Medical Imaging International February 2016 by Globetech

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Vol.26 No.1 1- 2 /2016 ISSN 1068-1779

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IN THIS ISSUE Clinical News . . . . . 2-26 PACS/ IT Update . . 27-32 Product News . . . . . 8-32 Industry News . . . . . . 33 International Calendar . 34

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Fluorescence System Detects Oral Cancer More Accurately noninvasive device uses fluorescence technology to measure and visualize the biochemical changes that occur in oral epithelial tissue as it turns cancerous. Developed by researchers at Texas A&M University (TAMU; College Station, TX, USA; www.tamu.edu), fluorescence lifetime imaging (FLIM) technology noninvasively detects distinct fluorescence signatures specific to benign, precancerous, and cancerous tissue. The system, a small, handheld reflectance confocal laser endomicroscope, detects natural fluorescence emissions from three molecules present in epithelial tissue: collagen, nicotinamide adenine dinucleotide (NADH), and flavin adenine dinucleotide (FAD). Collagen has a stronger signal in normal and benign tissue, but in cancerous or precancerous tissue the collagen signals weaken, and NADH and FAD signals increase, since both molecules are related to the energy cells use; malignant cells, per se, use more energy as they rapidly multiply. Another advantage of the system is that that since FLIM detects the natural fluorescence spectrum and lifetime of the molecules, there is no need to use any external contrast agent. Preliminary results from almost 20 patients suggest that FLIM technology can be used to distinguish between benign lesions and dysplasia or squamous cell carcinoma in the human oral cavity. According to the researchers, FLIM could potentially be used to assist in the clinical management of oral cancer patients, from early screening and diagnosis to treatment and monitoring of recurrence, which happens in 30% of patients who survive a first incidence. Device testing is planned in medical centers in Dallas (TX, USA), Brazil, and Qatar before moving to in-depth clinical trials and commercial licensing. The study presenting FLIM was presented at the World Molecular Imaging Congress, held during September 2015 in Culver City (CA, USA). “Using FLIM we can see a reduction in the fluorescence lifetime in precancerous tissue and changes in the fluorescence spectrum in malignant tissue that are not apparent in benign tissue,” said study presenter Associate Professor of Biomedical Engineering Javier Jo, PhD. “We then feed this information into a computer where it is processed by an algorithm that essentially color codes the images of the oral cavity; if the tissue is benign it shows up green. If it is cancerous or precancerous, it shows up red.” The [US] National Institutes of Health (NIH; Bethesda, MD, USA; www.nih.gov) estimates that more than 8,000 people in the United States will die from oral cancer, and another 37,000 new patients will be diagnosed this year alone. When oral cancer is diagnosed before it spreads, the fiveyear survival rate is about 80%, but only about 30% of patients are diagnosed at this early stage.

Image: A FLIM microscopy detecting oral cancer (Photo courtesy of Texas A&M University).

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Optical Scanner Images Breast Cancer in Vivo nnovative optical scanners show potential for real-time breast cancer screening, according to a new study. Researchers at Florida International University (FIU; Miami, USA; www.fiu.edu) and the Sylvester Comprehensive Cancer Center (Miami, FL, USA; www.sylvester.org) have developed a prototype hand-held optical imager with a contourable probe head that performs diffuse nonionizing optical imaging of breast tissue using a near-infrared (NIR) laser diode source to simultaneously illuminate and detect oxyhemoglobin and deoxyhemoglobin concentrations over large surface areas, thus mapping the optical absorption. The scanner uses 785 nm laser diode sources and intensified charge-coupled device (CCD) camera detectors to generate two-dimensional (2D) surface maps of total hemoglobin absorption. The subjects lay in supine position, and images are collected at various locations on both the ipsilateral (tumor-containing) and contralateral (non-tumor-containing) breasts. The 2D surface maps of optical absorption show regions of higher intensity at the tumor location, due to an increased hemoglobin concentration, indicative of an enlarged vasculature and higher blood content due to the presence of the tumor. In a study to examine the in vivo capabilities of the optical scanner in detecting breast tumors, five female human subjects (ages 51–74) diagnosed with breast cancer were imaged prior to surgical intervention. The scanner was able to detect the presence of invasive ductal carcinoma in three subjects, and ductal carcinoma in situ and metastatic carcinoma in the two other subjects, confirming its potential for imaging human breast cancer. The study describing the device was published on October 23, 2015, in Biomedical Physics & Engineering Express. “The optical analysis developed offers several

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

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Image: Diffuse optical images of a tumor (red) from several probe locations (Photo courtesy of FIU).

benefits over mammography, with no ionizing radiation dose and fewer issues imaging dense tissues,” said senior author Anuradha Godavarty, PhD, of the FIU Optical Imaging Laboratory. “Eventually, we hope that physicians will be able to use this for real-time imaging of breast tissues as part of regular visits by the patients. We’re currently working on the mathematical tools required to process the images and produce 3D tomographic images, in order to determine tumor size and depth.”

Study: Accelerated Partial Breast Irradiation Can Treat Early Stage Breast Cancer he results of a new prospective brachytherapy clinical study have been released. The randomized, multicenter phase III study evaluated 1,184 patients aged 40 years and older with a median age of 62, and compared treatment using Accelerated Partial Breast Irradiation (APBI) combined with interstitial multi-catheter brachytherapy to treatment using Whole Breast Irradiation (WBI). The study took place at 16 medical centers in six European countries – Austria, the Czech Republic, Germany, Hungary, Poland, Spain, and Switzerland. The study results were announced by the Groupe Européen de Curiethérapie – European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and showed that overall survival, local and regional cancer control rates using APBI brachytherapy, after breast conserving surgery for those patients with early stage breast cancers, were equivalent to those using WBI. The researchers randomized the patients either to a standardized treatment arm (WBI, n=551), or an investigational treatment arm (APBI, n=633). Follow-up exams were made for the patients every three months in the first 60 months, and then an-

nually, with a median follow up of 6.6 years. Nine patients were treated with APBI, and five patients with WBI. All had a local recurrence after five years, equivalent to cumulative recurrence rates of 1.44% and 0.92% (p=0.42) respectively. There was no significant difference in regional recurrence between the groups. The five-year overall survival was 97.27% for APBI and 95.55% for patients treated with WBI, with no observed difference in breast-cancer related deaths. Prof. Vratislav Strnad, MD, PhD, Department of Radiation Oncology, University Hospital, Erlangen, Germany, said, “GEC-ESTRO is the most comprehensive clinical study to date evaluating the efficacy of APBI brachytherapy alone versus traditional external whole breast irradiation. APBI brachytherapy is an attractive treatment approach with a high level of precision, versatility and flexibility. The benefits of APBI brachytherapy include an at least four-fold reduction in total radiation exposure to healthy surrounding tissue and nearby structures including the chest wall, heart, lungs or skin; preservation of future treatment options; and a notably shorter course of therapy – four or five days, compared to three or up to seven weeks for whole breast irradiation.”

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First Total-Body PET Scanner To Be Introduced in 2017 he development of world’s first total-body positron emission tomography (PET) scanner could change the way cancer and other diseases are diagnosed and treated. The project, called Explorer, will design and build a PET scanner that images the entire human body simultaneously. To do so, a consortium between the University of California, Davis (UCD; USA; http://ucdavis.edu), Lawrence Berkeley National Laboratory (LBL; Berkeley, CA, USA; www.lbl.gov), and the University of Pennsylvania (Philadelphia, PA, USA; www.upenn.edu) was formed with the goal of combining the strengths of each contributor to build a scanner that could reduce radiation doses by a factor of 40, and decrease scanning time from 20 minutes today to just 30 seconds. The LBL contribution is to develop the electronics that will send the data collected by the scanner’s detectors to a computer, which will convert it into a three-dimensional (3D) image of the patient. Since the new PET scanner will have half a million such detectors, the task is incredibly complex. UCD will develop a new molecular imaging agent and human-grade radio-labeled peptides for the project, as well as plans and computer simulations for the total-body scanner. The University of Pennsylvania team, led by Prof. Joel Karp, PhD, will investigate and improve time-of-flight (TOF) PET imaging, and the quality of the reconstructed images, as well as aid in the clinical interpretation of disease. To do so, each major factor affecting system performance, such as the scintillation detector, the calibrations and processing electronics, data correction techniques,

and the image reconstruction algorithm, will be studied independently to develop methodologies that are predictive of human ability to identify and quantify activity uptake in lesions. “We’re developing the electronic interface between the detectors and the computer algorithm – and the electronics for this scanner is an order of magnitude more complicated than what’s been done before,” said LBL project leader William Moses, PhD, of the molecular biophysics and integrated bioimaging division. “But Berkeley Lab has a long history developing instrumentation for nuclear medical imaging, including PET scanners, and this project is another milestone in our research.” “The vision of the Explorer project is to solve two fundamental limitations of PET as it is currently practiced. The first is to allow us to see the entire body

all at once,” said UC Davis project leader professor of biomedical engineering Simon Cherry, PhD. PET scans are widely used to diagnose and track a variety of diseases, including cancer, because they show how organs function in the body, in contrast to MRI or CT scans, which mostly show anatomy. Using radioactive tracers that produce a signal from within the body, PET scanners produce a 3D image that is constructed by computers using sophisticated mathematical techniques. The Explorer project will address shortcomings of the current scanning technology, which requires more time and exposes the patient to more radiation because scans are done in 20-cm segments. Image: An artist’s rendition of the Explorer total body PET scanner (Photo courtesy of Joe Proudman / UC Davis).

Nitric Oxide Inhalation Device for MRI Procedures Cleared by FDA

Gaming Technology Could Improve X-Ray Precision While Reducing Radiation Exposure

he US Food and Drug Administration (FDA) has cleared a system for use with neonates that require MRI procedures and a constant concentration of nitric oxide (NO) inhalation therapy gas in the patient-breathing circuit. The system, provided by a leading specialty biopharmaceutical company, enables continuity of care and uninterrupted nitric oxide for inhalation therapy for neonates, and increases delivery options. The FDA cleared the Mallinckrodt (St. Louis, MO, USA; www.mallinckrodt.com) INOmax (http://inomax.com) DSIR Plus Magnetic Resonance Imaging (MRI) device for delivery of INOMAX (nitric oxide) during MRI procedures only with validated and compatible Magnetic Resonance Conditional ventilators, identified in the device labeling. The FDA clearance is based on the determination of Substantial Equivalence of the new INOmax DSIR Plus MRI device to the INOmax DSIR. The delivery systems consist of the INOblender delivery system unit, a stand/cart, and INOmax cylinders. The new device features modified cart hardware, delivery cable and tubing, gas sampling tubing, MRI set-up wizard software, and modified labeling, but has the same intended therapeutic effect and is intended for the same patient population as the INOmax DSIR. The new device is considered MR Conditional for use with only with 1.5 T and 3.0 T static magnetic field scanners, where the field strength is less than 100 gauss. Dr. Stephen Welty, professor of pediatrics and leading neonatologist, said, “Neonates being treated with INOmax frequently have multiple medical concerns that may need diagnostic imaging, such as an MRI scan, to guide medical management. Before INOmax DSIR Plus MRI, physicians had to make the difficult decision to take the risk of interrupting INOmax treatment so that imaging could be done. Now, we can deliver uninterrupted inhaled nitric oxide treatment during diagnostic imaging, which will facilitate clinical decision-making and patient care.”

he results of a new feasibility study have shown that a new technology based on the Microsoft (Richmond, WA, USA; www.microsoft.com) Xbox gaming system could afford a new approach to imaging patients. The feasibility study was presented at the annual Radiological Society of North America (RSNA 2015) meeting in Chicago, USA. The aim of the new imaging technology is to produce high-quality X-rays with minimal radiation exposure, especially for imaging children. Researchers at Washington University School of Medicine (St. Louis, USA; https://news.wustl.edu) adapted the hands-free Xbox technology using proprietary software developed for the Microsoft Kinect system. The software coupled with the Kinect system was used to measure thickness of body parts, monitor motion, position, and the X-ray field-of-view, just before the X-Ray image was taken. The parameters were monitored in real-time to alert technologists of anything that could compromise image quality, reducing the need for additional images and radiation exposure. High-quality X-Rays are crucial for determining clinical diagnoses, and treatment. Steven Don, MD, associate professor of radiology at the Washington university’ Mallinckrodt Institute of Radiology, said, “The goal is to produce highquality X-ray images at a low radiation dose without repeating images. It sounds surprising to say that the Xbox gaming system could help us to improve medical imaging, but our study suggests that this is possible. To achieve the best image quality while minimizing radiation exposure, X-ray technique needs to be based on body-part thickness. The gaming software has an infrared sensor to measure body-part thickness automatically without patient contact. Patients, technologists and radiologists want the best quality X-rays at the lowest dose possible without repeating images. This technology is a tool to help achieve that goal.”

Medical Imaging International January-February/2016

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Innovative MR and CT Techniques Improve Treatment of People with COPD he results of a new study published online in the journal Radiology show that MRI and CT imaging could help clinicians find better treatments for some patients with mild-tomoderate Chronic Obstructive Pulmonary Disease (COPD). The researchers showed that measurements of emphysema using Magnetic Resonance Imaging (MRI) correlated strongly with the symptoms and exercise capabilities of patients with modestly abnormal lung function test results. COPD affects approximately 65 million people worldwide, and is a progressive lung disease. Current diagnosis of the disease involves a spirometry test that measures the Forced Expiratory Volume in One second (FEV1). MRI and CT can be used to measure disease and emphysema in airways directly, and explain COPD symptoms and exercise capability. Emphysema in COPD patients reduces the amount of oxygen they have access to, especially during exercise. While no cure exists for emphysema, there are steps people can take to mitigate symptoms. The researchers performed inhaled noble gas MRI to visualizing air spaces in the lungs, and conventional CT on a total of 116 COPD patients including 80 with milder COPD. In addition, the patients were questioned about their quality of life, underwent lung capacity testing, and had to take a six-minute walk to measure their short-term exercise tolerance. The researchers found that COPD symptoms could be explained with the help of CT and MRI emphysema measurements. In addition, for patients with mild-to-moderate COPD and modestly abnormal FEV1 results, MRI emphysema measurements correlated strongly with exercise limitation. Future studies could help explain symptoms and disease control in people with asthma, and cystic fibrosis. Coauthor of the study, Grace Parraga, PhD, Robarts Research Institute, London (ON, Canada), said, “COPD is a very heterogeneous disease. Patients are classified based on spirometry, but patients with the

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same airflow may have different symptoms and significant variation in how much regular activity they can perform, such as walking to their car or up the stairs in their home. FEV1 doesn’t tell the whole story. With lung imaging, we can look at patients with mild disease much more carefully and change treatment if necessary. One in four hospital beds in Canada is occupied by a COPD patient, and many of them return to a hospital because they’re not being optimally treated. Our study shows that when COPD symptoms and exercise limitations are discordant with FEV1 measurements, we should consider using lung imaging to provide a deeper understanding of the patient’s disease and to help improve their quality of life.” Image: Representative patients with mild-to-moderate or severe COPD (Photo courtesy of RSNA).

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PRODUCT NEWS WIRELESS CONNECTIVITY OPTION

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The Nugget is designed for wireless connectivity for the Accu-Gold Family of meters. The Nugget is Wi-Fi, and assures a secure and solid connection for non-invasive diagnostic x-ray measurements. It simply snaps onto an Accu-Gold digitizer to provide a useful subset of Accu-Gold functionality.

