Medical Imaging International December 2017 by Globetech

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Vol.27 No.4 11-12 /2017 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 4-21 PACS/ IT Update . . 29-32 Product News . . . . 14-32 Industry News . . . . . . 33 International Calendar . 34

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Personalized Radiotherapy Treatments for Cancer Patients esearchers have revealed a new innovative radiation therapy approach, called the radiosensitivity index, which can improve the outcomes of radiation therapy for patients with head and neck cancer. The clinical scientists developed the new test to determine the sensitivity of tumors in a specific patient to 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. The researchers 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 also be used in the fu-

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

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

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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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 Image: Medical image algorithms help identify evidence of disease (Photo courtesy of costs. The Zebra algorithm engine can be deployed in both cloud and onZebra Medical Imaging). 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 universiPRINT MAGAZINE ty 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 INTERACTIVE propositions will emerge as the technology is impleDIGITAL EDITION mented widely. It is a very exciting time for radiology.” WEB PORTAL 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.

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FDA Clears New Image-Guided Treatment System new radiotherapy system that offers advanced treatments for breast, prostate, and head and neck cancers, among many others, has received US FDA 510(k) clearance. The Image-Guided Volumetric Intensity Modulated Radiotherapy (IMRT) already received the European CE mark. The highly automated system features a new streamlined workflow with less than a third of the workflow steps of systems using older technologies. The Halcyon radiotherapy system was developed by Varian Medical Systems (Palo Alto, CA, USA; www.varian.com), one of the largest manufacturers of medical devices and software for the treatment and management of cancers. The Eclipse 15.1.1 treatment planning software, that is required to operate the Halcyon system, is currently pending US FDA 510(k) approval. The Halcyon radiotherapy system can be installed and commissioned faster, and requires less training than previous systems. The system

has large touch screens on both sides for ease of access, is nearly twice as quiet as older systems, and has soft indirect ambient lighting in the opening of the gantry for patient comfort. The system has a low couch height to facilitate patient access, an integrated couch-mounted camera to allow clinicians to monitor the patient during treatment, and an integrated noise-cancelling sound system for communicating with the patient. President of Varian Oncology Systems, Kolleen Kennedy, said, “We are proud that Halcyon has now received both 510(k) clearance and CE mark. With its human-centered and user-friendly design, Halcyon is engineered to revolutionize clinical workflow. These two clearances

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are very important milestones in the availability of this new system and advancing cost-effective cancer care worldwide.”

Sugar Could Replace Contrast Agents in Brain MRI Scans

CT Perfusion Predicts Treatment Response in Cancer Patients he results of a multi-center feasibility study and clinical trial have shown how CT perfusion can be used to predict the treatment response of patients with advanced ovarian cancer. Computed Tomography (CT) perfusion measures the volume and flow of blood to ovarian cancer tumors. This can provide an accurately prediction of treatment response and enable clinicians to improve treatment planning. The trial included 120 enrolled patients, of which 76 patients, with a median age of 61 years from 19 centers were evaluated. The study was published online in the May 15, 2017, issue of the journal Clinical Cancer Research by scientists from Western University (London, ON, Canada; www.uwo.ca) and Lawson Health Research Institute (London, ON, Canada; www.lawsonresearch.ca). According to the authors of the study, most ovarian cancer patients (60 to 85%) suffer from a relapse after initial treatment. This shows the importance of the new CT perfusion technique that enables clinicians to predict patients’ response to specific therapy, and improves treatment planning and patient selection.

Image: The Halcyon cancer treatment system has received US FDA 510(k) clearance (Photo courtesy of Varian Medical Systems).

new study suggests that glucose metabolism activity identified using magnetic resonance imaging (MRI) could help identify solid tumors or very aggressively growing tumor areas. Researchers at the German Cancer Research Center (DKFZ; Heidelberg, Germany; www.dkfz.de), the MaxPlanck-Institute for Biological Cybernetics (Tuebingen, Germany; http:// kyb.mpg.de), and other institutions used an ultrahigh field 7 Tesla MRI scanner to detect intracerebral regions of increased glucose concentration. For the study, they examined nine patients with newly diagnosed glioblastoma and four healthy volunteers between October 2015 and July 2016. T1 -weighted dynamic glucoseenhanced (DGE) MRI was performed with injection of 100 mL of 20% dglucose via the cubital vein. Glucose enhancement, given by the relative signal intensity change, was then quantitatively investigated in brain gray matter versus white matter in the healthy volunteers, and in tumor tissue versus normal-appearing white matter of patients with glioblastoma. The median signal intensities of the assessed brain regions were then compared. The results demonstrated that in healthy volunteers, the median signal intensity in basal ganglia gray matter was significantly increased compared with that in white matter tissue. But in the glioblastoma patients, the median signal intensity in the glucose-en-

hanced tumor region, as displayed on the T1 -weighted DGE images, was significantly higher than that in contralateral normal-appearing white matter, indicating the pathophysiologically increased glucose uptake that occurs in human brain cancer. The study was published on June 23, 2017, in Radiology. “We do not know yet how the shares of measured glucose are distributed between vessels and extracellular spaces on the one hand, and the cell interior on the other,” said study co-author radiologist Heinz-Peter Schlemmer, MD, PhD, of the DKFZ division of radiology. “If we can confirm that substantial signal levels originate from glucose in the cell interior, this would be important additional information for tumor imaging and functional MRI. This could enhance therapy planning and monitoring.” MRI contrast agents enhance signals in blood vessels and in spaces between cells, but do not reach the interior of the cell; by contrast, glucose is taken up and then broken down in the body cells, and tumor cells are particularly hungry for glucose in order to feed their high-energy needs. As glucose is found at much lower levels in the body, magnetization transfer effect is used to reinforce the glucose signal by transferring the signal from glucose protons to bodily water, which is measured in MRI. The amount of glucose needed corresponds to about five sugar cubes. Medical Imaging International November-December/2017

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Medical Imaging International

Non-Invasive CT Angiography Can Help Predict Heart Attacks esearchers have shown that non-invasive Computed Tomography (CT) angiography, together with stress tests, can be used to help clinicians predict heart attacks and other adverse cardiovascular event in their patients. The researchers studied 379 patients, all of whom had been referred for Invasive Coronary Angiography (ICA). The study compared invasive, and noninvasive ICA methods, and found that both approaches were equally efficient at identifying patients at risk of a future major adverse cardiac event. Standard practice until now has been to use both ICA and stress tests, together with Single Photon Emission Tomography (SPECT) myocardial imaging, but the approach is invasive and expensive. The researchers from the Johns Hopkins Hospital and School of Medicine (Baltimore, MD, USA; www.hopkinsmedicine.org/som) published their study online in the March 14, 2017, issue of the journal Radiology. The results showed that 51 patients (13.5%), had one or more Major Adverse Cardiac Events (MACE). Both approaches had similar high results for predicting MACE two years after presentation, as well as event-free survival.

The author of the study, João A.C. Lima, MD, Johns Hopkins Hospital and School of Medicine, said, “Previous studies show that a lesion is hemodynamically significant if there is a significant blood pressure drop corresponding to a big reduction in blood flow across the stenosis. If plaque has those characteristics, the patient should be targeted for intervention, be it with a stent or downstream bypass surgery. Invasive angiography is generally safe, but it can cause vascular problems in a significant number of patients, most commonly at site of the puncture. In rare cases, it can cause strokes or heart attacks. These risks are not trivial. The key finding of our study is that both techniques are equally effective in identifying which patients are going to have trouble down the road. The noninvasive option should be a preferred or at least strongly considered option by cardiologists and radiologists managing these patients because it is safer and less expensive, and patients like it better.”

Researchers Find Childhood Issues Can Lead to Cognitive Deficits esearchers have demonstrated the importance of treating children that have suffered serious head injuries and delayed visual perception, as early as possible to prevent lifelong cognitive deficits. According to the researchers, their finding could lead to targeted treatments for some of these children, preventing lifelong disabilities and structural changes in their brains. The researchers from the Keck School of Medicine, University of California (UC; Los Angeles, CA, USA; http://keck.usc.edu) studied diffusion-weighted Magnetic Resonance Imaging (MRI) brain scans of 21 children, aged 8 to 18 years, who had fallen from skateboards, bikes, or scooters, or had been in a car accident. The researchers also had a control group of 21 healthy children without brain injuries. The results of the preliminary study were published in the March 15, 2017, issue of the journal Neurology, and indicated that if information transfer between the children’s brain hemispheres took more than 18 milliseconds, the children’s chance of recovery from traumatic brain injury, compared to similarly-injured counterparts, was lower. Emily Dennis, lead author of the study, said, “We found that children who had delayed information transfer times between the two brain hemispheres had widespread regions of white matter disorganization and progressive loss of white matter volume. In children, this disruption to myelin – the insulation that facilitates information transfer – is compounded because the brain is still maturing. Myelination typically continues beyond age 30.”

