Medical Imaging International December 2018

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Vol.28 No.4 11-12 / 2018 ISSN 1068-1779

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Clinical News . . . . . 3-21 PACS/ IT Update . . 21-24 Product News . . . . . 6-24 Industry News . . . . . . 25 International Calendar . 26

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Medical Imaging International

7T Scanner Provides Detailed Maps of Brain Activity new generation of highly sensitive 7 Tesla (7T) functional magnetic resonance imaging (fMRI) scanners can create precise maps of the brain before surgery so as to avoid damaging vital areas.

A dynamic fMRI image correction process developed by researchers at the Medical University of Vienna (MedUni; Austria; www. meduniwien.ac.at) for pre-surgery planning uses the 7T scanner multi-channel coils to create individual three-dimensional (3D) maps of the brain, with functional areas localized within the anatomy of the brain by using a dualecho gradient echo reference scan and by calculating the phase offsets between the coils, which yields estimates with high signal-tonoise ratio.

Before the functional measurements start, the contribution of the 7T scanner to the measured signals is determined precisely. The resulting correction factor is then deducted from the fMRI images during the image computation.

Neurologists can then decide whether surgery is useful, or even possible, and also determine which parts of the brain need to be spared at all costs. In a follow-up project, the researchers intend to develop methods to help determine the best possible location for deep brain stimulation (DBS) probes in patients suffering from Parkinson’s disease. A study describing the process was published in the March 2018 issue of Neuroimage.

“The higher magnetic field strength provides faster images of the brain functions at a higher resolution, but they are also more susceptible to distortions, which lead to imprecise functional imaging,” said lead author Simon Robinson, PhD, of the MedUni High Field MR Centre of Excellence.

“In this way we are able to see, for instance, whether the language center has been displaced by a tumor. Unfortunately, the distortions of the magnetic field caused by bones, tissue and air are also stronger with 7T, which has implications for the mapping accuracy.”

Functional MRI measures brain activity by detecting changes associated with blood flow, based on the fact that cerebral blood flow and neuronal activation are coupled. Since the early 1990s, fMRI has come to dominate brain-mapping research because it does not require people to undergo shots or surgery, to ingest contrast agents, or be exposed to ionizing radiation. Using blood oxygen level dependent (BOLD) contrast, fMRI can localize activity to within millimeters, but only for a few seconds.

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Image: In preparation for surgery, fMRI scanners can map cerebral blood flow (Photo courtesy of Siemens Healthcare).

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Medical Imaging International

Wireless Ultrasound Device Scans Breasts at Point of Care novel portable ultrasound scanner transmits images wirelessly to smart devices and integrates with picture archiving and communication systems (PACS) or the cloud. The Hologic (Bedford, MA, USA; www.hologic.com) Viera portable breast ultrasound scanner is designed to be carried around for diagnostic and visual confirmations, as well as to guide point-of-care (POC) interventional procedures such as vascular access, nerve blocks, and targeted injections. Preset modes for breast, dense breast, and interventional procedures simplify workflow, with a customizable annotations package that enables efficient documentation, and a breast reporting package for quickly documenting services, ensuring accurate billing and audit.

Viera is constructed with a tough magnesium shell to withstand busy hospitals and other unpredictable environments. Features include an intuitive user interface with “point and shoot” simplicity, on-demand high-resolution images using a 14-4 MHz linear transducer with 192 elements, four software beam-formers, support for B,M, computational fluid dynamics (CFD), placental mesenchymal dysplasia (PMD), Doppler, and needle ultrasound enhancement modes, with automated gain and frequency settings.

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The system works with a mobile app that produces high-resolution images and transmits them wirelessly to most iOS or Android smart devices.

“As the global leader in breast cancer screening technology, Hologic continues to introduce breakthrough innovations that deliver superior clinical outcomes and experiences for clinicians and patients alike,” said Pete Valenti, president of breast and skeletal health solutions at Hologic. “The latest addition, our new Viera system, offers exceptional image quality and streamlined workflow, making it a natural and exciting addition to our growing portfolio of cutting-edge breast and skeletal health solutions.”

The Viera breast ultrasound scanner is the result of an exclusive worldwide agreement for distribution of Clarius Mobile Health (Burnaby, BC, Canada; www.clarius.me) wireless ultrasound scanners for breast applications. It works with the Clarius App on iOS and Android smart devices.

Image: The Viera portable breast ultrasound scanner (Photo courtesy of Hologic).

MRI Reveals Early Impact of Hypertension on Dementia Risk new study shows how magnetic resonance imaging (MRI) can reveal previously undetectable white matter (WM) brain damage induced by hypertension, a major risk factor for dementia.

Researchers at IRCCS Neuromed (Pozzilli, Italy; www.neuromed.it) and Sapienza University (Rome, Italy; www.uniroma1.it) conducted a study involving 42 outpatients (40-65 years of age), of whom 23 were hypertensive and 19 normotensive. The researchers first measured the cognitive performance of study participants with no signs of dementia or structural brain changes (as determined by a neuroradiologist), based on conventional MRI on T1 and AX DP/T2 scans. They then repeated imaging using WM fiber-tracking technology on a GE Healthcare (GE; Little Chalfont, United Kingdom; www.gehealthcare.com) 3T Signa Horizon scanner.

In addition, a blinded, certified psychologist tested cognitive function and looked for any impairment of activities of daily living at baseline.

Participants then underwent Montreal Cognitive Assessment (MoCA) neuropsychological testing. When specific MoCA cognitive subdomains were analyzed, the hypertensive group displayed significantly impaired memory, executive function, attention, and language domains, and scored worse on verbal paired-asso-

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ciate learning. Hypertension also appeared to impair executive function, as measured on the Stroop test.

When comparing WM finding between those with and without hypertension, specific signatures for dementia risk among hypertensive patients involved deterioration of projection fibers of the right anterior thalamic radiation (ATR), association fibers of the right superior longitudinal fasciculus (SLF), and callosum fibers of the forceps minor (FMI). The researchers concluded that WM tracking could identify patients in initial stages of brain damage that could benefit from therapies aimed at limiting the transition to dementia and neurodegeneration. The study was published on June 12, 2018, in Cardiovascular Research.

The ATR is a projection fiber that connects the thalamus’s anterior nucleus to the anterior cingulate gyrus and frontal cortex, and ATR damage is associated with impaired memory. The SLF connects the cerebrum parietal and occipital and temporal lobes with the ipsilateral frontal cortices; it facilitates the formation of a bidirectional neural network necessary for cognitive functions, such as attention, memory, emotions, and language. The FMI connects the frontal lobes’ lateral and medial surfaces, crosses the midline via the genu of the corpus callosum, and has been linked to processing speed tasks.

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ISSN 1068-1779 Vol.28 No.4. Published, under license, by Globetech Media, LLC. Copyright © 2018. All rights reserved. Reproduction in any form is forbidden without express permission.

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Medical Imaging International

New MRI Device Offers Fully Guided Patient Setup new magnetic resonance imaging (MRI) scanner and an integrated suite of software innovations enable clinicians to perform exams up to 50% faster without compromising image quality.

The Royal Philips (Amsterdam, The Netherlands; www.philips.com) Ingenia Elition 3T MRI scanner presents a patient-centric imaging experience from initial set-up to final image. The system features the VitalScreen user interface for workflow optimization, which provides operators with fully guided patient setup, and VitalEye, which senses the patient and detects breathing automatically, without the need for operator interaction. Using both technologies allows a routine examination to be launched in less than a minute, significantly improving scanner utilization.

Other features include SmartExam capability, an artificial intelligence (AI) platform for the planning, scanning, and processing of scans; dStream digital broadband technology; 3D APT, a contrast-free brain MRI solution that differentiates low-grade and high-grade gliomas; compressed SENSE, which reduces scan time by 50% while delivering sharp images for all 2D and 3D scans in all anatomies with anatomical contrasts; and the Philips Ambient Experience and Connect solution, which engages the patient using video and audio to reduce the claustrophobic experience and the need for rescans.

“As value-based care initiatives challenge healthcare organizations to drive better outcomes, radiology departments are specifically caught between ever-increasing imaging volume demands, while also facing pressure to engage more deeply with both referring physicians and patients,” said Arjen Radder, global business leader for MRI at Philips. “Philips is re-

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sponding to these challenges through the development of solutions such as Ingenia Elition to improve image quality and the patient and staff experience, as well as operational efficiency.”

“To deliver fast, consistent and accurate diagnoses, our staff need to be supported with technology that gives them the ability to provide the best patient care, in an efficient and cost-effective way,” said Chip Truwit, MD, chair of radiology at Hennepin Healthcare. “Philips’ Ingenia Elition plays a critical role in elevating the standard of care for our patients in imaging and in improving overall operations in our new imaging center.”

Image: The Ingenia Elition 3T MRI scanner (Photo courtesy of Royal Philips).

Wearable MRI Detector Captures Anatomical Motion new study describes how a magnetic resonance imaging (MRI) element woven into a glove-like detector could aid the diagnosis of repetitive strain injuries such as carpal tunnel syndrome.

Researchers at NYU Langone Medical Center (New York, NY, USA; www.med.nyu.edu) and New York University (NYU, USA; www. nyu.edu) have designed a wearable detector array for MRI of the hand that is based on high-impedance coils that can cloak themselves from electrodynamic interactions. The MRI signal is produced by hydrogen protons; since no electric current is created by the MRI signal, the new receiver coils no longer create magnetic fields that interfere with neighboring receivers, thus removing the need for rigid structures. The coils do not suffer from signal-to-noise (SNR) degradation mechanisms typically observed with the use of traditional low-impedance elements.

While MRI can efficiently image muscles, nerves, and even cartilage, which are difficult to study using other non-invasive methods, tendons and ligaments, which are made of dense proteins instead of fluid, remain difficult to see independently, because both appear as black bands running alongside bone. But with the new coils stitched into a cotton glove, they could generate images of freely moving muscles, tendons, and ligaments.

The new coils revealed how the black bands moved in concert with the bones, which could help to catalogue differences that come with injury. The study was published on May 4, 2018, in Nature Biomedical Engineering.

The densely packed resonant structures used for MRI, such as nuclear magnetic resonance phased array detectors, suffer from resonant inductive coupling, which restricts the coil design to fixed geometries, in which receiver coils are painstakingly arranged to cancel out magnetic fields in neighboring coils. Once the best arrangement is set, the coils can no longer move relative to one another, constraining the ability of MRI to image complex, moving joints. But by using high-impedance detectors, the receiver coils no longer create magnetic fields that interfere with neighboring receivers, thus removing the need for rigid structures.

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Non-Invasive Device Rapidly Identifies Liver Disease n innovative liver scanner uses a combination of shear waves and ultrasound to quantify liver fibrosis and steatosis.

The Echosens (Paris, France; www.echosens.com) FibroScan 630 Expert is a non-invasive device that can provide reproducible, accurate assessment of chronic liver diseases, such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). The FibroScan 630 Expert features a high performance elastography engine, improved ergonomics, an embedded ultrasound guidance system, an intuitive user interface, touchscreen, and advanced keyboard, and an integrated barcode reader.

