May, 2014
Rs. 100
Ultrasound in OB/GYN:
Wordsworth: Dr. Pankaj Desai
Smile of the Unborn
Judicious adoption of new technology in individual clinical practice is very much necessary
Vol 3, Issue 5, Pages 44
COLOR DOPPLER | MAY, 2014
India's First Complete Medical Imaging Magazine
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Inside Scan Under the Scanner – COLOR DOPPLER | MAY, 2014 Volume 3 | Issue 5 KERENG/2012/41766 editor-in-chief Joby Joseph joby@colordopplermedia.com publisher Niranjan Kumar K R M niranjan@indiaultrasound.com design editor Gireesh gireesh@colordopplermedia.com
Smile of the Unborn Advancements in technology realize many things that were previously unimaginable especially in areas such as OB/GYN. Here we take a walk through the revolutions brought in by the growth of Ultrasound techniques. Also, looks into the possible future growth of 3D and 4D ultrasound
page 17
chief coordinator Saraswathy M saraswathy@colordopplermedia.com
Wordsworth –
Judicious Adoption of Technology a Must
chief correspondent Jumana Engineer jumana@colordopplermedia.com
Recent trends in obstetrics and gynecology are so dynamic that you have to run to be at the same place. Gone are the days of masterly activity in obstetrics. Judicious adoption of new technology in clinical practice is a must, says Dr. Pankaj Desai, Consultant Obgyn Specialist, Janani Maternity Hospital, Baroda.
co-ordinating editor Rini Baby Thottil rini@colordoppleronline.com copy writers Ria Lakshman V ria@colordoppleronline.com Purnima Sah purnima@colordoppleronline.com senior designer Sohan V K sohanvishnu@colordopplermedia.com assistant designers Linda Daisy Paul linda@colordoppleronline.com Sooraj K sooraj@colordoppleronline.com designer, new media Amit Sudhans amit@colordoppleronline.com manager-product & HR Kishore Kumar P S kishore@colordopplermedia.com assistant manager, IT Swetha G swetha@colordopplermedia.com manager, accounts Hariharan V V assistant, accounts Shahana P shahana@colordoppleronline.com
COLOR DOPPLER #2/1775-B, Florican Road, P O Civil Station, Calicut, Kerala - 673020, India Phone : +91 495 2378808/ 09 Email : info@colordoppleronline.com www.colordoppleronline.com Vision and opinions expressed in this magazine are not necessarily those of Color Doppler, its publisher and/or editors. Color Doppler does its best to verify the information provided but will not take any responsibility for the business moves taken by any reader on the basis of any article published in this magazine. No part of Color Doppler can be reproduced without the prior written permission of the publisher, Niranjan Kumar K.R.M. The rights to reproduce any information published in this magazine are vested with Color Doppler. The magazine is sold on the condition that the jurisdiction for all disputes will be courts/ forums/tribunals at Kozhikode, Kerala. Printed, published and owned by Niranjan Kumar K R M, 3/1614 C, Sridevi Niranjan, Near 6th Rly Gate, Nadakkave Post, Calicut-673011 and Printed at Anaswara offset Private limited, 48/2123-c Perandoor Junction, Elamakkara, Cochin 682026 and Published at 34/1347-A, Florican Road, Malaparamba, Calicut-673009. Editor: Joby Joseph.
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page 13 Talking Point –
Making SOS a National Reality Providing emergency service in 16 states in the country, GVK EMRI is in a bid to expand its service for a greater good. In this chit-chat with Color Doppler, K Krishnam Raju, the Director in Charge of GVK EMRI, shares his vision on expanding emergency medicine
page 29 Product Focus
Seeing Beyond Color Doppler brings to you imaging devices for obstetrics and gynecology, incorporated with innovative technologies and smarter workflow solutions. These products deliver outstanding image quality with their cutting-edge technologies
page 26 Eventful
Conference with a Difference
Ultrafest 2014, the three-day conference organized by the Maharashtra State Branch of the Indian Radiological and Imaging Association (MSBIRIA) from April 18 to 20, 2014, Mumbai, discussed Emergency Ultrasound in detail
page 32 Event Preview
INSUOG 2014 Calling
Color Doppler, along with INSUOG team welcomes the delegates to INSUOG 2014 to participate in the industry’s premier OB/GYN knowledge spreading conference
page 35
COLOR DOPPLER | MAY, 2014
[ news scan ]
GE Healthcare Unveils Discovery IQ, First Ever PET/CT Designed in India
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E Healthcare unveiled Discovery IQ, an advanced Positron Emission Tomography/Computed Tomography (PET/CT) molecular imaging system designed in India for the world. The new Discovery IQ is the result of $15 Million (INR 90 Crores) investment, and three years of close collaborative development with Indian nuclear medicine physicians and oncologists. The new GE Discovery IQ PET/ CT comes with advanced early disease detection capabilities as well as measurements to understand patient’s response to cancer treatment. Discovery IQ is another feather in the cap for GE Healthcare’s Indian innovation capabilities. “Three years back, we promised to develop an advanced yet affordable PET/CT to improve access to early cancer detection. We are extremely proud that we have
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realized that commitment today with the launch of Discovery IQ — an advanced PET/CT that is 40 percent more affordable and can usher in personalized treatment for the patient. We are extremely thankful to the Indian healthcare providers for their close collaboration and insights into their needs that helped develop this important weapon against cancer,” said Terri Bresenham, President & CEO of GE Healthcare South Asia. “Molecular imaging is the epitome of healthcare imaging technologies. GE is very pleased to demonstrate to the world, India’s capabilities in developing the most sophisticated medical technologies.” she added. Designing an affordable technology solution in India — GE’s Discovery IQ, is another bold step GE has taken to help improve affordability and accessibility to this critical tool that can enable early de-
FDA Clears Siemens’ Cios Alpha Mobile C-arm
iemens Healthcare announced that the Food and Drug Administration (FDA) has cleared the Cios Alpha, a dynamic new mobile C-arm system with flat-panel detector that boasts a power output of 25 kilowatts (kW) and has a field of view (FoV) up to 25 percent larger than conventional C-arms. The Cios Alpha offers a host of features designed to boost the surgical team’s confidence and operational workflow. They include a user-friendly touch screen interface, a unique position storage feature, and an active cooling system that helps to ensure exceptional image quality during prolonged interventions.“With imaging technology that helps overcome disruption and reduce inefficiency in the OR, the new
COLOR DOPPLER | MAY, 2014
Cios Alpha mobile C-arm will aid surgical teams in maximizing productivity and fostering a higher quality of patient care across multiple disciplines,” said Laurie Fisher, VP, X-Ray Products, Siemens Healthcare. “Siemens has engineered the Cios Alpha to deliver the highest-quality images at the lowest possible dose during surgery and perform seamlessly even during prolonged operations.
tection and treatment of cancer. Moreover, GE’s new Discovery IQ is scalable to fit the needs of the many Indian healthcare providers and is built on a platform that is upgradable on site to meet the increasing demands of a hospital, making it a secure and affordable long term investment to provide continuous, superior care over the years. The value of PET/CT for diagnostic imaging in oncology is well established with its capabilities to combine anatomic and functional aspects of the body to provide a complete picture of patient’s health. But now, even brighter possibilities are coming to light, with new quantitative tools that enable more consistent PET measurements. “We know that cancer patients don’t always respond to their initial course of treatment,” said R Sureshkumar, General Manager, PET/CT Product Development, GE Healthcare.
Labeling Rules Strengthened The Drugs Controller General’s (India) Central Drugs Standard Control Organization (CDSCO) will now require labeling to be attached to imported devices at their Indian ports of entry by the distributors. This labeling should include importer and/ or distributor names and Import License numbers. The regulators of medical devices and drugs in India, Central Drugs Standard Control Organization (CDSCO) will now be requiring the importers to affix this information to their products before import to India from September 2014. The deadline has been set keeping in mind the priority to do so and also giving considerable amount of time to the importers to come into compliance and avoid short term shortages of medical devices in India. The CDSCO will begin enforcing its mandate from 28th September 2014. This active step from the regulators is seen as an outset of a complete medical device regulation pathway.
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[ news scan ]
GE Healthcare receives FDA Clearance for Q.Clear Technology
GE
Healthcare announced that it received US FDA 510(k) clearance of its Q.Clear Technology – a technology that can provide up to two times improvement in both quantitative accuracy and image quality in PET/CT imaging. This is an innovative tool for clinicians across the entire care continuum including diagnosis, staging, treatment planning, and treatment assessment. GE Healthcare’s new Q.Clear Technology shows the advantage of full convergence PET imaging with no more compromise between quantitation and image quality. “Q.Clear is a major step forward because it can give us a consistent and reliable
measurement when determining whether the current course of a patient’s cancer treatment is effective,” said Dr. Gustav von Schulthess, Nuclear Medicine Chair at University Hospital Zurich. “It will give the oncologist more confidence because if a change of therapy is needed, you want accurate information early on to best adjust treatment for the patient.” Clinicians not only want the ability to detect smaller lesions, but the ability to determine earlier whether the patient is responding to current treatment. Q.Clear aims to help in both areas by providing better quantitation accuracy for truly personalized medicine. Coupled with GE Healthcare’s Q.Suite, which introduced the importance of eliminating variability
Global Breast Imaging Market to Reach USD 4.06 billion by 2019
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he global breast imaging market was valued at USD 1.84 billion in 2012 and is expected to grow at a CAGR of 12 percent from 2013 to 2019, to reach an estimated value of USD 4.06 billion by 2019, according to a market report published by Transparency Market Research. Rising incidence of breast cancer and benefits of early detection of the condition are the major factors that augment this growth. Also, the governments are taking initiatives such as funding breast cancer screening in the respective countries, educating and spreading awareness and arranging free breast screening campaigns to encourage women for breast cancer screening. Such governmental and nongovernmental initiatives will result in increased awareness about breast cancer, and thereby, increase the rate of breast cancer screening worldwide. The report also says that the global market for mammography will reach USD 1,935.9 million in 2019 with the market growing at CAGR of 10.1 percent from 2013 to 2019. It is expected that the market for tomosynthesis will grow at a
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CAGR of 18.1 percent during the given period of forecast. The global breast imaging market is segmented on the basis of type of technologies used such as mammography, breast MRI, breast ultrasound, nuclear imaging, tomosynthesis and others. Most of the international breast cancer organizations and regulatory authorities recommend mammography as the first line screening method for breast cancer. Though mammography is followed by breast MRI or ultrasound in most of the cases, these technologies are not considered as standard substitutes for mammography. Apart from breast MRI and ultrasound, various technologies are approved by regulatory authorities such as the US Food and Drug Administration (FDA) and the European Union. Moreover, factors such as radiation exposure and associated hazards, and lack of safety data for use of technologies such as breast thermography for screening breast tissue, are limiting the adoption rate of these technologies in the breast imaging market.
such as respiratory motion, Q.Clear can enable clinicians to assess treatment response accurately so they can provide the best patient care. “We know that approximately 70 percent of cancer patients do not always respond to their initial course of treatment,” said Steve Gray, President and CEO of GE Healthcare MICT. “If we can give clinicians an accurate, reliable, and faster tool to confirm that a change in treatment is needed, the patient will benefit greatly. For example, PET/CT can help clinicians determine whether chemotherapy is working in fewer cycles, saving patients unnecessary procedures. Q.Clear gives clinicians the ability to help make that determination”, he added.
market scan Global Diagnostic Imaging Market worth $27,115.4 Billion by 2018 According to a recent study released by Marketsandmarkets, the global diagnostic imaging market is expected to reach $27.1 billion by 2018, at CAGR of 4.7 percent from 2013-2018. Three major factors drive this growth, namely; increasing application of diagnostic imaging systems, geographic expansion of market players across the globe, and the improving healthcare expenditure in emerging markets. The report also says that, as of 2013, North America held the largest share of approximately 34 percent of the global diagnostic imaging market, followed by Europe. However, the Asia-Pacific market is expected to grow at the fastest CAGR of approx. 5.9 percent from 2013 to 2018.