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Research Shows Viability of Cardiac Image Analysis he results of a global multicenter study demonstrate that automated 3D Echocardiographic (3DE) analysis of left-heart chambers is an accurate and reproducible alternative to the manual methods in use today. The research follows previous clinical assessments in laboratories in different locations, and affirms the consistency and reproducibility of the software analysis methodology. The study results were published in the February 4, 2017, issue of the European Heart Journal by Royal Philips (Amsterdam, the Netherlands; www.philips.com). The goal of the study was to verify the accuracy and reproducibility of cardiac measurements made using the Philips HeartModelA.I. Anatomically Intelligent Ultrasound (AIUS) software with images from the Philips EPIQ ultrasound system. The study group included 180 patients at six sites each of whom underwent Left Atrial (LA) volume, Left Ventricular (LV) volume, and Ejection Fraction (EF) ultrasound measurements of the heart. The images were analyzed using automated software that provided advanced quantification, automated 3D views, and reproducibility. The results of this study could lead to increased integration of 3DE quantification into clinical practice, potentially saving time, and providing real-time quantification of heart functions. Professor of medicine, and director of non-invasive cardiac imaging labs at University of Chicago Medicine (Chicago, IL, USA; www.uchospitals.edu/index.shtml), Dr. Roberto Lang, said, “The days of time-consuming, difficult collection and analysis of heart measurements are behind us. The results of this study provide further evidence that 3DE technology like Philips HeartModelA.I. is the way forward for global health systems to save time and gather accurate data for quality care delivery to patients.”

Image: The HeartModelA.I. provides automated 3DE quantification of heart functions from EPIQ ultrasound images (Photo courtesy of Philips Healthcare).

Software to Reduce Effects of Scatter Radiation

CT Dose Standardized Using Feedback Mechanism

ew optional software has been announced for a family of portable, and room-based DR systems that can help eliminate the need for an antiscatter grid. The company plans to begin shipping the software in Q3 2017. The software has been awarded US FDA 510(k) clearance, enhances image quality, and reduces the need for technologists to place grids over detectors. The SmartGrid software was developed by Carestream Health (Rochester, NY, USA; www.carestream.com) for their DRX Family of room-based, and portable Digital Radiography (DR) Systems, as well as the DRX-1 retrofit kit which converts Computed Tomography (CR) systems to DR. The SmartGrid image processing software is intended for use with adult patients, for Antero-Posterior (AP) chest, abdomen, spine, pelvis, and hip exams. Scatter radiation creates haze in images reducing image detail and contrast, and can occur when the collimator is too far away from the anatomy of interest, or when imaging thicker anatomy. To counter this, a heavy anti-scatter grid can be placed over a detector, but this can make positioning and alignment more difficult, and requires a higher radiation dose. The SmartGrid enhancement algorithm can estimate and remove low-frequency scatter in an image, and can accommodate for factors such as the thickness and size of the object, the energy spectrum of the beam, and collimation. Research Associate, Lori Barski, in Carestream’s Image Processing and Analysis Group, said, “Once installed, a technologist can utilize SmartGrid software on Carestream DRX systems whenever it is needed. And because this feature is easy to use, it can help boost image quality throughout an organization.”

esearchers have shown how radiation doses can be effectively reduced, and patient safety improved, by using a feedback mechanism to share dose levels for common CT scans between hospitals. There has been a steady increase in the use of Computed Tomography (CT) exams in the U.S. in the last 10 years, and radiation dose levels for these exams vary considerably between hospitals. Researchers at the University of California, San Francisco (UCSF; San Francisco, CA, USA; www.ucsf.edu) used the feedback mechanism between radiologists at five academic medical centers in UCSF in order to assess and compare the radiation dose for CT exams. Best practices were then shared between the participating hospitals resulting in significantly lower radiation doses for abdominal and chest CT scans, and more consistent doses for head scans. The study was published in the April 10, 2017, issue of JAMA Internal Medicine. Senior author of the study Professor Rebecca Smith-Bindman, MD, said, “We estimate that if the improvements we saw were applied to all abdominal CT scans performed in the U.S., this would result in the reduction of approximately 12,000 cancers annually. Reducing unnecessary and inconsistent radiation doses is an extremely important process for improving patient safety. We found that providing detailed and comparative feedback, and sharing best practices on how each institution was able to optimize their dose, leads to lower and more consistent CT doses. In short, it makes no sense for each institution to have to re-invent the wheel regarding how to optimize doses – this project focuses on helping the leaders at each institution learn from each other.”

Adolescent Brain Changes Influence Executive Functions esearchers have succeeded in mapping specific brain network organization changes in children during their transition from adolescence into young adulthood, that result in dramatic improvements in their executive functions. The study findings show how changes in the brain during adolescence result in improved executive functions such as the ability to control impulses, make decisions, and stay organized. These executive functions help determine future educational success, susceptibility to psychiatric illness or drug use. The study was published in the May 25, 2017, is-

sue of the journal Current Biology by researchers at the Pennsylvania School of Medicine (PENN Medicine, Philadelphia, PA, USA; www.pennmedicine. org) and showed that brains networks in adolescents increasingly become divided into modules that are part of a tightly connected network. The findings also suggest that the modular subnetworks are important for complex cognition and behavior, and could help clinicians identify biomarkers that could predict risks for psychosis, or major mood disorders. The findings could also help clinicians evaluate future risks for certain

mental illnesses. Co-leader of the study, Graham Baum, neuroscience doctoral student at PENN Medicine, said, “The development of network modules did not result in the brain network becoming fragmented. In fact, the brain’s predicted ability to send signals efficiently across the whole network actually increased. These results suggest that as kids grow up, their brains become both more modular but also more globally integrated. This may allow the brain to have specialized units that can work together to support advanced cognitive abilities.” Medical Imaging International November-December/2017

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Acoustic Breast Imaging System Predicts Malignancy novel opto-acoustic (OA/ US) system detects both tumor angiogenesis and the relative reduction in the oxygen content of blood that occur in cancer. The Seno Medical (San Antonio, TX, USA: www.senomedical.com) Imagio OA/US breast imaging system combines both laser optics and conventional ultrasound technology to deliver fused functional and

anatomical imaging of breast masses in real time. The images are generated based on hemoglobin concentration and oxygenation level, as the growth of malignant tumors is supported by angiogenesis to provide the necessary hemoglobin for that growth. The increased concentration of hemoglobin is a prime indicator of cancer. In contrast to existing optical and

ultrasonic imaging techniques that create images by transmitting energy in one wave form and detecting that energy in the same form, OA/US imaging transmits light energy but detects sound energy; by using multiple colors of laser light a much broader range of data can be captured, which makes the functional images possible. The images are also generated without using ionizing radiation or injection of contrast agents. The Seno Medical Imagio system has received the European Community CE mark of approval. In a recent Phase III pilot study to determine the histopathologic basis of OA/US breast imaging, 92 patients with 94 solid or complex cystic and solid breast masses assessed with conventional diagnostic ultrasound (CDU) were also imaged with OA/US. The mean OA scores were higher for malignant masses compared to benign masses for all individual in-

ternal and external features, as well as for combined internal and external OA features. The study was presented at the American Roentgen Ray Society (ARRA) annual meeting, held during May 2017 in New Orleans (LA, USA). “Opto-acoustic imaging provides real-time anatomic and functional information without ionizing radiation or the need for IV contrast injection, making it a potentially safer and more convenient option for patients,” said lead author and study presenter Reni Butler, MD, of Yale University School of Medicine (Yale; New Haven, CT, USA; www.medicine. yale.edu). “This could help us decrease the number of unnecessary breast biopsies performed for benign findings, reducing patient anxiety, discomfort, and healthcare cost.” Image: A new opto-acoustic system detects breast masses in real time (Photo courtesy of Seno Medical).

HypoFractionated RT Following Mastectomy Found Effective new study shows that a three-week course of radiation therapy (RT) following mastectomy is safe and cuts treatment time in half. Researchers at Rutgers Cancer Institute (New Brunswick, NJ, USA; www.cinj.org), Memorial Sloan-Kettering Cancer Center (MSKCC; New York, NY, USA; www.mskcc. org), and other institutions conducted a prospective study involving 67 women with stage II to IIIa breast cancer to evaluate if postmastectomy radiation therapy (PMRT) completed in just 15 treatment days is as effective as conventional PMRT that takes approximately 5-6 weeks to complete. Early RT stopping criteria was predefined based on known toxicity thresholds. The results showed that after a median follow up of 32 months, no grade three toxicities or higher were reported. There were 29 grade two toxicities, with a majority being skin rash followed by fatigue, similar to that experienced with conventional PMRT. Three-year estimated local recurrence-free survival was 89.2%, and 3-year estimated distant recurrence-free survival was 90.3%. The total rate of implant loss or failure was 24%, and the unplanned surgical correction rate was 8%, for a total complication rate of 32%. The study was published on

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May 1, 2017, in the Journal of Clinical Oncology. “When there is a concern that cancer cells may remain in the chest wall and lymph node regions following a mastectomy, a patient may be given targeted radiation over a five to six week period to further treat the breast cancer,” said senior author Professor Bruce Haffty, MD, of Rutgers Cancer Institute. “Receiving radiation for that long of a period becomes a quality of life issue for many patients. This includes the inconvenience of frequent travel to the treatment facility, as well as fatigue and other common side effects that can cause lost time at work and other challenges.” In standard chest wall irradiation, the therapeutic ratio of RT derives from differences in late-reacting normal tissues, which are more sensitive to high dose per fraction, versus rapidly proliferating tumor cells, which are less responsive to changes in fraction size. Thus, high cumulative doses of radiation are needed for tumor control, but daily fraction size has to be respectful of the sensitivity of normal tissues in the treated volume. Interestingly, breast cancer cells seem to possess fraction sensitivities similar to normal tissues, and so the primary rationale for prolonged fractionation is not applicable. Medical Imaging International November-December/2017

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

mammography experience, one that had not significantly changed for the last 40 years. After having a mammogram on Senographe Pristina, women immediately recognize a pleasant difference: It’s a faster and quieter exam with greater comfort and less pain during compression,” said Kathy Schilling, MD, of Boca Raton Regional Hospital (FL, USA). “Our goal is for all our baseline patients to have their mammograms with this new technology, with the intent that it will help to dismiss any preconceived fears and encourage more compliance with annual screening.” Image: The Senographe Pristina system (Photo courtesy of GE Healthcare).