The InReach is a dedicated CT imaging system with custom scan protocols for hand/wrist/elbow. The InReach is investigational and not available for sale.

The G-scan Brio offers increased diagnostic accuracy and confidence for musculoskeletal applications adding weight to diagnosis. The open/tilting design allows the study of joints and spine, either in supine or weight-bearing position, because the magnet and patient can rotate from 0-90 degrees.

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Laptop Style Portable Ultrasound System Introduced new compact portable ultrasound system with an ergonomic design including a sliding keyboard cover and support for users with wrist pain has been introduced at the annual Radiological Society of North America (RSNA 2015) conference. The system is the latest innovation in a series of ultrasound scanners, and features a 15.6-inch high-resolution LED screen, and a long-lasting battery. Images on the screen can be viewed from all angles, which can reduce eyestrain. The system is quiet with reduced cooling fan noise, and is ready to begin scanning in less than 45 seconds. The E-CUBE i7 was developed by ALPINION Medical Systems (Seoul, Korea; www.alpinion.com). The E-CUBE i7 uses single-crystal piezoelectric transducer technology instead of standard lead zirconate titanate (PZT) technology to provide improved image quality and detail, higher sensitivity, improved penetration, and less heat degradation. The single crystal phased-array transducers (SP1-5T, SP3-8T) support adult echo, pediatric echo, pediatric abdomen scans, and enhanced penetration in patients. The hockey stick-shaped IO8-17T transducer can be used for difficult-to-access locations, and is intended for imaging vascular, nerve block and superficial procedure. The IO8-17T is a high-frequency linear transducer with a small footprint, and good near-field resolution that can provide detailed anatomical information. The E-CUBE i7 features advanced Spatial Compounding Imaging (SCI),

Harmonic Imaging (FTHI/PITHI), Speckle Reduction Imaging (SRI/FullSRI), and Tissue Doppler Imaging (TDI) imaging technologies, and uses ALPINION needle vision, Xpeed (auto image optimization), auto IMT measurement, CW, and panoramic imaging software. Image: The E-Cube-i7 portable compact ultrasound system (Photo courtesy of ALPINION Medical Systems).

Additional Aggressive Cancers Can Be Found With Breast MRI Following Mammography Screening he results of a study published online in the journal Radiology have shown that performing MRI scans, after the discovery of mammography breast cancer findings, sometimes shows larger and more aggressive tumors than those discovered in mammography. Breast Magnetic Resonance Imaging (MRI) is widely used for the screening of high-risk patients, and pre-surgical planning, and is the most sensitive imaging technique available for detecting breast cancer. In younger women, and those with dense breasts, MRI can detect cancers that have two or more distinct primary tumors, often in different breast quadrants. Most of the so-called multicentric cancers were discovered in women with heterogeneously dense or very dense breasts, but cancer

was also found in 19% of patients with fatty or scattered fibro-glandular tissue. The researchers reviewed the records of 2,021 patients that had newly diagnosed breast cancer, had preoperative MRI, and a biopsy. The MRI detected additional cancers that were not found in the mammography, in 14% (285) of the patients. In 25.6% (73) of the 285 patients the MRI revealed one or more additional cancers in a different breast quadrant than the index cancer, or that detected by breast palpation and/or mammography. In 17 of the 73 patients (23.3%) the multicentric cancers were larger than the known index cancer. The MRI scan also detected multicentric cancers larger than 1 cm in 25% of the 73 patients. Lead author of the study, Chiara Iacconi, MD,

Breast Unit, USL1 Massa-Carrara, (Carrara, Italy; www.usl1.toscana.it), said, â&#x20AC;&#x153;Patients with clinically insignificant cancers undergoing potential overtreatment versus patients who may be undertreated is at the heart of the controversy surrounding breast MRI. We believe invasive cancer larger than 1 centimeter is clinically relevant disease. In general, it is accepted that radiation can likely treat invasive cancer less than 1 centimeter, but lesions larger than 1 centimeter, especially invasive carcinomas, may not be reliably treated with conservation. The results show that multicentric cancer detected on breast MRI after mammography appears to represent a larger tumor burden in approximately a quarter of patients and can result in potential changes to cancer grade and treatment. Medical Imaging International January-February/2016

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Medical Imaging International

Endoscopic Ultrasound Platform Unveiled n innovative ultrasound endoscopic imaging platform uses new ultrasound signal acquisition and detection technologies to provide high-resolution anatomical detail, image quality and display. The ARIETTA Endoscopic ultrasound platform was developed by Hitachi Medical Systems Europe (Zug, Switzerland; www.hitachi-medical-systems.eu) and Pentax Medical (Tokyo, Japan; www.pentaxmedical.com). Hitachi Medical also manufactures high-field Magnetic Resonance Imaging (MRI) systems, multi-slice Computed Tomography (CT) scanners, and medical ultrasound systems. Hitachi Medical ultrasound expertise includes applications for radiology, obstetrics and gynecology, urology, internal medicine, cardiology, gastroenterology, and surgery. The ARIETTA platform uses the Pentax EUS ultrasound scopes, which are part of an extensive range of user-specific ultrasound transducers that Pentax Medical produces. The ARIETTA platform uses flexible advanced algorithms to enable precision control of the ultrasound beam, and achieve the highest possible spatial resolution. The ultrasound-specific digital signal processors use advanced data processing techniques, and support a wide range of applications. The platform uses IPS-Pro LCD monitors, and highly sensitive CE-EUS scopes, and can provide Real-time Tissue Elastography (RTE), and contrast enhanced ultrasound images. The High Tissue Reduction Mode – TrC (Amplitude Modulation) provides highly sensitive contrast, depth penetration, reduction in movement artifacts, and uniform near field, and far field imaging.

Image: The ARIETTA V70 endoscopic platform (Photo courtesy of Hitachi Medical Systems).

Research Alliance for Brain Imaging Techniques wo universities in the US have agreed to cooperate on neuroscience research using the latest imaging technology for all modalities. The Human Brain Imaging Facility (HBIF) will allow researchers at the two universities to perform brain research using specialized equipment that is not available in hospitals or clinics. Researchers from many different disciplines such as psychology, linguistics, nursing, engineering, and neurobiology will benefit from access to the HBIF. The focus of the neuroscience research is to help patients suffering from neurological and mental health disorders, and find new solutions for brain diseases. The five-year joint research agreement was signed between Florida Atlantic University (FAU; Boca Raton, FL, USA; www.fau.edu) and University MRI (Boca Raton, FL, USA; www.universitymri.com) to spur neuroscience research using equipment such as 3-T Functional Magnetic Resonance Imaging (FMRI), and MR guided focused ultrasound scanners. University MRI provides leading-edge medical imaging using Computed Tomography (CT), ultrasound, nuclear medicine, Positron Emission Tomography (PET), fluoroscopy, bone density testing, and digital X-Ray equipment. J.A. Scott Kelso, PhD, FAU, said, “In addition to basic research in cognitive, behavioral and affective neuroscience, our human brain imaging research will most likely include studies on autism, traumatic brain injury, stroke, Alzheimer’s disease, Parkinson’s, and a host of other conditions related to aging and pain. This partnership will offer many opportunities for translational research and applications such as biomarkers, drug testing, and brain-computer interfaces. Having cutting-edge technology for human brain imaging available to our research community will enhance Florida Atlantic University’s place in the world of brain research and will greatly increase the likelihood of new discoveries.”

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DR SYSTEM

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The E-Cube i7 laptop-style portable ultrasound scanner features high-performance hardware and software and a variety of transducers for a range of applications. The system’s design has an ergonomically located keyboard for better support when typing, and a sliding keyboard cover.

The PRO retrofit system offers quality images, beam-detect mode, and full-digital imaging to help increase productivity and reduce image-delivery time. Users can choose a Gadolinium scintillator for general radiography imaging or Cesium scintillator for dose-sensitive applications.

The DBICX50-LED is a 5MP, high-bright color display designed for multimodality imaging including mammography and tomosynthesis. It comes with high-speed graphics controller, X-Cal calibration software, and front sensors for True DICOM gray level and luminance auto-calibration.

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Two New 64/128-Slice CT Scanners Receive Clearance wo new 64/128-slice Computed Tomography (CT) scanners have received US Food and Drug Administration (FDA; Silver Spring, MD, USA; www.fda.gov) clearance. The systems are Smart-Dose (XR-29) compliant, feature lower-dose patient safety capabilities, and workflow and ease-of-use improvements to enable increased daily scanning volumes. The Scenaria SE 64 and SE 128 scanners were developed by Hitachi Medical Systems America (Twinsburg, OH, USA; www.hitachimed.com) within its Scenaria Platform. The company produces a wide range of diagnostic imaging equipment including Magnetic Resonance Imaging (MRI), CT, and ultrasound systems. The workflow enhancements of the new models include a 40% increase in standard Recon Speed (up to 50 images per second) and Multi-Planar Reformatting (MPR) Recon Speed, and increased automation of common operator functions. In addition, the standard patient table weight capacity was upgraded to nearly 250 kg, to accommodate bariatric patients. Sheldon Schaffer, VP and general manager MR/CT, Hitachi Medical Systems America, said, “With Scenaria SE, Hitachi is demonstrating again the unmatched value of our customer support by providing a no-charge upgrade to full Scenaria SE capabilities for our entire installed base of Scenaria 128 customers, covered by warranty or full service agreements. This upgrade is in addition to

our exceptional commitments of unlimited no-charge Applications Training revisits and full replacement coverage of X-ray tubes without cost proration, under our warranty.” Image: The Scenaria SE 64/128-slice CT scanner (Photo courtesy of Hitachi Medical Systems America).

Total MRI Imaging Helps Detect Prostate Cancer new approach to magnetic resonance imaging (MRI) can assist in the detection of prostate cancer without using an invasive endorectal probe. Developed at Hospital San José Tec (Monterrey, Mexico; www.hsj.com.mx), the new approach replaces the standard endorectal MRI coil with a surface coil placed on the pelvis, like a collar. By using only external body coils, the technique offers more comfort to the patient, with a reliability that appears to be comparable to the invasive approach. The new approach is available due to the high element density of Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com) total imaging matrix (TIM) technology, which provides excellent signal-tonoise ratio (SNR). TIM represents a revolutionary addition to the traditional MRI process, using as many as 76 in-

tegrated coil elements and 32 independent receiver channels to create a whole-body imaging matrix, supporting a total field of view of 205 cm. And while conventional metastases evaluation requires changing coils and repositioning the patient for each anatomical area of interest – head, thoracic, abdominal, pelvis, etc., – TIM simplifies the process and shortens examination times. Both the matrix coils and the patient need only be positioned once for all desired exams, as multiple channels allow a unique and almost unlimited scanning flexibility. “The shame experienced with a rectal examination of the prostate is particularly high in the Mexican and Latin American cultures. This holds true for a simple digital prostate exam as well as for more advanced diagnostic procedures like magnetic resonance imaging with the aid of a rectal probe,” said Jorge Fernández de la Torre, MD,

chief radiologist at Hospital San José Tec. “My mother died of cancer shortly after I started college. Watching her suffer really stirred up my emotions. I would like to save other people from a fate like hers.” The American Cancer Society (ACS) recommends that a discussion about screening should take place in men 50 years old who are at average risk of prostate cancer and are expected to live at least 10 more years; men aged 45 at high risk of developing prostate cancer, including African-Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age (younger than age 65); and men aged 40 with more than one first-degree relative who had prostate cancer at an early age. Those screened should be tested with the prostate-specific antigen (PSA) blood test. A digital rectal exam (DRE) may also be done as a part of screening. Medical Imaging International January-February/2016

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Medical Imaging International

Simultaneously Operated Preclinical PET/MRI Imaging Research Scanners Available or the first time researchers now have access to preclinical imaging systems for simultaneous Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) imaging. Simultaneous acquisition of PET and MRI images provides researchers with more accurate comparative results, saves time, reduces radiation exposure, and can benefit neurobiology, cardiovascular, and cancer research scientists. A combined system enables researchers to view dynamic physiological and pathological processes, and locate PET findings more accurately as a result of improved image registration, and image fusion.

The combined PET/MRI system was developed by MR Solutions (Guildford, Surrey, UK; www.mrsolutions.com), a global MRI imaging leader with more than 1,000 installations globally in the last 30 years. The new MRS-PET system is inserted in the cryogen-free 3-T, 4.7-T, or 7-T MRI magnet and has an imaging resolution of <0.8 mm. MR Solutions also offers a lower cost solution, a sequential PET/MR imaging system, made by clipping MRS-PET in front of the bore of the MRI technology. This solution enables automatic imaging from one modality to another on the same axis, and allows MRI or PET imaging to be used independ-

ently without the need to move research subjects to a different machine. Chief Executive, MR Solutions, Dr. David Taylor, said, “We are always looking at ways to improve research results. Our multimodality technology now facilitates simultaneous PET/MRI imaging for much faster research outcomes as well as the acquisition of data from two imaging modalities simultaneously. Researchers will be able to quickly carry out their work on subjects with rapidly changing physiological and pathological processes. A great deal of time can now be saved in the laboratory helping to speed up drug development.”

Patient-Positioning Accessories for Radiology Procedures nnovative medical imaging tables and clear lead barriers provide better access to patients while minimizing clinician’s radiation exposure. Biodex Medical Systems (Shirley, NY, USA; www.biodex.com), a leading manufacturer and distributor of radiation shielding, protection and detection products for nuclear medicine, molecular imaging, and radiation safety, have revealed a new line of products that focus on facilitating access to patients in image-guided procedures where stability, and precise, quiet, vibration-free positioning are essential, such as in surgical, pain management, urology, brachytherapy, and three dimensional (3D) imaging setups. The C-Arm 840 table provides a large radiolucent area, free-float X-Y tabletop, motorized control of height, lateral roll, Trendelenburg motions, and catheter tray extensions, making it ideal for cardiovascular procedures. New Clear-Lead Personal Mobile Barriers offer a versatile, lightweight option for ionizing radiation protection (0.5 mm LE), with the convenience of height adjustability to protect the user, whether seated or standing. The durable, shatter resistant, and easy to maneuver Personal Mobile Barrier has an hour-glass design anatomically positioned to allow continuous contact with the patient while maximizing protection, an essential function for urologists, anesthesiologists, pain-care physicians, Xray technologists and more. In addition to its line of C-Arm Tables, Biodex features the SoundPro Combination Table, designed to accommodate both ultrasound and echocardiography procedures. Ergonomic enhancements include a cardiac drop-down cushion, which releases from either side of the table, to provide open access to the patient’s thorax area, and flushmounted side rails enable closer access to the patient, without sonographer contortion. The side rails stow beneath the table when not in use, eliminating obstruction.

Medical Imaging International January-February/2016

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The RadiForce RX350 features sharpness recovery technology that restores lost information in contours, resulting in images with maximum clarity. The 3MP monitor is ideal for displaying chest Xray, CR, and DR grayscale images and color images such as 3D rendering and image fusion.

The FDR Visionary suite is a flexible, automated system that lets users choose an imaging method for each exam by selecting from a range of advanced applications. It features enhanced image processing to improve positioning repeatability, workflow, image quality, and diagnostic visibility.