The technology is based on proprietary vibration-controlled transient elastography (VCTE), which allows for measurement of tissue stiffness as expressed in kilopascal (kPa) by controlling vibration frequency, energy intensity, and applied force using a standardized algorithm to ensure that the shear wave, which is the ultimate source of stiffness information, is properly induced in the medium. Ultrasound attenuation is measured by CAP, which corresponds to the decrease in amplitude of ultrasound waves as they propagate through the liver.

NAFLD is related to insulin resistance and the metabolic syndrome and may respond to treatments originally developed for other insulin-re-

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sistant states (e.g. diabetes mellitus type 2) such as weight loss, metformin and thiazolidinediones. For most people, it causes no signs, symptoms, or complications, but in some cases accumulated fat can cause inflammation and scarring in the liver, called nonalcoholic steatohepatitis, a major cause of cirrhosis of the liver of unknown cause.

Image: A new scanner combines shear waves and ultrasound to quantify liver disease (Photo courtesy of Echosens).

New MRI Technologies Advance Image-Guided Radiotherapy ew magnetic resonance imaging (MRI) pulse sequences and imaging enhancements further improve the precision by which radiotherapy (RT) is delivered to treat cancer.

Designed for the ViewRay (Oakwood Village, OH, USA; www.viewray.com) MRIdian SmartVISION system and the MRIdian Linac RT system, the new T1w and T2w pulse sequences can deliver diagnostic-quality MRI during RT treatments by providing refined high-definition visualization and enhancing diagnostic contrast between cancerous and healthy tissues. Newly introduced diffusion weighted imaging (DWI) can also be used to distinguish between tumor and normal tissues, as well as to potentially assess and predict tumor response to RT. Other enhancements to the SmartVISION

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system include a doubling of MRI speed (from four frames to eight frames per second), and twice the image resolution and signal-to-noise ratio (SNR), helping to providing brighter, more detailed anatomical images.

The system also continuously detects the shape and location of tumors and organs-atrisk (OAR) in real-time, automatically turning RT beams on and off when positional changes occur.

The MRIdian Linac system integrates realtime SmartVISION data and RT delivery via a rotating gantry assembly that a houses a compact inline S-band 6 MV standing wave linear accelerator (linac), with side-coupled cavities and double focused multi-leaf collimator technology; magnetic and radiofrequency (RF) shielding technology to isolate linac and MRI systems from each other; and

a 0.35 T split magnet 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 control console, located just outside the treatment room, is paired to an operator console for MRI acquisition, patient positioning, dose prediction, re-optimization, and realtime tumor tracking. An additional planning station helps define structures and constraints for planning and re-optimizing treatments, with support for plan reviews via a database server that contains patient and machine data, as well as software for creating treatment plans and managing the treatment delivery process.

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Medical Imaging International

Self–Exam Device Helps Detect Breast Cancer n innovative medical thermographic testing device detects breast cancer by imaging and recording temperature distribution in the breasts.

The Braster System (Braster; Warsaw, Poland; www.braster.eu) is based on a thermographic matrix made of liquid crystals that can monitor the distribution of temperature in the breasts, recording areas with increased temperature, which may indicate malignant changes. The liquid crystal matrices, when applied to the breast surface, show red, green, and blue color images that represent temperature distribution. To simplify the self-examination process, a mobile application guides users through the screening steps and allows them to view their results.

The thermal images are also sent online to the Braster telemedical center, where they are interpreted with the aid of specialized algorithms.

Detailed analysis of the temperature distribution can determine if neoplastic lesions have formed in the examined breast by assessing the thermal balance between the right and left breasts, and by comparing the current image with images from previous examinations. The results are verified by radiologists as part of quality control. If users have any doubts, qualified experts are available to answer questions and provide advice.

A study conducted in 2013 studied device parameters for women aged 18 years and older, determining that the thermographic matrix technology has a sensitivity of 72% and specificity of 58%, compared to standard methods of breast pathology detection. When combining ther-

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mographic examination and mammography, sensitivity rose to 96%. The study also proved that thermography, mammography, and ultrasonography complement one another, providing an opportunity for further development of various methods for breast pathology diagnostics.

Image: The Braster system and accompanying app (Photo courtesy of Braster).

Dolphin Echolocation Could Advance Medical Ultrasound ncreasing our understanding of the dolphin echolocation and communication signals could pave the way for sharper image quality on ultrasound technology.

Researchers at the Lund University (Sweden; www.lu.se) department of biomedical engineering built a measuring instrument composed of 47 hydrophones capable of capturing a complete cross-section of dolphin sonar beams transmitted over many different frequencies.

Dolphin sounds were then recorded in Kolmården Wildlife Park (Sweden) and in other wildlife parks located in the Bahamas, Honduras, and California (USA). The recordings revealed that dolphins actually emit two intertwined ultrasound beam components at different frequencies, and with slightly different timing.

Calculations revealed that the sound frequency is higher further up in the beam, producing a lighter echo within that area. According to the researchers, the slightly time separated signal components may enable the dolphin to quickly gauge the speed of approaching or fleeing prey, as variations in frequency provide more precise information on the position of an object. Working with researchers at the Lund Centre for Mathematical Sciences, they then developed a mathematical algorithm to disentangle and read the overlapping signals.

The algorithm effectively identified closely located Gaussian shaped transient pulses, even in heavy disruptive noise, automatically detecting and counting the number of transients, and giving the center times and center frequencies of all components. The study was published on May 22, 2018, in The Journal of the Acoustical Society of America.

Echolocation is a biological ability to locate objects through sound waves. As Dolphins lack vocal cords, they produce sounds from the nasal air sacs, the blowhole, the larynx, the lungs, and the melon, an organ located in the upper inner area of the head filled with low-density lipids. For echolocation, dolphins emit ultrasounds called “clicks” in the nasal passages. The melon then groups the sounds into beams and amplifies the resonance. Sound waves bounce back from objects in the water to the lower jaw, with the teeth of dolphins work like antennas to receive the signals. The intensity, pitch, and time that it takes the echo to return to the dolphin provide information about the target.

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Anchored Beacon Transponder Guides Lung Cancer Radiotherapy novel beacon transponder detects even slight movements of a tumor, helping clinicians deliver lung stereotactic body radiotherapy (SBRT) more precisely.

The Varian Medical Systems (Varian; Palo Alto, CA, USA; www. varian.com) Calypso Anchored Beacon Transponder is designed for implantation in small airways within or near the tumor target. Anchoring is provides via five expandable nitinol legs that provide stable fixation, preventing the transponder from moving. Once in place, the transponder emits continuous, non-ionizing electromagnetic signals that are tracked in real-time and used to keep a SBRT beam on target. The Anchored Beacon transponder is intended for use with the Varian TrueBeam, Edge, and Clinac C-series medical linear accelerators.

The direct internal tracking eliminates the need for external surrogates to track tumor motion in real time, so that high-dose lung SBRT can be delivered with reduced margins between the clinical target volume (CTV) and the planning target volume (PTV). The implantation process itself is straightforward, similar to a lung biopsy, using a preloaded, single use delivery catheter designed for interventional pulmonologists and general pulmonologists with advanced bronchoscopy training. The Calypso Anchored Beacon Transponder has been approved by the U.S. Food and Drug Administration (FDA).

“The 510(k) clearance of the Anchored Beacon Transponder expands the application of the Calypso system platform,” said Ed Vertatschitsch,

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vice president of global portfolio solutions at Varian. “Using the Calypso system and Anchored Beacon transponder, clinicians can deliver dose to lung tumors with increased confidence and accuracy.”

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

Image: The Calypso anchored beacon transponder (Photo courtesy of Varian Medical Systems).

Focal Ablation System Targets Prostate Conditions new high intensity focused ultrasound (HIFU) device combines imaging and biopsy data to direct prostate ablation procedures in real time.

The EDAP TMS (Vaulx-en-Velin, France; www.edap-tms.com) Focal One HIFU prostate ablation system fuses magnetic resonance imaging (MRI), three dimensional (3D) biopsy data, and real-time ultrasound imaging to provide urologists with detailed 3D images of the prostate. The 3D contours of the prostate are automatically matched to MRI targets and biopsy core locations, and are then displayed relative to the live ultrasound image. The area to be ablated can then precisely defined, with live follow-up of HIFU shots used to adjust treatment in real-time.

The technology allows urologic surgeons to establish precise contours around the diseased tissue and ablate a smaller portion of the prostate, lessening damage to healthy tissue and minimizing the known side effects of incontinence and impotence. Both pre-planning and realtime images are displayed on the large monitor, allowing the surgeon to

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control precise robotic movements and deliver HIFU using Dynamic Focusing technology to adjust the electronic displacement of the focal point in order to deliver precise ablation.

“Focal One’s real-time imaging and 3D robotic features allow for greater precision, leading to improved targeting and treatment planning,” said Marc Oczachowski, CEO of EDAP TMS. “The FDA’s clearance of Focal One validates not only the power of our technology but also the years of hard work and dedication by our clinical trial investigators and EDAP’s outstanding employees.”

“Focal One is a great step forward in using this new and important ultrasound technology for prostate tissue ablation,” said professor of urology Brian Miles, MD, of Houston Methodist Hospital (HMH; Houston, TX, USA; www.houstonmethodist.org). “Focal One’s ability to merge MRI images, ultrasound images, and biopsy data in order to precisely outline and treat just the diseased tissue area of the prostate is truly remarkable.”

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Medical Imaging International

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Digital System Combines Radiography and Fluoroscopy new premium digital radiography-fluoroscopy (DRF) system provides low-dose, high-quality images while supporting fast workflow and broadening clinical capacity.

The Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) ProxiDiagnost N90 DRF system provides high-quality images with flat panel detector (FPD) technology and dynamic Unique image processing, which enables sequences to remain stable and harmonized from the first frame to the last, eliminating the need for several frames to produce a usable image. In addition, the system permits both nearby fluoroscopy and digital X-rays measurement next to the patient – the nearby approach – in order to enhance the patient experience.

The system also features the Philips Eleva user interface, which allows clinicians familiar with the design to use the system immediately, without additional training in order to provide smooth, patient-centric workflows based on user-defined examinations. Greater patient accessibility is provided, thanks to a small footprint and an open overhead area and table, which allow radiology technologists or caregivers to remain close at hand during procedures. This is especially important for pediatric and elderly patients, or others who may need additional support to remain calm during the procedure.

“ProxiDiagnost N90 meets key dimensions of healthcare’s quadruple aim, and is a smart choice for healthcare organizations that need a new fluoroscopy solution, particularly those in the United States that follow a nearby use method,” said Sandra Burghardt, senior director of global marketing for diagnostic X-ray at Philips. “We are setting the

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bar higher and enabling a confident diagnosis from the first frame.

ProxiDiagnost N90 gives radiologists and technologists the ability to capture high-quality still or video images in a way that aligns with their workflow and provides an improved patient experience.”

Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the internal structure and function of a patient, which is useful for general radiology, interventional radiology, and image-guided surgery. Because the patient must be exposed to a continuous source of X-rays instead of a momentary pulse, a fluoroscopy procedure generally subjects a patient to a higher absorbed dose of radiation than an ordinary (still) radiograph, is it used only when a risk-benefit threshold for use is exceeded.