Premium Medical Imaging Ultrasound System Announced premium ultrasound system with new clinical innovations, such as a 200-times faster acquisition rate than existing systems, has been announced. 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.supersonicimagine.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 micro-vascularization, 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. SWE is used for Musculoskeletal (MSK) imaging to view muscles, tendons, ligaments

and joints, for diagnosing and monitoring conditions such as tendinopathy. Co-Founder, and CIO at SuperSonic Imagine, Jacques Souquet, said, “Aixplorer Ultimate is the result of 8 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 November-December/2017

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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 higherresolution 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

MRI Finds Breast Cancer Following Conservation Surgery

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 im-

ages 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).

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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 researchers found that when MRI screening was used in addition to mammography, another 3.8 cancers per 1,000 women were discovered. When ultrasonography screening was added to mammography instead of MRI only 2.4 new cancers were detected. 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 early-stage 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.”

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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. “By providing higher resolution views of the human brain, this technology can improve clinical practices and could lead to high performance

brain machine interfaces,” said senior author Professor Vikash Gilja, PhD, of the department of engineering at UC San Diego. “These electrodes occupy minuscule volumes; imagine Saran Wrap, but thinner. And we demonstrate that they can capture neural ac-

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Image: The PEDOT:PSS electrode grid (Photo courtesy of David Baillot / UCSD).

Radiosurgery Improves QOL 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 EQ-5D, and PHQ-9 were 55% and 59%, respectively. Overall, patients reported improved QOL and lower rates of depression after SRS. The benefit of treatment

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tivity from the human brain at least as well as conventional electrodes that are orders of magnitude larger.”

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 November-December/2017

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Medical Imaging International

New MRI Technology Tested on Patients

new metamaterial-enhanced MRI technique has been tested for the first time on hu-

mans. 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 ap-

plied 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

Medical Imaging International November-December/2017

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. “None of the other imaging technologies can do that. Ultrasound will not do that; X-rays will not do that; light is the only tool that allows us to provide biochemical information.” Photoacoustic imaging uses nonionizing 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. LINKXPRESS COM

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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.

we hope to provide help to the vast population of former athletes who experience neurological issues after retiring from contact sport.”

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 unacceptable 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,

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 cus-

tom 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. “We reengineered the BodyTom Elite so that it

more seamlessly integrates into any OR, neurosurgery, radiation oncology or radiology suite, and provides a more accurate, sharper image,” said Philip Sullivan, CEO of Samsung NeuroLogica. “From top to bottom, the BodyTom Elite is designed to empower our customers to capture the absolute best imaging information from their patients.” “We run a very busy department and depend on our equipment to deliver the highest quality results possible with ease to the patient. The Samsung BodyTom Elite does all the above and more allowing for safe, precise, and effective treatment,” said Michael Woodruff, director of medical imaging at John Muir Health (Walnut Creek, CA, USA). “The state-of-the-art BodyTom Elite features advanced technology including intuitive ergonomics, whisper-quiet portability, and exceptional image quality only to improve our department’s efficiency and patient comfort.” Medical Imaging International November-December/2017

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Medical Imaging International

Vascular Ultrasound Systems Assist Diagnostic Decisions nnovative ultrasound (US) systems visualize blood flow in multiple directions including axial and transverse, providing more comprehensive hemodynamic information. The Carestream Health (Rochester, NY, USA; www.carestream.com) Touch Prime and Touch Prime XE US systems feature Smart Flow technology that eliminates transducer angle limitations of ordinary Doppler US, thus allowing visualization and measurement velocity even when blood flow is perpendicular to the acoustic beam. Color coded arrows automatically display information from Smart Flow technology, with the length of the arrow and its color indicating magnitude of blood flow; ordinary color and spectral Doppler US measure velocity of flow components toward or away from a transducer. Advanced SynTek Architecture simultaneously provides enhanced spatial detail with increased frame rates for improved visualization of moving structures, while optimizing image formation to reduce noise and artifacts. Imaging and Doppler improvements allow for more consistent visualization of subtle tissue contrast differences, increasing the ability to see small structures. The systems also deliver uniform lateral resolution over the entire

depth, and deeper penetration for imaging of the abdomen and other areas. A sealed, all-touch control panel combines the speed and flexibility of a soft user interface with the tactile feedback of traditional keys. Etched markings for primary controls allow the user to easily locate frequently used functions, without looking away from the image display monitor. A direct transducer interface to the US processing board delivers lower noise and higher image quality, and four transducers can be connected simultaneously to any of the system’s four ports. Specialized transducers are available for vascular imaging, as well as radiology, OB/GYN, and musculoskeletal imaging. “Our advanced ultrasound systems deliver enhanced views of blood flow and allow sonographers and clinicians to gain improved visualization of complex and dynamic flow patterns that may not be visible using conventional color Doppler tech-

niques, irrespective of anatomical orientation,” said Helen Titus, worldwide marketing director for US & CT solutions at Carestream. “Carestream’s advanced ultrasound imaging technology can play a vital role in accurately assessing clinical applications, such as evaluation of hemodialysis vascular access and quantification of complex flow patterns in the presence of stenosis.” The Touch Prime XE is capable of frame rates in excess of 100Hz while maintaining enhanced imaging detail, and includes optional features such as a digital imaging and communications in medicine (DICOM) package and barcode and radiofrequency identification (RFID) badge readers. Wireless connectivity provides rapid image transfers to picture archiving and communication systems (PACS), radiology information systems (RIS), and other systems. An integrated gel warmer delivers added convenience and patient comfort.

Technique Used in 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 (F18-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.”

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Researchers Design Protein-Based Contrast Agent team of researchers has designed a human protein-based MRI contrast agent for detecting tumors that is easily cleared by the body. Gadolinium-based Magnetic Resonance Imaging (MRI) contrast agents are commonly used to detect, stage and monitor tumor malignancy without the need for ionizing radiation or radionuclides. While gadolinium contrast agents do not provoke an immune response in cells, they are retained in the human body. Researchers from the University of Massachusetts Medical School (UMMS; www.umassmed.edu) and the Second Hospital of Tianjin Medical University (Heping Qu, China; www.tijmu.edu.cn) developed the agent. The research results were published in the June 26, 2017, issue of the journal Nano Letters, ACS Publications. The new tumor-targeting MRI

contrast agent could be used for detecting early stage tumors. In the paper, the researchers explain how they were able to mimic a natural process occurring in the human body, and use human transferrin (Tf) proteins to create gadolinium bio-mineralized human transferrin protein-based (Gd@TfNP) MRI contrast nanoprobes. During their study, the researchers looked for naturally-occurring proteins that could be used as alternatives to gadolinium-based contrast agents, and managed to demonstrate the effectiveness of metal-based nanoparticulate contrast agents enclosed in protein scaffolds. One example of such a protein-bound nanoparticle called Abraxane, is already being used to treat metastatic breast cancer. First author of the paper, Yang Zhao, MD, PhD,

from the Second Hospital of Tianjin Medical University, said, “Such probes can immediately leave the tumor sites after delivery and we could track the overall process by MRI. Such a technique might be useful not only for visualizing tumor therapies, but for optimizing drug dose and evaluating clinical results.” Image: Researchers have developed a tumor-targeting MRI contrast agent that is based on human protein (Photo courtesy of UMMS).