COLOR DOPPLER | MAY, 2014
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[ news scan ]
ETIAM Revolutionizes Medical Imaging with new EIS Solution
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he medical imaging connectivity company ETIAM which is known for providing IT solutions introduces ETIAM Integrate Solution (EIS) that will allow the physicians and healthcare professionals to store and incorporate patient images and multimedia examinations. It allows the data interchange between the clinical systems’ components, the ‘image-centric’ PACS, hospital information systems, and the electronic medical record, thus providing secure and monitor access to patient information. The solution, which is compliable with the regulatory standards and healthcare best practices such as HIPAA acts as a central repository for multimedia data from multiple sources in various formats, but providing the EMR with normalized data forms clinicians can view. The product further provides
benefits such as messaging for ordering examinations, sending results, and updating patient demographic information, and strategy to accommodate all multimedia and image types and rapid growth in data size and in the number of users over time. New EIS is a result of ETIAM’s years’ of experience in healthcare connectivity. “The solution is really a comprised suite of intricate software modules that we have developed over the years. Until now, we have not been able to pinpoint a full scale, single product that would allow healthcare administrators to get the most out of their imaging enterprise,” said George Hunt, VP of Sales of the company. ETIAM Corp, a Massachusetts-based medical image sharing company is in business since 1997 and provides solutions to seamlessly connect medical professionals and patients by creating a platform to share medical studies and images instantly and securely.
Diagnostic Imaging: Obstetrics, 2nd Edition
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INSUOG 2014
Date: May 2-4, 2014 Venue: Hotel Taj Mahal Palace For Details: www.insuog.com
KSUM Open 2014
Date: May 23-24, 2014 Venue: Coex, Seoul, Korea For Details: 2014.ksum.or.kr
ISPR 2014
Date: September 12-13, 2014 Venue: Christian Medical College, Vellore For Details: www.ispr2014.com
CUSP 2014
Date: September 25-28, 2014 Venue: Chennai Trade Center For Details: cusp.org.in
book scan
Authors: Paula J Woodward MD; Anne Kennedy MD; Roya Sohaey MD, Janice L Byrne MD; Karen Y Oh MD; Michael D Puchalski MD; Tom C Winter MD; Logan A McLean MD Pages: 1000 pages Price: $339.00
event scan
With approximately 260 diagnoses, Diagnostic Imaging: Obstetrics, 2nd Edition, is a perfect reference guide for the physicians to go through the intricacies of obstetrics and gynecology. The book, written by Dr. Paula J Woodward and team covers topics such as Embryology and anatomy of the first trimester, including embryologic events, ovulation, fertilization, implantation, embryonic development, organogenesis, placental developments, umbilical cord development, anatomy-based imaging issues and more. The richly colored graphics and annotations highlight the diagnostic possibilities, making it easier for the readers to understand the significant concepts. The book is also coupled with new e-book.
USCON XXIII
Date: October 31 - November 2, 2014 Venue: JW Marriott Aerocity, New Delhi For Details: www.usconxxiii.com
EMCON 2014
Date: November 6-9, 2014 Venue: Renaissance Mumbai Convention Center Hotel, Powai, Mumbai For Details: emcon2014mumbai. com
COLOR DOPPLER | MAY, 2014
[ new product scan ]
Ysio FAST Movement in Six Axes Ysio digital radiography system offers simultaneous movement in all axes - high level of automation, effortless efficiency, increased patient throughput and safe operation
User-friendly Design
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igital radiography (DR) system, Ysio offers Multiple Advances in X-ray (MAX), including time-saving user support features and X-ray detectors. Ysio DR system provides unique immediate FAST movement in six axes, maximized comfort at fingertips with MAXTouch. It delivers directly outstanding image
quality, enhanced by DiamondView Plus. All together, Siemens’s Ysio comes with advanced organ-program-linked post-processing which brings out result faster and gives confidence in diagnoses system. The features of Ysio DR system supports the user more like a private intelligent helper.
Ysio’s free-floating table is designed to achieve high weight capacity and great patient coverage. It allows large patient’s examination from head to toe without repositioning. Table height is adjustable
OTHER FEATURES
ClearRead Bone Suppression The ClearRead Bone Suppression from Riverain suppresses bone structure on the digital image to enhance the clarity of chest X-rays without the need for two exposures
Smart Route with AIM
With unique Artificial Intelligence Mapping (AIM), Ysio calculates the shortest, fastest and safest path from one position to the next for fast, safe system
COLOR DOPPLER | MAY, 2014
positioning regardless of starting position or final destination
Control at Fingertips
MAXTouch gives an intuitive and convenient control for excellent usability with maximized comfort at fingertips
syngo FLC
syngo FLC is complete digital, one-stop system that brings together the entire radiograph workflow. It is easy to learn.
ClearRead +Detect ClearRead +Detect from Riverain helps to identify potential lesions that could be early-stage lung cancer.
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[ new product scan ]
ARIETTA 70
Real-time Tissue Elastography The feature of Real-time Tissue Elastography of complex breast lesion benefits the physicians in multiple ways
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itachi’s ARIETTA 70 comes with a feature that reduces stress and improves its ease-of-use. Its compact and light-weight platform provides brilliant ergonomics designed to recommended industry standards using operator feedback and supports a comfortable working environment.
It is designed to provide optimum wrist support to reduce stress from long periods of scanning. The two-way multi-rotary encoders offer spontaneous action, allowing the management of many functions in one control.
Tissue Doppler Measurement Tissue Doppler measurement of EE Display using Dual Gate Doppler can be analyzed with ARIETTA 70
OTHER FEATURES
Multi-layered and Single Crystal
This technology allows more efficient transmission and reception of the ultrasound pulse with minimal energy loss, increasing the sensitivity and clarity of the images
Front-end Technology
The Compound Pulsed Wave Generator (CPWG+) uses an efficient programmable transmission waveform to generate pulses with high sensitivity and resolution
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Accuracy and Reliability
ARIETTA 70 is equipped with advanced technologies that facilitate fast and accurate examinations, such as Real-time Virtual Sonography (RVS) and Real-Time Tissue Elastography
Diversity
ARIETTA 70 is equipped with a diverse range of advanced functions including Dual Gate Doppler, valuable for diagnosing fetal arrhythmia and STIC, providing morphological observation.
Enhanced Intra-operative Contrast Enhanced Intra-operative contrast of the liver can be seen in the ultrasound, which gives better diagnositic comfortability.
COLOR DOPPLER | MAY, 2014
[ new product scan ]
VISIQ
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hilips’ VISIQ ultrasound system is an innovative compact transducerplus-tablet. VISIQ is designed to deliver crystal clear images with ultra performance by incorporating clinically proven technologies and sharp optimization. This small and lightweight system provides better quality images with easy use.
The touch-screen tablet of VISIQ allows fast and easy access to information. VISIQ comes with various features such as high performance and simplicity into a compact single miniaturized solution, excellent image quality, availability of ultrasound anytime, anywhere for expectant mothers. Fetal Heart The above clinical image depicts 10 weeks fetal heart scanned with Philips VISIQ. The clarity in clinical images is a prime benefit of this newly launched machine
Bilateral Kidneys at 19 Weeks OTHER FEATURES
Mega Mobility
Philips VISIQ is made to achieve notable mobility. It gives the benefit of advance miniaturization to incorporate a stylish broadband digital beamformer. This feature helps to achieve powerful image acquisition module into the transducer
Light and Easy
VISIQ’s thin, lightweight tablet has a built-in kickstand that can be placed on a bedside tray or table to view its exceptional, high-definition images
Slim and Comfortable
The slim and ergonomic design stand is easy to move from one to place to another. Its slim carry bag makes transporting the system easy and allows delivering high quality care, in any environment
Quick Reboot
VISIQ works very fast right after waking COLOR DOPPLER | MAY, 2014
up from sleep mode. It starts scanning in a few seconds. Its battery life supports over 2.5 hours even after back to back scanning, making on-the-go ultrasound a reality
Through VISIQ, Philips has created an ultra mobile ultrasound systems. The advancements of miniature technology, offers high-end pictures for clinical diagnosis
Advanced with Time
VISIQ comes with built-in WiFi for DICOM data transfer to hospital and cloud PACS. This facility makes it very easy to share and store images
Multitasker
VISIQ is built with multi-touch ultrasound systems to deliver right features. The onscreen controls perform the task at hand
Touch-screen
Familiar touch-screen gestures allows the user to tap on icons to open features, pinch zoom in and out of images and pan the screen to easily adjust Doppler Gate and scroll through images.
Umbilical Cord The above is a clinical image of the umbilical cord at 28 weeks scanned using VISIQ. Its core imaging technology provides perfect diagnostic freedom.
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[ featured product ]
Revolutionary mHealth Device from BPL Medical Technologies BPL Medical Technologies Private Limited introduces a new revolutionary all-in-one home health and wellness monitoring mobile device - BPL LifePhone PlusTM, making easy-to-access healthcare practices a reality
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our smart phone can do many things. Can it be a doctor, too? Absolutely yes, with BPL Medical Technologies Private Limited introducing BPL LifePhone PlusTM, a revolutionary all-in-one health monitoring device, which can transform your smartphone to your family doctor. BPL LifePhone PlusTM will bring to you the power to take health counts such as ECG, blood glucose, pulse rate, calories burnt and activity counts with your smartphone in the comfort of your home, office or even an outdoor location, and helps you obtain feedback through remote monitoring from the physicians. The device has the biggest advantage of getting the patient connected with their doctors in real-time. The counts are shown on the mobile application screen soon after the measurement, and the results can be shared with the consultant by pressing the submit button. The advisory will come in shortly as an SMS alert. “BPL LifePhone PlusTM will become a regular health guide for all,” says Dr. Karthik Anantharaman, the Chief Marketing Officer of BPL Medical Technologies Private Limited. “BPL LifePhone PlusTM provides a healthcare connectivity between people and doctors, making it one of the most convenient healthcare devices to help patients, wherever they are. It is not only meant for cardiac patients but also for other who want to keep track of their health records. BPL LifePhone PlusTM will be in the market by late July 2014.”