Image: The Royal Philips ProxiDiagnost N90 DRF system (Photo courtesy of Philips Healthcare).

Brain Scans May Predict Cognitive Behavioral Therapy Success unctional magnetic resonance imaging (fMRI) and machine learning could enable therapists to tailor cognitive behavioral therapy (CBT) for individual patients, claims a new study.

Researchers at the University of California, Los Angeles (UCLA; USA; www.ucla.edu) conducted a clinical study that initially collected the resting-state fMRI scans of the brains of 42 people with obsessive-compulsive disorder (OCD), 18 to 60 years of age, before and after four weeks of intensive, daily, CBT. The researchers then leveraged machine learning with cross-validation in order to assess the power of functional connectivity (FC) patterns in predicting individual posttreatment OCD symptom severity.

The results revealed that pretreatment FC patterns within the default mode network (DMN) and visual network significantly predicted post-treatment OCD severity, explaining up to 67% of the variance. These networks were also stronger predictors than pretreatment clinical scores. In addition, machine learning predicted which patients would fail to respond to CBT with 70% accuracy, and also predicted the final symptoms assessment scores on within a small margin of error, regardless of how patients responded to treatment. The study was published on February 12, 2018, in Proceedings of the National Academy of Sciences (PNAS).

“This method opens a window into OCD patients’ brains to help us see how responsive they will be to treatment. The algorithm performed far better than our own predictions,”

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said senior author clinical neuroscientist Jamie Feusner, MD. “OCD treatment could someday start with a brain scan. The cost to perform and interpret a brief MRI is several hundred dollars, but that expense could help people who are unlikely to be helped by intensive CBT to avoid the cost of that treatment.”

Brain areas are linked together in a largescale network identified by their function, providing a coherent framework for understanding cognition. Four main networks have been identified; the dorsal attention network

(DAN), which is involved in voluntary deployment of attention and reorientation to unexpected events; the default-mode network (DMN), which is active during introspection; the salience network (SN), which monitors the salience of external inputs and internal brain events; and the executive control network (ECN), which is engaged during cognitive tasks that require externally-directed attention, such as working memory, relational integration, response inhibition and task-set switching.

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PRODUCT NEWS DIGITAL X-RAY SYSTEM

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MRI SYSTEM

ULTRASOUND SYSTEM

Swissray International

Canon Medical Systems

SonoScape

The ddRAura FMTS includes a manually positioned floor-mounted tube stand, vertical wall bucky stand and four-way floating patient table.

Its powerful generator, X-ray tube and collimator allow it to deliver consistent image quality.

The Vantage Orian 1.5T system uses rapid scan technologies to reduce scan time and a dockable table to assist in patient handling. Its wide bore offers the most open MRI available and its low energy consumption minimizes running costs.

The S2 features an intelligent patient file management system, convenient user-definable settings, and professional diagnostic applications. It also has two active transducer sockets for frequent changing of transducers and a 15-inch monitor.

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CT System Reconstructs Breast Specimens Digitally computerized tomography (CT) specimen imaging system provides detailed margin assessment by reconstructing a navigable three-dimensional (3D) render in real time.

The Faxitron (Tucson, AZ, USA; www. faxitron.com) VisionCT system is a fully automated 3D specimen cabinet system equipped with a motorized, 360-degree rotating platform that can capture up to six high-resolution images per second. The system reconstructs breast specimens in up to 1,024 slices at a standard slice thickness of 100 micron, allowing for complete and detailed radiographic assessment of margin status, in addition to immediate traditional orthogonal images. Users can review orthogonal images as the specimen is being scanned and reconstructed in real time, with automated magnification allowing for optimal resolution of any specimen size up to 11 cm in diameter.

The system is turn-key and fully automated, with no additional x-ray shielding, special-

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ized knowledge, or manual specimen repositioning required; the specimen is simply positioned in disposable holder, placed in a container in the chamber, and scanned. Fast, versatile imaging allows for presentation of both 2D and orthogonal images in less than 30 seconds, with full 3D reconstruction of the whole specimen in less than four minutes, including automatic metal artifact correction to minimize interference. DICOM images are automatically stored to PACS and saved to local or network drive, with images instantaneously displayed on the 24” high-resolution monitor.

Planar specimen radiography is the current standard of care in intraoperative margin assessment. This requires the surgeon and radiologist to attempt to visualize microcalcifications or lesion in 3D space by viewing images individually, but in relation to one another. The challenge is that both collecting and visualizing the images are manual processes, and therefore may not always be standard practice.

Image: The VisionCT system scans 360-degree images of excised lesions (Photo courtesy of Faxitron).

Breakthrough Technology Generates 3D Color X-Rays sing hybrid pixel-detector technology, a novel three-dimensional (3D) scanner can assign colors to different X-ray photons energy levels, thus identifying water, calcium, and disease markers. Researchers at the University of Canterbury (Christchurch, New Zealand; www.canterbury.ac.nz), the University of Otago (Christchurch, New Zealand; www.otago.ac.nz), and other institutions worldwide participating in the CERN (Geneva, Switzerland; https:// home.cern) Medipix collaboration have successfully scanned human tissues using a breakthrough color medical scanner developed by MARS Bioimaging (Christchurch, New Zealand; www.marsbioimaging.com), which is based on Medipix3 technology.

Initially developed to address the needs of particle tracking at the CERN Large Hadron Collider, the MARS solution couples the spectroscopic information generated by the Medipix3-enabled detector with powerful algorithms to generate 3D images. By assigning different energy levels of the Xray photons to distinct colors, the scanner can display high-resolution, high-

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contrast, and reliable images. A version of the MARS scanner has so far been used to study cancer, bone and joint health, and vascular disease. In the coming months, orthopedic and rheumatology patients in New Zealand will be scanned in a clinical trial of the technology.

“X-ray spectral information allows health professionals to measure the different components of body parts such as fat, water, calcium, and disease markers. Traditional black-and-white x-rays only allow measurement of the density and shape of an object,” said Professor Anthony Butler, PhD, of the University of Otago. The Medipix3 is a complementary metal-oxide-semiconductor (CMOS) pixel detector readout chip designed to be connected to a segmented semiconductor sensor. It acts as a camera, taking images based on the number of particles, which hit the pixels when the electronic shutter is open. A novel charge summing and allocation scheme is implemented at the pixel level, permitting proper binning of the energy of incoming photons in order to overcome the effects of fluorescence and charge diffusion.

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Medical Imaging International

Hyperscan Proton Therapy System Offers Pinpoint Accuracy n innovative Proton Therapy System improves on existing scanning capabilities and enables clinicians to deliver conformal fields faster and with more precision than in the past.

The Mevion Medical Systems (Mevion; Littleton, MA, USA; www. mevion.com) S250i Proton Therapy System with Hyperscan pencil beam scanning (PBS) shapes the delivered radiation dose by precisely targeting tumors with sub-atomic particles. To improve accuracy and speed, a robotically controlled adaptive aperture proton multi-leaf collimator (pMLC) is used, which trims the edges of the beam to achieve sharp lateral dose gradients. This capability can deliver up to a three times sharper drop off in radiation at the delivery field edge, sparing healthy tissue and limiting unnecessary radiation to sensitive locations.

By reducing delivery times to less than five seconds, errors resulting from target tumor shifting under normal organ motion, such as breathing, can be reduced. Other features of the S250i include a gantry mounted superconducting synchrocyclotron, a six degree-of-freedom treatment couch, and advanced in-room image guidance that creates a three-dimensional (3D) representation of the tumor and relays the information to the proton therapy device. The computerized tomography (CT) based imager can also be used to modify treatment in response to changes in the patient’s anatomy, such as tumor shrinkage.

“Proton therapy is an advanced form of radiation that can destroy cancer cells. A machine called a cyclotron speeds up protons to two thirds the speed of light and they become highly charged,” said radiation oncologist Peter Ahn, MD, of MedStar Georgetown (Washington DC, USA), which inaugurated the first system worldwide in April 2018.

“Because we can more tightly control the protons than we are able with traditional radiation, proton therapy can be given without damaging critical tissues and structures near the tumor because the beam conforms precisely to the tumor’s size and shape.”

“Delivering sharp field edges has been a real challenge for PBS, especially in shallow fields. In intracranial procedures, where critical structures are in close proximity to tumors at shallow depths, having the sharpest lateral penumbra is essential,” said Skip Rosenthal, VP of clinical education at Mevion.

Proton therapy is a precise form of radiotherapy (RT) that uses charged particles instead of x-rays. It can be a more effective form of treatment than conventional RT as it directs the beam more precisely, with minimal damage to surrounding tissue. Evidence is growing that protons can be effective in treating a number of cancers, in particular children and young people with brain tumors, for whom it appears to produce fewer side effects such as secondary cancers, growth deformity, hearing loss, and learning difficulties.

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Image: The S250i proton therapy system with Hyperscan PBS (Photo courtesy of Mevion Medial Systems/MedStar Georgetown).

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PRODUCT NEWS DIGITAL X-RAY SYSTEM

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DR SYSTEM

NEONATAL MRI SYSTEM

Swissray International

Thales Electron Devices

Time Medical

The ddRAura features a touch screen, collimator, system position, patient procedure list selection and image preview at the patient’s side. It offers automatic positioning and combines multiple images with automated single focus stitching option.

The Presto DR offers a wide choice of Pixium detectors and system configurations including x-ray generators, tables, DAP and buckys. Built for all radiography requirements, it provides the perfect alternative to film screen and CR.

The NEONA is designed for critically ill infants in the NICU and features a compact design to minimize patient transport issues. Its MR-compatible incubator monitors and stabilizes the patient's physiological and environmental needs.

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Angiographic Algorithm Facilitates Coronary Artery Assessment nnovative software can calculate pressure drop in the coronary artery non-invasively, obviating the need for a pressure wire and hyperemic agent.

The Pie Medical Imaging (Maastricht, The Netherlands; www. piemedicalimaging.com) Cardiovascular Angiographic Analysis Systems for vessel Fractional Flow Reserve (CAAS vFFR) software module is designed to reconstruct a three-dimensional (3D) model of the vasculature using just two angiograms taken during a standard catheterization procedure in order to assess pressure drop, which is expressed as a vFFR value. The 3D reconstruction also enables assessment of the severity and percentage of coronary artery stenosis.

For percutaneous coronary interventions (PCI), within one easy workflow, CAAS vFFR offers a unique combination of functional and anatomical lesion assessment to support the interventional cardiologist in the clinical decision making process. A recent study by researchers at Erasmus Medical Center (Rotterdam, the Netherlands; www. erasmusmc.nl) shows that CAAS vFFR has a high linear correlation to invasively measured FFR and high diagnostic accuracy. The study was presented at EuroPCR 2018, held during May 2018 in Paris (France).

FFR is an established technique used in interventional cardiology to the hemodynamic severity of atherosclerotic narrowing of the coroI

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nary arteries. It specifically identifies which coronary narrowing is responsible for the ischemic obstruction of blood flow to the myocardium, and helps determine which lesions warrant stenting, resulting in improved patient outcomes and reduced health care costs. The examination is usually done during a catheterization procedure with the support of costly pressure wire and hyperemic agent.