Results of Metastatic Colorectal Cancer Study Released

Multiple New Applications For Radiology Portal Platform

he results of a colorectal cancer study that compared standard first-line chemotherapy alone, and the same chemotherapy with Selective Internal Radiation Therapy (SIRT) treatment have been released. The researchers reviewed the overall survival of the 1,103 patients who took part in the study. All patients had colorectal cancer that had spread to the liver. The patients were randomized to receive either only chemotherapy, or chemotherapy with SIRT radioembolization using SIR-Spheres Y-90 resin microspheres. The results of the FOXFIRE Combined Analysis study were presented at the 2017 annual meeting of the American Society of Clinical Oncology (ASCO) by researchers from the University College London Cancer Institute (UCL; London, UK; www.ucl.ac.uk/cancer). The patients had a median age of 63 years and had all been diagnosed with unresectable metastatic Colorectal Cancer (mCRC). The cancer had either metastasized to only the liver, or several additional parts of the body. The results did not show any significant difference in Overall Survival (OS) for the two groups, however an exploratory subgroup analysis of the FOXFIRE, SIRFLOX and FOXFIRE Global study did show that adding Y-90 resin microspheres to first-line chemotherapy for mCRC could increase OS in patients with right-sided primary colon tumors. Co-principal investigator of the study, Professor Ricky Sharma, said, “Our analysis did not meet its primary endpoint of an overall survival (OS) benefit for patients treated with SIRT plus first-line chemotherapy compared to patients treated with chemotherapy alone. Nonetheless, I believe this study has significantly enriched scientific understanding of the role of SIRT in the management of metastatic colorectal cancer, particularly in the liver. Finding more effective treatments remains a critical issue for these patients. Following further validation, this unexpected finding may prove to be clinically meaningful as patients with right-sided primary colon tumors represent more than a third (35–38%) of all colon cancer patients.”

he latest release of the Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) clinical informatics platform, IntelliSpace Portal 9.0, provides enhanced applications for neurology, cardiology, and oncology, helping clinicians analyze and compare medical images, evaluate treatment options, and track therapy response using advanced visual analysis tools and image quantification. The platform thus provides a comprehensive overview for each patient, using multimodal clinical applications optimized for patient evaluation over longer periods of time. IntelliSpace Portal 9.0 now offers over 70 applications in various clinical domains within radiology that include among others neurology, oncology, and cardiology. For example, the longitudinal brain imaging (LoBI) application can be used to analyze brain images to support evaluation of neurological disorders and monitor disease progression over time in patients with neurodegenerative disorders such as stroke, Alzheimer’s disease (AD), and multiple sclerosis (MS). Proprietary quantitative European Association for the Study of the Liver (qEASL) technology within the multimodality tumor tracking app offers a new method for enhanced measurement of tumor volume, based on MRI and CT scans, with the aim of improving current standards for treatment follow-ups via visual indications of how cells respond to therapy. Also available is the lung nodule assessment app, a diagnostic imaging tool that provides quantitative and characterization information on lung nodules in a single CT study, or over time during the course of multiple thoracic studies. “Analytics applications optimized for clinical decision support and longitudinal and quantified patient tracking are becoming increasingly important to radiologists,” said professor of neuroradiology Mark van Buchem, MD, of Leiden University Medical Center (The Netherlands). “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.”

PET Tracer Detects Thrombi in Blood Vessels and Brain he results of a new pre-clinical study show that a fluorine-18 (18F) labeled ligand can be used to target GPIIb/IIIa receptors, and detect tiny blood clots during a diagnostic imaging scan. The small molecule tracer 18F-GP1 shows a high affinity for GPIIb/IIIa receptors, and accumulates at sites where blood clots are formed. The binding affinity of the novel Positron Emission Tomography (PET) tracer was not affected by heparin, aspirin and other anticoagulants, and was cleared rapidly from the blood stream. The results were published in the July 2017 issue

of The Journal of Nuclear Medicine’s (JNM) by the researchers from Piramal Imaging (Berlin, Germany; www.piramal.com). The researchers used Cynomolgus monkey models, and showed how the new technique could detect small arterial and venous blood clots, as well as emboli and endothelial damage in the brain. The researchers are now working on a first-in-human study of 18F-GP1 and have presented the preliminary results, and an interim analysis that confirmed the results from the earlier preclinical data, at the annual Society of Nuclear Medicine and Molecular Imaging (SNMMI) meeting in June 2017.

Piramal Imaging researcher, Andrew W. Stephens, MD, PhD, said, “Currently available diagnostic techniques of thrombus [blood clot] imaging rely on different modalities depending on the vascular territory. A single imaging modality that could visualize thrombi from various sources in different anatomic regions would be very valuable. Although the current studies are preliminary, 18F-GP1 may provide not only more accurate anatomic localization, but also information of the risk of the clot growth or embolization. This may lead to changes in clinical intervention to the individual patient.” Medical Imaging International November-December/2017

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Medical Imaging International

Upgraded System Improves Image Reconstruction nnovative patient-centered design helps an improved positron emission tomography/computed tomography (PET/CT) system deliver a safer and more comfortable experience. The Toshiba Medical (Tokyo, Japan; www. toshiba-medical.co.jp) Celesteion PUREViSION Edition PET/CT system possesses a 90 cm wide CT bore that facilitates compliance by creating a sense of openness, thus putting patients at ease and offering versatile positioning for optimal treatment planning. The system includes a 16-row PUREViSION CT detector that acquires high-quality CT images with a 70 cm true field-of-view. To ensure that clinicians do not have to choose between efficiency and safety, the system comes with adaptive diagnostic solutions as standard, such as adaptive iterative dose reduction 3D (AIDR 3D) technology and SUREFLiGHT reconstruction technology, which includes point of spread function and time-of-flight techniques, providing oncologists with sharper images and high contrast for enriched visualization of small tumors throughout the body. Another feature is the single energy metal artifact reduction algorithm (SEMARTM), which helps reduce artifacts caused by metal implants. “We developed the Celesteion PUREViSION Edition with our customers’ needs in mind,” said Dominic Smith, senior director of the CT,

Image: The Celesteion PUREViSION Edition PET/CT system (Photo courtesy of Toshiba Medical Systems).

PET/CT, and MR Business Units at Toshiba America Medical Systems. “Accuracy is everything when treating oncology patients, and Toshiba Medical is committed to providing our customers with the high-quality imaging solutions they require to provide efficient, effective patient care.” PET is a nuclear medicine imaging technique that produces a 3D image of functional processes

in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide tracer. Tracer concentrations within the body are then constructed in 3D by computer analysis. In modern PET-CT scanners, 3D imaging is often accomplished with the aid of a CT X-ray scan performed on the patient during the same session, in the same machine.

Pediatric Abdominal Trauma Ultrasound Shows No Benefit new study concludes that in children with blunt torso trauma, focused assessment with sonography does not improve clinical care, reduce computed tomography (CT) scans, or help identify missed intra-abdominal injuries. Researchers at the University of California Davis (UCD; Sacramento, USA; www.ucd.edu) conducted a randomized clinical study involving 925 hemodynamically stable children and adolescents with blunt torso trauma who were evaluated in the emergency department (ED). Patients were assigned to either standard trauma evaluation or to a focused assessment with sonography for trauma (FAST) examination by the ED physician. Outcomes included rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. A total of 50 patients were diagnosed with intraabdominal injuries. In the standard trauma evaluation group, 254 of 465 (54.6%) children underwent an abdominal CT; in the FAST group, 241 of 460 (52.4%) children had one. Overall, one case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group. The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care group. Median hospital charges were USD 46,415 in the FAST group and USD 47,759 in the standard care group. The study was published on June 13, 2017, in the Journal of the American Medical Association (JAMA). “While ultrasound appears to have the potential

Medical Imaging International November-December/2017

to decrease CT use in children, we wanted to determine whether it actually worked in practice,” said senior author Professor Nathan Kuppermann, MD, chair of emergency medicine at UCD. “In all of the cases where the risk was identified as low, but where CT scans were ordered anyway, we didn’t find one patient who actually had an intra-abdominal injury.” Guidelines for FAST examination published by

the American Institute of Ultrasound in Medicine (AIUM) and the American College of Emergency Physicians (ACEP) recommend evaluation of the torso for free fluid suggesting injury to the peritoneal, pericardial, and pleural cavities, particularly in cases of trauma; examination of the subxiphoid window of the heart to denote pericardial fluid; and evaluation of the lungs to identify pneumothorax.

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

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

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

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MRI Technique to Help Develop Improved Lung Disease Therapies esearchers have found that they can use hyper-polarized helium MRI to develop improved therapies for lung diseases such as cystic fibrosis. There is currently no cure for cystic fibrosis, and many people live with the disorder. The drug ‘ivacaftor’ is used to treat the root cause of the disease, but its effectiveness in each individual patient is unknown. Now, University of Missouri School of Medicine (UMKC; Columbia, MO, USA; https://medicine. missouri.edu) researchers have published the results of a study in which they used the new imaging technique to measure the effectiveness of the drug. The results of the study were published in the April 2017, issue of the Journal of Cystic Fibrosis. According to the researchers, the technique helps them find improved therapies for lung conditions such as cystic fibrosis. Clinicians currently use spirometry to measure lung function, and track their progress over time, but this technique does not work well with pediatric patients. Instead, clinicians use Computed Tomography (CT) scans, that provide structural images of the lungs. These scans however do not show the flow of gas or air. The researchers hope to

apply the new technique, which uses helium3 Magnetic Resonance Imaging (MRI), to babies or young children with impaired lung function. Lead author of the study, Talissa Altes, MD, at the MU School of Medicine, said, “Our study sought to use a new way of imaging the lung to understand how well the drug is working in patients with a specific gene mutation known as G551D-CFTR. We found that after using ‘ivacaftor,’ patients experienced a dramatic increase in lung improvement in both the short and long term. On an MRI, a healthy lung should look completely white when helium-3 is used as a contrast agent. Conversely, areas that are not white indicate poor ventilation. That’s the beauty of this technique – it’s very obvious if the drug is working or not. More drugs are under development to treat cystic fibrosis and other lung conditions, and improved imaging techniques are needed to test their effectiveness. The importance of this technique is that it may well be a cost-effective tool to aid in the development of these drugs. However, it also can help patients know which medications may work best for their unique conditions.”