The Supria 16-slice computed tomography scanner features a 48-kW generator and gantry with a 75-cm aperture, 180-cm scan range, and 226-kg table weight. It can be placed in a room as small as 18.6 m2, and is intended to meet the emerging demand for entry-level scanners.

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MRI Reveals Distinct Brain Injury Patterns in Concussion-Related Depression and Anxiety he results of a new MRI study published online in the journal Radiology has found that brain injury patterns are linked to post-concussion depression and anxiety. The new findings could lead to improved understanding, and treatment of post-concussion psychiatric disorders such as depression, anxiety, and irritability, which affect nearly 3.8 million people in the US every year. Researchers from the University of Pittsburgh Medical Center (UPMC; Pittsburgh, PA, USA; www.upmc.com) used a Magnetic Resonance Imaging (MRI) technique called Diffusion Tensor Imaging (DTI) to measure the integrity of white matter in the brain’s signal-transmitting nerve fibers. The researchers tested 45 post-concussion patients using the DTI technique, and neurocognitive tests. The patient group included 18 with anxiety, 32 with depression, and 38 with irritability. The results showed that patients with depression or anxiety had unique white matter injury patterns. Patients with depression had decreased Frac-

tional Anisotropy (FA) compared to the control group. Patients with anxiety had less FA in the vermis area of the brain whereas patients with irritability patients with irritability showed no regions of significantly decreased FA compared to the control group. Lead author of the study, Lea M. Alhilali, MD, assistant professor of radiology, UPMC, said, “Using other concussion patients as our controls was a big advantage of our study. When you are able to study a similar population with similar risk factors, you get much more reliable results. The regions injured in concussion patients with depression were very similar to those of people with non-traumatic major depression disorder. This suggests there may be similar mechanisms to non-trauma and trauma-dependent depression that may help guide treatment. There are two major implications for this study. First, it gives us insight into how ab-

normalities in the brain occur after trauma, and second, it shows that treatments for non-trauma patients with neuropsychological symptoms may be applicable to some concussion patients.” Image: Brain injury patterns linked to post-concussion depression and anxiety (Photo courtesy of RSNA).

CT Angiograms Outperform Ergometrics for Detecting Blocked Arteries new study shows that noninvasive computerized tomography (CT) scanning of cardiac vessels is far better at spotting coronary artery disease (CAD) than commonly prescribed exercise stress tests. Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA; www.jhu.edu), St. Luke’s International Hospital (Tokyo, Japan; http://hospital. luke.ac.jp), and other institutions conducted a study to compare the accuracy of single-photon emission computed tomography (CT)–acquired myocardial perfusion imaging (SPECT-MPI) and coronary CT angiography (CTA) for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in 16 hospitals in eight countries, after clinical referral for cardiac catheterization.

All the patients (ages 45–85) underwent noninvasive SPECT-MPI angiograms, followed by traditional CTA; within two months, each patient also underwent an exercise stress test. The results showed that sensitivity to identify CAD was greater for CTA than SPECT-MPI; the results were similar in patients without previous history of CAD. Noninvasive CTA accurately detected or ruled out artery blockages in 91% of the patients, compared with 69% for stress testing. The study was published online on October 14, 2015, in Circulation: Cardiovascular Imaging. “Results of the new study should help settle lingering doubts among physicians and the nearly 15 million Americans who seek medical attention each year for symptoms that signal a clogged artery, including chest pain, shortness of breath, and

extreme fatigue,” said lead author Armin Zadeh, MD, PhD, MPH, associate professor of medicine at the JHU School of Medicine. “We hope our findings will settle any residual uncertainty about the effectiveness of these two common noninvasive heart tests.” Current guidelines from the American Heart Association (AHA; Dallas, TX, USA; www.heart.org) and the American College Cardiology (ACC) call for a stress tests in all patients who show signs of CAD to confirm the diagnosis and define the severity of the blockage. CT angiograms are generally reserved only for patients with borderline stress test results. However, according to the researchers, the much higher accuracy of CTA may be a better firstline test in people with symptoms suggestive of a blocked artery. Medical Imaging International January-February/2016

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Medical Imaging International

Carotid Ultrasound Identifies Stroke Risk new study concludes that carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions larger than 8 mm3, but less accurate in detecting smaller volume calcified plaques. Researchers at Umeå University (Sweden; www.umu.se) conducted a study that analyzed 94 carotid arteries from 88 patients (mean age 70 years, 33% females) to determine the accuracy of ultrasound B mode in detecting atherosclerotic calcifications during pre-endarterectomy examinations. After the procedure, the excised plaques were quantified using cone beam computed tomography (CBCT), from which the calcification volume (in mm3) was calculated. Carotid artery calcification by the

two imaging techniques was then compared using conventional correlations. The results showed that carotid ultrasound was highly accurate in detecting calcifications, with a sensitivity of 88.2%. Based on calcification volumes as measured by CBCT, the researchers divided the plaque into four groups: less than 8; 8–35; 36–70; and over 70 mm3. They found that calcification volumes larger than 8 mm3 were accurately detectable by ultrasound, with a sensitivity of 96%. Of the 21 plaques with a smaller than 8 mm3 calcification volume; only 13 were detected by ultrasound, result-

ing in a sensitivity of 62%. The study was published in the August 2015 issue of International Journal of Molecular Sciences. Image: A preoperative carotid ultrasound evaluation (Photo courtesy of Umea University).

Fast, Noninvasive Assessment of Chronic Liver Disease as Alternative to Biopsies leading ultrasound imaging vendor has presented the clinical benefits of its innovative technology for noninvasive assessment of the severity of liver fibrosis, at the Liver Meeting 2015, in San Francisco (CA, USA). Researchers have published more than 60 items on the reliability and effectiveness of the new technology. A large-scale global multicenter retrospective study that took place in April 2015, and involved 1,340 participants, confirmed the accuracy of the technology as a noninvasive alternative to biopsy for staging liver fibrosis. The study evaluated several liver diseases including chronic Hepatitis B, chronic Hepatitis C, and Non-Alcoholic Fatty Liver Disease (NAFLD). The ShearWave Elastography (SWE) technology was developed by SuperSonic Imagine (Aix-en-Provence, France, www. supersonicimagine.com). The technology involves an exam that takes 60-seconds, and provides a quantitative color-coded map that visualizes and analyzes tissue stiffness. The stiffness of liver increases as fibrosis becomes more severe, and this makes it a useful indicator for assessing the advancement of fibrosis. The standard test for assessing the severity of liver fibrosis has been biopsy, which can cause morbidity, is expensive, can result in the underestimation of fibrosis in 10%–30% of the cases, and is not ideal for repeated follow-up exams. SWE technology can significantly reduce the need for liver biopsies. In the case of Hepatitis C patients for example, an initial assessment, a follow-up evaluation, and antiviral therapies could cure most cases of the disease, benefitting clinicians, patients, and hospitals.

Medical Imaging International January-February/2016

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The Biograph Horizon PET/CT system is designed to enable physicians to visualize small lesions early. The system’s 4-mm LSO crystals scintillate faster and have a higher light output than BGO crystals, resulting in high resolution and better image quality, and enabling TOF acquisition.

The Q-Rad-Digital system features a fully integrated X-Ray room with a high-frequency generator and a high-speed starter. Other features include a ceiling-mounted tube support with TechVision, an elevating/float-top radiographic table, a digital wall stand, and a wireless DRX Cesium detector.

The NExCT 7 CT scanner is the first premium CT scanner from Samsung that features high resolution, and it is designed to reduce the radiation dose as low as reasonably achievable. Some features of the NExCT 7 are pending 510(k) clearance from the US FDA.

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3D MRI of the Carotid Arteries Indicates Early Signs of Stroke Risk in Diabetic Patients he results of a new study indicate that 3D MRI exams of the carotid arteries in diabetic patients can show evidence of Intra-Plaque Hemorrhage (IPH). The researchers used 3D Magnetic Resonance Imaging (MRI) to study 159 asymptomatic type 2 diabetic patients, 37 of whom had IPH in one or both carotid arteries, and five had IPH in both. IPH is an indicator of advanced atherosclerotic disease. The 3D MRI exam showed that IPH was associated with an increased wall volume of the carotid artery, and was found in the absence of carotid artery stenosis. The average age of the patients who were recruited from a dietary trial between 2010 and 2013 was 63 years. The study was presented at the annual meeting of the Radiological Society of North America (RSNA 2015). The findings suggest that 3D MRI of arteries could help determine stroke risk for patients with diabetes. These patients may already have advanced vascular disease that was undiagnosed. Study author Tishan Maraj, MBBS, imaging analyst, Sunnybrook Research Institute (Toronto, Canada; http://sunnybrook.ca), said, “A recent analysis of multiple studies has shown that people with carotid artery narrowing and IPH have a five- to six-times higher risk of stroke in the near future compared to people without. It was surprising that so many diabetic patients had this feature. We already knew that people with diabetes face three to five times the risk of stroke, so perhaps IPH is an early indicator of stroke risk that should be followed up. The advantage of 3D MRI is you can image the entire carotid artery and pinpoint the area of interest over a shorter pe-

riod of time compared with multiple 2D sequences. Even though you can’t treat IPH, you can monitor patients a lot more closely. Image: (A) The 3D MRI Intra-Plaque Hemorrhage (IPH) sequence acquired in the coronal plane; (B) the reformatted axial plane; (C) the section of the right carotid artery; (D) contours drawn for the outer wall, and lumen, and the IPH area shaded blue (Photo courtesy of RSNA).

FDA Clearance for New Visualization Solution S Food and Drug Administration (FDA) 510(k) clearance was granted for a new medical visualization solution intended to meet the needs of mobile clinicians. Clinicians often rely on mobile ultrasound systems for point-of-care diagnosis of patients. The new solution enables clinicians to store exam findings, submit reports, and access learning resources and patient information. The system also connects with remote providers to provide near real-time assessment. This makes the system suitable for use in the field and in telemedicine. The iViz solution was developed by FUJIFILM SonoSite (Bothell, WA, USA; www.sonosite.com), a

world leader in bedside and point-of-care ultrasound solutions, and ultra-high frequency micro-ultrasound technology. The iViz is a next generation architecture and platform that integrates ultrasound systems with supporting medical IT systems. The iViz is the first medical visualization solution that has bidirectional Electronic Medical Record (EMR) connectivity through the FUJIFILM Synapse Vendor Neutral Archive (VNA). The iViz automatically takes patient demographics from the EMR saving clinicians’ time and effort, and can send patient reports to the EMR. The iViz is based on the Android Operating System (OS) and includes web-browsing, email and ECG capabilities. The system is light-

weight, and features a high-resolution, seven-inch display touchscreen, a wide dynamic range, and color flow images, and multiple imaging modes and exams to meet the needs of different medical providers. Masayuki Higuchi, president and CEO, FUJIFILM SonoSite, said, “iViz is a revolutionary solution for clinicians and represents a landmark in FUJIFILM SonoSite’s innovation. It achieves new levels of image performance and provides unprecedented connectivity in a highly mobile platform. Through iViz, we expand our core mission of increasing access to ultrasound to improve patient care quality and reduce healthcare costs.” Medical Imaging International January-February/2016

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Medical Imaging International

Updated FDA Labeling for the Use of Deep Brain Neurostimulators in Full-Body MR Diagnostic Scans he US Food and Drug Administration (FDA; Silver Spring, MD USA; www.fda. gov) has updated labeling of a series of Deep Brain Stimulation (DBS) neuro-stimulators, produced by a large medical technology company, enabling increased patient access to MRI scans. The DBS neurostimulators are the first to receive FDA approval for full-body Magnetic Resonance Imaging (MRI) scans, dependent on specific conditions of use, and enable patients receiving DBS therapy to undergo MRI imaging. Previously, patients DBS were limited to low power Radio Frequency (RF) MRI head scans and the DBS system had to be switched off before the scan. The FDA approval enables increased MRI RF power limits, and scanning, and when programmed correctly the DBS systems can even continue to deliver therapy during scans.

The Medtronic (Dublin, Ireland; www. medtronic.com) Activa portfolio of DBS Therapy systems uses a surgically implanted medical device to deliver mild electrical pulses to precisely targeted areas of the brain. A trained clinician can program and adjusted the system noninvasively to maximize symptom control and minimize side effects. Medtronic DBS Therapy is used by more than 130,000 patients worldwide. Medtronic tested and evaluated the DBS systems using advanced electromagnetic modeling tools across 10 million simulated patient scans, and over 38,000 unique implant conditions, in order to ensure patient safety. The therapy is currently approved in US and Europe, for the treatment of the symptoms of Parkinson’s disease, and chronic intractable primary dystonia, and in Europe, Canada and Australia for the treatment of

refractory epilepsy. DBS therapy is also approved for the treatment of severe, treatment-resistant Obsessive-Compulsive Disorder (OCD) in Australia, the US (under Humanitarian Device Exemption regulations) and in the European Union. Michael S. Okun, national medical director, US National Parkinson Foundation, said, “Access to full-body MRI scans has been a critical unmet need with DBS therapy, as many patients require MRI imaging but could not always safely obtain it. There will be important guidelines for centers to follow in order to apply MRI imaging in patients; however, the availability of this type of imaging is an important step that will facilitate a more optimal care experience. The use of MRI as a diagnostic tool has grown significantly, and Medtronic is proud to offer the only DBS systems that allow patients access to full-body MRIs.”

Risk of Recurrence of Depressive Episodes Can Be Predicted by fMRI Scans new study shows that Functional Magnetic Resonance Imaging (fMRI) could help predict whether patients risk a recurrence of depressive episodes after recovery from a major depressive disorder. The study was carried out by researchers from King’s College London (London, UK; www. kcl.ac.uk) and The University of Manchester (Manchester, UK; www.manchester.ac.uk) and was published in the journal JAMA Psychiatry. In the study the researchers carried out fMRI scans on 64 patients, who were not on prescribed medication, and were in remission from major depressive disorder, to look for atypical connections in the brain. The study participants’ brains were scanned while they experienced guilt or other self-blaming emotions, and were monitored regularly for symptoms over the following 14 months. By the end of the study 27 participants had a recurrence of the depression, while 37 participants remained in remission. Those participants with a recurrence of depression showed a higher level of connection between the anterior temporal lobe and the sub-genual region of the brain, in the fMRI scans. On the other hand those who remained in remission for a year and a control group of 39 people did not have the increased interconnectedness. The results of the study enabled the researchers to accurately predict (75%, 48 out of 64 cases) who would have another depressive episode. Dr. Kathryn Adcock, head of neurosciences and mental health, MRC, said, “This exciting research has the potential to help identify those individuals who are more likely to suffer from recurrent episodes of depression and will therefore benefit most from long-term treatment and medication. This work could aid the discovery of new treatments for depression because clinical trials will be better able to focus on people with a more comparable disorder and experience.”

Medical Imaging International January-February/2016

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The DR 600 is a multi-detector, high-productivity, high-throughput direct radiography (DR) solution. Featuring ZeroForce Technology, the DR 600 offers speed, precision and comfort, and excels in full leg/full spine (FLFS) imaging with EasyStitch technology.

The Celesteion PET/CT system delivers a more comfortable patient experience with the industry’s largest bore, widest field of view and TOF imaging. It combines high-performance PET and CT for all radiation/oncology imaging needs, including tumor detection, treatment evaluation and CT simulation.