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BPL LifePhone PlusTM will serve as a proven way to improve wellness at reduced costs through self-management and will facilitate a hands-on prevention solution among hospitals, physicians, caregivers and patients. The device is equipped with four stainless-steel electrodes, two at the front and two at rear-end of the device. These electrodes make contact with the patient’s skin and thus, help in acquiring accurate 6-12 leads through a simple four-step process. The users can check their blood glucose levels by pricking their finger using the lancet provided and placing the blood droplet on the BG strip that is inserted in the receptacle of the device. It can be determined with a sample of fresh capillary whole blood with a minimum sample size of 0.4µL and the test result can be obtained in four seconds. The device has been designed and tuned to be worn on the hip, and can measure activities. It has a three-axis sensor that
provides a digital accelerometer based activity sensing support, which will help in measuring the activities of the user such as number of steps walked, total time and the amount of calories burnt. All what the user has to do is place the device in his holster and clip it on to the waist strap or belt, click on the start button on the mobile phone, and then the activities will be recorded. A simple four-step procedure helps the users in acquiring six leads of ECG measurement easily. Emergency situations are never a rare thing in the life of a cardiac patient. With its emergency advisory option, BPL Life Phone PlusTM acts as a life saving tool. In emergency, the device gives the user guaranteed SMS/ Phone advisory, thus avoiding the wastage of crucial time to take the first golden step. Before submitting any reading to a consultant, the user can select SOS/ Emergency options which ensure quick response. With its 6-12 Lead ECG facility, BPL LifePhone PlusTM brings happier times for heart patients as the device provides them with as good ECG reading as any hospital settings can provide. BPL LifePhone PlusTM brings to you a full-time physician through its real-time consultancy service which can be obtained real-time by sending ECG and any other counts to the consultants round the clock through the mobile applications. BPL LifePhone PlusTM works with all android/J2ME phones with 2G or 3G connection and with those having BT and GPRS. A compact mobile healthcare device, BPL LifePhone PlusTM weighs at 70 gms and can be operated at a room temperature between 0°C to 35°C.
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[ wordsworth ]
‘Badly Organized Academic Meetings are Dangerous’ Well arranged conferences are important. Badly put together academic meetings are dangerous, says Dr. Ashok Khurana who has to his credits many academic and technological firsts in New Delhi, including transrectal scans, transvaginal scans, color Doppler, 3D and 4D ultrasound and ultrasound-guided surgical procedures. He also talks about how his OB/GYN practice has changed in the past 30 years
Dr. Ashok Khurana Jumana Engineer l cd news Ashok Khurana commenced his medical studies at the All India Institute of Medical Sciences, New Delhi, India in 1975, and then went on to do a post graduate (MD) degree in Radiology. During this period he had the unique experience of establishing the ultrasound services at this premier institution under the guidance of Prof Sneh Bhargava who is widely regarded as the ‘guru’ of contemporary medical imaging in India. It was during this time that he also had the opportunity to train at the ultrasound department of the Herlev Hospital in Denmark under the tutelage of Prof Hans Henrik Holm, a pioneer in ultrasound technology and its medical applications. Armed with this experience he went on to establish a private medical facility in New Delhi, with the vision of providing world-class ultrasound services.
Incorporating technology has always enhanced my practice. The cost of technology has always prevented my bank account from growing
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Apart from running this facility, Dr. Khurana has to his credit, several academic and technological firsts in the city, including transrectal scans, transvaginal scans, color Doppler, 3D and 4D ultrasound and ultrasound guided surgical procedures. He has authored two medical text books, one on 3D and 4D ultrasound and the other on breast ultrasound. He has contributed several articles on ultrasound in prestigious medical journals. He is a member of several academic societies where he has lectured extensively, conducted training workshops and chaired several scientific sessions. These include the International Society for Ultrasound in Obstetrics and Gynecology, Indian Radiological and Imaging Association, Indian Medical Association, Federation
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[ wordsworth ] Every human being can be inspired to do good work and evolve into a better person. What are the recent trends in obstetrics and gynecology? Recent trends in Obstetric and Gynecologic Ultrasound include newer user friendly software in 3D and 4D, anomalies scans at 11-14 weeks of gestation, new algorithms incorporating Non Invasive Prenatal Testing of cell free fetal DNA for the diagnosis of aneuploidies, a new list of likelihood ratios of second trimester markers of aneuploidies, incorporating a midsaggital view of the cranium and an anterior axial view of the palate in the midtrimester anomalies scan and the availability of high frequency intracavitary and linear transducers.
Dr. Ashok Khurana with delegates at the Fetal Medicine Symposium in 2013
of Obstetric and Gynecological Societies of India, Indian Academy of Human Reproduction and the Indian Federation of Ultrasound in Medicine and Biology. He is also a member of the FOGSI Genetic and Fetal Medicine Committee for which he conducts several academic exercises. His ultrasound facility is accredited by FOGSI for training programs. Dr. Khurana is also the former Clinical Director of the Test-Tube Baby facility of the Institute for Fertility Fulfilment, former President of the Indian Federation of Ultrasound in Medicine and Biology, Delhi Chapter and former Secretary, Indian Radiological and Imaging Association, Delhi branch. Excerpts from an interview: You have given innumerable lectures in many conferences, how important according to you are these conferences and what do the attendees get to learn? Well organized conferences are important. Badly put together academic meetings are dangerous. The former enhance knowledge, skills and patient care. They improve the quality of professionals and uphold the dignity of the medical profession. The latter degrade professionals and encourage negative aspects such as personal gain from product companies and academic mediocrity. How easy or difficult it is to inspire
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Recent trends in Obstetric and Gynecologic Ultrasound include newer user friendly software in 3D and 4D, anomalies scans at 11-14 weeks of gestation, new algorithms incorporating Non Invasive Prenatal Testing of cell free fetal DNA for the diagnosis of aneuploidies, a new list of likelihood ratios of second trimester markers of aneuploidies, incorporating a midsaggital view of the cranium and an anterior axial view of the palate in the midtrimester anomalies scan and the availability of high frequency intracavitary and linear transducers someone with your words to do good work in the medical field and even in general?
You are in this profession since many years now, how has your OB/GYN practice changed over the years? It changes everyday. As does technology, as does knowledge, as do patient requirements. What problems have you faced from the technological side in the course of your practice? Technology changes rapidly. It leaves you breathless to keep up! Also new technology is expensive. How have technological advancements helped/hampered your practice? Incorporating technology has always enhanced my practice. The cost of technology has always prevented my bank account from growing!!! What are the common medical scenarios that an obstetric or gynecologist has to face in India and the most easy and apt way to deal with the same? The biggest hassle is the implementation of the PCPNDT act. Random notifications by appropriate authorities frequently seem to harass the ethical practitioner. The impact of these on the original heinous act of female feticide which they are supposed to prevent is minimal in most areas. What future do you predict for the OB/ GYN specialty? In what way do you see it changing in terms of diagnosis and treatment? Obstetric and Gynecologic Ultrasound will continue to improve prenatal outcomes and objectivise diagnostic and management algorithms.
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[ wordsworth ]
‘Judicious Adoption of Technology a Must’ Recent trends in obstetrics and gynecology are so dynamic that you have to run to be at the same place. Gone are the days of masterly activity in obstetrics. Judicious adoption of new technology in individual clinical practice is very much necessary
Dr. Pankaj Desai Jumana Engineer l cd news Pankaj Desai is one of the best known academicians and teachers in obstetrics and gynecology in India. Dr. Desai is currently the consultant OB/GYN specialist in Janani Maternity Hospital, Baroda. He has a national and international repute as a fine academician, top-class practitioner of the subject, obgyn specialist with modern outlook, ‘in-pace’ with recent advances in the subject. All his books have proved to be best-sellers, one of which was awarded the best book award in the subject. A prolific writer, he has contributed 39 chapters to different national and international text books. His outstanding academic contributions in the subject have been acknowledged and honored with seven gold medals and 52 orations. A modern and keen practitioner in the subject he is an acknowledged a master in management of high-risk obstetric situations. His opinion on management of obstetric vasculopathies including Recurrent Pregnancy Loss, Pre-eclampsia, IUGR and the like is highly valued. He has inspired many by his “out-of-the-box” thinking style and positivity. His blogs on different academic, and non-academic aspects have also become very popular. Excerpts from an interview:
All that we have to remember is that it is not the machine but the human behind the machine who is important COLOR DOPPLER | MAY, 2014
You are a great orator with many lectures to your name, what drives you in doing so? A strong desire to share and ‘give back’. By lecturing, I share with the audience whatever knowledge and experience I gather during my practice. Besides, I am a teacher. As a teacher, it is my duty to give back to the society what all knowledge I collect so that someone, somewhere gets benefitted and a life is touched. There cannot be a greater happiness than this for me.
