-to-Noise Ratio (SNR). The system can perform a routine fast brain exam in less than five minutes using GE’s new HyperSense speed scanning tool that is part of GE’s HyperWorks application suite. President, and CEO of GE Healthcare MRI, Eric Stahre, said, “We are thrilled to bring SIGNA Premier to clinicians. We believe that

its advanced applications and breakthrough innovations will deliver research-focused clinical capabilities and wide-bore patient comfort. This new system will help clinicians push the boundaries of what’s possible with MR.” Image: The SIGNA Premier MRI system (Photo courtesy of GE Healthcare). Medical Imaging International February-March/2018

To view this issue in interactive digital magazine format visit www.LinkXpress.com

IT/PACS Update

Surgeons Perform MIS in Hybrid OR with Robot System urgeons in a Brazilian hospital have for the first time performed a liver resection on a patient in a hybrid OR using robotic imaging system, and a surgical robot. The success or failure of endophytic liver tumor resection surgery often depends on the quality of the diagnostic images acquired before and during the procedure. The surgeons at the Albert Einstein Hospital Interventional Medical Center (São Paulo, Brazil; http://apps.einstein.br/english) used the Siemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) hybrid OR, the da Vinci multi-arm surgical robot, the Artis zeego robotic imaging system, and the syngo DynaCT software for the procedure. The patient who underwent the liver resection had three hypovascular endophytic liver tumors. Instead of using standard ultrasound imaging to mark the tumors, the surgeons used both pre-operative Computed Tomography (CT) imaging and intra-operative imaging with Siemens’ Artis zeego. The tumors were clearly visible in the preoperative CT images and were followed during the procedure using the intra-operative syngo DynaCT and the Artis zeego system. The surgeons then fused both CT datasets to create a combined 3D volume image dataset and analyzed this using Siemens’ syngo Em-

bolization Guidance software to locate and highlight the tumors and feeding arteries. The surgeons then docked the da Vinci system to the patient for the tumor resection using the da Vinci system. During the procedure they used the highlighted tumors in the combined 3D dataset as a reference to help them navi-

gate to the tumors during surgery. The surgeons also plan to use the procedure for kidney or lung cancer resections in the future. Image: The CT image shows how the surgeons adjusted the trapezoid controls on the table window for improved liver segmentation (Photo courtesy of Siemens Healthcare).

3D Data Used to Visualize Cardiac Conductive System esearchers have discovered new details of how the conductive system of the human heart functions that could help cardiac surgeons repair hearts without damaging healthy tissue. The results of this pioneering study provide improved and more accurate computer models of the conductive system of the human heart, and the origins of the heartbeat, and could help improve clinicians’ understanding of atrial fibrillation and other common cardiac problems. The scientists from Liverpool John Moores University (LJMU; Liverpool, UK; www.ljmu.ac.uk), The University of Manchester (Manchester, UK; www.manchester.ac.uk), Aarhus University (Aarhus, Denmark; www.au.dk/en), and Newcastle University (Newcastle, UK; www.ncl.ac.uk) published the research findings online in the August 3, 2017, issue of the journal Nature, Scientific Reports. The scientists soaked post-mortem samples of heart tissue in an iodine solution to enhance visualization of heart tissue in X-Ray images. They then used X-Ray scanners to make 3D images, some of which were so detailed that they showed the boundaries between individual heart cells, and the cellular layout in the tissue. Professor Jonathan Jarvis, at the LJMU School of Sport and Exercise Sciences, said, “The 3D data makes it much easier to understand the complex relationships between the cardiac conduction system and the rest of the heart. We also use the data to make 3D printed models that are really useful in our discussions with heart doctors, other researchers and patients with heart problems. New strategies to repair or replace the aortic valve must therefore make sure that they do not damage or compress this precious tissue. In future work we will be able to see where the cardiac conduction system runs in hearts that have not formed properly. This will help the surgeons who repair such hearts to design operations that have the least risk of damaging the cardiac conduction system.”