Image: New research shows hyper-polarized MRI may offer improved therapies for diseases such as CF (Photo courtesy of iStock).

Study Indicates CT Screening Could Improve Cardiac Treatments he results of a new review indicate that Coronary Artery Calcium (CAC) screening for heart disease using Computed Tomography (CT), and other imaging technologies, could enable the early detection of coronary plaques, well before symptoms develop. In approximately 40-60% of cases, heart disease is found only when a patient has a heart attack, or dies. On the other hand screening for breast, lung, and colon cancer is in some cases routine. Heart disease is the leading cause of death in the US, and currently patients are assessed using only historical data in conjunction with a standard blood test.

The review was published in the March 4, 2017, issue of the journal JACC, and included an evaluation of five clinical trials, including 4,615 participants without signs of heart disease. In the first trial cardiac stress imaging was used, three of the trials used CAC cardiovascular imaging, and in the fifth trial researchers used coronary CT angiography. The results indicated that a CAC scan was far more accurate – a higher CAC score correlated with an increased risk for future heart disease. Lead author of the study, chief academic officer Alan Rozanski, MD, division of cardiology, Mount Sinai St. Lukes Hospital (New York, NY, USA;

www.mountsinai.org/locations/st-lukes), said, “The CAC scan can detect heart disease even decades before the symptoms of heart disease may first appear. Additionally, using current state-of-theart scanners, CAC scans are associated with only very low radiation exposure, similar to that of a mammogram, and they are less costly than all other types of imaging. Given these advantages, there is increasing interest in determining whether the use of CAC scanning could lead to earlier and more effective treatment of heart disease. There is now sufficient evidence to support the routine use of CAC scanning for screening in clinical practice.” Medical Imaging International November-December/2017

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Medical Imaging International

New Breast Biopsy System Capable of RT Tissue Imaging he commercial availability of a new, enhanced, groundbreaking real-time breast biopsy and verification system has been announced. The system features a new transformational workflow intended to streamline the entire breast biopsy process, improve the patient experience, and save time and costs. The Brevera breast biopsy system was developed by Hologic (Bedford, MA, USA; www.hologic.com) and uses the CorLumina imaging technology realtime breast biopsy and verification system. The Brevera can increase the accuracy of a biopsy at the point-of-care, and help clinicians by providing realtime imaging. The system is the first integrated system that can provide real-time imaging, tissue acquisition, sample verification, and advanced post-biopsy handling. The system is designed for 3D and 2D breast biopsies. The Brevera system also features integration with a Picture Archiving and Communication System (PACS) to facilitate the transfer of patient records and advanced image sharing. The Brevera system is de-

signed for use with the Affirm prone biopsy and breast biopsy guidance system, and the MultiCare Platinum system, also manufactured by Hologic. Division president, Breast and Skeletal Health Solutions at Hologic, Pete Valenti, said, “We’re proud to launch the Brevera system, a major breakthrough for radiologists who, for the first time, will be able to image and verify tissue samples in real-time in the procedure room. The Brevera system provides clinicians with more information at the point of care and women with a vastly improved experience, resulting in significant cost and timesavings without compromising accuracy or patient health outcomes. The system transforms the stereotactic breast biopsy procedure as we know it, and serves as further proof of Hologic’s commitment to better serve the needs of our customers and their patients.” Image: The Brevera breast biopsy system (Photo courtesy of Hologic).

Post-Surgical X-Rays Predict Bunion Recurrence Risk easuring the hallux valgus angle (HVA) on postoperative x-rays immediately following bunion surgery can reliably predict satisfactory correction and risk of recurrence. Researchers at Yeungnam University (Daegu, South Korea; www.yu.ac.kr) and Injie University Seoul Paik Hospital (Republic of Korea; www. paik.ac.kr) conducted a study in 93 patients (for a total of 117 feet) who underwent proximal chevron osteotomy combined with a distal soft-tissue procedure in order to treat moderate to severe hallux valgus deformity. Changes in hallux valgus angle, intermetatarsal angle, and sesamoid position over time were analyzed by comparing non-weight-bearing radiographs during each postoperative period. The relative risks of recurrence, as indicated by preoperative and postoperative radiographic parameters were then determined. The results showed that hallux valgus angle and inter-metatarsal angle stabilized at six months after surgery in the nonrecurrence group. Hallux valgus recurrence was associated with an immediate postoperative hallux valgus angle higher than 8°, immediate postoperative sesamoid position of grade 4 or greater, a preoperative metatarsus adductus angle of 23° or higher, and a preoperative hallux valgus angle of higher than 40°. The study was published in the July 2017 issue of The Journal of Bone and Joint Surgery. A bunion is a painful bony bump that develops when the metatarsophalangeal (MTP) joints move out of alignment: the long metatarsal bone shifts toward the inside of the foot, and the phalanx bones of the big toe angle toward the second toe. The MTP joint gets larger and protrudes from the inside of the forefoot. The enlarged joint is often inflamed, red, and swollen. The word bunion, in fact, comes from the Greek word for turnip, hinting to its appearance.

Medical Imaging International November-December/2017

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

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

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

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Weight Loss Slows Progression of Joint Degeneration he results of a new study indicate that weight loss in overweight and obese patients can slow down the degeneration of cartilage in the knee. The goal of the research was to investigate the relationship between the progression of changes in the knees of patients, and their weight. Extra body weight causes joints and cartilage to wear away faster, and can also cause changes in the menisci. Being overweight or obese also increase the risk for osteoarthritis. The research team from the University of California San Francisco (UCSF; San Francisco, CA, USA; www.ucsf.edu) published the results of their study online in the May 2, 2017, issue of the journal Radiology. The results of the study showed that a 5% weight loss in patients, during the study period, resulted in lower rates of cartilage degeneration compared with other participants with a stable weight. The decrease in the speed of cartilage degeneration was even more pronounced in those patients who lost 10% of their weight. Light or moderate exercise can also help prevent cartilage degeneration in the knee. Lead author of the study, Alexandra Gersing, MD,

Department of Radiology and Biomedical Imaging, UCSF, said, “For this research, we analyzed the differences between groups with and without weight loss. We looked at the degeneration of all knee joint structures, such as menisci, articular cartilage and bone marrow. The most exciting finding of our research was that not only did we see slower degeneration in the articular cartilage, we saw that the menisci degenerated a lot slower in overweight and obese individuals who lost more than 5 percent of their body weight, and that the effects were strongest in overweight individuals and in individuals with substantial weight loss. Our study emphasizes the importance of individualized therapy strategies and lifestyle interventions in order to prevent structural knee joint degeneration as early as

possible in obese and overweight patients at risk for osteoarthritis or with symptomatic osteoarthritis.” Image: MRI scans of the right knee of a patient using the coronal proton density-weighted fast spinecho fat-suppression sequence (Photo courtesy of RSNA).

Prolonged Prenatal Ultrasound Can Decrease Bone Density new study suggests that prolonged prenatal ultrasound exposure leads to decreased bone density and strength. Researchers at Universiti Teknologi MARA (UiTM; Selangor, Malaysia; www.uitm.edu.my) conducted a study in 22 pregnant New Zealand white rabbits (Oryctolagus cuniculus) to study potential damage and side effects to the developing fetus of ultrasound exposure during osteogenesis. Four rabbits received no ultrasounds, while the others were exposed to ultrasound for 30 minutes, 60 minutes, or 90 minutes once during pregnancy. Each rabbit received only one ultrasound, but timing was varied throughout the three trimesters of pregnancy to see if there were different effects.

They rabbit does gave birth to 142 young, and the researchers analyzed the bunnies’ femurs at one and five months for bone strength. The results revealed that trabecular thickness of the experimental group was reduced significantly as compared to the control group. Porosity, tissue mineral density, and empty lacunae were also higher in the experimental group. The study was published in the January 2017 issue of Pertanika Journal of Science & Technology. “Prolonged exposure to ultrasound during early intrauterine life can cause disturbance in osteogenesis. The effects last until after birth leading to poor bone strength and increasing bone fragility,” concluded study co-author Sulaiman Md Dom, PhD, and colleagues of the department of medical imag-

ing. “The damage in the subjects’ bone was at a faster rate than can be repaired by normal bone remodeling. As a result, bone becomes more fragile and loses its mass.” A rise in temperature of fetal tissue can cause significant damage to a developing fetus’s central nervous system (CNS) and can result in neurological birth defects. In fact, a recent study suggests that exposure to ultrasound early in gestation could increase autism spectrum disorder (ASD) severity. Osteogenesis is also very sensitive to heat exposure, and a temperature rise can lead to denaturation of the enzymatic and membrane proteins, microcirculation blockage, bone tissue necrosis, and activation of bone marrow macrophages. Medical Imaging International November-December/2017

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Medical Imaging International