The CleanShield is designed to securely store disinfected endocavity transducers and semi-critical devices. Constructed of polypropylene, the cabinet is easy to clean with any hard surface disinfectant and can accommodate up to six endocavity or general-purpose ultrasound probes.

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Range of Touch Control Premium Ultrasound Systems Introduced newly designed family of three premium ultrasound scanners feature innovations to improve system operation, and reduce user errors. The new systems feature workflow innovations to increase patient throughput, a reduction in the number of inconclusive studies as a result of improved image quality, and clear upgrade path to ensure a longer equipment lifetime and investment protection. The control panel of the new systems features a touch display that maximizes workflow efficiency and simplifies user operation. The new user interface uses 44% less software keys, 33% less tactile keys, and 22% less homebase controls. The family of ultrasound systems, the Acuson S Family, HELX Evolution with Touch Control, was announced by Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com). The systems are intended for use in hospitals, clinics, and private practices. New imaging optimization technologies in the Acuson S Family enhance image quality in breast, abdominal, vascular and musculoskeletal examinations, and for challenging patients. The systems also feature shear wave elastography for improved quantitative or qualitative tissue characterization. The systems include workflow tools that facilitate superimposed multimodality imaging with 3D Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) volumes. The Acuson S3000 ultrasound system is designed for multimodality imaging,

the Acuson S2000 for general imaging and women’s health, and the ACUSON S1000 for cardiology and vascular imaging. Image: The Acuson S Family, HELX Evolution with touch control ultrasound systems (Photo courtesy of Siemens Healthcare).

First 2D/3D Orthopedic Imaging System Installed in Saudi Arabia company that pioneered 2D/3D orthopedic medical imaging has announced that it has entered the Middle East market with an initial installation in Saudi Arabia.

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The system was installed at the Jeddah Scan Radiology Center (Jeddah, Saudi Arabia; www. thefirstscan.com) with the aim to reduce radiation dose and provide 3D modeling for axial skeleton diagnosis, planning and control, serving patients in a large urban population of 3.4 million. The EOS system was installed by EOS imaging (Paris, France; www.eos-imaging.com). The EOS medical imaging system is designed for osteoarticular pathologies, and orthopedics, and other solutions, and is marketed in 48 countries including the US, Japan, and the European Union (EC). EOS imaging has offices in Paris and five subsidiaries in Besançon (France), Montreal (Canada), Frankfurt (Germany), Cambridge (Massachusetts), and in Singapore. The Jeddah Scan Radiology Center provides

specialist orthopedics, rheumatology, and pediatric services at a number of regional hospitals. The EOS platform provides stereo-radiographic 2D and 3D full-body images of patients, in functional positions, and reduces radiation dose by up to 85% Digital Radiology (DR) systems, or by up to 95% than a standard Computed Tomography (CT) scan. The system has been cleared the US Food and Drug Administration (FDA). Marie Meynadier, CEO, EOS imaging, said, “We’re excited to enter the Middle Eastern market, especially in a city like Jeddah, Saudi Arabia, which has come to be considered a center of excellence in medical care. As part of our commitment to our shareholders and future patients, we are thrilled to see the EOS platform reach a new and important market with significant potential.” Medical Imaging International January-February/2016

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Medical Imaging International

Antibody Cancer Marker Causes Tumors to Light Up novel marker attaches to a molecule on highly aggressive brain cancer, resulting in glioblastoma tumor tissue being easily identified in a positron emission tomography (PET) scanner. Developed by researchers at the University of Wisconsin (WISC; Madison, USA; www.wisc.edu) and the Third Military Medical University (Chongqing, China; www.tmmu.edu. cn), the antibody created is specific to a unique protein, called CD146, that is present on the surface of glioblastoma multiforme cancer cells; the antibody was joined to a copper isotope to create a radio-labeled anti-CD146 antibody (YY146). The researchers then implanted a human glioblastoma sample into a mouse and injected the antibody-marker combination into its blood, waiting for it to spread through the body.

When the mouse was later placed into a PET scanner, the tumors with a high level of CD146 protein on the outside of their cells were easily identified. In comparison, signals from a genetically distinct variant of glioblastoma with low CD146 activity were much weaker. In their study, the researchers also explored the potential therapeutic effects of YY146 on cancer stem cell (CSC) and epithelial-to-mesenchymal (ETM) properties of glioblastoma cells, demonstrating that it can mitigate aggressive U87MG phenotypes. The researchers also demonstrated that YY146 could be used to detect CD146 in cancer cell lines and human resected tumor tissues of multiple other origins, such as in gastric, ovarian, liver, and lung tissues. These findings, according to the researchers, indicate a broad applicability of the YY146 marker in solid tu-

mors, including for diagnosis, stratification, and targeted therapy. The study was published on November 9,

2015, in Proceedings of the National Academy of Sciences of the United States of America (PNAS).

Image: A glioblastoma in a PET scanner with (left) and without (right) the YY146 marker (Photo courtesy of Weibo Cai, WISC).

Metabolic PET Tracer Can Locate Brain Tumors and Improve Therapy Outcomes esearchers at the Stanford School of Medicine (Stanford, MD, USA; http://med. stanford.edu) have found a new way to visualize brain tumor tissue using Positron Emission Tomography (PET) imaging. Cancer cells divide rapidly, and require large stores of molecular building block to divide and grow. The Stanford team used this property of cancer cells, and developed a molecular tracer to track the activity of a key regulatory protein called pyruvate kinase M2 (PKM2) that helps control the metabolism of tumor cells. The tracer enabled the researchers to track the precise location of cancer cells in the brain. According to the researchers, the tracer could also help provide feedback about how a tumor is responding to therapy. Pyruvate kinase is a key regulator in the cellular process of metabolizing energy sources such as glucose. Cells can either convert energy into the coenzyme Adenosine Triphosphate (ATP), or use the energy to generate amino acids and other cellular building blocks. When pyruvate kinase exists as a dimer, a complex of two pyruvate kinase molecules, it favors the accumulation of amino acids. When the protein exists as four molecules bound together the cell generates more ATP. Cancer cells have higher levels of the dimer, and DASA molecules bind to the dimer. The researchers labeled DASA-23 molecules

Medical Imaging International January-February/2016

with a radioactive carbon molecule, and used PET scans observed how the DASA-23 molecules found, and bound to human glioblastoma cells, implanted in the brains of mice. Sanjiv Sam Gambhir, MD, PhD, director Molecular Imaging at Stanford, senior author of the research, said, “Tumor cells do all kinds of things to survive and prosper in the body. One of the key things they modify is a master switch that controls cell metabolism and allows the cell to make more of the building blocks necessary for cell division. But until now we’ve had no way to assess the presence or activity levels of the PKM2 protein involved in that switch. This is the first time we can noninvasively interrogate the biochemistry of a tumor with respect to this master switch PKM2. If we treat a tumor with a drug, we now see whether the cancer cells’ metabolic properties are changing. So we could know very quickly, possibly within a few days, whether the therapeutic approach is working. This new molecule, or tracer, works particularly well in the brain because normal brain cells have very low levels of PKM2 dimers. It’s possible, though, that this tracer could also be used in cancers in other tissues like the prostate, or to even learn more about how normal tissues adjust their metabolism during development or in response to varied environmental conditions.”

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PRODUCT NEWS FLAT PANEL DETECTOR

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Kubtec

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The DIGIVIEW 395 wireless flat panel detector is designed to be lightweight, durable, versatile, and easy to use. It incorporates rapid image acquisition and display, and features wireless data transmission, giving users immediate access to critical data for faster interpretation and diagnosis.

The G-SPECT enables ultra-fast and highly detailed scanning of biological processes, relevant for diagnosis and research in the human body. The high SPECT resolution of better than three millimeters is expected to enable physicians to arrive at a more accurate diagnosis.

The TE7 touch-enabled ultrasound system supports rapid and confident evaluation in multiple point-of-care (POC) settings. The intuitive tabletlike operation, superior image quality with onetouch image optimization, and exam presets improve both diagnostic confidence and efficiency.

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Ultraportable Ultrasounds Plug into Smartphone dvanced handheld ultrasound (US) transducers and an app-based online portal and subscription platform provide a comprehensive, connected digital imaging solution. The Philips Lumify is a complete portable ultrasound system intended for a range of specialties and settings, including acute and emergency care as well as standard office practice. The system is supplied with two US transducers and a scanning app that controls several types of US scans, including those of the gall bladder, abdomen and lungs, as well as OB-GYN, vascular, superficial, musculoskeletal and soft tissue structures. The app is also linked to an online portal access. Lumify will be supplied under a USD 199 monthly subscription plan that includes not only the devices and app, but also an entire healthcare ecosystem dedicated to care delivery. The system easily connects to any patient picture archiving and communication system (PACS), to share images, video, and notes with colleagues via email or a shared network. Real-time automatic app updates include rollout of new features as soon as they are developed. At the moment, Lumify only works with Android smart devices. Once the Lumify App is down-

loaded from Google Play, users simply connect a transducer to a smart device via microUSB and launch the app to start ultrasound scanning. The app connects to the cloud, where data and images are also accessible via the Philips HealthSuite Digital Platform. The app-based platform also allows for broader use of the device, such as browsing the internet. The Philips Lumify is a product of Royal Philips (Philips; Amsterdam, The Netherlands; www.philips.com). “In an increasingly connected world where the power of technology is at our fingertips, it’s no longer enough to create an ultrasound product or service. At Philips, we create solutions holistically with the patient at the center,” said Randy Hamlin, VP and business segment leader of Ultra Mobile at Philips. “Lumify leverages advanced digital health technology to provide critical information to the right people at the right time, transforming how we approach care delivery and connecting the various touch points along the health continuum.” “Lumify has the potential to provide on-demand, point-of-care diagnostics in a more connected envi-

ronment,” said Bret Nelson, MD, associate professor of emergency medicine at Mount Sinai Hospital (New York, NY, USA). “Leveraging a familiar device with portable diagnostic testing makes learning ultrasound easier for new users and more convenient for experienced imagers. I think that convenience and availability will increase the utility of this technology, improving patient care and efficiency.” Image: The Lumify portable ultrasound system connected to a smartphone (Photo courtesy of Royal Philips).

Breakthrough Microvascular Imaging Technology Demonstrated at French Radiology Congress new technology significantly improves color Doppler spatial resolution, and sensitivity, enabling the visualization of fast microvascular flows for the first time. The technology also provides real time, detailed information to physicians, for the diagnosis of cancerous lesions. The technology, called AngioPLUS – PLanewave UltraSensitive imaging, was developed by SuperSonic Imagine (Aix-en-Provence, France; www. supersonicimagine.com), pioneers of ShearWave Elastography. SuperSonic Imagine plans to implement AngioPLUS on its Aixplorer ultrasound system, to help clinicians diagnose cancerous lesions

in lymph nodes, thyroid, liver, and breast, by enabling visualization of microvascularization and vessel flow of the lesions. AngioPLUS is an important addition to existing noninvasive tools for diagnosing cancer. Another application of AngioPLUS is for the identification of low-grade tendon inflammation in musculoskeletal assessments. The SuperSonic Imagine Aixplorer ultrasound system, together with the UltraFast platform can acquire images 200 times faster than conventional ultrasound systems, and is the only system that can image two types of ultrasound waves. The system

can help clinicians visualize, and analyze tissue stiffness reliably, in real-time, to ensure high image quality and shear waves. Prof. Jean-Michel Correas, vice chairman, Adult Radiology Department, Necker University Hospital (Paris, France), said, “The AngioPLUS technology significantly improves flow sensitivity in color imaging. This innovation allows physicians to quickly and accurately address challenging clinical situations such as characterizing fortuitously discovered focal liver lesions and renal blood flow disturbance. We believe AngioPLUS can help avoid additional imaging or biopsy procedures”. Medical Imaging International January-February/2016

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Medical Imaging International

Wearable Ultrasound System Enables Vascular Imaging at POC new point-of-care (POC) ultrasound device provides clear, anatomically accurate real-time vascular imaging in a wearable glasses format. The Eyes-On Glasses 3.0 platform is intended for viewing deep tissue vascular images such as the femoral vein and artery, and provide augmented vision/augmented reality (AV/AR) capabilities to enable digital overlays via wireless connectivity. To do so, the system utilizes a custom camera, developed by Xacti (Osaka, Japan; www.xacti-co.com), to attain high-quality images and provide an AV/AR environment that is devoid of the typical image latency problems that are encountered on most smart glasses during real-world imaging procedures. The Glasses unit is battery powered and offers a dual, multispectral imaging platform to enable visualization of even the most difficult peripheral veins. The see-through, eyes-on

technology allows the user to have full situational awareness while maintaining eye contact with the patient. The system is effective for all clinical encounters, including difficult to image dark-skinned or obese patients. DeepVu ultrasound is available via a USB-connected transducer for imaging deeper veins. The Eyes-On Glasses 3.0 platform is a product of Evena Medical (Roseville, VA, USA; www. evenamed.com). “The Eyes-On 3.0 system offers medical professionals the first complete vascular imaging platform available today, offering large, clinically useful images for adult primary care, pediatrics, emergency medical care and other medical specialties,” said Frank Ball, President and CEO of Evena Medical. “With DeepVu ultrasound, clinicians can now visualize veins deep beneath the skin with superior, real-time imaging in front of their eyes with simple, hands-free operation.”

Combined PET/CT Scanning Can Change the Management Of High-Risk Cancers he results of a new study show that PET/CT and whole body MRI scanning can be used to change the management of high-risk breast and prostate cancer patients. The study was published in the December 2015 issue of the Journal of Nuclear Medicine and indicated that Positron Emission Tomography/Computed Tomography (PET/CT) and whole-body Magnetic Resonance Imaging (MRI) could detect extra-skeletal disease and change the management of high-risk breast and prostate cancer patients. The administration of F-18 sodium fluoride (NaF) and F-18 fluorodeoxyglucose (FDG) in a single PET/CT scan also provided significantly higher accuracy, and sensitivity for the detection of skeletal lesions. The study group consisted of patients with breast or prostate cancers and compared results of the combined use of F-18 NaF/F-18 FDG PET/CT, to those obtained with Tc99m MDP Bone Scintigraphy (BS) and Whole-Body MRI (WBMRI). The study included 15 women with breast cancer, and 15 men with prostate cancer that had been referred for standard of care BS and subsequently underwent NaF/FDG

Medical Imaging International January-February/2016

PET/CT and WBMRI. According to the results of the preliminary study NaF/FDG PET/CT was significantly more accurate in detecting skeletal lesions than WBMRI and Tc-99m MDP scintigraphy, and NaF/FDG PET/CT and WBMRI were able to detect extra-skeletal disease, and could change the way high-risk breast and prostate cancer patients treatment are managed. Corresponding author of the study Andrei H. Iagaru, MD, FACNM, cochief of the Stanford University (Stanford, CA, USA; www.stanford.edu) division of Nuclear Medicine and Molecular Imaging, and co-director of the PET-MRI research program, said, “Using results from previous studies, this project attempts to identify the most appropriate approach for identifying lesions in selected breast and prostate cancer patients who are at high risk of developing metastatic disease. More work remains to be done, and our group is now exploring the use of combined NaF/FDG injections with state of the art PET/MRI technology for significant decreases in radiation exposure and improved diagnostic performance in accurately evaluating extent of disease in cancer patients.”