Medical Imaging International February-March/2018

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PRODUCT NEWS SURGICAL DISPLAY

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PACS SYSTEM

DRX RETROFIT SOLUTION

Sony

Medicatech

Carestream Health

The LMD-X310MD 4K delivers four times the resolution of HD for the true-to-life clarity that’s critical for seeing various nuances of color and detail. The display is considered ideal for general surgery, medical education and training.

The PACS offers medical 3D and color image desktop/web viewer with full-enhanced functionality such as measurements, annotations and rotations. The scalable system can be installed as stand-alone or can be integrated with any suite of applications.

The DRX-Transportable System/Lite is equipped with wireless tablet PC featuring a 12-inch touch screen. The tablet uses a virtual access point within the detector to display images as they are acquired and provides the user with complete control of the system.

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FDA Clears Specialty Applications for Radiology Platform he US FDA has provided 510(k) clearance for new oncology, neurology and cardiology advanced applications for image comparison and analysis, and evaluation treatments and therapy response assessment. The latest release of the clinical informatics platform now includes new advanced clinical applications for multi-modality tumor tracking, optimized lung-nodule assessment, and longitudinal brain imaging. The new applications are for the Royal Philips (Amsterdam, the Netherlands; www. philips.com) IntelliSpace Portal 9.0 portal, and are now available for marketing in the US. The most recent innovation cleared by the FDA was the Longitudinal Brain Imaging (LoBI) application that can be used to analyze brain images for tracking neurodegenerative disorders including stroke, Multiple Sclerosis (MS), and Alzheimer’s disease. New oncology functionality includes qEASL, part of the Multi-Modality

Tumor Tracking application, for enhanced tumor volume measurements using Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans. The new Lung Nodule Assessment tool provides information about lung nodules from a single CT study, and can also track them across multiple studies. The IntelliSpace Portal 9.0 portal already offers more than 70 radiology, cardiology, oncology, and neurology applications, and provides a comprehensive overview of a patient’s health. The new applications can enable clinicians to evaluate patients faster, across modalities, and to track therapy response over time. Leiden University Medical Center professor of neuroradiology, Mark van Buchem, said, “Analytics applications optimized for clinical decision support and longitudinal and quanti-

fied patient tracking are becoming increasingly important to radiologists. They can help visualize and quantify very subtle manifestations of disease and differences over time that may not be seen with the naked eye. IntelliSpace Portal 9.0 integrates into our existing workflow and adds greatly to our patient care.” Image: The Longitudinal Brain Imaging (LoBI) is the newest Intellispace 9.0 portal clinical application approved US distribution (Photo courtesy of Philips Healthcare).

3D Models Improve Outcomes for Heart Surgery esearchers have shown that cardiologists could benefit from using patientspecific heart valve models while preparing for heart valve replacement surgery. The scientists used new 3D printing technologies and standard Computed Tomography (CT) scans to create patient-specific heart valve models. The researchers from the Georgia Institute of Technology (Georgia Tech; Atlanta, GA; USA; www.gatech.edu) and the Piedmont Heart Institute (Atlanta, GA, USA; www.piedmont. org/heart) intend to use the technology to increase the success rate of Transcatheter Aortic Valve Replacements (TAVR) procedures. The study was published in the July 3, 2017, issue

of the journal JACC: Cardiovascular Imaging. The researchers used CT imaging to scan 18 valve-replacement surgery patients, and created the models using a multi-material 3D printer. The researchers were able to recreate calcium deposition, aortic stenosis, and other patient-unique cardiac aspects. The researchers found that the 3D-printed valves accurately mimicked the physiological qualities of the real heart valves and could help cardiologists reliably predict paravalvular leakage, and pick the best prosthetic valve. Zhen Qian, chief of Cardiovascular Imaging Research at Piedmont Heart Institute, part of Piedmont Healthcare, said, “Paravalvular leakage is an extremely important indicator in

how well the patient will do long term with their new valve. The idea was, now that we can make a patient-specific model with this tissue-mimicking 3D printing technology, we can test how the prosthetic valves interact with the 3D-printed models to learn whether we can predict leakage. Even though this valve replacement procedure is quite mature, there are still cases where picking a different size prosthetic or different manufacturer could improve the outcome, and 3D printing will be very helpful to determine which one. Eventually, once a patient has a CT scan, we could create a model, try different kinds of valves in there, and tell the physician which one might work best.” Medical Imaging International February-March/2018