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[ wordsworth ] How easy or difficult it is to inspire someone with your words to do good work in the medical field and in general? If you have sincerity of purpose and honesty to the cause, it just happens. One need not labor to inspire. Inspiration just flows once you walk your talk. Which are the recent trends in obstetrics and gynecology? Recent trends in obstetrics and gynecology are so dynamic that you have to run to be at the same place. Recent trends are in accepting and then treating the role played by immunology in many high-risk obstetric conditions and to include new light in non-invasive prenatal screening in low-risk women. Current focus in the discipline is also on greater awareness to contraception and postpartum risk of thrombosis. Safety of NSAIDs vis-à-vis risk of spontaneous abortion from their exposure is currently being closely reviewed. Interestingly, epidural anaesthesia is being tried for pain relief in second stage of labour. In gynecology, after establishing the role of vaccines in prevention of carcinoma cervix, now HPV vaccine dosing is being standardized for genital warts. Safety and efficacy of levonorgestrelreleasing intrauterine devices is being investigated for women on anticoagulants. In gynec-oncology, new staging system has come into vogue for ovarian, fallopian tubal and peritoneal carcinomas. In ART, obesity and outcomes of IVF with donor oocytes are being investigated. In gynec urology mesh-related complications are under great focus in pelvic organ prolapse repair. How has the OB/GYN practice changed over the years? There is a vast change. Gone are the days of masterly activity in obstetrics. Obstetricians now play a much more active role in all aspects of obstetrics. Pregnancies could be pushed closer to term. Just about two decades ago obstetricians were struggling for taking pregnancies to 34 weeks and saving about 1200-1400 gram babies. Now they are comfortable even at 29-30 weeks and 800-1000 grams. Caesarean sections have increased as new indications get added to the list. Vaginal births after caesarean section are declining. In gynecology, endoscopy has come
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New technologies are excellent, but all new technologies need not be helpful. What is useful in my practice needs to be carefully evaluated rather than jumping on to the bandwagon of acquiring new technology just to show-off or satisfy one’s ego to occupy a centre stage in handling most gynec conditions including malignancies. Thus, the entire face of OB/GYN practice, right from the type of abdominal incisions that we practitioners were making on abdomens to the complete overhaul of indications needing surgery, all seem to have changed. What problems have you faced from the technological side in the course of your practice? The biggest problem I am facing is that the technology that we are using in day-today practice has failed to keep pace with user-friendliness that we require. More often than not we have to adapt to the facilities in the technology rather than the technology evolving its facilities to meet our needs. Also, technology is unable to adapt fast enough to new developments. Flexibility too is limited. How have technological advancements helped/hampered your practice? I can write a PhD thesis on this. It is difficult to answer in few lines. Technology has greatly helped and hardly hampered our practice as OB/GYN specialists. However, all that we have to remember is that it is not the machine but the human behind the machine who is important. Also, new technologies are excellent, but all new technologies need not be helpful. What is useful in my practice needs to be carefully evaluated rather than jumping on to the bandwagon of acquiring new technology just to show-off or satisfy one’s ego. New technology is always very costly and resources are scant and hard-earned. As a result, judicious adoption of new technol-
ogy in individual clinical practice is very much necessary. How have environmental factors affected the health of your patients and in turn affect your diagnosis in recent years? Environmental health risks are factors outside of the body that can affect a person’s well-being. Examples include the quality of their air, food and water supply or their exposure to hazardous materials. Preventing or reducing the risk of illness, injury or disease in the community is important for environmental health. Environmental health covers many different factors in a person’s surroundings. These can include: Air pollution – for example, smog, wood smoke and mould. Water quality – for example, grey water, tank water, fluoridation and drought. Food quality – for example, contamination and nutrition. Chemicals – for example, pesticides, farm chemicals, arsenic etc. Metals – for example, exposure to lead, mercury and cadmium. Diseases from animals and insects (vector borne) – for example, dengue fever and malaria. Infectious diseases – for example, viral infections like swine flu and hepatitis. Natural hazards – for example, solar radiation and extreme weather events. Man-made structures – for example, exposure to asbestos or electromagnetic radiation sources like mobile phones. Occupational health – for example, safety issues relating to the workplace such as noise pollution and hazardous waste. Climate change – for example, higher sea levels, increased soil salinity and increased temperatures. Preventing or reducing the risk of illness, injury or disease in the community is essential to good environmental health. An important way to achieve this is by improving the quality of people’s surroundings. These include emergencies, natural disasters, water supply, increased urban development, etc. What future do you predict for the OB/ GYN specialty? In what way do you see it changing in terms of diagnosis and treatment? Bright pulsatile and vibrant future for OB/ GYN in India and in the world. COLOR DOPPLER | MAY, 2014
[ under the scanner ]
Smile of the Unborn
Advancements in technology realize many things that were previously unimaginable especially in areas such as OB/GYN. Here we take a walk through the revolutions brought in by the growth of Ultrasound techniques
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Ria Lakshman V l cd news ltrasound is the backbone of modern obstetrics and gynecology practice. It has evolved into a sophisticated tool for diagnosis and management of both fetal and maternal problems encountered during pregnancy, and for the reassurance of normal fetal anatomy and development.
Role of Ultrasound in Obstetrics The usage of ultrasound during pregnancy begins from the diagnosis and confirmation of early pregnancy. This includes the observation of the gestation sac, the yolk sac, the size and the location of embryo and its measurement during the first six weeks of pregnancy.
The viability of fetus too is determined by ultrasound, precisely pulsed doppler ultrasound. At about seven weeks of pregnancy, the heart beat of the fetus is measured using the pulsed Doppler ultrasound. Based on this, the continuity of pregnancy is determined. To say, the normal heart beat rate of a fetus at six weeks is around 90-110 beats per minute (bpm) and at 9 weeks is 140-170 bpm. Higher chances of miscarriage occurs if the rate is below 90bpm. The missed abortions in women are determined by a series of ultrasound. An embryo, which is measured 7mm in an ultrasound scan, but failed to detect heart beat is presumed as missed abortion. In order to ensure it as error-free, usually the scans are repeated in 7-10 days.
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[ under the scanner ] Similar is the use of ultrasound in determining gestational age and assessment of fetal size. Ultrasound is used to assess the body parameters of the fetus to confirm the healthy growth of fetus. This will greatly assist in the diagnosis and management of intrauterine growth retardation (IUGR). Transvaginal ultrasounds are used to look at women’s reproductive organs, including uterus, ovaries and cervix. Its usage is not limited to the time of pregnancy. Rather, numerous other gynecological conditions of women are assessed using this ultrasound technique. Under obstetrics and gynecology, transvaginal scans are used to create a clearer picture of fetal cardiac pulsation, early diagnosis of ectopic pregnancies, diagnosis of congenital anomalies and other increasing number of fetal abnormalities. Thus, this method has become inevitable in obstetrics and gynecology. Mostly, the transvaginal scans are performed during the early stages of pregnancy. However, in diagnosing congenital anomalies, it is performed during second trimester. As the transducer probe is closer to the organs being viewed, transvaginal scans create a clearer picture than transabdominal scans. The examination is suitable, particularly, for women who are obese, unable to maintain a full bladder and for those who possess a retroverted uterus. The Doppler ultrasounds are usually used to estimate the blood flow through the blood vessels by bouncing high frequency sound waves off circulating red blood cells. A regular ultrasound too uses sound waves to produce images, but cannot show the blood flow. Similar to its role in other specialties, Doppler ultrasound is used in obstetrics to assess the blood flow in different parts of the baby’s body, such as umbilical cord, brain, kidneys and heart. As the fetus is completely dependent on the supply of oxygen and nutrients from placenta, examination of flow of blood through the umbilical cord has a great potential for the assessment of fetal health. Restricted blood flow to the fetus could cause lower birth weight, reduced size and impaired development. The Doppler ultrasound provides the physician a visual or audible representa-
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tion of blood movement. There are three types of Doppler ultrasound – a) Continuous Doppler ultrasound, b) Duplex Doppler ultrasound and c) color Doppler. In Continuous Doppler ultrasound, the detection is through sounds. The physician uses a small, portable unit to listen to the reflected sounds. The reflected sound from a blocked blood vessels will be different from that of an open blood vessel. Thus, the blockage can be seamlessly determined using this Doppler ultrasound. The Duplex Doppler ultrasound produces a visual picture with sound waves. When the sound waves are reflected, a concurrent image is also created. The sounds are also converted into graphs that will showcase the direction and the speed of blood flow. Each direction of flow is determined by different colors. A color Doppler ultrasound is similar to that of Duplex Doppler ultrasound that the picture is created from the sound waves. However, instead of graph, a color picture of blood flow is generated from the scan. In addition to determining the defects in blood vessels and fetal cardiac issues, the color Doppler is used in the assessment of the hemodynamic responses to fetal hypoxia and anemia. Power Doppler is a form of color Doppler which are powerful enough to penetrate better into the organs to provide a clearer picture. It is capable to visualize slower flow in smaller blood vessels. The resulting image includes a color overlay showing blood speed and direction. The blood flow characteristics in the
fetal blood vessels can be assessed with Doppler ‘flow velocity waveforms’ as well. Diminished flow, particularly in the diastolic phase of a pulse cycle is associated with compromise in the fetus. Apart from umbilical cord, the aorta, the middle cerebral arteries, the uterine arcuate arteries, and the inferior vena cava are assessed for their efficiency in blood flow. Further, Doppler ultrasounds are used to assess the fetal progression in the face of intrauterine growth restriction and the diagnosis of cardiac malformations. It is widely employed in the detection of fetal cardiac pulsations. The Doppler ultrasound can be performed abdominally or via transvaginal route. The power emitted by a Doppler device is higher than the emission in usual two-dimensional scans and thus, its usages are cautioned during the early stage of pregnancy. Most of the modern ultrasound scanners in the market are incorporated with Doppler facility. The physicians merely need to switch the function to Doppler mode, and do not need another equipment for the same.
3D and 4D Ultrasound Three-dimensional (3D) and four-dimensional (4D) ultrasounds are the recent development in the field. In standard twodimensional (2D) ultrasounds, the images depicted on the monitors are thin slices of a particular area of the organ. Only one thin slice can be seen at a time and that is why, sometimes it can be confusing or misinterpreted by untrained professionals.
COLOR DOPPLER | MAY, 2014
[ under the scanner ]
5D Technology: The Future is Here! Samsung Electronics has recently launched the UGEO WS80A, its first premium ultrasound with 5D technology in India. With stylish Samsung design and innovative features including the 5D Technologies, MPI and ElastoScan™ that provide superior image performance, the UGEO WS80A redefines premium ultrasound for women’s health. The device features a 21.5″ wide LED imaging screen and a 10.1″ touchscreen for the controls, as well as a variety of software optimizations that help resolve relevant anatomy and outputs data to 3D TV’s for an even more realistic view. “As the first premium device, the UGEO WS80A represents the latest ultrasound innovation and leading IT technologies of Samsung,” said Dinesh Lodha, Vice President, Health and Medical Equipment Business, Samsung India. “Samsung will continue to put its best efforts towards developing medical devices that deliver true-to-life images and features that provide faster diagnosis.” The new UGEO WS80A combines Samsung’s latest technology in display to deliver faster and more accurate diagnoses in the field of women’s health. Key features include : The 21.5” Wide LED screen offers users higher qualThe 3D images makes this much easier. In 3D images, a series of multiple 2D images are combined to display a ‘life-like picture’. To be more explicit, the transducer takes a series of images or thin slices of the subject. These images or slices are processed by the computer to produce a 3D image. The 4D images goes one step further, by depicting ‘motion’, which is the fourth dimension. It shows the moving 3D images like a video. The addition of motion in ultrasound provide a greater assistance in examining the fetal heart structure and fetal limb motion. The benefit of 3D and 4D images
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ity color image representation as well as higher resolution compared to conventional monitors, delivering enhanced vision of the ultrasound images. A 10.1” Touch Control Pad is highly sensitive, allowing for easy input to minimize users’ stress from pressing the buttons FRV™ + Inversion Mode – FRV™ (Feto Realistic View) has been upgraded to improve speed and to support inversion mode. Advanced FRV™ allows for detailed visualization of subtle anatomical features, thereby enabling intuitive diagnosis on the scanned 3D images and enriching patient communication 5D NT™ (Nuchal translucency)* - Enables realistic visualization of NT images that help detect Down syndrome 5D Cine™ - Provides images that can be viewed on 3D TV for healthcare practitioners to acquire new clinical value through more accurate diagnoses of lesions and blood vessels. Apart from the clinical benefit, this feature also gives life-like 3D images of the unborn child. ElastoScan™ - Applies Strain Imaging Technology which displays the gradient value of tissue displacement via color map, thus making it easier for users to differentiate between benign and malignant masses through acquiring the strain ratio between the target and reference area at a much faster rate than its predecessors. Simple ROI selection and automatic calculation make breast diagnosis more efficient and intuitive. Other additional features include the Additional EV Probe Holder, Probe Cable Hangers, Default Gel Warmer and Up & Down Lift that allows the user to adjust the system to the user’s preferred height without straining.
amounts to better view. Faster and more advanced 3D scanners has now reduced the rendering time from minutes to seconds. The scans require special probes and software to accumulate and render the images. 3D scans can further refine the diagnosis depicted in 2D scans. To be precise, fetal problems such as a facial cleft lip or a club foot and spina bifida may be more clearly demonstrated using 3D scans. Other more subtle features such as low-set ears, facial dysmorphia or clubbing of feet can be better assessed, leading to more effective diagnosis of chromosomal abnormalities. The 3D and 4D scans also possess a
psychological benefit of creating better bond between the parents and the baby. Unlike the 2D scans, 3D scans show the baby better, making it impressive to the parents. Also, the demonstrations of the fetal behaviors through 3D and 4D ultrasounds, such as fetal yawning, smiling et cetera brings a better enjoyable experience to the parents. Most of the experts do not consider 3D or 4D ultrasound as a mandatory evolution of 2D ultrasound. This is because the 2D still can furnish most of the problems and 3D scans work as an additional tool. The potential of 3D and 4D scans are more in research and areas like fetal embryology.