“Venipuncture is the most common invasive medical procedure, yet studies have shown that up to 40% of IV starts require multiple attempts to locate and access a vein, which not only wastes valuable nursing time but also delays therapy and causes patient discomfort and dissatisfaction,” added Mr. Ball.

“With Evena’s Eyes-On Glasses, nurses can quickly and easily locate and access the best veins for each patient – even in challenging clinical environments such as pediatric or neonatal units.” Image: The Eyes-On Glasses 3.0 platform (Photo courtesy of Evena Medical).

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PRODUCT NEWS MEDICAL DISPLAY

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CR READER

DR SYSTEM

Ampronix

3DISC Imaging

Agfa HealthCare

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

The FireCR Flash Reader offers crystal-clear image quality, compact size, and fast scanning speeds. The CR reader offers increased productivity with a fast throughput of up to 125 plates/hour. The lightweight device can be placed on a counter or it can be wall-mounted.

The DX-D600 is designed to streamline imaging workflow, increase throughput and enhance the experience of patients and staff. The system combines robotization with MUSICA image processing and seamless integration with RIS and PACS to meet all DR needs.

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Telerobotic Ultrasound Could Revolutionize Telemedicine esearchers are testing whether telerobotic ultrasound technology could be used to provide critical healthcare services to resource-poor areas of the world with results comparable to those of manual ultrasound examinations. The new technology, called Tele Robotic Ultrasound for Distance Imaging (TRUDI), enables an operator to perform an ultrasound exam using an Internet connection, from any location. The ultrasound system is part of a robotic kiosk and can be moved rapidly to perform an examination by the remote operator. The ultrasound system is based on a Personal Computer (PC) platform and was made by Telemed Ultrasound Medical Systems (Milano, Italy; www. telemedultrasound.com). The system is still in the early stages of development, but has the potential for providing critical healthcare to resource-poor areas of the world. The technology could cut life-threatening waiting times for diagnosis of patients with heart failure for example, who often do not have access to a specialist. The technology could also be used in the future for advanced cardiac procedures such as transcutaneous valve replacements. Other uses could be for examinations by a fetal ultrasound specialist in hard-to-reach rural communities, anywhere in the world, reducing maternal mortality by providing access to antenatal care in developing countries. Vikram Dogra, MD, director of ultrasound and professor of radiology and biomedical engineering, University of Rochester (New York, USA), said, “Telerobotic ultrasound has the potential to revolutionize telemedicine by connect-

ing the remote underserved areas of the world with a real-time imaging capability for diagnosis of acute diseases such as acute appendicitis and ectopic pregnancy.” Image: A new clinical trial is testing the feasibility of telerobotic ultrasound exams over the Internet (Photo courtesy of RSNA).

World’s First DR Detector for Long-Length Digital Imaging n innovative long-length DR detector was unveiled at the annual meeting of the Radiological Society of North America (RSNA 2015). The Digital Radiography (DR) detector is intended for single exposure long-length digital imaging and has a 43.18 x 124.46 cm field of view. The detector enhances image quality, features Irradiation Side Sampling (ISS) technology, and noise reduction circuitry to ensure clear, sharp images at a low dose for upright long-length radiography imaging. The FDR D-EVO GL detector was developed by FUJIFILM Medical Systems USA (Stamford, CT, USA; www.fujifilmusa.com) and received FDA 510(k) clearance on November 5, 2015. The company provides a range of digital X-Ray systems, the Synapse Picture Archiving and Communication System (PACS), Radiology Information (RIS) systems, advanced women’s health im-

aging and cardiovascular systems, and vendor neutral enterprise-wide medical image management solutions. The FDR D-EVO GL can enhance long-length exam efficiency dramatically compared to conventional DR stitching systems that require multiple exposures and more time. Stitching systems also increase the chance of patient movement during exposures, compared to single exposure systems. Rob Fabrizio, director of marketing and product development, Digital X-Ray and Women’s Health, FUJIFILM Medical Systems USA, said, “Once again, Fujifilm is revolutionizing digital radiography. The new detector allows technologists to efficiently acquire challenging long-length exams using low dose DR technology.” Image: The FDR D-EVO GL DR detector (Photo courtesy of Fujifilm). Medical Imaging International January-February/2016

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Medical Imaging International

T1 Mapping Could Offer Safer Heart Scans new study claims that the T1 mapping technique could be used with a wider range of patients than current techniques, as it does not require the rare earth heavy metal Gadolinium. Developed by researchers at Oxford University (United Kingdom; www.oxford.ac.uk), the new technique makes use of a property of hydrogen atoms to create a pixel-by-pixel map called a shortened modified look-locker inversion (ShMOLLI) T1map, which allows examination of healthy and diseased heart tissue in greater detail than before. According to the researchers, T1 mapping could improve heart scans for patients, giving more information about the heart than traditional scans and all without any injections, making them safer and faster. T1 maps provide an objective number that indicates the length of

time atoms take to return to a normal thermodynamic state after being affected by radio waves and strong magnetic fields. During cardiac scanning, the T1-map helps to visualize areas of the heart suffering from lack of blood supply due to blocked arteries, since long T1 times indicate the presence of more water, something found in a number of heart conditions. It takes around three minutes to map the whole heart, and the values it measures are turned into a color-coded map, giving doctors an image which is potentially quicker to understand and with less subjective interpretation. “T1 mapping allows us to look in finer detail at the heart in a noninvasive way, which has not been possible before. We can now get results without Gadolinium, meaning we have a technique that is safer and quicker and can be used with more people,” said study coauthor Stefan Piechnik,

Retrofit System Assists Upgrade To Digital Radiography n affordable retrofit system allows small to mid-size hospitals, urgent care centers, orthopedic offices, and clinics to upgrade existing rooms or mobile X-ray systems to fully featured digital radiography. The Carestream Health (Rochester, NY, USA; www.carestream.com) Pro Retrofit System offers a choice of detectors, including gadolinium ones for general radiography imaging or cesium iodide detectors for dose-sensitive applications. Users have a choice of either wireless or tethered 35 x 43 cm cassette-size detectors that will fit into an existing bucky, or a 43 x 43 cm fixed detector. The detectors are provided with beam-detect mode, which eliminates the need for a cable connection to the generator, and as a result image capture can begin when the detector senses the X-ray exposure. Enhanced productivity and workflow features include wireless transmission of images to the capture console, immediate image viewing and manipulation, and image forwarding to a printer, a picture archiving and communication system (PACS), or to a computer or laptop. Each detector can be identified by a unique access point, or it can be connected to a system control unit that provides continuous signals to one or more detectors. The Pro Retrofit system also in-

Medical Imaging International January-February/2016

PhD, MScEE, who developed the specific ShMOLLI T1 mapping technique used at Oxford. “The results are also less dependent on interpreting the images – medics have something based on hard numbers.” “The potential of this research is huge – not only for heart scans. Each type of tissue across the body has a range of normal T1 values, so any values outside that range may signify disease; the pixel by pixel level of detail from these scans could help identify unhealthy tissue wherever it appears,” said senior author Vanessa Ferreira, MD, PhD, deputy clinical director of the Oxford Center for Clinical Mag-

netic Resonance Research (OCMR). “Oxford is now applying this technique to scan other organs.” Current stress scans of the heart using magnetic resonance imaging (MRI) that requires patients to be injected with two substances. The first is adenosine, which is injected to cause effects similar to exercise during the scan. Gadolinium – a rare earth heavy metal – is then injected as a contrast agent to highlight areas of the heart suffering from decreased blood flow under exercise conditions. Image: A standard MRI compared to T1-map (Photo courtesy of Dr. Alexander Liu / OCMR / University of Oxford).

cludes preloaded Carestream VXvue image management software and an Image Suite mini-PACS module for web-based patient scheduling, image review and reporting, and flexible archiving solutions. “This flexible retrofit system enables value-based healthcare providers to convert existing X-ray systems to a digital radiography system at a very reasonable cost,” said Sarah Verna, worldwide marketing manager for global X-ray solutions at Carestream. “Facilities across the world can achieve higher image quality and gain rapid image access, which can help enhance patient care and boost productivity.” Image: The Pro retrofit system (Photo courtesy of Carestream Health). LINKXPRESS COM

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PRODUCT NEWS MOBILE C-ARM

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X-RAY DETECTOR

MOBILE C-ARM

Siemens Healthcare

Teledyne DALSA

Ziehm Imaging

The Cios Alpha features a square flat-panel detector, expanded field of vision, and sharp images down to the sub-millimeter range, which are essential for guiding fine catheters and tools in the Xray image. The Cios family of C-arms also includes the Fusion, Connect, and Select models.

The Xineos-2329 features high-speed image capture at a high resolution of 49.5µm pixel size, realtime image processing, low X-ray dose and the lowest noise performance. Designed for mammography systems, it offers excellent stability and support for static/dynamic imaging modalities.

The Vision RFD 3D combines 2D and 3D functionality to offer full intraoperative control in highend applications in orthopedics, trauma and spine surgery. With its 30 cm by 30 cm flat-panel and up to 7 cervical vertebrae in one scan volume, it offers the largest 3D image volume available.

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Clearance for CT Scanners For Low-Dose Lung Cancer Screening he US Food and Drug Administration (FDA) have approved the use of a leading imaging equipment provider’ CT scanners for lung cancer screening using standard low-dose lung protocols. The FDA approval for the use of Computed Tomography (CT) as a screening tool is a milestone for CT as a modality, making it available for the first time as a screening tool for a subset of high-risk asymptomatic patients, and could save the lives of patients by enabling earlier diagnosis of lung cancer. Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com) now offers a comprehensive approach to low-dose lung cancer screening using its new and current installed base of CT scanners, with standard low-dose lung protocols. The FDA indication for low-dose lung cancer screening applies to the SOMATOM Force, SOMATOM Definition Flash, SOMATOM Definition Edge, SOMATOM Definition AS/AS+, SOMATOM Perspective, SOMATOM Scope, and the SOMATOM Emotion 16 CT systems. Siemens CT systems feature Fully Assisting Scanner Technologies (FAST) planning to reduce user

variability, optimize workflow and reproducibility, and set optimum range for scan settings avoiding cut-offs, or excessive radiation. The Combined Applications to Reduce Exposure (CARE) feature optimizes radiation dose in scan parameters making the clinical workflow more efficient. Other features help radiologist report dose and sharing findings in an interdisciplinary lung cancer team. Siemens has also launched a mobile imaging solution for lung cancer screening, the Mobile SOMATOM Scope CT system. The scanner is a selfpowered mobile CT system using a diesel generator, and can begin scanning within minutes. The Mobile SOMATOM Scope CT also features a high-speed wireless connection. David Pacitti, president, Siemens Healthcare North America, said, “Lung cancer screening repre-

sents one of the most significant opportunities to improve population health through earlier detection and improved follow-up opportunities for high-risk patients. That’s why Siemens pursued the most expansive indication for lung cancer screening, bringing this valuable tool to all varieties of our current SOMATOM CT scanners.” Image: The SOMATOM Definition Edge computed tomography (CT) scanner (Photo courtesy of Siemens Healthcare).

Mammography CMOS X-Ray Detector for DBT and FFDM Applications new high resolution X-Ray detector with high X-ray absorption and contrast sensitivity that can improve the accuracy of diagnostics was launched at the annual meeting of the Radiological Society of North America (RSNA 2015). The detector, the latest in a family of advanced CMOS X-Ray detectors, provides low-dose, highresolution, high-speed imaging, and supports Digital Breast Tomosynthesis (DBT), and Flat Field Digital Mammography (FFDM). Teledyne DALSA (Waterloo, ON, Canada; www.teledynedalsa.com), a global leader in digital X-Ray image sensing technology, developed the

new Xineos-2329 mammography Complementary Metal-Oxide Semiconductor (CMOS) detector. The Xineos family of breast-imaging detectors features a high dynamic range, switchable saturation dose, and low dose signal-to-noise performance, and can help clinicians diagnosis and treat medical anomalies earlier. The Xineos-2329 detector features high resolution at 49.5 μm pixel size, real-time image processing, and the lowest noise performance compared to competitors. The detector also supports static and dynamic imaging modalities, and has good environmental stability.

Teledyne DALSA will also showcase the Xineos-2222 HS and Xineos-3030 HS high-speed detectors with 152 μm pixel size for surgical and cardio vascular procedures, the Xineos-2022 HR and Xineos-3030 HR high-resolution detectors with 99 μm pixel size for clinical and scientific applications, the new Xineos-1501 and Xineos-2301 ultrafast scanning detectors with 99 μm pixel size and 300 fps at full-resolution sampling, the new Xineos-1511 medium-sized detector with 99 μm pixel size, and the Xineos-1515 with switchable saturation dose for both high-dynamic range and high sensitivity. Medical Imaging International January-February/2016

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Medical Imaging International

Proton Therapy System to Be Installed he new Los Angeles Proton Therapy Center (LAPTC; Montebello, CA, USA; http:// pptus.com/lacptc) will include a Mevion S250mx proton therapy system that will serve the Greater Los Angeles area as well as international patients. The MEVION S250mx is a gantry-mounted proton accelerator that provides direct beam technology with highly stable, next-generation volumetric delivery capabilities. Novel HyperScan technology will help overcome pencil beam scanning uncertainties by delivering robust intensity modulated proton therapy treatment at hyper-speed. The system will be installed in a three-room configuration, with each room fully independent and with its own proton accelerator, providing inherent

redundancy and 100% facility uptime 365 days per year. The core technology of the system is engineered to eliminate the time inefficiencies associated with beam lines, complex operations and typical, disruptive maintenance requirements. As a result, highly conformal and robust image-guided radiation therapy (IGRT) treatments can be delivered safely in standard treatment intervals with no comprise to quality or throughput. The installation of the LAPTC system will take place in phases, with the first of the three rooms slated for late 2017.The MEVION S250mx is a product of Mevion Medical Systems (Littleton, MA, USA; www.mevion.com). “The MEVION S250mx is unique in the industry because it allows cancer centers to phase-in the installa-

Hip Osteoarthritis May Not Be Apparent on X-Rays new study concludes that in the majority of cases, X-rays are not reliable for diagnosing hip osteoarthritis (OA). Researchers at Boston University School of Medicine (BUSM; MA, USA; www.bumc.bu.edu/busm), the University of California, San Francisco (UCSF; USA; www.ucsf.edu), and other institutions conducted a diagnostic test study in two cohorts to assess the usefulness of pelvic radiographs for hip OA. Using visual representation of the hip joint, participants reported on hip pain presence and location. The agreement between radiographic hip OA and hip pain was then analyzed, and for those with hip pain suggestive of hip OA they calculated the sensitivity, specificity, and positive and negative predictive value of radiographs as the diagnostic test. The results showed that in the Framingham osteoarthritis study, among 946 participants only 15.6% of hips in those with frequent hip pain showed radiographic evidence of hip OA, and 20.7% of hips with radiographic hip OA were frequently painful. The sensitivity of radiographic hip OA for hip pain localized to the groin was 36.7%, specificity was 90.5%, positive predictive value was 6%, and negative predictive value was 98.9%; the results did not differ much for hip pain at other locations or for painful internal rotation. In the osteoarthritis initiative study, which involved 4,366 patients,

Medical Imaging International January-February/2016

the results were even worse; only 9.1% of hips in patients with frequent pain showed radiographic hip OA, and 23.8% of hips with radiographic hip OA were frequently painful. The sensitivity of definite radiographic hip OA for hip pain localized to the groin was 16.5%, specificity was 95%, positive predictive value was 7.1%, and negative predictive value was 97.6%. Once again, the results did not differ much for hip pain at other locations. The study was published on December 2, 2015, in BMJ. “Hip pain was not present in many hips with radiographic osteoarthritis, and many hips with pain did not show radiographic hip osteoarthritis,” concluded corresponding author Chan Kim, MD, of BUSM, and colleagues. “Most older participants with a high suspicion for clinical hip osteoarthritis did not have radiographic hip osteoarthritis. Given these findings, patients with suspected hip OA should be treated regardless of X-ray confirmation.” The most common symptoms of hip OA are pain and decreased range of motion. Common signs and symptoms include aching and stiffness in the groin, buttock, or thigh; decreased range of motion; chronic hip swelling; hip crunching or popping; limping or lurching; and loss of hip joint function. Discomfort is usually most noticeable when getting out of bed in the morning and may flare up when participating in sports or other intense activities.

tion of a multi-room system as their patient volume increases,” said Joseph K. Jachinowski, President and CEO of Mevion Medical Systems. “By adding one room at a time, initial cash flow demands are lower and financial risk is reduced.” “The Mevion S250mx was the optimal solution for our facility because it allows for a flexible, phased installation. Just as importantly, we continue to be impressed with the proven results of all of Mevion’s clinically operational systems, including Mevion’s industry-leading ramp-up time, high patient throughput, and low staffing and maintenance requirements,” said Charles Liu, president of the LAPTC. “The decision to select Mevion and its product solutions will allow us to consistently provide high-quality proton therapy to a large number of patients.” 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 radiotherapy as it directs the RT 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. Image: The MEVION S250mx proton therapy system (Photo courtesy of Mevion Medical Systems).