To view this issue in interactive digital magazine format visit www.LinkXpress.com

IT/PACS Update

New PACS Modules with Enhanced Workflows Released he new MR Brain Perfusion and MR Brain Diffusion modules were developed by Carestream Health (Rochester, NY, USA; www.carestream.com), and now enable radiologists to read MR brain imaging studies from the diagnostic viewer of the CARESTREAM Vue PACS. The MR Brain Perfusion module has interactive tools for analyzing tissue blood volume, tissue blood flow, and capillary permeability. The system automatically generates perfusion maps, and quantitative data for radiology reports. The MR Brain Diffusion module includes interactive tools for MR diffusion tensor imaging, and MR diffusion-weighted images (DWI), and can visualize local water diffusion properties by analyzing diffusion-weighted MR data. The module can also enhance diagnostic confidence, and improve efficiency by automatically displaying DWI images and calculating ADC maps. The manufacturer of the Picture Archiving and Communication System (PACS) has already received US FDA 510(k), and Europe-wide clearance for the new Magnetic Resonance (MR) reading modules. The modules have also undergone successful clinical evaluation at a major French hospital. Dr. Daniel Reizine, Neuroradiology, Hôpital

Lariboisière, Assistance Publique Hôpitaux de Paris, University Hospital of Île-de-France, said, “The Carestream software was simple to use and Carestream’s modules showed better consistency of perfusion and diffusion maps and results than our existing software. This new soft-

Enterprise Imaging Viewer Receives Clearance for Additional Apps major medical hardware and software provider has received US FDA 510(k) clearance for additional functionalities on its enterprise imaging zero-footprint viewer. The viewer merges patient images and data from different departments and various sources in a hospital. Clinicians inside and outside a hospital, who satisfy the security policies and have the appropriate access rights, can now use the viewer to access the Digital Imaging and Communications in Medicine (DICOM) and non-DICOM imaging data in a single consolidated view. The US FDA approval includes Xtend 3D processing and advanced clinical applications functionality on the Agfa Healthcare (Mortsel, Belgium; www.global.agfahealthcare.com) XERO Viewer. The functionality is now cleared for diagnostic viewing on desktop devices. The approved advanced clinical applications on the browser-agnostic XERO Viewer now include Maximum Intensity Projection (MIP), MultiPlanar Reconstruction (MPR), mammography, orthopedics, nuclear medicine, and 3D visualization. In addition, iPad mobile diagnostic review and analysis now includes reports and ECG images. The viewer can display images from either the Agfa HealthCare Enterprise Imaging IT platform, third-party Vendor Neutral Archives (VNA), or Picture Archiving and Communication Systems (PACS) in a single screen. President of Imaging IT Solutions, Agfa HealthCare, James Jay, said, “We focus our continuous improvement efforts on meeting specific and real needs of healthcare providers; the features included in XERO Xtend fit that criterion. XERO, and the XERO Xtend feature set, help the healthcare enterprises to provide anywhere, anytime image access complete with powerful, useful image processing functions. The FDA 510(k) clearance for XERO Xtend supports our continued march forward.”

Medical Imaging International February-March/2018

ware will be very useful in making clinical decisions for treating acute stroke and lesions.” Image: A new set of MR perfusion and MR diffusion reading modules for the diagnostic viewer of an existing PACS system have been released (Photo courtesy of Carestream Health).

PRODUCT NEWS WIRELESS IMAGING SYSTEM

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BREAST PACS SYSTEM

BREAST IMAGING MONITOR

Primax International

Sectra

Totoku

The PRIMO W is composed of a cassettesized wireless flat panel and mobile acquisition station. It can be used with any existing X-ray source and is perfect for upgrading any existing analog system, as well as for inhouse radiology.