Linear Accelerator Powers Novel Radiation Therapy System next-generation linear accelerator (linac)-based magnetic resonance imaging (MRI)-guided radiation therapy (RT) system improves treatment efficacy. The ViewRay (Oakwood Village, OH, USA; www.viewray.com) MRIdian Linac system integrates real-time MRI, linac-based RT delivery, and intelligent software automation to provide high-quality pretreatment images and continuous soft-tissue imaging during RT treatment, in real time, in order to accurately align the tumor to the treatment beams, adapt or reshape treatment volume, and to accommodate changes in the shape and location of the tumor and healthy internal structures. The system includes a rotating gantry assembly that a houses a compact inline S-band 6 MV standing wave linac, with side-coupled cavities and double focused multi-leaf collimator technology; a patented magnetic and RF shielding technology that isolates the workings of the linac and the MRI system from each other; and a 0.35 T split magnet designed for unrestricted beam path, volumetric, and multi-planar soft tissue imaging. The system also includes a patient couch with three degrees of freedom, two in-room couch control panels, and a laser positioning system to facilitate initial patient setup. A planning station helps define structures and constraints for initial planning and re-optimization of RT treatments and management of the treatment delivery process, and also supports subsequent reviews via a database server containing patient and machine data. A control console just outside the treatment room is paired to an operator console for MRI acquisition, patient positioning, dose prediction, and real-time tumor tracking. The MRIdian Linac system has been approved by the U.S. Food and Drug Administration (FDA). “With MRI-guided radiation therapy, we’re able to watch the movement of tumors and organs in the body as radiation is being delivered and adapt the dose of radiation in real time, to help ensure the maximum dose reaches the tumor and that surrounding healthy tissue is spared,” said Sasa Mutic, PhD, director of radiation oncology physics at Washington University School of Medicine (WUSTL; St. Louis, MO, USA; www.medschool.wustl.edu). A linac uses microwave technology to accelerate electrons, forming high energy x-rays that can be shaped to conform to the shape of the patient’s tu-

mor in a customized beam. The beam may be shaped either by blocks or a multileaf collimator incorporated into the head of the machine. RT can be delivered to the tumor from any angle by rotating the gantry and moving the treatment couch. Image: The MRIdian Linac radiation therapy system (Photo courtesy of ViewRay).

Headband Images Brain During Conversations iomedical engineers and psychologists are using a brainimaging headband to investigate how brains interact and synchronize when humans communicate with each other. The functional Near-Infrared Spectroscopy (or fNIRS) device uses light to measure neural activity in the brain, and can be worn as a headband. According to the researchers this is only one of many applications for fNIRS systems. The results of the study were published online in the February 27, 2017, issue of Scientific Reports, by researchers from Drexel University (Philadelphia, PA, USA; www.drexel. edu), and Princeton University (Princeton, NJ, USA; www.princeton.edu). The researchers previously used functional Magnetic Resonance Imaging (fMRI) to study what mechanisms the human brain uses to help us produce and comprehend language. The researchers found that the brain activity of both a listener and the speaker are mirrored when the speaker relates a story about a real-life experience.

Medical Imaging International November-December/2017

The researchers also found that improved coupling was associated with improved understanding. However fMRI equipment is noisy and bulky, and cannot be used to image several individuals speaking face-to-face. As an alternative the researchers explored the use of fNIRS for studying the prefrontal and parietal brain regions, including areas related to cognitive and higher-order understanding. Another goal of the researchers was to compare the fNIRS and fMRI methods. Research team leader, Hasan Ayaz, PhD, associate research professor, Drexel School of Biomedical Engineering, Science and Health Systems, said, “Being able to look at how multiple brains interact is an emerging context in social neuroscience. We live in a social world where everybody is interacting. And we now have a tool that can give us richer information about the brain during everyday tasks – such as natural communication – that we could not receive in artificial lab settings or from single brain studies.” LINKXPRESS COM

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The Amadeo P offers high performance in miniature format using only a standard power connection. Its low weight, user-friendly operation and integrated interface for use with a digital system enable various fields of application in medical practices, hospitals and emergency medicine.

The ECHELON Smart offers superb clinical images, sophisticated applications, reduced exam time, quiet patient experience, low running costs and the smallest possible installation footprint. It features a 1.5T superconducting system for fast scanning and offers a wide range of sequences.

The Aquilion LB features a 90-centimeter bore and optional high-capacity couch that holds up to 660 pounds. It also has a 70-cm FOV with an optional extended 85-cm FOV, making it suitable for hospital radiation oncology departments, as well as free standing radiation oncology centers.

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Novel Work Surface Facilitates Interventional Radiology stable, radiolucent platform placed over the patient during femoral artery access procedures replaces the current practice of laying procedural equipment over the patient’s legs. The Adept Medical (Auckland, New Zealand; www.adeptmedical.co.nz) IR Platform provides an ultimate stable solution for interventional radiologists during catheter and guide wire manipulation, with a large work area for laying out equipment. The platform can be set up at two different lengths according to equipment needs; the stand-alone platform is suited for shorter wire procedures such as rapid exchange catheter systems, while an attachable extension adds extra length when using overthe-wire catheter systems or neuroradiology wires. Placed over the patient’s legs once they are in a supine position on the imaging table, the IR Platform is made of a carbon fiber composite that is light, radiolucent, strong, and easy to set up and remove for each patient. The platform can be heightadjusted to suit the specific patient size, ensuring the platform surface’s feathered leading edge can be

exactly aligned with the planned femoral access site. When needed for restless patients, the IR platform can also be locked down to ensure that their movements will not dislodge it. “This is a specially designed clinician work surface offering stability, a secured work surface over a restless patient, and vast work area with additional extension piece,” noted the company in their blog. “These procedures require long wires, sometimes

up to three meters in length that are fed in to the patient’s vascular system through the femoral artery. They could be ablating an embolism in the brain of stroke patient or placing a stent in the coronary artery, both of which require fine control of the wire.” Image: A novel platform provides a stable environment for femoral PCI procedures (Photo courtesy of Adept Medical).

FDA Approves Ultrasound Aimed At Liver Tissue Assessment he US Food and Drug Administration (FDA) 510(k) has approved the use of new Ultrasound Shear Wave Elastography (SWE) functionality, with an existing family of ultrasound systems, for liver tissue-stiffness assessment. The new functionality will enable simultaneous imaging of tissue together with stiffness assessment, and will help clinicians diagnosis various liver conditions such as hepatitis B and C, cirrhosis of the liver, and liver cancer. The US FDA approved the new SWE functionality the ElastQ ultrasound system manufactured by Royal Philips (Amsterdam, the Netherlands, www. philips.com). ElastQ imaging provides a non-invasive, reproducible, and comprehensive solution for the assessment and diagnosis of liver conditions. Ul-

trasound SWE technology could in the future become routine for assessing the status of liver disease in patients, and could help reduce or even avoid the need for painful invasive liver biopsies. ElastQ Imaging shear wave elastography provides a large Region of Interest (ROI), color-coded quantitative tissue-stiffness assessment, real-time feedback, intelligent analysis, and quantitative measurements using multiple sample points. Ultrasound Business Leader at Philips, Vitor Rocha, said, “Philips aims to provide the tools necessary for assessing and managing chronic conditions that so many people face, and liver disease is no exception. We know that liver disease is a growing health concern around the globe, and we are committed to pioneering innovations like ElastQ

Imaging to create our ultimate ultrasound liver solution that offers exceptional clinical performance, further improving patient care.” Image: Liver disease assessment using the ultrasound ElastQ Imaging SWE functionality is faster and than a tissue biopsy, and noninvasive (Photo courtesy of Philips Healthcare). Medical Imaging International November-December/2017

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Research Shows MRI-DTI Techniques Can Track mTBI n a recent study, researchers found a total of seven brain-imaging predictors that were related to cognitive function in professional fighters. Some of these predictors showed changes in the thickness and volume of gray matter, and in the integrity of the white matter tracts of the fighter’s brains. The researchers from the Cleveland Clinic Lou Ruvo Center for Brain Health (Las Vegas, NV, USA; https://my.clevelandclinic.org) used a combination of T1-weighted Magnetic Resonance Imaging (MRI) and Diffusion-Tensor Imaging (DTI) to look at both gray and white matter brain tissue. The study included data from 273 male fighters who also underwent neuropsychological, processing speed, and psychomotor speed tests. The study results showed that two of the seven imaging predictors, T1-weighted volume measurements of the left thalamus, and fractional anisotropy values for two white matter tracts, could help clinicians distinguish fighters with and without cognitively impairment. Lead author of the study Virendra Mishra, PhD, said, “DTI is specific to the white matter part of the brain and T1-weighted images are sen-

Study Shows Advantages Of Brachytherapy for Prostate Cancer Treatment new study has shown that brachytherapy treatment of prostate cancer patients using the Cesium-131 Isotope provides a targeted, fast-acting treatment, within a 30-day delivery time, that is significantly better than other isotopes. While many prostate cancer patients still undergo costly invasive surgery, or long-term radiation treatment, then new brachytherapy treatment could provide a more cost-effective and safer alternative with fewer side effects. The study was published in the August 1, 2017, issue of the International Journal of Radiation Oncology, Biology and Physics. The researchers evaluated the long-term Quality of Life (QOL) scores reported by patients with prostate cancer, and showed that treatment using the newest brachytherapy isotope, Cesium-131, reduced the QOL and the length of the recovery period. The faster-acting Cesium-131 isotope is made by Isoray Medical (Richmond, WA, USA; www.isoray.com) and enables patients to recover faster from the radiation side effects, and return to normal bowel, urinary, and sexual function than those treated with other brachytherapy isotopes. Isoray uses a new proprietary process to manufacture the Cesium-131 brachytherapy isotope seeds. Chicago Prostate Cancer Center medical director, Dr. Brian Moran, said, “For far too long, patients have been treated for prostate cancer based on a medical professionals’ familiarity or, in some cases, due to far greater financial benefits to the physician. This study reinforces that a new, patient-friendly treatment exists. Brachytherapy with Cesium-131 leverages the isotope’s short half-life to significantly reduce the duration of long-term symptoms and side effects.”