Medical Imaging International

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Study: Concussions in Military Personnel With Blast-Related Injuries Surprisingly High he results of a new study published in the online edition of the journal Radiology show that brain damage in active duty military personnel with blast-related injuries is evident in a surprisingly high percentage of cases. Concussion or Mild Traumatic Brain Injury (MTBI) is very common among US military personnel returning from fighting in Iraq, and Afghanistan, with over 300,000 of them diagnosed with MTBI between 2000 and 2015. Currently MTBI injuries are assessed mainly using behavioral observations, and symptoms such as post-traumatic amnesia, and loss of consciousness. The need for a more definitive marker spurred the research team to use advanced Magnetic Resonance (MR) brain imaging as a tool for assessing MTBI, and to try to link the acquired MRI data with subjective MTBI symptoms. The researchers are trying to use the technique to diagnose Post-Traumatic Stress Disorder (PTSD), which has similar symptoms to TBI, but different treatments. The ability to show evidence of micro-hemor-

rhages, hyper-intense areas, and softening or loss of brain tissue in the advanced MRI scans also allows military personnel and their families to visualize the previously invisible “wounds of war.” Gerard Riedy, MD, PhD, US National Intrepid Center of Excellence (NICoE; Bethesda, Maryland, USA; www.nicoe.capmed.mil), said, “We were really surprised to see so much damage to the brain in the MTBI patients. It’s expected that people with MTBI should have normal MRI results, yet more than 50 percent had these abnormalities. This paper is just the tip of the iceberg. We have several more papers coming up that build on these findings and look at brain function, brain wiring, connectivity and perfusion, or brain blood flow. A scar on a brain scan is an objective finding. We start with the objective and build a foundation for the correct diagnosis of MTBI and then bring in the subjective measures later. An objective measure of traumatic brain injury can lead to proper therapies. Military traumatic brain injury is not a small problem for our country. Through this research, we hope to learn

more about what the future entails for our military personnel who’ve suffered these injuries.” Image: The susceptibility-weighted image shows extensive micro-hemorrhage (see arrows) consistent with diffuse axonal injury in a 25-year-old man with blast-related mild TBI (Photo courtesy of RSNA).

Study on Risk of Falls Prevention for Elderly Patients indings from a new study correlate the risk of falls by elderly patients with postural balance quantified using 2D and 3D fullbody, stereo-radiographic scans of the patients in functional positions. The 2D/3D orthopedic medical imaging company presented the first clinical results of the preliminary study, at the French Rheumatology Congress that took place in mid-December 2015, in Paris (France). The aim of the study was to determine the correlation between various sagittal balance measurements, and the risk of falls in elderly patients. EOS Imaging (Paris, France; www.eos-imaging. com) announced the findings. In 2013, the US Center for Disease Control and Prevention reported

that direct medical costs for falls in the US were USD 34 billion, making them one of the 20 most expensive medical conditions. The study was held at the Cochin Hospital (Paris, France) in a collaborative program with EOS imaging, and included 122 patients at high risk of falling. The patients underwent an exam using EOS scanning systems. Clinical parameters for postural alignment were measured. The results showed that specific parameters were significantly associated with the risk of falling. Clinical examinations, risk of bone fractures, were then assessed using measurements of bone mineral density. The study showed that 2D/3D orthopedic imaging could, for the first time, be used in prevention and screening

in aging-related diseases, by analyzing sagittal balance, and overall posture. The EOS platform provides 2D and 3D full-body, stereo-radiographic imaging, in functional positions, with a 50% to 85% lower radiation dose than Digital Radiology (DR) scans, and 95% less radiation than a standard Computed Tomography (CT) scans. Prof. Christian Roux, Director, Center for the Evaluation of Bone Diseases, Cochin Hospital (Paris, France), said, “The prevention of fall and fracture risk in the elderly is a public health priority and screening at-risk patients must be simple and reliable. The preliminary results obtained by the analysis of sagittal balance with EOS are extremely encouraging, especially in light of this need.”

Ultrasound System Designed for Overweight Patients new ultrasound system that can penetrate large amounts of tissue in the abdomen and other body areas of obese and overweight patients has been announced. According to the US Centers for Disease Control and Prevention 69% of adults in the US aged 20 years and over, and 20.5% of adolescents age 12 to 19 years, are overweight or obese. Ultrasound imaging is more difficult for these patients because of the larger amounts of tissue that hinder the ability of the equipment to acquire high-resolution images. The Carestream (Rochester, NY, USA; www. carestream.com) Touch Prime and Touch Prime XE ultrasound systems provide more uniform resolution over the entire depth of the area being scanned. The systems use new technologies such as the Carestream SynTek architecture, and can provide enhanced spatial detail, with increased frame rates, while reducing noise, and artifacts. Additional design breakthroughs enable more consistent vi-

sualization of subtle differences in tissue contrast, and an improved ability to visualize small structures. Carestream’s architecture combines information independently obtained from multiple transmissions, and synthesizes a transmit beam that is narrow over the entire spatial area of an image, not only at a single point or region. This can lead to higher image quality. The Touch Prime and Touch Prime XE systems feature a sealed, all-touch control panel, and etched markings for primary controls enabling a clinician to use the system without having to look at the keyboard. The systems are intended for general diagnostic radiology, musculoskeletal, and vascular applications, and obstetrics and gynecology (OB/GYN) imaging. Andrew J. Hartmann, Carestream VP and general manager, Global Ultrasound and Computed Tomography (CT) Solutions, said, “Our ultrasound platform contains features designed to address

many challenges in sonography and imaging of large patients is just one example. Our new architecture also enhances visualization of moving anatomical structures while reducing noise and artifacts to help clinicians make diagnostic and treatment decisions.” Image: The Touch ultrasound system (Photo courtesy of Carestream Health). Medical Imaging International January-February/2016

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Medical Imaging International

Improved Molecular Breast Imaging Screening System Receives Clearance breast imaging medical device manufacturer has announced that their Molecular Breast Imaging (MBI) system, intended for women with dense breast tissue, has received the European CE Marking. The MBI screening system is already in use in leading hospitals in the US following approval by the US Food and Drug Administration (FDA) in 2011. The system is intended for the screening and early detection of breast cancer in women with dense breast tissue for whom conventional mammography and screening with other modalities is insufficient. CE Marking approval of the LumaGEM MBA screening system was announced by the manufacturer, Gamma Medica (Salem, NH, USA;

PET Reveals Vascular Microcalcifications new study reveals how a combination of positron emission tomography and computed tomography (PET/CT) can identify calcified deposits in the vasculature. Researchers at the University of Cambridge (United Kingdom; www.cam.ac.uk) and the University of Edinburgh (United Kingdom; www.ed.ac.uk) used a radiotracer version of sodium fluoride (18FNaF) to try and to identify the process by which microcalcifications are formed in the blood vessels and build up into atherosclerotic plaque. To do so, they used electron microscopy, histology, autoradiography, and preclinical and clinical PET/CT to analyze how sodium fluoride builds up and binds to active, unstable calcium deposits. The researchers succeeded in showing that sodium fluoride adsorbs to calcified deposits within atherosclerotic plaque with high affinity, and is selective and specific. Using the radioactive (18)F-NaF tracer, PET/CT imaging can even distinguish between areas of macro- and micro-calcification in active unstable atherosclerosis, and could thus potentially help foster new approaches to developing treatments for vascular calcification. The study was published on July 7, 2015, in Nature Communications. “Sodium fluoride is commonly found in toothpaste as it binds to calcium compounds in our teeth’s enamel. In a similar way, it also binds to unstable areas of calcification in arteries and so we’re able to see, by measuring the levels of radioactivity, exactly where the deposits are building up,” said senior author Anthony Davenport, MD, of the department of medicine at Cambridge. “This new emerging technique is the only imaging platform that can noninvasively detect the early stages of calcification in unstable atherosclerosis.” Calcification in atherosclerotic plaque is a complex process that exhibits similarities to new bone formation, representing a confluence of bone biology and chronic plaque inflammation. Since the rate of calcification is a surrogate measure for atherosclerosis progression, noninvasive detection of calcium could serve as a useful risk stratification tool.

Medical Imaging International January-February/2016

www.gammamedica.com), a women’s health company, and enables the company to sell and distribute the system in the European Economic Area (EEA). Nearly one in 10 women in Europe develops breast cancer before the age of 80, making it the common cancer affecting women. Conventional mammography has less sensitivity when imaging dense breast tissue – both dense tissue and cancerous areas appear white on the mammogram. At the same time women with dense breast have an increased risk of developing breast cancer. A recent has shown that the addition of MBI screening test to an annual mammogram resulted in a nearly 400% percent increase in detection rates of invasive breast cancer. The use of MBI screening also resulted in 50% less biopsies, and cost savings of 15% per cancer detected, compared to only screening with conventional mam-

mography. MBI is a functional imaging modality and can show activity and detect tumors in dense tissue, whereas other modalities such as ultrasound, Magnetic Resonance Imaging (MRI), and tomosynthesis, are anatomical imaging systems. MBI is also useful for high-risk patients, and those who cannot undergo an MRI exam. Philip M. Croxford, President and CEO of Gamma Medica, said, “Securing the CE Mark for the LumaGEM MBI system represents a major step forward in our commercialization plans to market this technology to benefit women with dense breast tissue in Europe. By offering the best MBI solution to physicians, we are helping them manage their patients’ risk efficiently by providing a highly accurate and cost-efficient secondary breast cancer screening for women with complex mammograms and dense breast tissue.”

Medical Imaging International

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Functional MRI Shows Child Obesity Has Neurological Component ew Functional MRI research has shown that the impulse area of obese children’s brains is activated when they are introduced to food smells. The researchers found that the area of the brain associated with impulsivity and Obsessive-Compulsive Disorder (OCD) becomes active when the children were presented with various food smells, while other impulse-control areas of the brain showed no activity. The study was presented at the annual meeting of the Radiological Society of North America (RSNA 2015). According to the US Centers for Disease Control and Prevention (CDC), nearly 12.7 million children in the US are obese, increasing their risk of developing health issues such as high blood pressure, type 2 diabetes, and breathing and joint problems, and of becoming obese adults. Thirty children aged between 6 and 10 years took part in the study. Half had a normal Body Mass Index (BMI) from 19 to 24, while the other 15 children were obese with a BMI of more than 30. The children underwent functional Magnetic Resonance Imaging (fMRI) and functional connectivity MRI (fcMRI) exams to measure brain activity, and at the same time were presented with odors of chocolate, onion, and diluted acetone, a neutral smell. The fMRI results showed that in obese children the food odors activated areas of the brain associated with impulse and OCD but no activity was observed in areas of the brain associated with impulse control. On the other hand, brain areas activated in those children with a normal BMI included areas

associated with pleasure regulation, planning, organization, emotional processing or memory function. When researchers analyzed the fcMRI results, they found that children with a normal BMI also showed a connection between the gustatory cortex of the brain and the reward anticipation area, when presented with the onion odor. The fcMRI results for children with high BMI did not show this connection. In addition, the chocolate odor produced significant brain connections in obese children, compared to children with a normal BMI. Pilar Dies-Suarez, MD, chief radiologist, Hospital Infantil de México Federico Gómez (Doctores,

Mexico City, Mexico; www.himfg.edu.mx), said, “In order to fight obesity, it is crucial to understand the brain mechanisms of odor stimulus. This study has given us a better understanding that obesity has a neurological disorder component, and the findings have the potential to affect treatment of obese patients. If we are able to identify the mechanisms that cause obesity, we will be able to change the way we treat these patients, and in turn, reduce obesity prevalence and save lives. Image: The different connections found in the brains of normal weight children compared to those in obese children when presented with various food odors (Photo courtesy of RSNA).