The Breast Imaging PACS comprehensive, vendor-neutral solution supports high-volume screening, advanced diagnostic workflows and telemammography services. It gives clinicians a full patient overview by allowing them to read all types of radiology images.

The MS55i2 Plus 5MP offers super highbright image quality for breast imaging. Its screen increases the number of perceptual grayscale steps to improve visibility of microcalcifications, tumors and structures, making it ideal for breast tomosynthesis imaging.

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Groundbreaking Medical Education and Clinical Training Portal Installed new education and clinical training solution for medical students and staff is now installed and being used for the first time in a medical center in the Netherlands. The portal will enable all medical students and staff to access and interact digitally with full-body Computed Tomography (CT) rendered virtual-representations of real-life medical cases for improved understanding and insight into the human anatomy during their studies. The Education Portal was developed by Sectra (Linköping, Sweden; www.sectra.com) and installed at the Amsterdam Medical Center (AMC; Amsterdam, the Netherlands; www.amc.nl/web/Zorg.htm), Amsterdam Center for Radiological Anatomy (ACRA). The system will be used to help combine anatomy and radiology data for medical education purposes. The AMC already has approximately 500 full-body CT

cases and will scan around 150 more bodies used for medical education every year. The cloud-based Education Portal also allows remote access and enables the cases to be shared between portal users outside AMC creating an international shared educational workspace. Read access to all medical image types, including 3D renderings, will allow student and researchers to find anatomical variations in multiple cases. Lecturer in Anatomy and Embryology at the Academic Medical Center, MD Bernadette S de Bakker, said, “To interact with the 3D renderings on the Sectra Table enables our students to learn and explore in a realistic environment. The portal itself is yet another way for enhancing medical training since students can access cases from their own workstations.”

Upgrade Enables Searches Across Multiple Clinical Archives

First Surgical Use of 3D Reality System

n enterprise medical imaging workflow solutions provider has released an upgrade for their routing workflow manager that will allow image record searches across many PACS systems, VNAs, and other clinical archives. The software upgrade now enables a one-click search of the whole imaging record of a patient across any number of Picture Archiving and Communication System (PACS) systems, Vendor Neutral Archives (VNAs), and other clinical archives. The upgrade of the Compass Routing Workflow Manager was released by Laurel Bridge Software (Newark, DE, USA; www .laurelbridge.com), and now enables healthcare systems to use query spanning, and results filtering to unify access to a number of clinical archives, as well as Multiple Modality Worklists (MWLs). The new functionality provides scheduled procedures for a modality, federated identification of individual imaging studies for a patient, and integration with a Master Patient Index (MPI), or Patient Identity Cross-Reference (PIX). The upgrade also includes system security, performance, scalability, throughput, performance, and ease-of-use improvements, as well as an improved mobile-friendly User Interface (UI) that simplifies enterprise user management and access. The Compass software can also be integrated with the Laurel Bridge Software Navigator, Imaging Retrieval Workflow Manager, which allows organizations to retrieve and normalize imaging studies from multiple facilities, VNA system and PACS, and solve other complex enterprise imaging workflow problems.

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

Medical Imaging International February-March/2018

Industry News

Siemens Healthineers: 2025 Strategy to Focus on Artificial Intelligence iemens Healthineers (Erlangen, Germany; www.healthcare.siemens.com) has laid out its strategy to bolster its market leadership by 2025 and beyond, aimed at accelerating profitable growth and delivering return. The company has stated that it is well prepared to take advantage of the paradigm shift and structural growth opportunities in healthcare. Siemens Healthineers estimates its core markets to grow by 3-5% annually on average from 2016 to 2021 to more than ğ50 billion per year, driven by growing and aging population, rise in chronic diseases, and improved access to healthcare in the emerging markets. With healthcare productivity historically lagging behind that of the other industries, the industry is witnessing horizontal and vertical consolidation, and governments and insurers are changing the financial incentive systems to transform healthcare delivery from volume to value. Additionally, medicine is becoming more precise and accessible, thereby empowering patients. Digitalization and the use of artificial intel-