Medical Imaging International November-December/2017

sitive to the gray matter. By combining these approaches, we hoped to find imaging biomarkers on MRI that could be used to predict whether or not fighters will become impaired. We found lower gray matter volume and thickness measures along with lower white matter tract integrity at baseline measurements that declined over time in those with ongoing trauma, and only by looking at both were we able to predict which fighters would be cognitively impaired. The combined observation of both gray and white matter as useful predictors of cognitive impairment is understandable because these two types of brain tissue work in tandem.” Image: The results of a new study show that MRIDTI can help clinicians predict cognitive impairment and Mild Traumatic Brain Injuries (mTBI) in professional fighters (Photo courtesy of iStock).

Medical Imaging International

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The GM85 improves user convenience when moving through narrow hallways and being positioned in tight patient rooms. Its advanced imaging functions ensure superior image quality for accurate diagnoses, while its multi-touch function allows users to control and adjust images easily.

The iSono works with a tablet or smartphone and uses advanced digital imaging technology for delivering clear images. Small and light, easy to carry, it comes with a built-in and replaceable battery and is suitable for use in emergencies, clinics and outdoor inspections.

The MyLab 9 eXP offers smart upgradability, remote serviceability, long-term maintenance options and transducer compatibility. It offers an ultra-ergonomic experience and has been developed to provide ultra-quality technology to hospitals, clinics and private practices.

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MR-Linac System for Difficult Cases Unveiled n innovative new MR/RT system that could change cancer care especially for cases that are difficult to treat has been unveiled. The manufacturer expects the system to go on sale in Europe and globally, later in 2017, when it is expected to receive the CE Mark (Conformité Européenne). The Elekta Unity was developed by Elekta (Stockholm, Sweden; www. elekta.com) and is the only Magnetic Resonance Radiation Therapy (MR/RT) system that combines a premium diagnostic quality (1.5T) MRI scanner with an advanced linear accelerator (linac). The system is designed to deliver a precise radiation dose, and at the same time capture high-quality MR images. This will enable clinicians to visualize tumors, and adapt treatment. Unity features a compact, 70 cm wide-bore MRI, a table with a low load height for patient comfort and a soft tabletop, and non-glare room lighting. Unity is the fruit of a global partnership consortium set up by Elekta with Royal Philips (Amsterdam, the Netherlands; www.philips.com) as MR technology partner. The consortium has also developed new clinical and workflow protocols for the system. Conceptual architect and inventor of the system, Professor Jan Lagendijk, PhD, Head Radiation Oncology, University Medical Center Utrecht (UMC; Utrecht, Netherlands; www.umcutrecht.nl), said, “We started the development of an integrated MR-linac system 18 years ago; the presentation of the clinical system is a huge milestone. This system will enable tumor dose escalation and extreme nor-

mal tissue sparing, it will also enable shorter and more effective treatment regimens, while its ability to perform functional imaging has the potential to perform better dose painting and tumor response assessment.” Image: The Unity MR-linac system was unveiled at the ESTRO 36 meeting in Vienna, Austria (Photo courtesy of Elekta).

Advanced Mid-Range Ultrasound Systems Unveiled wo new mid-range ultrasound systems that include advanced image quality and technologies from high-end systems have been showcased. The new systems are designed for use in clinical practices and include innovative features such as advanced volume imaging and measurement capabilities, and a simplified workflow. The compact HS50 and HS60 ultrasound system were unveiled by Samsung (Seoul, Korea; www.samsungmedical solution.com), and already received US FDA clearance in Spring 2017. The HS50 and HS60 use Samsung’s advanced Digital Signal Processing techniques together with hybrid beamform technology to provide improved image quality. Clinical decision-making, treatment planning, and efficiency are enhanced by features such as advanced 3D/4D diagnostic views, a new simplified workflow, and new timesaving tools. The systems are intended for general imaging, Obstetrics and Gynecology, musculoskeletal, and other clinical practices. Additional features of the new systems include faster Solid State Drive (SSD) storage, one-touch Quick Preset for se-

lecting common transducer and preset combinations, and QuickScan that provides optimized gray scale and Doppler parameters. The systems also include a 21.5-inch LED monitor, S-Vue wide-bandwidth transducers for improved depth penetration and resolution, Realistic Vue for high-resolution 3D anatomy, and S-Harmonic for improved near-to-far field image uniformity, and reduced signal noise. The HS60 system also includes the Samsung E-Strain feature for the calculation of the strain ratio between two regions of interest. President and CEO of Samsung NeuroLogica, Phil Sullivan, said, “With the introduction of the HS50 and HS60, Samsung is able to bring the exceptional image quality and penetration that our high-end customers have come to expect and rely on to a wider audience. With its smaller footprint and affordability, it will allow more clinicians to provide their patients the very best of care.” Image: The new mid-range HS60 ultrasound system that includes advanced high-end technologies (Photo courtesy of Samsung). Medical Imaging International November-December/2017

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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 Embolization 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 navigate 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).

Annual Mammogram Proves Most Effective To Prevent Cancer esearchers comparing breast cancer screening recommendations have found that annual screening starting from age 40 would reduce breast cancer-specific deaths by the highest percentage. The researchers used computer models to investigate the effectiveness of three annual screening strategies that were also programmed to look for risks related to screening such as callbacks for more imaging scans, or a needle biopsy to find false positive results. The study was led by researchers from Weill Cornell Medicine (New York, NY, USA; http://weill. cornell.edu), New York-Presbyterian (New York, NY, USA; www.nyp.org), and the University of Colorado School of Medicine (Aurora, CO, USA; www. ucdenver.edu), and was published in the August 21, 2017, issue of the journal Cancer. The goal of the study was intended to uncover insights to help women make the best choices for mammography screening. The first screening strategy consisted of screening from age 40 years; the second consisted of annual screening beginning at ages of 45 to 54 years, with additional biennial screening for 55 to 79 year olds. The third strategy consisted only of biennial screening for 50 to 74 year olds. The results showed that screening beginning at age 40 reduced breast cancer-specific deaths by nearly 40%, while the other recommendations reduced deaths from the disease by between 23% and 31%. Elizabeth Kagan Arleo, MD, Weill Cornell Medicine, and New York-Presbyterian, said, “Our findings are important and novel because this is the first time the three most widely discussed recommendations for screening mammography have been compared head to head. Our research would be put to good use if, because of our findings, women chose to start annual screening mammography starting at age 40. Over the long term, this would be significant because fewer women would die from breast cancer.”

Medical Imaging International November-December/2017

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PACS DATA MANAGEMENT

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

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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 lungnodule 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 quantified patient tracking are becoming increasingly im-

portant 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 Patients esearchers have shown that cardiologists could benefit from using patient-specific 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: Cardiovas-

cular 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 November-December/2017

PRODUCT NEWS PET/CT IMAGE VIEWER

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

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

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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.”

Image: The Sectra Education Portal allows medical students and staff to interact with virtual representations of bodies rendered from clinical images, enhancing their clinical training and medical education (Photo courtesy of Sectra).

Upgrade Enables Searches across Multiple Clinical Archives n upgrade for a routing workflow system allows 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. Security improvements include support for LDAP user authentication support for protection against cyber-security threats, and improved audit logging functionality that helps enhance system monitoring, and troubleshooting. 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. Medical Imaging International November-December/2017

Industry News

Two Leading Developers of Research-Oriented Imaging Join Forces nvicro, LLC (Boston, MA, USA; www. invicro.com), a provider of imaging services and software for research and drug development, has acquired Imanova (London, UK; www.imanova.co.uk), a translational research company that specializes in applying positron emission tomography (PET) and magnetic resonance imaging (MRI) scanning techniques to improve productivity in early drug development and to help improve disease understanding. Invicro and Imanova will merge all activities to establish the world’s largest provider of translational imaging services and analytics from pre-clinical development through to latephase clinical trials. Invicro focuses on improving the role and function of imaging in translational drug discovery and development across all therapeutic areas. The company provides a full range of image informatics, engineering and operational services. Through its preclinical and clinical divisions, Invicro develops and leverages the latest approaches in imaging

Toshiba to Change Name to Canon in January oshiba Medical Systems Corporation (Otawara, Tochigi Prefecture, Japan; www.toshibamedicalsystems.com) will change its company name to Canon Medical Systems Corporation on January 4, 2018. The decision by Toshiba Medical to change the company’s name comes after it officially became a subsidiary of Canon Inc. (Tokyo, Japan; www.global.canon/en) in December 2016. After leaving the Toshiba Group and joining the Canon group, Toshiba Medical Systems has been undertaking the procedures for obtaining regulatory approval for integration with Canon and change of the company name under the relevant national or regional laws concerning pharmaceuticals and medical devices. Since it is now close to completing these procedures, the company has announced that its name will be changed to Canon Medical Systems Corporation on January 4, 2018. Toshiba Medical has a broad portfolio of medical imaging products, including diagnostic X-ray systems, X-ray computed tomography (CT) systems, magnetic resonance imaging (MRI) systems, diagnostic ultrasound systems, and diagnostic nuclear medicine systems. The company also offers medical imaging solutions and in-vitro diagnostics for individualized care. Canon, which currently produces equipment such as digital X-ray imaging systems and OCT ophthalmic devices, aims to leverage Toshiba Medical’s core strength in imaging diagnostics, further reinforce its operational strength in the in-vitro diagnostics business and next-generation medical IT through M&A and other strategic investment, in order to strengthen its own biomedical business. Toshiba Medical has reiterated its commitment to continue strengthening and expanding the healthcare business, which is strategically important to Canon, while contributing to healthcare worldwide.