Image: A 3D representation of vessel with color scale indicating vFFR value (Photo courtesy of Pie Medical Imaging).

PET Imaging Technique Pinpoints Colitis Inflammation new positron emission tomography (PET) method can detect inflammation sites in people with inflammatory bowel disease (IBD), according to a new study.

Researchers at the University of California, Los Angeles (UCLA; USA; www.ucla.edu) and Regeneron Pharmaceuticals (Tarrytown, NY, USA; www.regeneron.com) conducted a mouse model study of colitis that used PET imaging with antibody fragment probes (immunoPET) based on GK1.5 cys-diabody (cDb) that target CD4+ T cells, a subset of immune cells characteristic of IBD. A zirconium-89 (89Zr)-labeled antiCD4 engineered cDb probe was used for noninvasive imaging of the distribution of CD4+ T cells in mice with induced colitis.

The results revealed an increased number of CD4+ T cells in the colons of colitic mice, as confirmed by immunohistochemistry. Increased uptake of 89Zr-malDFO-GK1.5 cDb was detected in the distal colon, ceca, and mesenteric lymph nodes (MLNs) in in-vivo PET scans. Ex-vivo scans and biodistribution also confirmed the higher uptake in dextran sulfate sodium (DSS)-treated colons, ceca, and MLN. The researchers suggest that CD4 immunoPET has the potential to guide development of

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antibody-based imaging in humans with IBD. The study was published in the June 2018 issue of The Journal of Nuclear Medicine.

“ImmunoPET is a robust and general platform for visualization of highly specific molecular targets. CD4 immunoPET could provide a noninvasive means to detect and localize sites of inflammation in the bowel and also provide image guidance for biopsies,” said senior author Professor Anna Wu, PhD, director of the UCLA cancer molecular imaging program. “It could unlock our ability to assess inflammation in a broad spectrum of disease areas, including oncology and immune-oncology, autoimmunity, cardiovascular disease, neuroinflammation, and more.”

CD4+ T helper cells are white blood cells that are an essential part of the human immune system. They are called helper cells because one of their main roles is to send signals to other types of immune cells, including CD8 killer cells, which then destroy the infectious particle. If CD4 cells become depleted, for example in untreated HIV infection, or following immune suppression prior to a transplant, the body is left vulnerable to a wide range of infections that it would otherwise have been able to fight.

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Medical Imaging International

New Radiation Therapy System Personalizes Cancer Treatment n innovative magnetic resonance imaging/radiation therapy (MRI/RT) system allows clinicians to adapt the patient’s RT treatment plan to current anatomical information.

The Elekta (Stockholm, Sweden; www.elekta.com) Unity system integrates MRI, linear accelerator (LINAC) technologies, and advanced treatment planning into a single platform, allowing clinicians to see and track difficult-to-visualize soft tissue anatomies as radiation dose is being delivered. The new technology addresses an unmet need in cancer therapy by enabling clinicians to confidently track the target during treatment and respond accordingly. The core of the system is the combination of three key aspects: A digital LINAC equipped with multileaf collimator technology and positioned on a gantry capable of continuous rotation around the MRI scanner, with the treatment beam passing through the inner MRI ring; A high-field 1.5Tesla MRI imaging system made by Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com) that allows clear, high resolution soft tissue visualization simultaneous to treatment delivery; Intelligent software that allows treatment plans to be adapted while the patient is on the table in response to changes in tumor position, shape, biology and the relationship to sensitive organs over time.

“Our MR-LINAC system is truly groundbreaking because it overcomes the technical barriers that have hindered the integration of radiation therapy with real-time high-field imaging,” said Richard Hausmann, CEO of Elekta. “It is the first system that provides the ability to ‘see what you treat’ with diagnostic image quality during treatment and respond based on what is being seen, offering the potential to personalize therapy for each patient.”

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“Unity is a tremendous innovation in patient care, one that enables a scan-plan-treat approach to developing tailored regimens that should yield substantive clinical benefits,” said professor of experimental clinical physics Bas Raaymakers, PhD, of University Medical Center (UMC; Utrecht, The Netherlands), which invented the high-field MR-LINAC concept. “I am thrilled that our vision of personalized radiation therapy is becoming a clinical reality.”

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 tumor 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: A new RT system integrates LINAC technology and MRI (Photo courtesy of Elekta).

Protein Clumping May Contribute To Heart Failure Development new positron emission tomography (PET) study reveals that cardiac preamyloid oligomers (PAOs) form clumps in developing heart failure (HF). Researchers at the Medical University of Vienna (MedUni; Austria; www.meduniwien.ac.at), Johns Hopkins University (JHU; Baltimore, MD, USA; www.jhu.edu), and other institutions conducted a study to see if the mono-phosphorylated protein desmin acts as the seed nucleating PAOs found in human HF. To do so, they used a fluorescent antibody and an amyloid fluorescent stain to visualize and quantify protein clumps in heart tissue biopsies from people with or without HF. They then used a common mouse model of HF to look for desmin clumps. The model involves surgical constriction of the aorta, which raises blood pressure and stress.

After four weeks, the mice develop symptoms of HF, such as an enlarged heart and lung congestion. The researchers used the radioactive dye Amyvid to image the protein clumps by PET. The results showed that desmin amyloid was more than doubled in the HF mice, when using the same antibody and staining techniques used for the human tissue samples. Conversely, when the researchers used epigallocatechin gallate (EGCG) to break up amyloid, the number of protein clumps halved. The study was published on May 11, 2018, in Circulation Research.

“PET imaging of protein clumps may be eventually used in patients to identify structural changes in the heart as the disease progresses, and this information likely holds prognostic value,” said lead author Peter Rainer, MD, PhD, of the Medical University of Graz.

“From a molecular standpoint there’s not a unified, clear mechanism for why the heart goes into failure. But by figuring out this mechanism, we may be able to devise better treatments and diagnostic tools,” said senior author Giulio Agnetti, PhD, of JHU. “I think the next step is to follow up with the proteins that are dynamically modified in response to environment, which places a larger emphasis on lifestyle intervention to help prevent diseases.”

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PRODUCT NEWS DUAL-HEAD INJECTOR

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DR SYSTEM

ULTRASOUND SYSTEM

Antmed

Xoran Technologies

Mindray

The CT Dual-Head Injector allows simultaneous injection of contrast and saline, along with control of contrast density in the ventricles. It allows the observation of the right coronary arteries, atrium and ventricle in a single study in the same image.

The LuminX ceiling-suspended system is available with fully motorized auto-positioning tracking and synchronization or lightweight manual positioning. Other features include tube-mounted interface and automated or manual stitching.

The DC-N3 PRO offers high image quality with the best 4D imaging in range, innovative rendering modes, in-built tutorial module and simplified workflow. It features Purified Harmonic Imaging for better contrast resolution and less noise.

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Simple CT Scans Can Determine Thrombectomy Need new study suggests that using non-contrast simple computerized tomography (CT) scans to determine thrombectomy treatment in stroke is just as effective as advanced CT perfusion scans. Researchers at the University of Texas Health Science Center (UT Health; Houston, USA; www.uth.edu) and Stanford University (CA, USA; www.stanford.edu) conducted a clinical trial, which enrolled 445 patients who received both simple and advanced imaging at nine academic health centers across the United States from January 2016 to February 2018. The results showed that patients who were treated based on simple imaging had identical clinical outcomes to those treated based on advanced imaging.

In addition, those patients who had a good imaging profile – as demonstrated by a smaller area of dead brain tissue – had the same clinical outcomes, regardless of which imaging was used. On the other hand, 42% of patients who were excluded from thrombectomy by one of the imaging profiles, but had a good profile on the other type of imaging, also had positive clinical outcomes. The study was presented at the 4th European Stroke Organization Conference (ESOC), held during May 2018 in Göteborg (Sweden).

“The results show that simple imaging, while not perfect, may be good enough. This basic technique is faster, which means patients could potentially be treated more quickly,” said lead author Amrou Sarraj, MD, of UT Health. “The advanced imaging of CT perfusion isn’t available everywhere, so this could open up the door to identify more people for potential treatment, especially in remote areas.”

“Our results should not be interpreted that advanced perfusion images are not necessary, or should not be acquired at all, as they still iden-

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tified a group of patients that may be treated with thrombectomy when CT alone was not enough,” cautioned Dr. Sarraj. “The numbers involved are significant because 17.6% of patients could have been excluded from having surgery if the CT or CT perfusion were relied on alone, so there’s a real opportunity here to help more people if both forms of imaging are available.”

Timely restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for salvaging ischemic brain tissue that is not already infarcted. For eligible patients with acute ischemic stroke, intravenous alteplase is first-line therapy, provided that treatment is initiated within 4.5 hours of clearly defined symptom onset. Mechanical thrombectomy is indicated for patients with acute ischemic stroke due to a large artery occlusion in the anterior circulation who can be treated within 24 hours of the time last known to be well, regardless of whether they receive intravenous alteplase for the same ischemic stroke event.

Image: A new study suggests regular CT scans may be sufficient to determine thrombectomy needs (Photo courtesy of Getty Images).

Imaging Software Rapidly Identifies Dendritic Spines novel 2-photon microscopy algorithm autonomously and efficiently identifies small dendritic spines with over 90% accuracy, according to a new study.

Developed by researchers at the Max Planck Florida Institute for Neuroscience (Jupiter, USA; www.maxplanckflorida.org), the software is built on a machine learning approach that uses custom thresholding and binarization functions to clean up fluorescent images, and a neural network trained to differentiate between the dendrite backbone and dendritic spines using the relative shape of the spine perimeter and its corresponding dendritic backbone. Once the training period finishes, the software can automatically scan through an image and demarcate spines it comes across with high precision.

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By automating the process of spine identification, the high-throughput imaging system has the potential to dramatically increase workflow efficiency by stimulating and monitoring hundreds of dendritic spines under various conditions at the same time, shaving hours off analysis time. In addition, the source code is provided free of charge bundled together with a user-friendly, open-source, MATLAB-based software package for spine analysis. The study was published on July 5, 2018, in PLOS One. Synaptic plasticity, the cellular basis for learning and memory, is mediated by a complex biochemical network of signaling proteins. These proteins are compartmentalized in dendritic spines, the tiny, bulbous, post-synaptic structures found on neuronal dendrites.

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Near-Infrared Imaging System Visualizes Lymph And Blood Vessels new indocyanine green (ICG) fluorescence imaging system supports breast cancer (BC) treatment by identifying lymph and blood vessels.

The Shimadzu (Kyoto, Japan; www. shimadzu.com) LightVision near-infrared (NIR) imaging system can create real time contrast images of lymph vessels below tissue surfaces by administering ICG through lymph vessels or veins, exposing it to an excitation light, and then detecting and visualizing the slight emission of NIR light from the ICG with an integrated X10 zoom camera. The camera mount arm can be extended to a length of 180 cm for optimal positioning during procedures, while the main unit is easily controlled via a simple and detachable control console.