ligence is further driving these changes in healthcare. Big data is becoming a source of value creation in the sector due to its abundant availability. Siemens Healthineers believes that it is well positioned to capitalize on the opportunities being created in the market due to its strong market position across the continuum of care. The company aims to drive profitable growth in its core business further and has a roadmap to its improve future profitability. Siemens Healthineers' Strategy 2025 is focused specifically on five future-oriented areas: • Utilizing its unique position in the in-vivo and in-vitro markets to combine data and knowledge around precision medicine and make it relevant for clinical use; • Using data and artificial intelligence to integrate existing and innovative technologies for therapy; • Coordinating and optimizing the patient journey through the healthcare continuum; • Developing a full range of technical, operational and clinical service offerings that are more effective and more efficient by using

Global Ultrasound Market to Approach USD 7 Billion by 2021 he global ultrasound market is expected to grow at a CAGR of 5.2% during 2016 to 2021 to reach a value of USD 6.86 billion by 2021, driven by a growing patient population base for chronic and lifestyle-related disorders, technological advancements, and increasing demand for minimally invasive diagnostic and therapeutic techniques. These are the latest findings of Research and Markets, (Dublin, Ireland; www.researchandmarkets.com), a global market research company. The growth of the global ultrasound market is being driven mainly by technological advancements in ultrasound devices, rising prevalence of targeted diseases, growing preference for minimally invasive procedures, increasing public-private investments, funding, & grants; and rising birth rate/fertility rate, especially in the emerging countries. However, the dearth of skilled and well-trained sonographers, and stringent government regulations are acting as the key constraints to the growth of the ultrasound market. Nevertheless, the expanding applications of ultrasound and the emerging markets will create significant opportunities for market growth. On the other hand, the growing end-user preference for refurbished equipment poses a challenge to the growth of the ultrasound market. Geographically, North America and Europe dominated the global ultrasound market with the largest share in 2016. However, Asia-Pacific is expected to be the world’s fastest growing ultrasound market during the forecast period, driven by the rising incidence of chronic and infectious diseases, growing awareness of advanced diagnostic and therapeutic ultrasound, and continuously increasing healthcare expenditure in the region. A large number of global and local manufacturers make the ultrasound market fairly competitive. During 2013-2016, a majority of the market players adopted the strategies of product launches, approvals, & product enhancements; agreements, partnerships, & collaborations; and geographic expansions to drive growth in the ultrasound market.

Medical Imaging International February-March/2018

technologies from Siemens Healthineers; • Continuing to develop and invest in capa-

bilities in artificial intelligence that support the above areas. Siemens AG is preparing to list Siemens Healthineers on the Prime Standard segment of the Frankfurt Stock Exchange's Regulated Market during the first half of calendar year 2018. "It is a pleasure to talk about Siemens Healthineers, a business well prepared to take advantage of the paradigm shifts in healthcare," said Michael Sen. Chairman of the Supervisory Board of Siemens Healthineers and member of the Siemens Managing Board also responsible for the company's healthcare activities. "As a separate listed entity, Siemens Healthineers will have the entrepreneurial flexibility to actively shape its industry with a view to accelerating profitable growth and deliver return. It will also have direct access to the capital market, which will improve its ability to fund investment. Siemens will continue to actively support Siemens Healthineers as a majority shareholder."

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

exhibition.com ECIO 2018 - European Conference on Interventional Oncology. Apr 22-25; Vienna, Austia; Web: www.ecio.org ARRS2018 - Annual Meeting of American Roentgen Ray Society. Apr 22-27; Washington, DC, USA; Web: www.arrs. org/am18 Radiology in Marbella. Apr 22-28; Marbella, Spain; Web: www.radiologyintl.com Charing Cross Symposium 2018. Apr 24-27; London, UK; Web: www.cxsymposium.com CAR 2018 - 81st Annual Scientific Meeting. Apr 26-29; Montreal, QC, Canada; Web: www.car.ca