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[ under the scanner ] History of Three-Dimensional Ultrasound There are plenty of historical references to the development of 3D ultrasound in Obstetrics and gynecology. According to Donald School Textbook of Ultrasound in Obstetrics and Gynecology, it was in 1974 that Szilard developed a mechanical 3D display to view fetus three-dimensionally. Subsequently, Brinkley and colleagues invented 3D position sensor for probe. By 1982, they were able to display wiredframe 3D images. However, this was done manually by tracing the outlines of the
Unlike the 2D scanning, 3D ultrasound offers many options. The freedom to rotate and translate the three perpendicular planes displayed provides the physicians accurate sections and comfortable views for diagnosis and geometric measurements. The surface rendering offers detailed plastic images if there exist layers of different echogenicity allowing for the definition of certain threshold tomographic images. In 1986, Baba and colleagues displayed a live fetus in utero three-dimensionally with the help of an ultrasound scanner, position sensor and computer via the imaging technology named ‘surface rendering’. By 1989, 3D probe and an ultrasound scanner became commercially viable. Two unique 3D ultrasound technologies were also developed – 1) defocusing lens method and 2) real-time ultrasonic beam tracing. In former, a fetal volume was obtained only by using a probe with a defocusing lens. In the latter, construction of 3D imaging and 3D scanning were performed simultaneously and a complete 3D image can be obtained as soon as the
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scanning was done. Unlike the 2D scanning, three-dimensional ultrasound offers a variety of options. The freedom to rotate and translate the three perpendicular planes displayed provides the physicians accurate sections and comfortable views needed for diagnosis and geometric measurements. The surface rendering offers detailed plastic images if there exist layers of different echogenicity allowing for the definition of certain threshold. An imaging of structures with a higher echogenicity in the interior of object can be obtained in transparent modes. To sum up, the 3D ultrasound performs the following functions: Display of a 3D image Display of an arbitrary section Measurement of 3D space Display of a 3D blood flow image Saving, copying and transmission of all information in 3D space Re-examination with a saved data set, without the patient Practical Tips for Good 3D Scanning Four golden rules are suggested to obtain good 3D images: Probe position and Orientation While choosing the probe position and orientation, the primary focus for the physician is to choose an area where sufficient amount of amniotic fluid is seen over fetus. Direction of Scanning While scanning, it is vital to fit the Region of Interest (ROI) to the object as much as possible, by translating and rotating the original the original 3D data set and by choosing ROI size. Setting the threshold By setting threshold low, the clinicians can hide the weak noises around the object. However, when set high, parts of the image gets eliminated. Electrical Scalpel or 3D cutting The process of eliminating the unnecessary parts in the 3D data set with the help of computer is called electrical scalpel or 3D cutting.
Safety of Ultrasound in Obstetrics and Gynecology The safety aspects of ultrasound in obstetrics and gynecology is a much talked about topic of today. Although no adverse effects of ultrasound diagnosis have
been reported, it is emphasized that the ultrasound scanning are to be performed only when medically indicated. One of the main reasons for accentuating this is due to the probability in destructions of the biological tissues of developing embryos and fetuses under intense ultrasound. Sometimes, ultrasound absorption can cause temperature rise, which may lead to teratogenicity in fetal. There also exists the chances of inertial cavitation and other mechanical effects. However, when the temperature rise in exposed tissue is less than 1.50C and local temperature stays below 38.50C, no hazardous effects will occur. In common B-mode imaging devices, the heat production is low. Hence, the users must have a prudent knowledge on the ultrasonic intensity of the imaging devices used, the mechanisms of the ultrasound bioeffects and usage of their instruments. The ultrasound bioeffects are estimated by thermal effect with Thermal Index (TI), mechanical effects are estimated by Mechanical Index (MI) and also by output ultrasound power. The safe obstetric ultrasound intensity level is reported to be one thermal index and one mechanical index. However, the TI level can be allowed to be two, but the exposure time should not exceed five minutes. The ultrasound devices in the market comply with the safety guidelines. The measurements such as TI, MI, Transducer temperature and other indices are marked on the monitor screens. Due to the fact that the safety of ultrasound cannot be assured, the usage of ultrasound should be limited. Also, ultrasound should be employed only by the health professionals who are welltrained and updated about the clinical usage and bioeffects of ultrasound. Occasionally, non-medical usage of ultrasound are seen. Live scanning if pregnant models for equipment exhibition at ultrasound conferences is one such usage. Such practices should to be prohibited. Thermal Index (TI) < 0.5 and Mechanical Index (MI) < 0.3 are recommended levels while using ultrasound for non-medical reasons. To summarize, the safety of ultrasound equipment depends on the system. Due to low temporal average intensity, Simple B-mode, 3D and 4D ultrasound, fetal heart detector and fetal monitor are considered safe.
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Mobile Apps
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[ under the scanner ]
OB/GYN Mobile Apps
Perfect OB Wheel
Obstetric Ultrasound-Lite
ore than just a paper wheel, Perfect OB Wheel is a fast and flexible gestational calculator app that will help clinicians determine a pregnant woman’s due date, first trimester end date, second trimester end date, current gestational age, expected fetal length and weight based on standard fetal growth curves. The app also helps in determining the estimated due date and enables the adjustment of length of cycle and luteal phase. Developer: Evan Schoenberg Compatibility: iOS, Windows Price: US $1.99
esigned and developed for healthcare professionals, Obstetric Ultrasound-Lite provides a thorough explanation on how to carry out obstetric ultrasound. The app includes everything about first, second and third trimester scanning such as various scanning techniques, normal ultrasound images with color overlays recounting the anatomy seen, schematics of anatomy, biometric measurements, growth charts, graphs, biochemistry information, etc. Developer: Ultrasoundpaedia Compatibility: Android Price: Free
RCOG Guidelines
drawMD OBGYN
COG Guidelines is a significant source for obstetrics and gynecology specialists, providing them with the access to high-quality clinical guidelines. The app enables the access to all of the Green-top guidelines, search facility, easy navigation, landscapes and portrait views. The app can be accessed even without wi-fi or 3G. It also provides free updates as new guidelines are published by the RCOG. Developer: Royal College of Obstetricians and Gynaecologists Compatibility: iOS, Android Price: US $8.27
rawMD OBGYN app helps clinicians to demonstrate and modify medical images, which will facilitate an easy communication between clinicians and patients. The user can upload images and can annotate any condition on those images. The app has easy-to-use drawing ability that fits effortlessly into any workflow. It also has clinically validated anatomical artwork and also anatomic image import functionality to library for annotation. Developer: Visible Health, Inc. Compatibility: iOS Price: Free
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iRounds OBGYN
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eveloped keeping in mind the busy physicians, iRounds OBGYN mobile app enables easy tracking of patients through better communication. The application includes features such as patient sign-out, MD to MD communication, schedule upcoming cases and on call. The app also includes Cross Coverage, a feature that helps physicians share their patient census with the group they cross over with in real-time. The app is also HIPAA security enabled. Developer: iRounds LLC Compatibility: iOS Price: Free
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OB/GYN Constellation
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B/GYN Constellation seamlessly integrates the most trusted OB/ GYN resources and tools, making it a customizable key for clinicians. This comprehensive suit includes The Medical Letter’s Adverse Drug Interactions Tool, Dr Drug: Drug Guide for Physicians, Gynecology and Obstetrics: The Johns Hopkins Manual, Archimedes 360° Medical Calculator, Clinical Summaries, etc. The app can be totally cross-indexed with all of Skyscape’s 500 nursing and medical references. Developer: Skyscape Compatibility: iOS, Android Price: US $109.99
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Mobile Apps
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Clinical Obstetrics and Gynecology
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linical Obstetrics and Gynecology provides a inclusive view of all timely topics in obstetrics and gynecology. The app enables sharing articles via email or social media and has got features such as convenient ‘pinch and zoom’ text resizing, facility to store or delete downloaded issues, fast browsing capabilities, quick scrolling through abstract summaries and provides notification when a new issue is available. It acts as an instructive resource that offers trustworthy clinical guidance. Developer: Wolters Kluwer Health and Lippincott Williams & Wilkins Compatibility: iOS Price: US $48.99
Calculate
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alculate is an innovative app that helps clinicians save time and enhance patient care by providing them with significant tools such as clinical calculators and decision support tools. The app also features pregnancy wheel/ due date calculator, gestational age calculator, WHO surgical safety checklist and DVT and pre-test probability. The app comprises of more than 150 clinical calculators and decision support tools, and offers thorough references with Pubmed integration. Developer: QxMD Compatibility: iOS, Blackberry, Android Price: Free
Obstetrics and Gynaecology Complete Revision Aid
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n essential app for obstetrics and gynecology or GUM examinations, Obstetrics and Gynaecology Aid is developed for medical students specializing in obstetrics, gynecology and genitourinary medicine. 13 core subjects in these areas are segmented into OSCE stations, MCQs, SBAs and EMQs. The app also provides a full break down and graphical feedback of results after completion of each session. This helps in tracking the development and also highlights the weaker areas that need additional revision. Developer: One 2 One Medicine Ltd Compatibility: iOS, Android Price: Rs.133.11/US $2.36