Features of the system include built-in high-definition sensors to produce high quality, real-time images on a single monitor; automatic focusing, light exposure adjustment, and white balance (WB) adjustment; and image acquisition in a bright field of view, without needing to turn off room lighting in the operating room. The system also supports simultaneous display of three concurrent images, which means that a visible light image, a NIR fluorescence image, and a combined, superimposed image can all be displayed simultaneously, in real-time, on the same monitor screen. To identify the position of lymph nodes, lymph vessels, and blood vessels, the ICG areas of fluorescence can be displayed as either green or blue.

By visualizing lymph vessels during surgery, surgeons can perform procedures while monitoring and shielding the position of the lymph vessels being excised, especially useful for identifying the position of sentinel lymph nodes (SLNs), which are important for diagnosing the metastasis status of cancer cells during BC surgery. Monitoring blood flow intraoperatively is also useful, by helping to evaluate blood flow through flaps and anastomotic vessels during breast reconstructive surgery.

“Due to the increasing rate of breast cancer morbidity, Shimadzu has invested significant resources toward applying state-of-theart science and technology supporting the diagnosis and treatment of breast cancer,” said the company in a press statement. “The new LightVision system has been developed as part of this ongoing initiative. Shimadzu’s long-term goal is to provide comprehensive support for early diagnosis, examination, treat-

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ment and prognosis management of diseases.”

Finding metastatic cancer cells during BC surgery requires first identifying the position of SNLs, which have a diameter of just a few millimeters, and then excising these nodes to diagnose their pathology. If the cancer has not yet metastasized to an SLN, subsequent axillary lymph node excision can be omitted, thus preventing consequent lymphedema and maintaining the patient’s quality of life after surgery. In recent years the interest in using fluorescence methods for SLN biopsies has been increasing.

Image: The LightVision NIR fluorescence imaging system (Photo courtesy of Shimadzu)

Medical Imaging International

PRODUCT NEWS FLAT PANEL DETECTOR

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DIGITAL IMAGING SYSTEM

PORTABLE X-RAY

Thales Electron Devices

Guerbet

OR Technology

The Pixium Portable 2430 EZ weighs under 1.6 kg and has up to eight hours of autonomy. It allows dozens of images to be stored, facilitating emergency and stitching exams, as well as exams at the bedside.

The L-F Hydra Vision is a RT digital device engineered to streamline workflow and improve efficiency in urological imaging. It incorporates a moving imaging system that allows the patient to remain stationary during sensitive procedures.

The Leonardo DR mini II is one of the world's lightest portable X-ray case systems, weighing only 8.9 kg.

The x-ray solution supports its users in outpatient digital radiology in the areas of human and veterinary medicine.

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Mobile CT System Supports Real-Time Imaging mobile computerized tomography (CD) system provides high quality intraoperative images, increasing surgeon confidence and supporting advanced minimally invasive surgery (MIS).

The Mobius Imaging (Shirley, MA, USA; www.mobiusimaging.com) Airo Mobile TruCT Imaging System is designed for diagnostic and intraoperative procedures inside existing operating room (OR) suites by combining an extra-large bore size, an extra-small footprint, and an extra-slim patented gantry design. The innovative design provides a scan volume of 50 cm diameter x 100 cm length, allowing surgeons to image the entire spine in a single scan and to visualize more anatomical context than traditional C-arms. Indications include cranial, spine, trauma, and pediatric procedures.

The gantry houses custom components including an X-Ray tube, a 32-slice helical scan detector array, a high-voltage generator, an air-cooling system and a built-in battery pack. The gantry is fully integrated into the TRUMPF Medical (Saalfeld, Germany; www.trumpf.com) TruSystem 7500 surgical table, which permits a fixed correlation between the patient and the scanner, resulting in reliable, reproducible, imaging. Fully adaptable, the Airo TruCT can move into a variety of procedural setups for cranial, spine, and trauma cases.

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Image: The Airo mobile CT imaging system (Photo courtesy of Mobius Imaging).

MRI Multitasking Increases Diagnostic Accuracy and Reliability new cardiac magnetic resonance (CMR) imaging technique improves patient comfort and shortens testing time, according to a new study. Researchers at Cedars-Sinai Medical Center (Los Angeles, CA, USA; www.cedars-sinai.edu), the University of California, Los Angeles (UCLA; USA; www.ucla.edu), and Xuanwu Hospital (Beijing, China; www.xwhosp.com.cn) conducted a study to examine how the need to reduce CMR imaging artefacts arising from body motion, the beating heart, and blood flow during quantitative imaging could be circumvented in order to make the procedure more reliable. The researchers decided therefore that rather than try to avoid the motion caused by breathing and heartbeats, they would embrace it.

The new technique, which they dubbed CMR Multitasking, abstracts physiological motion and other dynamic processes as time extents, which can be resolved via low-rank tensor imaging, allowing for motion-resolved quantitative CMR in up to four time dimensions. The continuous-acquisition approach, captures – rather than avoids – motion, relaxation, and other dynamics, allowing for T1 mapping, T1/T2 mapping and time-resolved T1mapping of myocardial perfusion without

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electrocardiography (ECG) information and/or under free-breathing conditions. The study was published on April 9, 2018, in Nature Biomedical Engineering.

“MR Multitasking continuously acquires image data and then, when the test is completed, the program separates out the overlapping sources of motion and other changes into multiple time dimensions,” said lead author Anthony Christodoulou, PhD, of the Cedars-Sinai Biomedical Imaging Research Institute. “If a picture is 2D, then a video is 3D because it adds the passage of time. Our videos are 6D because we can play them back four different ways: We can playback cardiac motion, respiratory motion, and two different tissue processes that reveal cardiac health.”

CMR is a medical imaging technology for the non-invasive assessment of the function and structure of the cardiovascular system, based on the same basic principles as magnetic resonance imaging (MRI), with optimizations that use rapid imaging sequences. As a result, CMR images are currently acquired in steps. Patients breathe in and then hold their breath for each image, then recover before repeating the process for the next image.

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Medical Imaging International

Artificial Intelligence Surpasses Dermatologists At Melanoma Recognition rained artificial Intelligence (AI) convolutional neural networks (CNNs) are better than experienced dermatologists at detecting skin cancer, claims a new study. Researchers at the University of Heidelberg (Germany; www.uni-heidelberg.de), the University of Passau (Germany; www.uni-passau.de), and other institutions trained the Google (Mountain View, CA, USA; www.google.com) Inception CNN to identify skin cancer by showing it more than 100,000 stored images of malignant melanomas, as well as benign moles and nevi.

They then compared the performance of the CNN with that of 58 international dermatologists via a 100-image test-set, using two levels of evidence; level-I included dermoscopy images alone, and level-II included dermoscopy plus clinical information and photos.

The dermatologists were asked to first make a diagnosis of malignant melanoma or benign mole just from the dermoscopic images (level I) and make a decision about how to manage the condition (i.e., surgery, short-term follow-up, or no action needed). Four weeks later, they were given additional clinical information on the patient – including age, sex, and position of the lesion – and close-up images of the same 100 cases (level II), and asked once again for their diagnoses and management decisions.

The results revealed that in level I, the dermatologists accurately detected an average of 86.6% of melanomas, and correctly identified an average of 71.3% of lesions that were not malignant. However, when the CNN was re-tuned to the same level as the physicians to correctly identify benign moles (71.3%), the CNN successfully detected 95% of melanomas. At level II, the dermatologists improved their performance, accurately diagnosing 88.9% of malignant melanomas and 75.7% that were not cancer. The study was published on May 28, 2018, in Annals of Oncology.

“The CNN missed fewer melanomas, meaning it had a higher sensitivity than the dermatologists, and it misdiagnosed fewer benign moles as malignant melanoma, which means it had a higher specificity; this would result in less unnecessary surgery,” said lead author Professor Holger Haenssle, MD, of the University of Heidelberg. “When dermatologists received more clinical information and images at level II, their diagnostic performance improved.

However, the CNN, which was still working solely from the dermoscopic images with no additional clinical information, continued to out-perform the physicians’ diagnostic abilities.”

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“This CNN may serve physicians involved in skin cancer screening as an aid in their decision whether to biopsy a lesion or not. Most dermatologists already use digital dermoscopy systems to image and store lesions for documentation and follow-up,” concluded Professor Haenssle. “The CNN can then easily and rapidly evaluate the stored image for an ‘expert opinion’ on the probability of melanoma.

We are currently planning prospective studies to assess the real-life impact of the CNN for physicians and patients.”

Deep learning is part of a broader family of AI machine learning methods based on learning data representations, as opposed to task specific algorithms. It involves neural network algorithms that use a cascade of

many layers of nonlinear processing units for feature extraction and transformation, with each successive layer using the output from the previous layer as input, thus forming a hierarchical representation.

Image: A new study claims deep-learning algorithms beat dermatologists at dermoscopy interpretation (Photo courtesy of Dreamstime).

PRODUCT NEWS X-RAY DETECTOR

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CREAM ELECTROLYTE

Thales Electron Devices

Vinno Technology

Parker Laboratories

The Pixium RAD 4600 is designed to replace conventional film-based radiology and computed radiography. It can be used for all types of exams and features a large square format, high resolution and wide dynamic range.

The VINNO G86 provides users with more precise imaging and highly efficient control procedures. It is also equipped with high precision, high speed imaging technology, smart recognition functions and complete measuring software.

The Signacreme conductive cream electrolyte is for use in electromedical procedures where a cosmetic quality cream is preferred. It is conveniently packaged in a refillable see-thru dispenser with a flip-top cap.

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Advanced Ultrasound System Expands Clinical Capabilities n advanced automated breast ultrasound device provides better interpretation of dense breast tissue than traditional mammography. The Siemens Healthineers (Erlangen, Germany; www. healthcare.siemens.com) ACUSON S2000 ultrasound system, HELX Evolution with Touch Control is a premium ultrasound system that offers advanced technologies and diagnostic tools to provide sharp, clear images that increase diagnostic confidence. Powered by an intuitive, user-centric interface, the system boasts an intuitive 12.1” high-resolution touch display with instant response technology, a laser-optical trackball, and a simplified home-base control structure that help to optimize exam workflows and reduce training time.

Workflow innovations include context-sensitive body markers, intuitive pictograms, transducer markers, and supportive protocols. Smartswap annotations with color-coded guidance simplify annotations by suggesting logical replacement text specific to the exam being performed. Innovative ergonomics and digital and tactile keyboards, together with access to proprietary eSieScan workflow protocols increase flexibility for different user preferences and workflow situations, thus allowing fewer motions and inputs, improved operation, and reduced repetitive stress injuries.

System features include HD transducer technology for sharper detail and contrast resolution; full-body coverage; automated breast volume scanning (ABVS) for three dimensional (3D) and hand-held imaging of the breast; tissue strain analytics that provide deeper insights into dense breast tissue; shear wave elastography to evaluate tissue stiffness; indepth anatomy visualization when using contrast enhanced ultrasound

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(CEUS); and visualization of lesions in organs using Cadence contrast harmonic imaging (CHI) and Cadence contrast pulse sequencing (CPS) for vascularity and microbubble visualization.

ABVS uses high-frequency sound waves to produce a 3D volumetric image of the entire breast, which allows radiologists to check the breast from multiple angles. Using traditional ultrasound, exams can take up to 30 minutes and are highly impacted by the operator’s skill level due to the device’s handheld transducer. ABVS solves both of these problems by automatically scanning the breast in as little as seven minutes.