International Calendar Medical Imaging International P.O.Box 801932, Miami, FL 33280-2214, USA Fax: 1-954-893-0038 • E-mail: info@globetech.net

MARCH 2018 Acute Cardiovascular Care 2018. Mar 35; Milan, Italy; Web: www.escardio.org Thoracic Imaging 2018 - Annual Meeting and Postgraduate Course. Mar 4-7; Austin, TX, USA; Web: http://thoracicrad. org SAR 2018 - Annual Scientific Meeting and Educational Course. Mar 4-9; Scottsdale, USA; Web: www.abdominal radiology.org APCCVIR 2018 - The Asia Pacific Congress of Cardiovascular and Interventional Radiology. Mar 8-11; Auckland, New Zealand; Web: www.apscvir2018. com KIMES 2018. Mar 15-18; Seoul, Korea South; Web: www.kimes.kr Medical Fair India. Mar 16-18; Mumbai, India; Web: http://medicalfair-india.com SIR 2018 - 43rd Annual Scientific Meeting of Society of Interventional Radiology. Mar 17-22; Los Angeles, CA, USA; Web: www.sirmeeting.org 13th European Molecular Imaging Meeting. Mar 20-23; San Sebastián, Spain; Web: www.emim.eu ISICEM 2018 - The International Symposium on Intensive Care and Emergency Medicine. Mar 20-23; Brussels, Belgium; Web: www.intensive.org ExpoMed Eurasia 2018. Mar 22-25; Istanbul, Turkey; http://expomedistanbul. com AIUM Annual Convention 2018 - Ameri-

can Institute of Ultrasound in Medicine. Mar 24-28; New York, NY, USA; Web: www.aium.org/annualConvention 50th International Diagnostic Course Davos. Mar 25-29; Davos, Switzerland; Web: www.idkd.org

APRIL 2018 ISBI 2018 - International Symposium on Biomedical Imaging. Apr 4-7; Washington, DC, USA; Web: http://biomedicalimaging.org Society of Breast Imaging (SBI)/American College of Radiology (ACR) Breast Imaging Symposium. Apr 12-15; Las Vegas, NV, USA; Web: www.sbi-online.org 77th Annual Meeting of Japan Radiological Society. Apr 12; Yokohama, Japan; Web: www2.convention.co.jp IEEE 2018 - Nuclear Science Symposium and Medical Imaging Conference. Apr 16-19; Denver, CO, USA; Web: www.ieee.org Clinical Nuclear Medicine 2018. Apr 1920; Lake Buena Vista, FL, USA; Web: www.edusymp.com EuroPrevent 2018. Apr 19-21; Ljubljana, Slovenia; Web: www.escardio.org ESTRO 2018. Apr 20-24; Barcelona, Spain; Web: www.estro.org PET/CT Imaging 2018. Apr 21-22; Lake Buena Vista, FL, USA; Web: www. edusymp.com Saudi Health 2018. Apr 22-24; Riyadh, Saudi Arabia; Web: www.saudihealth

MEDICAL IMAGING INTERNATIONAL

MAY 2018 JPR 2018 - Sao Paulo Radiology Meeting. May 3-6; Sao Paulo, Brazil; Web: www.jpr2018.org.br ESTES 2018 - 19th European Congress of Trauma & Emergency Surgery. May 6-8; Valencia, Spain; Web: www.estes online.org 99th German Congress of Radiology. May 9-12; Leipzig, Germany; Web: www.roentgenkongress.de Swiss Congress of Radiology 2018. May 10-12; Lausanne, Switzerland; Web: www.radiologiekongress.ch ISFRI/IAFR Joint Congress 2018 - International Society of Forensic Radiology and Imaging & International Association of Forensic Radiographers. May 10-12; Melborne, Australia; Web: www.afr.org.uk SEACare 2018 - Southeast-Asian Healthcare Show. May 14-16; Kuala Lumpur, Malaysia; Web: www.abcex.com CMEF 2018. May 15-18; Shanghai, China;

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