Medical Imaging International November-December/2017

quantitative biomarkers. Imanova, an alliance between the UK’s Medical Research Council, Imperial College London, King’s College London and University College London, acts as a conduit between academia and industry. Imanova is among the leading players in the application of PET and MR imaging, with a focus on translational research to support the transition from pre-clinical studies to Phase I/II studies in humans. The services of the combined business cover the entire translational spectrum, ranging from novel biomarker evaluation and development in early discovery to late-phase clinical trials support. The addition of Imanova is part of Invicro’s ongoing growth strategy to realize its mission to improve therapeutic discovery and development efforts through visualizing and quantifying biological and pathological processes in order to better diagnose, characterize, prevent, treat and, ultimately, cure disease. “Joining forces with the phenomenal research

team at Imanova expands our translational, analytic and geographic offering. Our groups share a common mission of improving research trials through the development and application of quantitative imaging biomarkers,” said Dr. Jack Hoppin, Invicro’s Co-Founder and CEO. “Our combined research teams hold a collective pride in the development of novel offerings in discovery as well as the engineering of scalable, reproducible solutions for deployment in late-phase development.” “Invicro develops innovative analytical approaches for clinical trials, which are highly complementary with our own. Combining Invicro’s and Imanova’s analytics platforms means we have a best-in-class imaging informatics team to help reduce risk in drug development,” said Dr. Kevin Cox, Imanova’s CEO. “As a combined enterprise we will be a truly translational quantitative biomarker company, with an expanding late-phase clinical trial offering, able to meet the needs of a growing global market.”

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

APRIL 2018

International Calendar Medical Imaging International

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 19-20; 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.saudihealthexhibition.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

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Breast Imaging in the Caribbean. Jan 7-10; Grand Cayman, Cayman Islands; Web: www. pennmedicine.org Gastrointestinal Cancers Symposium. Jan 18-20; San Francisco, CA, USA; Web: http://gicasym.org Maternal-Fetal Imaging 2018 - Advances in Ob-Gyn Ultrasound. Jan 19-21; San Antonio, TX, USA; Web: www.ptmg.com TOPIM 2018 - Imaging Inflammation. Jan 2116; Les Houches, France; Web: www.topim.eu The 17th Asian Oceanian Congress of Radiology. Jan 25-28; Mumbai, India; Web: https://aocr2018.org Arab Health 2018. Jan 29-Feb 1; Dubai, UAE; Web: www.arabhealthonline.com

FEBRUARY 2018 2018 Genitourinary Cancers Symposium. Feb 8-10; San Francisco, CA, USA; Web: http://gucasym.org SPIE Medical Imaging 2018. Feb 10-15; Houston, TX, USA; Web: http://spie.org Frontiers in Cardiovascular Biology 2018. Feb 20-22; Vienna, Austria; Web: www.escardio.org 10th German Cardio Diagnostics Days. Feb 22-24; Leipzig, Germany; Web: www.kardiodiagnostik.de 46th Meeting of Society of Critical Care Congress. Feb 25-28; San Antonio, TX, USA; Web: www.sccm.org ECR 2018 - European Congress of Radiology. Feb 28-Mar 4; Vienna, Austria; Web: www.myesr.org

Acute Cardiovascular Care 2018. Mar 3-5; 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.abdominalradiology.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 1722; 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 - American Institute of Ultrasound in Medicine. Mar 2428; New York, NY, USA; Web: www.aium.org/ annualConvention 50th International Diagnostic Course Davos. Mar 25-29; Davos, Switzerland; Web: www. idkd.org

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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

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Trauma & Emergency Surgery. May 6-8; Valencia, Spain; Web: www.estesonline.org 99th German Congress of Radiology. May 912; Leipzig, Germany; Web: www.roentgenkongress.de Swiss Congress of Radiology 2018. May 1012; 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; Web: www.cmef.com.cn SPR 2018 - Annual Meeting of Society for Pediatric Radiology. May 16-19; Nashville, TN, USA; Web: www.pedrad.org CRCPD Annual Meeting 2018 - Conference of Radiation Control Program Directors. May 21-24; Charleston, SC, USA; Web: www.crcpd.org Heart Failure 2018. May 26-29; Vienna, Austria; Web: www.escardio.org SIIM 2018 - Society of Imaging Informatics in Medicine. May 31-Jun 2; National Harbor, MD, USA; Web: http://siim.org

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International Calendar tional Oncology. Jun 7-10; Boston, MA, USA; Web: http://wcioevents.org ESGAR 2018 - 27th Annual Meeting and Postgraduate Course. Jun 12-15; Dublin, Ireland; Web: www.esgar.org ISMRM-ESMRMB Joint Annual Meeting 2018. Jun 16-21; Paris, France; Web: www.esmrmb.org ESPR 2018. Jun 18-22; Berlin, Germany; Web: www.espr2018.org CARS 2018 - Computer Assisted Radiology and Surgery. Jun 20-23; Berlin, Germany; Web: www.cars-int.org ASE 2018 Annual Scientific Sessions American Society of Echocardiography. Jun 22-26; Nashville, TN, USA; Web: http://asescientificsessions.org

JULY 2018 UKRC 2018 - The UK Radiological Congress. Jul 2-4; Liverpool, UK; Web: www. ukrc.org.uk FIME 2018 - Florida International Medical Exhibition. Jul 17-19; Orlando, FL, USA; Web: www.fimeshow.com/exhibit.cfm EMBC 2018 - 40th Annual International Conference Of The IEEE Engineering In Medicine And Biology Society. Jul 17-21; Honolulu, HI, USA; Web: http://embc.embs.org AAPM 2018 - Spring Clinical Meeting - American Association Of Physicists In Medicine. Jul 29-Aug 2; Nashville, TN, USA; Web: www.aapm.org

AUGUST 2018 ESC 2018 - European Society of Cardiology Congress. Aug 25-29; Munich, Germany; Web: www.escardio.org

SEPTEMBER 2018 Euroson 2018 - Congress of the European Federation of Societies for Ultrasound. Sep 6-9; Poznan, Poland; Web: www.euroson2018 poznan.pl ESUR 2018 - European Symposium on Uro-

genital Radiology. Sep 13-16; Barcelona, Spain; Web: https://esur2018.org CIRSE 2018 - Cardiovascular and Interventional Radiological Society of Europe. Sep 22-26; Lisbon, Portugal; Web: www.cirse.org ISS 2018 - International Skeletal Society Annual Meeting and Musculoskeletal Imaging Course. Sep 26-28; Berlin, Germany; Web: www.internationalskeletalsociety.com

OCTOBER 2018 Baltic Congress of Radiology. Oct 4-6; Kaunas, Lithuania; Web: www.radiologija.lv Image Soundly - Society of Radiologists in Ultrasound (SRU) Annual Meeting. Oct 5-7; San Diego, CA, USA; Web: www.sru.org JFR 2018 - Journees Francophone de Radiologie. Oct 12-15; Paris, France; Web: http://jfr.radiologie.fr 28th World Congress on Ultrasound in Obstetrics and Gynecology. Oct 20-24; Singapore; Web: www.isuog.org UEG Week 2018 - United European Gastroenterology. Oct 20-24; Vienna, Austria; Web: www.ueg.eu ASTRO 2018 - 60th Annual Meeting of American Society for Therapeutic Radiology and Oncology. Oct 21-24; www.astro.org

NOVEMBER 2018 Medica 2018. Nov 12-15; Dusseldorf, Germany; Web: www.medica.de RSNA 2018 - Annual Meeting of Radiological Society of North America. Nov 25-30; Chicago, IL, USA; Web: www.rsna.org IEEE 2018 - Nuclear Science Symposium and Medical Imaging Conference. Nov 9-17; Sydney, Australia; Web: www.ieee.org

DECEMBER 2018 EuroEcho-Imaging 2018. Dec 6-9; Lisbon, Portugal; Web: www.escardio.org

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Medical Imaging International November-December/2017

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Vol. 27 No.4 11-12/ 2017

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