Image: The ACUSON S2000 ultrasound system (Photo courtesy of Siemens Healthineers).

Ultra-High Resolution CT Doubles Image Sharpness he world’s first ultra-high resolution computerized tomography system (UHR CT) can resolve anatomy as small as 150 microns.

The Canon Medical Systems ( tawara, Japan; https:// global.medical.canon) Aquilion Precision UHR CT features a resolution never before seen in CT imaging, with a small focal spot tube at 0.4 x 0.5 mm, and a routine 1024 x 1024 reconstruction matrix. The ultrahigh resolution capabilities are combined with 1,792 efficient detector channels in 160 rows that are only 0.25 mm thick, major improvements in scintillator quantum efficiency, new digital acquisition system (DAS) and detector circuitry components, and improved tube, gantry, and reconstruction technologies.

New UHR CT applications include novel data sets that take advantage of artificial intelligence (AI) and computational learning techniques and im-

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age texture analysis algorithms in order to improve staging, treatment, and earlier tumor detection. A model-based iterative reconstruction (MBIR) computational algorithm reduces noise while maintaining resolution. On the patient side, precision technology provides a two-step slide mechanism and an ultra-high rigid couch with a precision reinforced drive mechanism.

“In order to deliver Ultra-High Resolution CT into clinical practice, it required a complete re-engineering of the detector manufacturing process,” said Dominic Smith, senior director of the CT, PET/CT, and MR Business Units. “The Aquilion Precision represents not only a breakthrough in imaging technology, but a breakthrough for health care providers who can potentially use the increased amount of accurate data from this system to further research artificial intelligence and computational learning techniques.

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Medical Imaging International

Laser-Sonic Scanner Images Entire Breast in Seconds new study describes how a photoacoustic computed tomography (PACT) scanning system can find breast tumors faster than mammography.

Developed by researchers at Washington University School of Medicine (WUSTL; St. Louis, MO, USA; www.medschool.wustl.edu), the California Institute of Technology (Caltech; Pasadena, USA; www.caltech.edu), and other institutions, PACT involves shining a nearinfrared (NIR) laser pulse that diffuses through the breast and is absorbed by oxygen-carrying hemoglobin molecules in the patient’s red blood cells (RBCs), causing the molecules to vibrate ultrasonically. The vibrations travel through the tissue and are picked up by an array of 512 tiny ultrasonic sensors around the skin of the breast.

The data from the sensors are used to assemble an image of the breast’s internal structures in a process that is similar to ultrasound imaging, though much more precise. Because the laser light is so strongly absorbed by hemoglobin, PACT can construct images that primarily show the blood vessels present in the tissue being scanned, providing a clear view of structures as small as a quarter of a millimeter at a depth of four centimeters.

Since the scan is quick, taking only 15 seconds, the patient can easily hold their breath while being scanned, and a clearer image can be developed. According to the researchers, the speed with which a PACT scan can be performed gives it advantages over other imaging techniques. For example, magnetic resonance imaging (MRI) scans can take 45 minutes, are expensive, and sometimes requires contrast agents to be injected into the patient’s blood. The study was published on June 15, 2018, in Nature Communications.

“Mammograms cannot provide soft-tissue contrast with the level of detail in PACT images. This is the only single-breath-hold technology that

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Photochromic Materials Help Monitor UV Radiation Levels synthetic material based on natural hackmanite can be tuned to change color in response to ultraviolet (UV) radiation levels, according to a new study.

Developed at the University of Turku (UTU; Finland; www.utu.fi), Uppsala University (UU; Sweden; www.uu.se), and other institutions, SensoGlow is composed of (Na,M)8Al6Si6O24(Cl,S)2 synthetic hackmanites that have been modified so that their body color is sensitive to the solar UV index as well as to different UVA, UVB, UVC radiation levels. The color change material is not based on a structural change, but rather on the electron storage in the material, which makes it more durable than organic alternatives and also reversible.

The color intensity of the SensoGlow material correlates with the dose of radiation. It could be used, for example, as a sticker attached to a watch. The amount of radiation could be quantified by taking a picture of the sticker with a mobile phone, with an app indicating the value of the UV index. Once removed from UV radiation, the hackmanite electrons return to their ground state, and the color of the material returns to normal. According to the researchers, the production of SensoGlow material is very inexpensive due to the fact that it is composed of common elements. The study was published in the June 2018 issue of Materials Horizons.

UV is an electromagnetic radiation with a wavelength from 10 nm to 400 nm, shorter than that of visible light but longer than X-rays. It is present in sunlight, constituting about 10% of the total light output of the Sun, and is also produced by electric arcs and other specialized lights, such as mercury-vapor lamps. Although UV is not considered an ionizing radiation, it can cause chemical reactions and causes many substances to glow or fluoresce. Consequently, the chemical and biological effects of UV are greater than simple heating effects, and many practical applications of UV radiation derive from its interactions with organic molecules.

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gives us high-contrast, high-resolution, 3D images of the entire breast,” said senior author professor of medical and electrical engineering Lihong Wang, PhD, of WUSTL. “Our goal is to build a dream machine for breast screening, diagnosis, monitoring, and prognosis without any harm to the patient. We want it to be fast, painless, safe, and inexpensive.”

PACT offers high spatial and temporal resolutions with sufficiently deep nonionizing optical penetration, since the principal optical absorber in the NIR region, hemoglobin, provides an endogenous contrast for imaging a high density of blood vessels. The concentration of blood vessels is often associated with angiogenesis, which plays an important role in tumor growth and metastasis.

Image: The internal vascular structure of a human breast created using a PACT scanner (Photo courtesy of Caltech).

PRODUCT NEWS MAMMOGRAPHY PLATE

To receive prompt and free information on products, log on to www.LinkXpress.com or fill out reader service form located on last page

DOSE PROTECTION APRON

FLAT PANEL DETECTOR

Konica Minolta Medical Imaging

Wolf X-Ray

Varex Imaging

The CP1M200 was created especially to deliver the highest image quality for mammography. It offers exceptional sharpness and granularity, clear recognition of anatomical edges and clear visibility of micro calcifications.

The Special Procedure: Light Weight Lead apron has an elastic belt that helps lift the apron weight off the shoulders of the wearer. A back panel gives wearers full protection and a hook-n-loop closure makes putting the apron on/off easy.

The PaxScan DXV4343 combines readout electronics with a Cesium Iodide scintillator. It is available with a Windows-based app and a communications command library to assist OEM customers with developing their own system interface.

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Macrophage Targeting Agent Aids Rheumatoid Arthritis Diagnosis novel positron emission tomography (PET) tracer can visualize joint inflammation and could provide early diagnosis of rheumatoid arthritis (RA), according to a new study.

Researchers at Ewha Women’s University (Seoul, Korea; www. ewha.ac.kr), Seoul National University College of Medicine (SNU; South Korea; http://medicine.snu.ac.kr), and other institutions conducted a study in mice to examine if Fluorine-18 (18F)-FEDAC, a radiolabeled ligand that targets the 18-kDa translocator protein (TSPO), which is abundant in activated macrophages, could be used to detect and monitor RA development. The mouse model studied both 18FFEDAC and 18F-FDG PET imaging, with microscopic examinations of tissue performed to evaluate macrophages and TSPO expression.

The results revealed increased TSPO mRNA and protein expression in the activated macrophages, with uptake of 18F-FEDAC in activated macrophages higher than in non-activated cells. In addition, 18F-FEDAC uptake by arthritic joints increased early on, whereas uptake of 18FFDG uptake did not; on the other hand, 18F-FDG uptake by arthritic joints increased at later stages to a higher level than 18F-FEDAC uptake.

Histologic sections of arthritic joints demonstrated an influx of macrophages, as compared with that in normal joints. The study was published in the May 2015 issue of The Journal of Nuclear Medicine.

18 F is a fluorine radioisotope that decays by positron emission 97% of

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the time, and electron capture 3% of the time; both modes of decay yield stable oxygen-18 (18O). 18F is an important radioisotope as a result of both its short half-life and the emission of positrons when decaying.

It is primarily synthesized into fluorodeoxyglucose (FDG) for use in PET scans for cancer detection.

Image: Increased 18F-FEDAC as seen on PET/CT (Photo courtesy of Seoul National University College of Medicine).

Smoking, Age and Diabetes Linked to Hippocampal Calcifications new multiplanar computerized tomography (CT) study shows that older age, diabetes mellitus, and smoking are associated with an increased risk of hippocampal calcifications.

Researchers at University Medical Center Utrecht (UMCU; The Netherlands; www.umcutrecht.nl) and Tergooi Hospital (Hilversum, The Netherlands; https://www.tergooi.nl) conducted a study in 1,991 patients (average age 78 years), who visited the memory clinic at Tergooi Hospital between 2009 and 2015. All patients had a standard diagnostic workup, including cognitive tests and brain CT scans, which were analyzed for presence and severity of hippocampal calcifications.

The researchers then studied their association with vascular risk factors such as high blood pressure, diabetes and smoking, and also assessed the effects of calcifications on cognitive function.

The results revealed that 19.1% of the patients had hippocampal calcifications. Older age, diabetes mellitus, and smoking were associated with the presence of hippocampal calcifications, but no link was found between the presence and severity of hippocampal calcifications and

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cognitive function. As a result, the researchers plan to carry out additional studies in different groups of people to better understand possible connections between hippocampal calcifications and cognitive problems. The study was published on June 12, 2018, in Radiology.

“Multiplanar CT scan makes it possible to see the hippocampus in different anatomical planes; for example, from top to bottom, right to left, and front to back,” concluded Dr. de Brouwer.”Before multiplanar CT scans, hippocampal calcifications were often mistaken for choroid plexus calcifications.”

Hippocampal calcifications were first described in a pathology study in 2002 as a vasculopathy with fibrosis and calcifications with a predilection for the middle hippocampal artery. These calcifications can spread from the tail to the body of the hippocampus and occasionally to the head, and may lead to patchy neuronal loss. Accordingly, it has been hypothesized that hippocampal calcifications may be a manifestation of vascular abnormalities that could contribute to hippocampal atrophy and cognitive deterioration, such as in dementia.

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Medical Imaging International

Virtual Reality Helps Teach Interventional Radiology one-hour multi-segment movie shows how an immersive virtual reality (VR) experience can help educate patients, trainees, and attending physicians about interventional radiology.

The VR360 movie, developed by Prof. Ziv Haskal, MD, of the University of Virginia Health System (UVHS; Charlottesville, USA; www. healthsystem.virginia.edu), walks viewers through an interventional radiology procedure called transjugular intrahepatic portosystemic shunt (TIPS), guiding them step-by-step through the entire process, with strategic use of picture-in-picture (PIP) to allow viewers to observe both what the radiologist is doing and what he is seeing. The movie was presented at the Society of Interventional Radiology (SIR) annual scientific meeting, held during March 2018 in Los Angeles (CA, USA).

From inside VR goggles, or even simple inexpensive cardboard viewers that hook onto a smartphone, observers can look around in 360 degrees at the procedure, with optional multi-camera points of view and floating high-definition inserts providing them with every perspective of the case needed in order to maximizing learning. VR can also be used to show patients what to expect during a procedure, to teach a nursing student what must be kept sterile in an operating room, or to provide a refresher for physicians who have not performed the procedure recently.