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Oxford Handbook of Obstetrics and Gynaecology
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xford Handbook of Obstetrics and Gynaecology app is a vital and concise resource to all aspects of obstetrics and gynecological medical care, diagnosis and management. An efficient source for specialist trainees, junior doctors and medical students, this app provides a wealth of practical recommendation and includes references to up-to-date evidence-based guidelines. The app is also packed with high-quality illustrations, including new full-color photographs. Developer: MedHand – Mobile Libraries Compatibility: iOS, Android Price: Free
Ultrasound Protocols and Image Reference Handbook
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reated by a sonographer for sonographers, Ultrasound Protocols and Image Reference Handbook includes 25 examinations and over 430 high quality images making it an firstrate resource for daily use. The app includes protocols of first and second trimester obstetrical examinations. Besides these functions, it also aids in normal measurements for each body area and also provides supervision on patient preparations as well. Developer: Natalie Cauffman Compatibility: iOS Price: US $5.99
AirStrip OB
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useful application for obstetricians, AirStrip OB helps them to securely log on to a hospital’s Labor and Delivery unit. They can see virtual real-time waveform data as well as other patient data from anywhere. It also enables the user to view patient census as well as other relevant patient information such as nursing notes, vital signs, physical exam, labor status and maternal/fetal waveform data. The user can also scroll through historical data and turn to landscape to evaluate even more of the fetal heart tracing. Developer: AirStrip Technologies, LLC Compatibility: iOS, Android Price: Free
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Mobile Apps
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Obstetrics and Gynaecology
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bstetrics and Gynaecology is a smart app that helps in reviewing the clinical evaluation and management of obstetrical and gynecological problems. The app includes operational dictations for cesarean section, vacuum delivery, tubal ligations, hysterectomy, laparoscopy, urethral suspension, and other common surgical procedures. Its efficiency proves that it is an inevitable resource for nurses, nursing students, residents, medical students, physicianâ&#x20AC;&#x2122;s assistants, and nurse practitioners. Developer: By Anna Chan Compatibility: iOS Price: Free
Obstetrics, Gynecology and Infertility, Handbook for Clinicians
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bstetrics, Gynecology and Infertility, Handbook for Clinicians is an application that will provide the medical professionals everything they need to know so as to provide a comprehensive healthcare to women. The app contains over 500 tables, flowcharts and figures related to obstetrics and gynecology. This will help the users recall the topics at ease when in need. Developer: USBMIS, Inc Compatibility: iOS, Android Price: US $29.99
Gynecology and Obstetrics: Johns Hopkins Manual
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he Gynecology and Obstetrics: Johns Hopkins Manual is an efficient app that will help students, residents, and clinicians find answers to all their questions in the fields of gynecology and obstetrics. This mobile resource provides information on basic and high-risk obstetrics, reproductive endocrinology and infertility, and a full range of gynecologic diseases and oncology. The app incorporates detailed figures for enhanced learning, tables and charts, latest information on hormone therapies. Developer: Unbound Medicine, Inc Compatibility: iOS, Android Price: US $63.99
Practice OSCEs in Obstetrics and Gynaecology
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n efficient practice and preparation tool for all medical students, Practice OSCEs in Obstetrics and Gynaecology includes 60 OSCE scenarios that mirrors real-world situations, sample marking schemes preparation tips, quick reference guides and self-directed learning. It covers a wide range of topics such as general obstetrics and gynecology, infertility, oncology, endocrinology, fetal medicine and ultrasound. Developer: Elsevier Inc Compatibility: iOS Price: EUR 33.99
Obstetrics: OB Wheel + Medical Reference Tool
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n OB reference application, Obstetrics: OB Wheel + Medical Reference Tool has a pregnancy wheel to calculate estimated due date, gestational age, dates of conception, end of the 1st trimester, and end of the 2nd trimester by last menstrual period or ultrasound. Once the gestational age is calculated, the app provides recommended screening tests for that particular gestational age. All the information catered by the app is taken from current recommendations by the ACOG, CDC, FDA, the AMA and USPSTF. Developer: Medical Doctor Apps Compatibility: iOS, Android Price: US $1.99
Rapid Obstetrics and Gynaecology, 2nd Edition
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apid Obstetrics and Gynaecology, 2nd Edition is a useful app for all those preparing for major exams in obstetrics and gynecology. It is also a great aid for those needing a quick reminder during a clinical attachment. The app provides a systematic approach to learning key topics in obstetrics and gynecology. It helps the user in enhancing clinical performance by providing quick access to relevant, valid material with minimal effort. Developer: MedHand â&#x20AC;&#x201C; Mobile Libraries Compatibility: iOS, Android Price: US $46.29
: Rini Baby Thottil COLOR DOPPLER | MAY, 2014
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Product Focus
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Seeing Beyond The below portfolio offers an array of ultra-premium imaging devices for obstetrics and gynecology, incorporated with innovative technologies and smarter workflow solutions. They deliver outstanding image quality with their cutting-edge technology and are equipped to meet diverse clinical needs
Mindray DC-8
Siemens ACUSON S1000 Mindrayâ&#x20AC;&#x2122;s top-of-the-range ultrasound system, DC-8 integrates quality and ergonomics, providing you with a unique scanning experience. Be it a fetal biometry analysis, an ovarian mass examination or showing parents the first image of their child, the DC-8 has it all. With a crystal clear image quality, comprehensive analysis package and a highly user-friendly interface, the DC-8 is your standalone solution for OB/ GYN imaging. It comes with 3T Transducer Technology to increase image bandwidth and transmission efficiency. Its Echo-enriched beam former permits the use of traditionally neglected echo signals of adjacent beams to form stronger imaging beam.
FujiFilm SonoSite Edge EDGE ultrasound systems from FUJIFILM SonoSite offers a new standard in pointof-care visualization image quality with its SonoHD2 Second Generation Imaging Technology. The machine comes with a series of image enhancement algorithms that reduce speckle noise and image artifacts. SonoADAPT Tissue Optimization capability of these ultrasound systems eliminate the complicated manipulation of multiple controls.
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The ACUSON S1000 ultrasound system encompasses state-of-the-art ultrasound technology, stellar imaging performance, and versatile applications at an exceptional cost of ownership. The machine is equipped with features like syngo Auto OB measurements utilize pattern recognition algorithms that reduces keystrokes in routine fetal exams by 75 percent. A detailed volume visualization is enabled by its advanced fourSight Technology, and eSieScan workflow protocols incorporated in it are completely customizable, taking the flexibility of workflow to a whole new level.
GE Voluson E8 Expert This premium ultrasound system made exclusively for womenâ&#x20AC;&#x2122;s healthcare delivers outstanding image quality, automation, transducer technology and image analysis. Its Speckle Reduction Imaging (SRI) suppresses speckle artifact while maintaining true tissue architecture. Its CrossXBeam Technology enhances tissue and border differentiation, and HD-Flow helps achieve a more sensitive vascular study and reduces overwriting. The machine also possesses Advanced Volume Contrast Imaging (VCI) with OmniView Technology for improved contrast.
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Product Focus
[ under the scanner ]
Samsung UGEO WS80A This is the first premium ultrasound for OB/GYN that feature innovations in display such as ‘Hello Mom, an Android smartphone application that wirelessly connects to the ultrasound device, allowing parents to download images and movies of the fetus. Parents can then easily share the images with family and friends and keep track of their babies’ growth using ‘Hello Mom’. The device is further encompassed with 5D technologies, MPI and ElastoScan, Hybrid Beamforming Engine and Samsung Dynamic MR evo that ultimately offers unparalleled image quality with seamless workflow solutions.
Toshiba Xario 200 Xario 200 meets the clinical demands with outstanding versatility, flexible workflow and consistent, high quality imaging performance at an affordable price. It has fully customizable console and mode-sensitive touch screen that suit any clinical needs and personal preferences. It is also heavily adaptable and versatile, with its premium quality screen, articulating arm and convenient monitor that can be easily moved into position. The system’s compact and mobile design enables you to create an ergonomic work environment in virtually any clinical setting. With Xario 200, clinicians can review, analyze report and archive their clinical data anytime with no loss of functionality.
COLOR DOPPLER | MAY, 2014
Philips HD9 Philips HD9 ultrasound system provides the outstanding image quality required in OB/GYN practices, as well as the versatility to meet the needs of all women’s health applications. Live iSlice, which creates slices of a volume rendering to zero in on the region of interest; Breast elastography, which offers a way to characterize tissue by differentiating areas of relative stiffness; Trimesteroptimized Spatio-Temporal Image; Correlation (STIC) that aids in evaluating fetal heart anatomy and function; and Tissue Specific Imaging (TSI) that optimizes the system for the specific transducer and exam type are the major features.
Hitachi Aloka ProSound F75 The ProSound F75 system has been designed with the new Hitachi Aloka “FIT” ethos (Facilitate Workflow; Investment Return; True Diagnostic) at its heart and each system can be tailored to the needs of any clinician. The ProSound F75 reduces burden on the examiners and patients, assures and maintains versatility at a high dimension, reduces patient dependency by increasing the level of diagnostic ability, and improves productivity of routine examinations by accuracy and efficiency. The ProSound F75 acknowledges the needs of performing examinations in a natural posture without stress or discomfort.