Twin Robotic X-Ray System Combines Care and Productivity he world’s first twin robotic X-ray scanner delivers a combination of high asset utilization, new clinical insights, and less patient positioning and transfers. The Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com) Multitom Robotic Advanced X-ray (Rax) offers radiology departments a comprehensive range of applications by integrating multiple X-ray capabilities in one room, thus improving asset utilization and saving on costs. Modalities include radiography, tomography, fluoroscopy, and angiography; multi-clinical options, including trauma, orthopedic, intervention, pain management, and more; static, dynamic, and threedimensional (3D) scanning; and multiple patient configurations. The two ceiling-mounted arms of the Multitom Rax can be moved into position automatically using robotic technology, and they can also be moved manually (servo motor supported) when required, such as for fine adjustment. One arm moves the Xray tube and the large touchscreen control, while the other carries a 43 x 43 cm flat panel detector. Consequently, there is no need to reposition the patient or to change rooms for further imaging procedures, which makes examinations less painful and less time-consuming. Multitom Rax also offers Real 3D – the ability to

perform X-ray examinations and diagnoses under natural weight-bearing conditions, such as in lying, sitting, and standing conditions, allowing comfortable patient positioning with an open design, while still maintaining low-dose protocols. Another comfort feature is that the scanner revolves around the patient utilizing an open, patient-centered design, resulting in less patient risks and pain due to fewer transfers and repositioning, especially important in pediatric, geriatric, bariatric, immobile, and trauma patients. “The robotic technology ensures a new level of precision and automation, enabling a new level of standardization and throughput,” said Francois Nolte, head of the X-ray products business line at Siemens Healthcare. “The precise positioning of the arms in all three planes makes the examinations so much easier: regardless of whether the patient is standing, sitting or lying down, the robotic arms move with perfect accuracy using robotic technology. Our strategy is based on the principle that the system moves, not the patient, which reduces risk of additional injuries and pain.” The Siemens Multitom Robotic Advanced X-ray (Rax) also offers optional wireless, portable, detectors in two different sizes that can be positioned di-

rectly between a wheelchair or mattress and the patient’s back, which avoids the need to sit the patient up. Preprogrammed safety zones, an automatic stop in response to contact, and automatic control of the robotic arms that ensures that they will always take the shortest and safest route to reach the next programmed position also improve safety. Image: The Multitom Robotic Advanced X-ray (Rax) system (Photo courtesy of Siemens Healthcare). Medical Imaging International January-February/2016

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Medical Imaging International

3D Modeling System Accurately Predicts Pediatric Donor Heart Volumes new three-dimensional (3D) computer modeling system may more accurately identify the best donor heart for a pediatric transplant patient. To develop the new 3D system, researchers at Arizona State University (ASU; Tempe, USA; www.asu.edu) and Phoenix Children’s Hospital (AZ, USA; www.phoenixchildrens. org) first created a library of 3D reconstructed hearts in healthy children weighing up to 45 kilograms, using magnetic resonance imaging (MRI) and computerized tomography (CT) scans. They then used the virtual library to predict the best donor body weight/heart size correlation needed for pediatric transplant recipients. Concomitantly, they examined before and after images from infants who had already received a heart transplant. When the researchers compared the post-operative data from the real infants with the virtual transplant images, they found that the 3D imaging system accurately identified an appropriate size heart, validating their findings. The researchers are currently expanding the virtual library to improve prognostic capabilities, thus allowing more effective organ allocation and minimizing the number of otherwise acceptable organs that are ultimately discarded. The study was presented at the annual American Heart Association (AHA) Scientific Sessions, held during November 2015 in Orlando (FL, USA). “It is critical to optimize the range of acceptable donors for each child. 3D reconstruction has tremendous potential to improve donor size matching,” said lead author and study presenter Jonathan Plasencia, BSc, of the ASU image processing applications lab. “We feel that we now have evidence that 3D match-

Rebuilt Web-Version of Free Mobile Healthcare Network new, redesigned web version of a free mobile-first network, that enables radiologists and other healthcare professionals to view and share medical cases, was showcased at the annual meeting of the Radiological Society of North America (RSNA 2015) during November 29–December 4, 2015). The network is available on iOS and Android operating systems, and on the web, and can be downloaded for free on the App Store and Google Play Store. The web version now enables radiologists, using a desktop computer, to upload images directly from their workstation. Figure 1 (www.figure1.com) is one of the fastest-growing mobile startups in healthcare, and is used by more than 500,000 healthcare professionals in more than 100 countries. Figure 1 is one of the largest networks of healthcare professionals worldwide, and the Figure 1 team hosted their first community at the RSNA Annual Meeting. Dr. Joshua Landy, chief medical officer, Figure 1, said, “We are continuously looking for ways to improve he access and functionality of Figure 1 for a broad set of global users. Visually-oriented fields like radiology have so much to share on Figure 1, and now those specialists can easily upload radiological scans from their desktop to a global network of clinicians.”

Medical Imaging International January-February/2016

ing can improve selection and hope this will soon help transplant doctors, patients, and their parents make the best decision by taking some of the uncertainty out of this difficult situation.” “Analyzing future transplant cases using 3D matching will allow us to predict the true upper and lower limits of acceptable donor size. The big question is how long it will take to further test the technique and move it into actual use,” concluded Mr. Plasencia, who is a PhD student at ASU. “One day transplant teams may be able to use the 3D process to perform virtual transplants before an actual procedure to rapidly measure a donated heart to ensure a better fit and to reduce the risk of mismatching in pediatric transplants.” Transplant centers currently assess compatibility

of a potential donor heart by comparing the donor weight to the recipient weight, and then picking an upper and lower limit based on the size of the patient’s heart on chest X-ray. But the assessment is not precise and variations in size and volume can have a major effect on the recipient’s outcome. Image: A 3D scan of a child’s heart born with congenital heart defects (Photo courtesy of the Phoenix Children’s Hospital).

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The Enterprise Edition supports large groups of users that read images at the same time. Features include centralized work list among multiple workstations; customizable study-status values/filtering; and automatic updates when opening a study, launching reporting, and finishing digital dictation.

The VNAHealth software confirms the validity of DICOM imaging studies as they move between a source (modality or PACS) and a destination (VNA or PACS). It confirms that all studies that exist on the source also exist on the destination, per customer-defined rules.

The Arterys system is an intelligence platform designed to enhance medical imaging. It was launched as part of GE Healthcare's ViosWorks, a comprehensive cardiac solution that reduces magnetic resonance imaging assessment to a fraction of the time of conventional cardiac scans.

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Liège University Hospital and Agfa to Enable Improved Information Sharing entre Hospitalier Universitaire de Liège (CHU; Belgium; www. chuliege.be) and Agfa Healthcare (Mortsel, Belgium; www. agfahealthcare.com) have launched an innovative Portal project to promote greater information sharing with external caregivers. The Portal is intended to provide easy, authorized access to images and reports, replacing the current CD distribution system with a more accessible, secure way to share information with caregivers outside the hospital that is in-line with the CHU high level, long term CAP 2020 strategy. “CD burning technology has become more outdated compared to other innovations in the digital age, and it no longer answers our needs or the needs of the referring physicians and patients we serve,” said computer scientist Gregory Canivet, RIS/PACS/ cardio application manager at CHU Liege. “We wanted to replace all CD-burning activity in the radiology department with a patient & referral portal that would give easy, fast access to the patient’s images using the most up-to-date technology. But it would need to be a solution that could scale up in the future to include more and more information.” To implement the new Patient & Referral Portal solution, CHU de Liège and Agfa HealthCare installed the XERO Viewer, which was directly connected to the hospital’s existing Agfa HealthCare picture archiving and communication system (PACS). XERO converts images and content for display

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without requiring any client software installation. Very intuitive to use, it includes advanced clinical tools for the referring physician and is based on upto-date web technology. Importantly, the single platform and direct connection allow access to the patient’s complete image history, from all five of the hospital’s sites. “We have a very positive relationship with Agfa HealthCare and their team worked in close collaboration with our own team on this project. “They were able to offer us a unique technology concept: putting the PACS backend and the XERO Viewer on the same platform,” continued Gregory Canivet. “This means we don’t need an extra cache, saving us storage and hardware costs. With a single cache there is no risk of error due to synchronization, while a second cache is also slower. So this unique platform set-up is more effective and faster.” The project team and Agfa HealthCare also worked closely with the CHU IT department to develop and implement an e-ID based security system for secure authentication, without making the login process too complicated for users. To access their images, patients need a standard e-card reader, a Belgian electronic ID card, and their PIN number for the ID card. For referring physicians, their unique identifier (INAMI code) was mapped to their national ID number, so they are automatically identified as such when they connect. When a patient checks in at the reception, the secretary indicates in the system whether a Portal access code must be generated on the report, and prints out a unique access code for the patient. The validated report automatically includes the access code, and it is printed on a centralized printer. The reports are then sent to the referring physician by post or by a secure messaging system; additional specialists or GPs who need to receive the report and access the images can be easily included in the email. Patients and referring physicians also receive a link for each request, allowing them to connect any time they wish to the Portal webpage, which is integrated directly into the hospital’s website. The referring physician can access both images and reports, while the patient can see images only; this enables patients to get a proper explanation of images and results from their own doctor. “The patients have been very positive about the Portal. Being able to access, download and share their images makes them feel part of a more transparent process. In the first week, between 10 and 20 patients logged in each day. By week four, that number had reached 100 per day,” concluded Mr. Canivet. “The referring physicians are also quickly adopting the Portal; in the first four weeks following the launch, 96 had already connected. And even our internal clinicians appreciate the DICOM export functionality, which allows them to use the images for other purposes, such as conference calls, case studies, and more.” The Portal is also complementary to the “Réseau de Santé Wallon,” which allows sharing of digitalized images and other patient information across the region of Wallonia (Belgium). Medical Imaging International January-February/2016

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IT/PACS Update

First Display System for Viewing All Types of Breast Images he US Food and Drug Administration (FDA; Silver Spring, MD USA; www. fda.gov) has approved a display system for use in breast Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and ultrasound, breast ultrasound, vascular and gynecological ultrasound on a single display, in grayscale, color, 2D or 3D, static or dynamic. The display system had been previously cleared for viewing of mammography images, breast tomosynthesis, and PACS images. The Coronis Uniti display was announced by Barco (Kortrijk, Belgium; www.barco.com) and can used to access any image on a single workstation, saving time, and providing workflow and clinical benefits. The ability to run side-by-side comparisons and fuse images such as those from breast ultrasound and conven-

tional mammography in women with dense breasts, has resulted in better detection of early breast cancer. The display can automatically set the correct color and grayscale settings for every image modality. Coronis Uniti also enables radiologists to accurately visualize moving images in a 3D stack, ensuring efficient diagnosis, and a rapid workflow to prevent loss of detail while scrolling. Barco also found a way to counteract motion blur when reviewing image sequences. Lynda Domogalla, Barco’s VP product marketing for Healthcare, said, “With Coronis Uniti, we wanted to break through the technical boundaries of multimodality integration and deliver the first unified workflow for radiolo-

New Cloud Ecosystem Targets Healthcare Industry E Healthcare (GE; Little Chalfont, United Kingdom; www.gehealthcare.com) has unveiled a Health Cloud and apps that are designed exclusively to connect medical imaging with analytics. The GE cloud ecosystem will connect to more than 500,000 GE imaging machines, shifting image postprocessing from on-site machines to the Cloud, where three-dimensional (3D) images can be viewed on multiple devices both inside and outside the hospital setting. Radiologists and clinicians will link with the ecosystem using cloud-based apps that can connect them in real time with imaging, data, analytics and insights, as well as with other clinicians, thus promoting collaboration across care pathways and multidisciplinary teams. Apps available will include Centricity Cloud Advanced Visualization, Centricity Multi-Disciplinary Team Virtual Meeting, Centricity Case Exchange, and Centricity Image Access. The apps will be delivered on a subscription basis, allowing hospitals and health systems an on-demand, flexible computing power that can be scaled up or down on a variable cost model that will allow them to control computing expenses. The cloud ecosystem will also include a software development toolkit (SDK), and

Medical Imaging International January-February/2016

its app store will host and promote new software solutions. “Healthcare devices are generating enormous amounts of data, and that data is expected to increase 50 fold by 2020. The GE Health Cloud can help unlock the value of this data quickly and seamlessly for better patient care,” said John Flannery, president of GE Healthcare. “The GE Health Cloud will help clinicians turn data into insights, and insights into tangible actions for decision-makers to drive better outcomes.” “Our new apps will bring incredible computing and mobility power to radiologists and clinicians,” said Jan De Witte, president of IT at GE Healthcare. “By enhancing radiologists’ speed and confidence through the apps, we can help improve their ability to collaborate with referring clinicians inside and outside the hospital.” The apps are being developed as part of a partnership with the University of Pittsburgh Medical Center (UPMC; PA, USA; www.upmc.com) in a joint venture known as Omnyx. The Health Cloud and apps will also be open for development by third parties, healthcare providers, and academic institutions, in a bid to attract independent software vendors (ISVs) to develop their apps in the new cloud ecosystem.

gists in order to improve reading productivity as well health outcomes. We have succeeded in developing a ‘one size fits all’ diagnostic display, which defines a new bar for clinically focused display solutions. To maximize the diagnostic value of color breast images, we developed new technologies to calibrate and main-

tain the consistency of these color images, and we are leading in the definition of a Color Standard Display Function (CSDF) to ensure the accuracy and consistency of color images on diagnostic displays.” Image: The Coronis Uniti multimodality diagnostic display (Photo courtesy of Barco).

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IMAGE VIEWER

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Sphinx Medical Technologies

The DoseWatch Explore is a web-based, cloud deployed, introductory dose management software designed to track, analyze and report practice-level data for GE CT systems. It collects radiation dose data directly from CT scanners, then summarizes/presents the data via a web app.

The The zero-footprint AbbaDox HTML5 DICOM image viewer requires no client installation and is compatible with all modern web browsers that are HTML5-compliant. Users can also access the image viewer through native apps on the iPhone, iPad, and Android mobile devices.

The Patient Self-Scheduler allows patients to make appointments without a receptionist or office staff. The after-hours smartphone app allows a physician to respond to a patient call using either voice, text or message response choices, while being able to access the complete patient record.

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Integration of CVIS System with Ultrasound Post-Acquisition Image Management healthcare Information Technology vendor and an ultrasound-imaging manufacturer have integrated their Cardiovascular Information System (CVIS) and advanced 3D/4D ultrasound imaging and strain rate software to improve productivity and streamline the clinical workflow. he ultrasound image-processing tool can now be launched with a single mouse click, while viewing an ultrasound study in the CVIS. The clinical workflow of the two tools has been merged and can be operated from one workstation instead of two. This now enables a clinician to launch the 3D/4D tool, perform an analysis of the image and return the image back to the CVIS in one location. GE Healthcare’s (Chalfont St Giles, Buckinghamshire, UK; www3.gehealthcare.co.uk) EchoPAC ultrasound post-processing and reporting tool, and Digisonics’s (Houston, TX, USA; www.digisonics. com) CVIS solutions can now directly store and retrieve images acquired by GE Healthcare’s Vivid range of ultrasound scanners.

The Digisonics CVIS solution is standards-based and vendor-neutral, and can be used with all cardiovascular modalities. The CVIS combines a Picture Archive and Communications System (PACS) with a clinical database, for high-performance image review. The CVIS conforms to and exceeds US Health Insurance Portability and Accountability Act (HIPAA) requirements for a secure environment with electronic signature, and audit trail capabilities. The EchoPAC tool can be used to perform image processing, analysis, measurement, and annotation. The tool is also used to generate reports, and for communications. The EchoPAC software is integrated into each Vivid ultrasound system. Ernest Jackson, chief technology officer Digisonics, said, “Digisonics is very pleased to add the GE EchoPAC application to our best-in-class suite of CVIS interfaces. With EchoPAC, users have the ability to post-process the original RAW data acquired on the ultrasound system, expanding pro-

ductivity and leveraging the advanced quantitative and multidimensional analysis provided.” Image: The standards-based, vendor-neutral Cardiovascular Information System (CVIS) solution for all cardiovascular modalities (Photo courtesy of Digisonics).