“Interventional radiology has always been on the forefront of modern medicine and VR360 is the cutting-edge of medical simulation, so this project embodies the innovative spirit of our specialty,” concluded Professor Haskal, who is also the editor-in-chief of the Journal of Vascular and Interventional Radiology (JVIR). “We took one of the hardest

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procedures we perform and created an all-enveloping, in-the-room VR film allowing an operating physician to return to any complex segment they wish for learning, review and perspective.”

Image: Prof. Ziv Haskal and a pair of VR goggles (Photo courtesy of UVHS).

Remote Tracking Reduces Dehydration Risk in Radiation Therapy Patients new study suggests that mobile sensor technology can help identify early dehydration risk in head and neck cancer patients undergoing radiation therapy (RT) treatment.

Researchers at the University of California, San Diego (UCSD, USA; www.ucsd.edu) and the University of Texas MD Anderson Cancer Center (MD Anderson; Houston, USA; www.mdanderson.org) conducted a prospective randomized trial involving 357 patients with head and neck cancer undergoing RT in order to evaluate the self-monitoring CYberinfrastructure for COmparative effectiveness Research (CYCORE) system, which utilizes sensor and mobile technology to remotely assess daily weight, blood pressure (BP), pulse, and patient-reported outcomes.

Patients were randomly assigned to usual care or to CYCORE selfmonitoring during RT, and both groups had standard weekly visits with their oncologists. In addition, all patients completed the 28-item MD Anderson Symptom Inventory (MDASI) at baseline, at completion of 67 weeks of RT, and at 6-8 weeks post-RT completion. The MDASI includes general cancer symptoms, such as pain, fatigue, nausea, and those more specific to head and neck cancer, such as difficulty swallowing, and skin pain, burning, and rash. Symptoms did not differ between the two groups at the beginning of treatment.

The results revealed that when RT was completed, patients in the CYCORE cohort reported significantly lower scores than did those in the usual care group for both general MDASI symptoms and specific head and neck cancer symptoms. The mean scores on symptom interference in daily life were similar for both study groups across all time periods. The study was presented at the annual meeting of the American Society of Clinical Oncology (ASCO), held during June 2018 in Chicago (IL, USA).

When undergoing cancer treatment, side effects such as vomiting or diarrhea can lead to dehydration. Infections, high fever, bleeding, or merely not drinking enough fluids also can lead to dehydration. Signs and symptoms of dehydration include headache, dizziness or lightheadedness, sleepiness, decrease in urination, dark yellow- or amber-colored urine, decreased skin elasticity, dry mouth and mucous membranes, and low blood pressure.

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PRODUCT NEWS MAMMOGRAPHY DISPLAY

To receive prompt and free information on products, log on to www.LinkXpress.com or fill out reader service form located on last page

DICOM PACS WORKSTATION

CV INFORMATION SYSTEM

EIZO Display Technologies

Aycan Medical Systems

Fujifilm

The RX560 MammoDuo integrates two 5MP highbrightness color monitors on a specifically designed stand. It offers the high-definition needed for breast imaging, along with a narrow design to help the eyes easily move between monitors.

The aycan workstation is an image-processing tool and DICOM PACS workstation for conventional, multi-slice and other image reading. Its navigation and visualization of images makes processing and diagnosis easy.

The Synapse Cardiovascular 5.0 creates finalized, signed CV-structured reports quickly and easily, and offers tools to help quantify results.

It is uniquely suited to fit into any IT infrastructure, and can be optimized for CV-related procedures.

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App-Based System Provides Flexible Ultrasound Technology new mobile ultrasound device that costs one-tenth of a traditional ultrasound machine provides primary care providers instant insight.

The Healcerion (Seoul, South Korea; www.healcerion.com) Sonon 300L handheld ultrasound probe is an advanced diagnostic imaging device weighing just 370 grams, allowing it to be used anywhere with the aid of a mobile app compatible with Android and iOS devices, and downloadable from the Google Play or Apple App Store. Using intuitive finger-touch controls and a simple user interface to operate it, the Sonon 300L provides rapid, accurate, diagnostics to improve patient care and procedural efficiency.

Intended to provide a diagnostic ultrasound option for retail clinics, urgent care centers, mini-hospitals, home healthcare providers, and rural and third-world regions, the Sonon 300L boasts a three-hour continuous scanning battery life, Wi-Fi, 3G, and LTE connectivity, and support for most medical imaging protocols, including Digital Imaging and Communications in Medicine (DICOM) and picture archiving and communication systems (PACS). The Sonon 300L handheld ultrasound probe was approved by the U.S. Food and Drug Administration (FDA).

“Sonon 300L is smaller and easier to use than any other ultrasound technology in the US market. It empowers American physicians to ad-

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vance their practice to align with state-of-the-art practices,” said Benjamin Jeongwon Ryu, MD, Founder and CEO of Healcerion. “It allows primary care providers to be more efficient and effective with instant insight to diagnose or refer a patient to a specialist.”

Image: A novel portable ultrasound device displays images on mobile devices (Photo courtesy of Healcerion).

Ultrasound Device Improves Peripheral IV Catheter Insertion new ultrasound-based vascular access tool aids nurses successfully insert peripheral intravenous (IV) catheters at the first try.

The EchoNous (Seattle, WA, USA; www.echonous.com) Vein is designed to provide immediate, clear images of superficial and deeper veins one to five centimeters from the skin surface. High-resolution images can be quickly acquired using presets optimized for gain and depth to find and evaluate veins in both pediatric and adult patients.

The system is composed of a linear 9.3MHz, 128 element transducer probe, a dedicated tablet unit, a connecting cable, and a rolling stand.

Features include two simple on-screen touch screen controls to enable immediately visualization of veins in the center of the display; text and voice recording; data and ultrasound image outputs; Wi-Fi and Bluetooth connectivity; automatic software updates; and wireless printing.

EchoNous Vein also integrates with EchoNous UScan, an artificial intelligence (AI)-driven bladder volume measurement tool which combines machine learning with highly miniaturized ultrasound. Together, they form the EchoNous Platform.

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“Time is critical, especially when patients need an infusion or antibiotic treatment, and finding the right vein can be challenging. We designed the EchoNous Vein to provide nurses with rapid, clear images of veins to directly improve patient care, satisfaction and HCAHPS scores,” said Kevin Goodwin, CEO of EchoNous. “We wanted to create an easyto-use tool that would help to reduce failed sticks, as with each failure comes a much higher risk of vessel trauma or infections which can lead to longer stays in hospital and higher medical costs.”

“EchoNous Vein’s simple on-screen controls allows clinicians using ultrasound to clearly identify veins in the center of the display, helping to not just locate veins, but to evaluate their health and quality prior to peripheral IV placement,” said Nancy Moureau, RN, PhD, CEO of PICC Excellence (Hartwell, GA, USA). “As clinicians we know that IV insertion selecting a healthy vein for catheter placement can help to reduce the chance of post-insertional complications. To have a tool specifically designed to easily select veins and guide catheter placement is extremely valuable, as we’re always looking to improve the patient experience.”

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Medical Imaging International

New System Expands Neuro and Cardiac MRI Capabilities new magnetic resonance imaging (MRI) system enables healthcare providers to produce higher resolution images for myriad exams in less than five minutes.

The Canon Medical Systems (Otawara, Japan; https://global.medical.canon) Galan 3T XGO offers the ability to conduct quick, comfortable, and high-quality neuro MRI exams, as well as faster sampling and higher-resolution images. The system comes with the allnew Saturn X Gradient, which provides up to 30% improved signal-to-noise ratio (SNR) for brain diffusion weighted imaging (DWI), resulting in even higher resolution neuro images. And by stacking protocol sequences, neuro sequences such as SAG T1, AX T2, AX T2 FLAIR, AX T2 and AX DWI/ADC can be performed in less than five minutes.

Galan 3T XGO also delivers enhanced cardiac capabilities, including T1 mapping using a modified looklocker inversion (MOLLI) recovery sequence that allows quantitative characterization of myocardial tissue within a single breath hold. In addition, cardiac phase sensitive inversion recovery (PSIR) provides improved contrast in late-enhanced imaging and eliminates the need for inversion time (TI) calibration scan, allowing cardiac exams to be completed with fewer breath holds and greater patient comfort.

New PURERF shielding technology maximizes the radiofrequency

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Oxygen Microbubbles Sensitize Tumors to Radiation Therapy njecting breast cancer with oxygen-filled microbubbles makes tumors three times more sensitive to radiation therapy (RT), according to a new study.

Researchers at Thomas Jefferson University (TJU; Philadelphia, PA, USA; www.jefferson.edu), Drexel University (Philadelphia, PA, USA; www.drexel.edu), and other institutions conducted a murine study in order to investigate if surfactant-shelled oxygen microbubbles injected intravenously into a tumor and “popped” by noninvasive ultrasound could elevate hypoxic tumor oxygen levels, thus making them more sensitive to RT. The researchers managed to show that the injected oxygen microbubbles successfully increased breast tumor oxygenation levels by 20 mmHg, significantly more than control injections of saline or untriggered oxygen microbubbles.

Using photoacoustic imaging, the researchers also showed that using the microbubbles ensured that oxygen delivery was independent of hemoglobin transport, and thus effective in avascular regions of the tumor. Overcoming hypoxia by this method immediately prior to RT nearly triples RT radiosensitivity, resulting in roughly 30 days of improved tumor control, as well as statistically significant improvements in tumor growth and survival.

The study was published on January 21, 2018, in the International Journal of Radiation Oncology* Biology* Physics.

“Finding a way to reverse oxygen deficiency in tumors has been a goal in radiation therapy for over 50 years. Oxygen microbubbles flush tumors with the gas, and make radiation therapy significantly more effective in animal models,” said senior author John Eisenbrey, PhD, of Jefferson University. “The very act of bursting these microbubbles within the tumor tissue seems to change the local physiology of the tumor and make cells generally more permeable to oxygen and potentially to chemotherapy as well.”

Microbubbles are bubbles smaller than one mm in diameter, but larger than one micrometer. Gas-filled microbubbles oscillate and vibrate when a sonic energy field is applied and may reflect ultrasound waves. But because gas bubbles in liquid lack stability and therefore quickly dissolve, microbubbles must be encapsulated with a solid shell made from a lipid or a protein, such as albumin.

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(RF) transmission efficiency for optimal image quality and an increase of up to 20% in SNR, while MultiBand SPEEDER technology allows for multiple slices to be acquired at the same time, reducing DWI scan times by up to two times. Patients undergoing MR exams can also enjoy the new MR Theater, an immersive virtual experience that gives patients a visual focal point to distract them from the exam, encouraging them to relax and stay still, enabling clinicians to produce efficient, highquality imaging.

Image: An immersive virtual experience helps patients relax during an MRI scan (photo courtesy of Canon Medical Systems).