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COLOR DOPPLER | MAY, 2014
‘Making SOS a National Reality’ Providing emergency service in 16 states in the country, GVK EMRI is in a bid to expand its service for a greater good. In this chit-chat with Color Doppler, K Krishnam Raju, the Director in Charge of GVK EMRI, shares his vision on expanding emergency medicine
K
Purnima Sah l cd news Krishnam Raju, the Director in Charge, GVK EMRI, has a big dream: Building a strong emergency care service network across the country. And he has been pursuing the same since his entry into the segment in 2005 – a year when he decided to take up the challenge of providing 24X7 emergency healthcare services in every nook and corner of the country. This was the year when he joined GVK EMRI as a Director and continued to bring the best for the welfare of society. GVK EMRI (Emergency Management and Research Institute) is the pioneer in Emergency Management Services in India. At present GVK EMRI is the largest professional emergency service provider. GVK EMRI takes care of medical, police and fire emergencies through their 24X7 Emergency Service ‘108’. At present GVK EMRI has over 7016 ambulances including 996 drop back ambulances across Andhra Pradesh, Gujarat, Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, Madhya Pradesh, Himachal Pradesh, Chhattisgarh, Uttar Pradesh, Rajasthan, Kerala and union territories of Dadra and Nagar Haveli and Daman and Diu. COLOR DOPPLER | MAY, 2014
Before joining GVK EMRI, K Krishnam Raju, has played different roles during his professional life. Like many of his friends, he also took engineering but right after his college he started his phenomenal entrepreneurial journey by establishing ‘Suchitra Group of Industries’ in the year 1972. Excerpts from an interview: You took over the challenge to provide speedy emergency healthcare service in the year 2005 by joining GVK EMRI. How has pre-hospital care and emergency services evolved since then? GVK EMRI has the honour of leveraging technology and enabling pioneering, professional and integrated emergency response services in Public Private Partnership (PPP) framework in India. Our services are popular as ‘108’ ambulancebased pre-hospital services. GVK EMRI services are currently available to over 750 million people spread in 16 States and UTs with a fleet of over 7000 ambulances, responding to nearly 22000 emergencies every day, saving 625 lives every day. Since 2005, over 2.6 crore emergencies were responded and 900,000 lives were saved and nearly 250000 deliveries were assisted. This evolution is possible by the synergy of information technology, telecommunication technology, fleet technology
and medical technology. Key factors for evolution and becoming world’s largest emergency response service provider are: Partnerships with State Governments Collaborating with reputed national and international institutions Endeavoring towards executing excellence Constant efforts for innovative solutions and Guidance on mission of saving lives by GVK EMRI board members and in particular, our Chairman Dr. GVK Reddy’s involvement on a daily basis. Common Review Mission Report of National Rural Health Mission (6th CRM, 2012), Government of India documented that ‘one form of PPP that has unquestionably worked well across states, is the dial 108 emergency response services.’ How did the idea of forming GVK Emergency Management and Research Institute (EMRI) evolve? Most of the deaths in emergencies are occurring due to lack of pre-hospital care within the golden hour. After an emergency, next one hour is the most important for the victim. If you provide pre-hospital care within the golden hour, chain of survival can be strengthened, majority of the lives and limbs can be saved, many complications can be reduced and duration
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of hospital stay can also be minimized. That’s why we started with GVK EMRI 108 Services. Nearly two-thirds of the lives can be saved by having global standard care in emergencies. What was the feeling when GVK EMRI successfully met the criteria of being India’s significant corporate contributor for growth and development of the country? We feel very proud because we are successfully running emergency services in 16 states including two union territories with the help of Dr. GVK Reddy, Chairman, GVK Group of Industries. We also feel humbled by the recognition and strive to make our organization more responsible towards the society. 108 emergency services are still not available in parts of West Bengal, Odisha, Bihar and Jharkhand where the need of pre-hospital care is high. Do you plan to reach there as well? We have submitted the proposals to the aforementioned State Governments and will try to implement this 108 service across the country and also in abroad with focus on the developing countries. Awareness on Emergency Medicine and pre-hospital training is still in its infancy in most parts of our country. Do you think five years from now, every nook and corner of this country will get emergency care facility? GVK EMRI believes that capacity building at community, ambulance and hospitals (connecting the dots) to save lives. We have a specialized department of Emergency Medicine and Learning Centre (EMLC) and through this department we have trained 1,56,844 people including doctors, nurses, paramedics and first responders. Since 2007, GVK EMRI is collaborating with Stanford School of Medicine, USA to facilitate international standard emergency care education and services. Our collaboration with Stanford focuses
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After an emergency, next one hour is the most important for the victim. If you provide pre-hospital care within the golden hour, chain of survival can be strengthened, majority of the lives and limbs can be saved, many complications can be reduced and duration of hospital stay can also be minimized on Emergency Medical Technician (Basic and Advanced) education, EMS protocols, hospital physicians training and on-line medical research. GVK EMRI is also recognized as an international training centre by American Heart Association (AHA), American College of Emergency Physicians (ACEP) and American Academy of Family Physicians (AAFP) to conduct global certification of life support programs in cardiac, trauma and obstetric emergencies respectively. Our First Responder Training Programs meet the first aid needs of all socially conscious citizens of India. GVK EMRI has recently started establishing Emergency Care Centres (ECCs) to model hospital-based immediate emergency care. ECC, if scaled up to all the hospitals in country can provide evidencebased care continuum to every emergency patient at an affordable cost. With such a pro-active approach, complementing the government and private healthcare initiatives government and private healthcare system, GVK EMRI is confident to realize ubiquitous emergency care in India. Year 2013 brought SKOCH Platinum
Award for GVK EMRI in corporate excellence and outstanding contribution in nation building. Please share with us the secrets of GVK EMRI’s success. Scientific selection of the workers, setting international standards of care, best cost control mechanism and constant monitoring is our key to success, because of these efforts we have provided excellent service with minimum cost. Under your guidance, GVK EMRI has achieved enormous success. How did you make it happen? For each and every department, we have prepared good process charts and implemented across the states. That is our success mantra. How do you manage to stay so active, despite being one of the legends in the sector? What drives you to be so passionate, lively and dedicated towards your work all the time? My commitment and absolute dedication to the business of saving lives, I choose to take up, is what drives me incessantly. Also Chairman Dr. GVK Reddy is a towering inspiration who is going strong at 77. How do you see the youth of today when it comes to corporate social responsibility? Do you think this fast, busy, tech-savvy generation is very active when it comes to social responsibilities? In my opinion, all youngsters should spend some money and time to take up CSR activities liberally. There is utmost joy in giving back. GVK EMRI started 100 (AP Police), 104 (Health Helpline) and 108 (Emergency) services. What is the next project of GVK EMRI? Next gift most probably will be air ambulances from GVK EMRI. We also started 102 drop back facility for mother and child in five states and mobile medical units to the rural areas. What are the upcoming projects of GVK
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We have submitted the proposals to the West Bengal, Odisha, Bihar and Jharkhand Governments and will try to implement this 108 service across the country and also abroad with focus on the developing countries EMRI? In addition to the air ambulances, GVK EMRI will be taking up projects mentioned below: Support state and central departments of transport, disaster management, police, fire, rural development, women and child development in right to safety in addition to the health department Establishing Emergency Stabilization
Centres in primary and secondary level hospitals Provision of emergency care services in mass gathering events in all states (example Sabarimala in Kerala; Maha Kumbh Mela in UP etc) Linking pre-hospital and hospital systems by state of art technology and telemedicine practices Conducting training for first aiders in com-
munity and also training doctors and nurses Meeting last mile challenges using village volunteers, point-of care services, palanquins, mobile medical units, etc Enabling services of hospital-based EMTs Conducting EMS research on cardiac, trauma and other priority emergencies Educate people on emergency prevention and establish medical schools with Emergency Medicine as the subject.
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COLOR DOPPLER | MAY, 2014
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[ eventful ]
Conference with a Difference
Ultrafest 2014, the three-day conference organized by the Maharashtra State Branch of the Indian Radiological and Imaging Association (MSBIRIA) from April 18 to 20, 2014, Mumbai, discussed Emergency, Infertility, Gynecological and Fetal Ultrasound in detail
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Purnima Sah l cd news ltrafest 2014 has become a perfect platfrom for knowledge sharing with more than 1100 delegates attending the event held between April 18 and 20. Ultrafest 2014 was organized under the chairmanship of Dr. Jignesh Thakker. The conference brought a good number of acclaimed national speakers who shared up to date knowledge on varied topics which are required in daily practise such as Emergency Ultrasound, Infertility, Gyne-
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cological and of course, Fetal Ultrasound. Ultrafest 2014 saw four keynote speakers – Dr. Thomas Winter, Dr. Peter Doubilet, Dr. Carol Benson and Dr. Nawaz Ali Khan who shared their knowledge on the above mentioned topics. Dr. Shailendra Singh, the Organizing Secretary of Ultrafest 2014 was elated to see the crowd. He said, “The sixth edition of Ultrafest was great. On the very first day, we received 1100 registrations. The conference hall was running full with a good number of participants. Delegates were very happy with the scientific program, workshops and topics discussed in the conference. We also received a very good feedback regarding food, venue and
everything else.” With such a high registration number, Ultrafest 2014 has increased expectations for Ultrafest 2015 in terms of delegate turnout. Dr. Abhijit Ghosh, Senior Consultant Sonologist, Udayan, Kolkata spoke to Color Doppler about the new developments in ultrasonography. “There are remarkable developments happening in the world of ultrasonography, such as CES, Elastography and the latest is the Endo Ultrasonography,” said Dr. Ghosh. He is of the opinion that such conferences should take place even in smaller cities. “Initiative needs to be taken by the main parent body organizations like IFUMB or
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[ eventful ]
Team Ultrafest 2014
IRIA which are the important associations in the field of ultrasound and radiology. Every year, we get something new from Ultrafest. The conference gives us new topics to discuss. I am glad to see that the participants have increased this year in comparision to 2013,” he added. Events like Ultrafest help at many levels. Here delegates get a chance to learn from professors whom they wish they had in their classrooms. Delegates from all over the country, and some even from abroad, come together to share their experiences and knowledge regarding the latest technology and its clinical applications. Dr. Balkrishna Kitture presented a very interesting presentation called ‘Chhupa Rustom’. He spoke to Color Doppler about the story behind the ‘Chhupa Rustom’ game. “We have one Whatsapp group where all of us share interesting cases. I shared many interesting cases in the group and I that is how I came in touch with the main body of this conference. They went through my shared cases and selected me for the session ‘Chhupa Rustom’. So it is all the benefit of Whatsapp,” said Dr. Kitture. He added, “Technology is a really big player. We exchange a lot of cases, share COLOR DOPPLER | MAY, 2014
and discuss many topics on the go through social networking websites and smarphone applications. I think ‘Whatsapp’ has become an idol modality of social networking site. Everyone has appreciated and encouraged me for my effort. For the first time, I have the opportunity to be a part of such a big social gathering. Technology is going to play a vital role in the coming days of ultrasound modality because of the 3D and 4D facilities which will help us to exchange and share our cases much faster and easier than before.” Vinod Bhateja, Director, Nature’s Global Service said, “It was great to see the delegates participating in the conference and trade show actively. Conferences like this give hands on experience which generally we can’t gather from books and in the four walls of classroom. I think we should try to organize this kind of events in every six months.” Rajeev Joshi, General Marketing Manager-Ultrasound Imaging, Konica Minolta Healthcare India Pvt Ltd said, “The event was very well-organised and it was good to see something happening so actively about ultrasound. We will be participating in many more conferences like this in future.” Gaurav Mangol, the Deputy Application
Manager, Ultrasound Imaging Systems, Mindray talked about how such conferences help the companies to grow their business. “Mindray received a good response from delegates at Ultrafest 2014. Lot of people have now accepted that Mindray is a good company and has highquality equipment.” “Now, we are getting many installation orders across the country, so definitely doctors are getting used to our equipment. They appreciate the image quality because we have superior technology and are comfortable to work with our machines. It is definitely a good platform to obtain higher visibility for our brand,” he said. Apart from the normal scientific programs and sessions, there was special tribute given to late Dr. Kirit R Shah. He was a very well known ultrasonologist who passed away recently at an early age. Radiology in India is yet to make a good stand in the market and conferences like Ultrafest are highly important for developing countries like India. These conferences invite delegates from every corner of the country thereby allowing one and all to experience a knowledge sharing platform. The best part about Ultrafest 2014 was the high participation of young doctors and medical students.