Cloud-Based Radiology IT Solution Offers Greater Efficiency of Protocols new Information Technology (IT) platform now includes protocol management to standardize work and examination sequences. The platform’s protocol function enhances a user’s ability to combine, process and analyze protocols, and will allow protocols from the vendor’s Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scanners to be compared, commented on, and archived. In addition, the platform allows sample protocols to be transferred to other modalities for further use, and enable reuse of existing protocols scans of the same type. The new version of the teamplay network solution was developed by Siemens Healthcare (Erlangen, Germany; www.healthcare.siemens.com). The system enables hospital staff to assess utilization of imaging devices, workflows, and individual exams,

for increased transparency, economic efficiency, and more precise dose management. Anonymized data also can be analyzed and compared against values from other healthcare providers. The teamplay platform is designed to be userfriendly and intuitive with minimal training required, and can be used on tablets, laptops, and desktop Personal Computers (PC). The teamplay Usage function provides an overview of the performance data, such as a daily usage report, from imaging modalities, recording the frequency, time, and nature of exams, and total capacity utilization per imaging device. This can help optimize hospital workflows and workloads, reduce patient waiting times, and reduce costs. The teamplay platform Dose offering monitors the radiation dose applied in each scan, and can compare

this to national reference values, and those of other facilities and similar exams. Teamplay meets or exceeds US Health Insurance Portability and Accountability Act (HIPAA) legal data protection requirements, and European data protection laws using encryption technology. Dr. Frank Schellhammer, chief radiologist, Augustinian Hospital, (Cologne, Germany; www. koeln-kh-augustinerinnen.de), said, “The workflow in a hospital ultimately depends on how the communication functions between the various departments, and also within the individual departments themselves. The better we share data, the more efficiently we are able to use our modalities, and the more time we have for each individual patient, which in turn leads to a quality of results and an image quality that will benefit the patient.” Medical Imaging International January-February/2016

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IT/PACS Update

Virtual Reality Device Helps Treat Blocked Arteries wearable virtual reality (VR) device based on Google Glass can be used to guide revascularization of chronically blocked coronary arteries. Developed by researchers at the Institute of Cardiology (Warsaw, Poland; www.ikard.pl), the optical VR device projects three-dimensional (3D) coronary computed tomography angiography (CTA) reconstructions to a wearable head-mounted display that is worn by interventional cardiologists in the catheterization laboratory. The projection of the 3D CTA reconstructions onto the screen of virtual reality glass allows the operator to clearly visualize the distal right coronary vessel and verify the direction of the guide wire advancement, relative to the course of the occluded vessel segment. The wearable computer, which is also equipped with a hands-free voice recognition system and a zoom function, was developed specifically by a

team of physicists at the Interdisciplinary Center for Mathematical and Computational Modelling of the University of Warsaw (Poland; www.uw. edu.pl) to improve procedure efficiency in interventional cardiology by enabling physician-operators to clearly visualize coronary vessels. The study describing the development and first in-human use of the VR device was published on November 19, 2015, in the Canadian Journal of Cardiology. “Mobile technology is easily accessible and offers an incremental opportunity to expand the existing open platform for mobile applications, which might in turn overcome the economic and capacity limitations of advanced angiography systems with dedicated monitors for projection of CTA data sets,” said lead author Maksymilian Opolski, MD. Chronic total occlusion, a complete blockage of the coronary artery, represents a major challenge for catheter-based percutaneous coronary intervention (PCI) due to unpredictable procedural

success rates that are related to incomplete visualization of the occluded coronary arteries by conventional coronary angiography radiology methods. As a result, coronary CTA is being increasingly used to provide physicians with guidance when performing PCI in this subset of lesions. Image: CTA images displayed in Google Glass (Photo courtesy of the Canadian Journal of Cardiology).

Software Package for Compatibility of MRI Scanners with Post-Processing Tools ew software that enhances the efficiency of the Magnetic Resonance Imaging (MRI) workflow, and clinical decision has been released. The release is part of a cooperation and co-marketing agreement between a software company and a major manufacturer of MRI scanners. The software upgrade is optional, and makes MRI scanners compatible with the post-processing software packages from the software vendor. Philips Healthcare is offering the SyntheticMR, SyntAc sequence software to customers. The SyntAc will

enable most Philips MRI customers to use the SyMRI post-processing software packages. The SyntheticMR, SyMRI software can use the data from one SyntAc scan and convert this into several image contrasts, even after the scan has taken place, without re-calling the patient for multiple scans. The need for only a single scan saves time and simplifies workflow. There are three versions of the SyMRI software. The SyMRI IMAGE package can optimize workflows and short scan times using a single MR quantification scan. The SyMRI NEU-

RO package aids analysis and decision-making during brain imaging for the follow-up in the development of neurodegenerative diseases, by adding quantitative data. Stefan Tell, CEO of SyntheticMR, said, “I am very pleased that cus-

tomers using most Philips MRI scanners will now have access to SyMRI, expanding our software packages to a broader, global customer base and enabling them to explore new imaging strategies and efficient quantification capabilities.”

Mac-Based DICOM PACS Enterprise Workstation new PACS workstation intended for the enterprise environment and simultaneous image reading for large groups of clinicians was presented at the annual Radiological Society of North America (RSNA 2015) conference. The Picture Archive and Communications System (PACS) workstation has been cleared by the US FDA. The medical solutions provider showcasing the workstation will also present an advanced image-processing tool, and a DICOM PACS workstation for conventional and multi-slice image reading. The Enterprise Edition workstation was developed by aycan Medical Systems (Rochester, NY, USA; www. aycan.com), a company that provides vendor neutral integration and service, viewing, printing, sharing, and storage solutions for medical images, and information.

Medical Imaging International January-February/2016

The Enterprise workstation is designed to support simultaneous reading of images by large groups of users. The workstation features a centralized study worklist shared among a number of aycan workstations simultaneously, automatic status updates upon opening a study, customizable study-status values and filtering, automatic export of completed reports as DICOM PDFs, launching of reports, completing digital dictation, centralized settings of preferences, and HL7 messaging for incoming orders and status events. Clinical and workflow plugins such as an Advanced Hanging Protocol optimized for mammography workflow, advanced image registration, FusionSync, and Vessel Analysis for segmentation and calculation of center lines for vessel assessment are available for all aycan workstations.

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The MDSC-8232 is a 32-inch 4K monitor intended for laparoscopic visualization, as well as for use within the interventional radiology control room. It is available with an integrated Nexxis 4K decoder to work perfectly together with Barco’s Nexxis platform for video-over-IP integration in the OR.

The MR2416 is sealed with an edge-to-edge frontcovered glass, and is DICOM-calibrated for accurate and consistent image display during every clinical review. It also meets medical design standards and safety requirements for medical electrical equipment with IEC 60601-1 compliance.

The Suitestensa CVIS-PACS encompasses all cardiology specialties and allows diagnostic image acquisition, archiving, distribution and management within healthcare networks. It enables doctors to access and track current/previous patient reports, images, and test results.

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Advanced Visualization Table Features Capacitive Touch Interface n enhanced 55-inch visualization table with state-of-the-art touch technology enables medical staff to smoothly navigate three dimensional (3D) images of actual patient cases. The next-generation Sectra (Linköping, Sweden; www.sectra.com) F15 visualization table with capacitive touch technology allows medical staff and students to gain enhanced understanding of the body’s anatomy and functions, the variation between individuals, and visually explore more unusual diseases. The 3D images are taken by modern computed tomography (CT) and magnetic resonance imaging (MRI) cameras. Users of the table can simply zoom in, rotate, or cut into the visualized body without using a scalpel, and can repeat virtual autopsies and dissections over and over. The table also serves as a terminal for the proprietary Sectra Education Portal, a concept for sharing patient cases and teaching content and knowledge with other universities that use the Sectra Table. Based on an enterprise image management

platform, the tables is suitable for all training programs, including anatomy training on virtual images of actual patient cases from other universities, in addition to the preinstalled training images that accompany the table. “The visualization table allows us to modernize and increase the quality of our teaching,” said Sandra Ceccatelli, MD, PhD, head of the department of neuroscience and in charge of anatomy teaching at the Karolinska Institutet (Solna, Sweden; www. ki.se). “The table opens up unique opportunities to convey basic knowledge about the body, offering a whole new way to teach anatomy to our students.” The visualization table was developed in cooperation between the Linköping University (Sweden; www.liu.se) Center for Medical Image Science and Visualization (CMIV), Visualiseringscenter C (Norrköping, Sweden; www.visualiseringscenter.se), and The Interactive Institute (TII; Stockholm, Sweden; www.tii.se).

Image: The F15 visualization table (Photo courtesy of Sectra).

ACR Assist Empowers Radiologists by Providing Clinical Decision Support new ACR Assist toolbox will provide radiologists with a collection of structured information to replace existing variable, unstructured narrative reporting. ACR Assist is part of a suite of products intended to bring Imaging 3.0 principles into standard clinical practice. ACR Assist helps radiologists produce structured, actionable reports within their natural workflow and includes raw clinical content, an encoding scheme, and a communication framework for improved content delivery. ACR Assist is provided by the ACR American College of Radiology (ACR; Reston, VA, USA; www.acr.org). The tools are vendor neutral and provide point-of-interpretation access to taxonomies, classification and communication guidance, care pathways and algorithms to existing reporting systems.

The core clinical components of ACR Assist include computer-readable versions of the Lung Cancer Screening Reporting and Data System (LungRADSTM), Prostate Imaging Reporting and Data System (PI-RADSTM), Liver Imaging Reporting and Data System (LI-RADS), and other structured classification and reporting taxonomies. Vendors of radiological reporting software can integrate clinical guidance objects from the ACR Assist toolset into their reporting process using Natural Language Processing (NLP). The tools then help determine when to provide the relevant content objects to the interpreting radiologist within a conventional reporting workflow. The Imaging 3.0 Informatics Infrastructure consists of ACR Select clinical decision support, ACR Assist, ACR Common, a standardized core set of terminology still in development, and ACR Connect.

Epic Systems (Verona, Wisconsin, USA; www.epic.com), Cerner (North Kansas City, MO, USA; www.cerner.com) and Nuance (Burlington, MA, USA; www.nuance.com) demonstrated ACR Assist together with other value-based imaging tools at the Radiological Society of North America (RSNA 2015) annual meeting. “ACR Assist brings evidence-based guidelines for recommendations and actionable reporting into clinical practice, providing guidance during interpretation at the time this information is most useful to radiologists,” says Keith Dreyer, DO, PhD, FACR, chair of the American College of Radiology Commission on Informatics. “The technology was developed to meet practices’ changing needs while enhancing patient care quality by integrating key, structured data elements into variable, free-form narrative reports,” he added. Medical Imaging International January-February/2016

Industry News

Further Growth Seen in Surgical Robotics for Radiology Oncology new report has been published indicating that worldwide market for radiology oncology surgical robots is growing mainly due to an aging world population, and the benefits the new technology can offer. Radiology oncology surgical robot technology provides opportunities to change cancer treatment methods, including the increased use of stereotactic body radiosurgery, instead of surgery or other conventional treatments. Radiosurgery has the potential to revolutionize cancer treatment by removing tumors without damage to surrounding healthy tissue. The report entitled "Radiology Oncology Surgical Robots: Market Shares, Strategies, and Forecasts, Worldwide, 2016–2022" was published by Wintergreen Research (Lexington, MA, USA; www.wintergreenresearch.com) and was made available by Research and Markets (Dublin, Ireland; www.researchand markets.com). Radiosurgery equipment providers mentioned in the report include Accuray (Sunnyvale, CA; USA; www.accuray.com), Brainlab (Munich, Germany), and ViewRay (Cleveland OH, USA). The annual number new cancer cases diagnosed is forecast to increase to 20 million by 2025, from 14.9 million in 2015. Radiosurgery makes use of high radiation doses precisely eliminate tumors, and leaves healthy tissue unharmed. The demand and sales of this radiosurgery has increased profit margins for companies offering this technology during the last five years. Hospitals are also adopting the technology to improve outcomes.

Sectra Acquires Cloud-Based Imaging Network Provider xEye (Stockholm, Sweden), a company specializing in cloud-based remote imaging systems was acquired by Sectra (Linköping, Sweden; www.sectra. com). Sectra develops IT systems, and services for radiology, orthopedics, rheumatology, and other image-intensive hospital departments. RxEye is being acquired by Sectra’s Imaging IT Solutions business unit. Customers currently using the RxEye Cloud network are located in Sweden, Norway and France. RxEye had sales of around SEK 7 million in the 2015 financial year. The company’s cloudbased services are designed for efficient and secure viewing of radiology, pathology, nuclear medicine images, and for use in teleradiology. Torbjörn Kronander, president and CEO, Sectra, said, “Providing services to the medical care sector via the Internet is a delivery model that we can see is increasing in importance and remote viewing of medical images is a growing area due to efficiency requirements and, in certain cases, staff shortages in the medical care sector. RxEye is a small company with products that complement our offering of IT services, which can enhance the efficiency of communication and use of resources in medical care.”

Medical Imaging International January-February/2016

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MARCH 2016 ECR 2016 - European Congress of Radiology. Mar 2-6; Vienna, Austria; Web: www.myesr.org 2016 AAPM Spring Clinical Meeting American Association Of Physicists In Medicine. Mar 5-8; Salt Lake City, UT, USA; Web: www.aapm.org 11th European Molecular Imaging Meeting. Mar 8-10; Utrecht, Netherlands; Web: www.emim.eu Medical Fair India 2016. Mar 11-13; Mumbai, India; Web: www.medicalfairindia.com Thoracic Imaging 2016: Annual Meeting and Postgraduate Course. Mar 13-16; Scottsdale, AZ, USA; Web: http://thoracicrad.org KIMES 2016. Mar 17-20; Seoul, Korea; Web: www.kimes.kr

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International Calendar Dublin, Ireland; Web: www.ecio.org 2016 ARRS Annual Meeting - American Roentgen Ray Society. Apr 17-22; Los Angeles, CA, USA; Web: www.arrs.org Radiology in China. Apr 24-30; Shanghai, China; Web: www.radiologyintl.com APCCVIR 2016 – The Asia Pacific Congress of Cardiovascular and Interventional Radiology. Apr 21-24; Suzhou, China; Web: www.apccvir2016.org Charing Cross Symposium 2016. Apr 26-29; London, UK; Web: www. cxsymposium.com ESTRO 2016. Apr 29-May 3; Turin, Italy; Web: www.estro.org

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AUGUST 2016 38th Annual International Conference Of The IEEE Engineering In Medicine And Biology Society (EMBC). Aug 1720; Orlando, FL; Web: http://embc.embs.org The 16th Asian Oceanian Congress of Radiology. Aug 19-21; Beijing, China; Web: www.theaosr.org FIME 2016 – Florida International Medical Exhibition. Aug 20-24; Miami, FL, USA; Web: www.fimeshow.com ESC 2016 – European Society of Cardiology. Aug 27-31; Rome, Italy; Web: www.escardio.org

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26th World Congress on Ultrasound in Obstetrics and Gynecology. Sep 25-28; Rome, Italy; Web: www.isuog.org ESMRMB 2016 - Annual Scientific Meeting. Sep 29-Oct 1; Wien, Austria; Web: www.esmrmb-eventcalendar.org

OCTOBER 2016 Baltic Congress of Radiology. Oct 78; Riga, Latvia; Web: www.radiologija.lv 24th UEG Week – United European Gastroenterology. Oct 15-19; Vienna, Austria; Web: www.ueg.eu ESCR 2016 - Annual Scientific Meeting of European Society of Cardiac Radiology. Oct 20-22; Krakow, Poland; Web: www.escr.org Image Soundly: Society of Radiologists in Ultrasound (SRU) Annual Meeting. Oct 21-23; Baltimore, MD, USA; Web: www.sru.org Euroson 2016 – Congress of the European Federation of Societies for Ultrasound. Oct 26-29; Leipzig, Germany; Web: www.efsumb.org 2016 IEEE Nuclear Science Symposium and Medical Imaging Conference. Oct 29-Nov 6; Strasbourg, France; Web: www.ieee.org/index.html

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