PRODUCT NEWS BREAST CANCER SOFTWARE

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CANCER CARE PLATFORM

IMAGE DATA SOFTWARE

iCAD

Varian Medical Systems

CHILI

The PowerLook Mammo Detection is based on algorithms that analyze data, identifying and marking suspicious regions in 2D mammography images. It helps detect actionable missed cancers earlier than screening mammography alone.

The 360 Oncology is a comprehensive solution that connects the entire care team and engages patients.

The platform allows users to make better, more informed decisions while keeping patients engaged throughout their cancer care journey.

The CHILI Diagnost software is designed so the contents of two monitors can be displayed simultaneously. Image retrieval can be controlled from the RIS or the workstation, while previous studies are made available on the second monitor.

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Mobile Ultrasound Device Enhances Medical Exam Efficiency n innovative compact diagnostic ultrasound system produces and highresolution images during point of care (POC) testing and treatment.

The Konica Minolta (Osaka, Japan; www. konicaminolta.com) SonImage MX1 portable ultrasound system uses Dual Sonic technology to control ultrasonic noise and enhance transmission efficiency, delivering clear delineation of structures just hundreds of microns in diameter. The system has been optimized for musculoskeletal (MSK) and orthopedic use, and for interventional guidance. The intuitive touch screen interface allows instinctive operation and simplified workflow, enabling users to customize the layout of the large buttons and design the touch panel to suit respective workflows.

Features include an intuitive touch screen with focused POC exams, and a five-button console to further improve clinical workflow and ease-of-use. One-touch image optimization, with multiple imaging parameters, such

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as frequency, focus, and compounding, allows values to be recalculated automatically just by adjusting scanning depth. By using customized settings, exceptional image quality and resolution can be maintained reliably and repeatedly, enabling physicians to make a confident diagnosis, provide therapeutic needle guidance, and monitor rehabilitation.

A high-mobility pole cart and a desktop stand are available to enhance usability in a hospital, with other optional products designed for greater portability including a threeway carrier bag that can be used also as a backpack and shoulder bag, a hard suitcase trolley for airplane travel, and a display cover to protect the unit. Built-in batteries and optional extended batteries provide run times of one hour and up to two hours respectively. In addition, a three-port connector enables the use of three different probes, providing a wide range of diagnosis and treatment approaches without switching probes.

“From the one-touch image optimization

and extreme portability, to the simple needle visualization software, the MX1 System enables clinicians to do more with ultrasound anytime and anywhere,” said Joan Toth, senior product marketing manager at Konica Minolta Healthcare. “In a competitive outpatient marketplace, the MSK practitioner can rely on the immediacy of information with the SonImage MX1 to make confidant decisions that enhance patient care and satisfaction.”

Image: The SonImage MX1 portable ultrasound system (Photo courtesy of Konica Minolta).

Ultrasound as Effective as Surgery for Prostate Cancer new study suggests that high-intensity focused ultrasound (HIFU) can destroy prostate cancer (PC) tumors as efficiently as surgery or radiotherapy (RT), but with fewer side effects.

Researchers at Imperial College London (Imperial; United Kingdom; www3.imperial.ac.uk), University College London (UCL, United Kingdom; www.ucl.ac.uk), and other institutions conducted a prospective study of 625 consecutive patients with non-metastatic, clinically significant PC who underwent focal HIFU between January 1, 2006 and December 31, 2015. Disease was first localized using multiparametric magnetic resonance imaging (mpMRI), combined with targeted systematic biopsies, or transperineal mapping biopsies.

Areas of significant disease were treated, with follow-up including prostate-specific antigen (PSA) measurement, mpMRI, and biopsy. The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality after five years. During median follow-up of 56 months, high-risk PC

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was found in 505 patients (84%). FFS was 99% at one year, 92% at 3 years, and 88% at 5 years. For the whole patient cohort, metastasis-free, cancer-specific, and overall survival at five years was 98%, 100%, and 99% respectively. The results confirmed that cancer survival rate from HIFU was 100%, identical to that of surgery and RT. The study showed, however, that the risk of side effects when HIFU was used was lower than the risk incurred by the other treatment options. Urinary incontinence affected two percent of patients, but none required more than one pad per day. Erectile dysfunction affected 15% of the study population. The study was published on June 27, 2018, in European Urology.

HIFU technology is based on nonlinear acoustic mathematical optimization methods to analyze and simulate the propagation of sound in material. The information is then used to enhance the shape of an acoustic lens so that that ultrasound pressure is focused precisely on the location of the tissue to be ablated, while the surrounding tissue retains as little damage as possible.

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Industry News

Digital X-Ray Market Projected to Grow at 8.5% Annually in Coming Years he digital X-ray market is expected to grow at a compound annual growth rate (CAGR) of 8.5% from USD 8.68 billion in 2018 to USD 13.04 billion by 2023, driven by a growing geriatric population and resultant increase in the incidence of global diseases, favorable regulations and government initiatives & investments, increased advantages of digital X-ray systems, and technological advancements and product development. These are the latest findings of MarketsandMarkets (Northbrook, IL, USA; www.marketsandmarkets.com), a global market research company.

Based on application, the general radiography segment is expected to account for the largest share of the digital X-ray market in 2018, led mainly by the rising prevalence of diseases such as tuberculosis, osteoporosis, and CVD, an increasing aging population, and product launches.

Based on technology, the direct radiography segment is expected to reg-

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ister the highest CAGR during the forecast period due to the advantages offered by direct radiography systems, such as effective dynamic range, better contrast detectability, better medical evaluation, superior and more accurate images, reduced radiation exposure for patients and workers, flexibility in image management, improved patient throughput, superior evaluation of data and images, and lower operational costs.

Geographically, North America is expected to dominate the global digital X-ray market in 2018 due to strong economies in the US and Canada, which have witnessed significant investments in new technologies. Europe is expected to hold the second-largest share of the global digital X-ray market in 2018 on account of the increasing prevalence of diseases, growing geriatric population, favorable reimbursement scenario in several countries, and easy access to and affordability of quality healthcare technologies and solutions in the region.

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

2019 AIUM Annual Convention –

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

American Institute of Ultrasound in Medicine. Apr 4-7; Orlando, FL, USA; Web: www.aium.org

apscvir2019.com

DECEMBER 2018

Medical Fair India 2019. Feb 21-23;

Lisbon, Portugal; Web: www.escar-

New

dio.org

medicalfair-india.com

India;

Web:

ECIO 2019 – European Conference on Inteventional Oncology. Apr 8-

www.

11; Amsterdam, Netherlands; Web: www.ecio.org

MARCH 2019

JANUARY 2019

ISBI 2019 – International Sympo-

TOPIM 2019 – Imaging the Biome-

ECR 2019 – European Congress of

sium on Biomedical Imaging. Apr

chanics of Life. Jan 13-18; Les

Radiology. Feb 27-Mar 3; Vienna,

8-11; Venice, Italy; Web: biomedical-

Houches, France; Web: www.e-

Austria; Web: www.myesr.org

imaging.org/2019

smi.eu

KIMES 2019. Mar 14-17; Seoul, Ko-

CAR 2019 – 82nd Annual Scientific

Arab Health 2019. Jan 28-Feb 1;

rea; Web: www.kimes.kr

Meeting of the Canadian Associa-

Dubai, UAE; Web:

www.arab-

healthonline.com

tion of Radiologists. Apr 11-14;

EMIM 2019 – 14th European Molecular Imaging Meeting. Mar 19-22; Glasgow, UK; Web: www.

FEBRUARY 2019

Apr 30-May 4; San Francisco, CA, USA; Web: www.pedrad.org

MAY 2019 EuroCMR 2019 – 17 Annual Meet-

EuroEcho-Imaging 2018. Dec 6-9;

Delhi,

Society for Pediatric Radiology.

APRIL 2019

International Calendar Medical Imaging International

e-smi.eu

ing on Cardiovascular Magnetic Resonance. May 2-4; Venice, Italy; Web: www.escardio.org 2019 ARRS Annual Meeting – American Roentgen Ray Society.

May 5-10; Honolulu, HI, USA; Web: www.arrs.org 100th German Congress of Radiology 2019. May 9-12; Leipzig, Germany; Web: www.roentgenkongress.de

Montreal, Canada; Web: www.car.ca

ISMRM 2019 – 27th Annual Meet-

15th ISUOG International Sympo-

ing of the International Society for

sium – International Society of Ul-

Magnetic Resonance in Medicine.

trasound in Obstetrics & Gynecol-

May 11-16; Montreal, QC, Canada;

Feb 2-7; San Francisco, CA, USA;

SIR 2019 – 44th Annual Meeting of

ogy. Apr 12-14; Sao Paulo, Brazil;

Web: www.ismrm.org

Web: http://spie.org

the Society of Interventional Radi-

Web: www.isuog.org

ICNC 2019 – International Confer-

Charing Cross International Sym-

ence on Nuclear Cardiology & Car-

posium 2019. Apr 15-18; London,

diac CT. May 12-14; Lisbon, Portu-

BiOS 2019 – SPIE Photonics West.

SPIE Medical Imaging 2019. Feb 16-21; San Diego, CA, USA; Web:

ology. Mar 23-28; Austin, TX, USA; Web: www.sirmeeting.org

http://spie.org

Thoracic Imaging 2019. Mar 24-27;

UK; Web: www.cxsymposium.com

gal; Web: www.escardio.org

APSCVIR 2019 –

Savannah, Georgia; Web: http://

ESTRO 38 – Annual Congress of

CMEF Spring 2019 – China Inter-

Meeting of the Asia Pacific Con-

thoracicrad.org

the European Society of Radiology

national Medical Equipment Fair.

gress of Cardiovascular and Inter-

ExpoMed Eurasia 2019. Mar 28-30;

& Oncology. Apr 26-30; Milan, Italy;

May 14-17; Shanghai, China; Web:

ventional Radiology. Feb 21-24;

Istanbul, Turkey; Web: expomed

Web: www.estro.org

www.cmef.com.cn

Bali,

istanbul.com

SPR 2019 – Annual Meeting of the

ESPR 2019 – 55th Annual Meeting

Indonesia;

14th Annual

Web:

http://

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International Calendar of the European Society of Pedi-

Conference of Computer Assisted

atric Radiology. May 14-18; Helsin-

Radiology & Surgery. Jun 17-22;

ki, Finland; Web: www.espr.org

Rennes,

ASNR 2019 – 57th Annual Meeting

www.cars2019.org

of the American Society of Neuro-

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radiology. May 18-23; Boston, MA,

Echocardiography’s 30th Annual

USA; Web: www.asnr.org

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Portland, OR, USA; Web: http://as-

Athens, Greece; Web: www.escar-

escientificsessions.org

dio.org

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EURSON 2018 – Congress of the

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Radiology. Jun 5-8; Rome, Italy; Web: www.esgar.org

ESMRMB 2019 – 37th Annual Meet-

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ing of the European Society for

Radiology. Jun 13-15; St. Gallen,

Magnetic Resonance in Medicine

Swit-zerland; Web: www.radiologie

and Biology. Oct 3-5; Rotterdam,

kongress.ch

Netherlands; Web: www.esmrmb.org

Radiology at Scotland. Jun 16-22;

ISUOG World Congress 2019 – In-

Gleneagles, Scotland; Web: radiolo-

ternational Society of Ultrasound in

gyintl.com

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