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Ultrafest Memories
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COLOR DOPPLER | MAY, 2014
[ event preview ]
INSUOG 2014 Calling Color Doppler, along with INSUOG team welcomes the delegates to INSUOG 2014 to participate in the industryâ&#x20AC;&#x2122;s premier OB/GYN knowledge spreading conference
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he time has arrived to witness an avalanche in the countryâ&#x20AC;&#x2122;s financial powerhouse and vogue centre of fashion and film! INSUOG 2014 is set to raise its curtains from May 2-4, 2014 at Hotel Taj Mahal Palace, Mumbai, clubbing the treasure-trove of invaluable memorabilia of every pillar at Hotel Taj Mahal Palace with the sophistications of the medical speciality obstetrics and gynecology (OB/GYN). This aura of entertainment with information makes it one of the must-attending medical events of 2014. In April 2014, Color Doppler brought to you a detailed event preview of the event covering the content of INSUOG 2014, faculty members and overall schedule. Here, Color Doppler gives the overview of the conference below:
Program At a Glance Time
Friday, May 2, 2014
Saturday, May 3, 2014
Sunday, May 4, 2014
8.00-8.30
Registration
8.30-10.30
Registration/Welcome
Registration
Hall A
Hall B
Hall A
Hall B
Hall A
Hall B
Fetal Heart
US in Gynec
Fetal Face/ CNS
Gyenacological USG
Heart 2
Fetal Anomalies
Infertility
Aneuploidy
Fetal Therapy
Pelvic Mass lesion
CD and FGR
PCPNDT
10.30-11.00 11.00-1.00
COFFEE BREAK
Fetal CNS
US in infertility
1.00-2.00 2.00-4.00
LUNCH & TRADE
Fetal Anomaly
4.00-4.30 4.30-6.30
CNS
Misc
Heart COFFEE BREAK
CD and FGR
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[ eventful ]
Heightening the Stature of Ultrasound Education With an intention to open doors of training in advanced ultrasound to the physicians in developing nations, KSUM welcomes Indian ultrasound practioners to its 45th Annual Congress (KSUM Open 2014) which is to be held from May 23-24, 2014 at Seoul, Korea in the ultrasound industry, KSUM invests in education and training programs such as e-learning. The International Fellowship Program providing ultrasound training to doctors from Asia and around the world is another highlight of the organization. The doors of training are open even wider for other developing countries so that the global standard of ultrasound usage across the world will be equal, benefitting the public as a whole.
Ria Lakshman V l cd news
T
here exists an array of ultrasound associations in the country dedicated to the mission of spreading awareness among the ultrasound community. Most of these organizations have turned out to be inevitable. They became the common platform to share the updates of the ultrasound segment with numerous international faculty members delivering lectures to the delegates. They also act as a perfect bridge for the industries to collaborate with the research requirements. Here arrives the time that the international associations welcome the Indian physicians to their podium, offering advanced training that could elevate the standards of ultrasound usage in the industry. Such a mission ultimately globalize the standard of usage, providing equal care to the patients from across the world. The Korean Society of Ultrasound in Medicine is one such organization dedicated to solidify the international standard of ultrasound usage. Fondly addressed as KSUM, the organization established itself as a leading organization in the field of ultrasound since its inception in 1980. Through hosting symposia â&#x20AC;&#x2DC;KSUM Openâ&#x20AC;&#x2122;, the organization tries to reach every ultrasound practioner living in the nook and cranny of the globe. KSUM Open will commence from May 23-24, 2014 at Coex in Seoul, Korea. This annual congress has planned exciting scientific programs including Interactive Case Review, Hands on Session, and Case of the Day (Quiz), which will bring together eminent speakers and delegates from all over the world. Furthermore, a practice workshop program will be organized to give helpful information to
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Joon Koo Han students and young doctors who will lead the future of Ultrasound Medicine. To encourage scientific activities, the organizing committee is also preparing various awards and prizes. The daily scientific program covers various topics relevant for the day-to-day practice of the ultrasound clinicians, from the history of ultrasound to advanced diagnostic techniques. A few topics that will be covered are Ultrasound-guided (US-guided) Reduction of Intussusception: Pearls and Pitfalls; TRUS-guided Prostate Biopsy; US-guided Kidney Biopsy; Rectum Evaluation for Tumorous & Non-tumorous Conditions; Transrectal US: Pros and Cons; Rectal MRI: Pros and Cons; Abdominal US at Emergency Department; Abdominal US at Operation Room; Artifacts and Pitfall Errors in Ultrasound Color Doppler Imaging; Artifacts and Pitfall Errors in Ultrasound Spectral Doppler Imaging, and Molecular US: USguided Targeted Drug or Gene Therapy. Through organizing KSUM Open, KSUM also intends to proactively respond to the challenges that the industry faces. With an objective to enrich the quality of education
To give more insight on KSUM and KSUM Open 2014, Joon Koo Han, the Chair of KSUM organizing committee and Hyo-Keun Lim, the President of KSUM share a short conversation with Color Doppler. Excerpts of Interview with Joon Koo Han, the Chair of KSUM Organizing Committee: What are the strategies you intend to adopt to solidify the international nature of KSUM? In order to establish itself firmly as an international society in ultrasound, KSUM strives to provide high-performance, cost-efficient programs in Asia, which are at par with the programs offered by ultrasound societies in Europe and North America. At a relatively low cost, participants can gain the most up-to-date medical knowledge and have exchanges with ultrasound specialists from Asian countries. With the growing technological advancements, there is a need to keep the ultrasound industry updated in its quality. What are the steps taken by KSUM to spread education among the global ultrasound practitioners? KSUM has continued to pursue various educational programs in economically developing Asian countries in partner-
COLOR DOPPLER | MAY, 2014
[ eventful ] ship with the WHO, AFSUMB, and WFUMB. For example, KSUM has been dispatching an excellent team of instructors to the WFUMB Educational Center of Excellence in Dhaka, Bangladesh. It also successfully operated a training program for clinicians from Vietnam, Laos, and Cambodia in alliance with the WHO in Ho Chi Minh City, Vietnam. These educational programs have received positive feedback from the countries concerned, and KSUM has been working on expanding its programs around the world. What are the challenges faced by the ultrasound industry that hinder its growth? The challenges that the ultrasound industry faces vary from country to country, so it is a bit tricky to talk about specific cases that concern Korea. How do you compare the Indian and Korean ultrasound industry? India is well-known for its strongly-motivated, high-caliber human resource that possesses infinite potential. I find that the Indian and Korean ultrasound industries share this point in common. What are the strategies adopted by KSUM to establish a cordial relationship between the medical imaging companies and ultrasound practitioners? Do you think there exists a gap between both? The feedback of imaging practitioners and joint researches are essential for medical imaging companies to secure and maintain a steady development. In order to clinically apply newly developed technologies such as new signal processing and new transducers, medical companies need to find a common ground between the perspectives of the engineers and the clinicians. In this regard, I find that most imaging companies have done a great job up to now of controlling the gap with the clinical field. The members of KSUM, either on an individual level or through the society, continue to be involved actively in researches conducted across the industry. What is your take on the research activities in the ultrasound industry? Are there any areas that are less focused? Ultrasound has now entered a stable and mature stage in terms of technology; consequently, the pace of the development of
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Hyo-Keun Lim new fields has slowed down. Fortunately, new application areas such as elastography, molecular imaging, and drug delivery have emerged recently for which research is becoming increasingly active. Excerpts of Interview with Hyo-Keun Lim, the President of KSUM: Perhaps for the Indian ultrasound industry, Korean Society of Ultrasound Medicine (KSUM) is a new name. Can you share with our readers what KSUM is and what its services and vision are? Since its founding in May 1980, KSUM has established itself as the leading organization in the field of ultrasound in Korea. The objectives of KSUM are to achieve academic progress in using medical ultrasound and to facilitate communication among its members. In 2010, marking its 30th anniversary, it started hosting symposia under the name of “KSUM Open,” and since 2011, it has been organizing international symposia with English as the official language. In 2012, it successfully hosted a joint symposium with the Asian Conference on Ultrasound Contrast Imaging and the Korean Society of Thyroid Radiology, further heightening the stature of its international events. KSUM held the 3rd AFSUMB meeting in Seoul, Korea in August 1992 with 1600 participants from 15 countries. This 3rd meeting in Seoul was appreciated as a turning point for the AFSUMB that validated its status as an international academic society meeting. The AFSUMB was officially affiliated to the World Federation for Ultrasound in Medicine and Biology (WFUMB) on January 1, 1992 as the largest federation in that body. KSUM also held the WFUMB 2006 in Seoul, Korea from May 28 to June 1, 2006.
Now, KSUM has over 2,800 members and is pursuing further growth and development by enhancing its quality. It will focus on continuously upgrading its website and investing in its education and training programs such as e-learning to increase membership and enable more active participation by specialists and foreigners. The International Fellowship Program that provides ultrasound training to doctors from Asia and around the world will also be expanded. The doors for training will be open even wider for other developing countries so that we may keep moving forward together. Have you conducted any events in India? No, KSUM has not conducted any event in India. However, many KSUM members attended AFSUMB 2010 held in New Delhi, India, and the Korean company Samsung Medison was the main sponsor of AFSUMB 2010. Currently, the 45th Annual Congress of KSUM is set to happen from May 23-24 in Korea. What is the main objective of this event? The main objective of KSUM Open 2014 is to be an active international congress serving to improve ultrasound education, support research, promote the importance of ultrasound, and build a good relationship with radiologists and ultrasound societies worldwide, especially in Asian countries. KSUM Open 2014 will propose an exciting two-day Scientific Program including Interactive Case Review, Hands on Session, Case of the Day (Quiz), and a Practice Workshop Program for young doctors who will lead the future of ultrasound medicine. To encourage scientific activities, the organizing committee is also preparing various awards and prizes. What are the highlights of KSUM Open 2014? Highlighted programs of KSUM Open 2014 are “History of Ultrasound,’ ‘Handson Session (Fusion Imaging),’ ‘Meet the Professor Sessions,’ and ‘Interactive Case Review.’ During the session of ‘History of Ultrasound,’ the histories of WFUMB, AFSUMB, AIUM, KSUM, and the ultrasound industry in Korea will be presented. ‘Hands-on Session’ will provide concrete hands-on experience as well.
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[ eventful ]
Excellence in Focus NCoBC brings together medical and industry professionals from across the globe to interact, learn and share ideas, methodologies and treatment options which in turn will improve quality of patient care
A Ria Lakshman V l cd news
ccording to data, breast cancer is the most common cancer in women worldwide. It is also the principle cause of death from cancer among the women globally. To be more precise, one in eight women will get breast cancer, if the current pace of increase in the number of breast cancer cases sustains. In the midst of such an era, there needs dedicated efforts to achieve prevention and cure for breast cancer by providing awareness, critical funding and research. One such dedicated missionary is National Consortium of Breast Centres (NCoBC) which carries this mission through the sleepless efforts of its members who comprise mainly of breast health professionals. It is a non-profit membership organization and conducts evidence-based education, advocacy and quality validation programs in order to spread the message of good breast health. Recently, NCoBC had its 24th Annual Interdisciplinary Breast Center Conference (NCoBC 2014) at Caesars Palace, Las Vegas from March 15-19, 2014. The event witnessed the participation of over 800 physicians, nurses, radiologists, administrators and other breast health
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professionals. The conference offered up to 44 continuing education credits for attendees cost effectively, making it one of the best-value conference of its type. The conference provided continuing education to oncologists, surgeons, nurses, clinicians and administrators in order to help in advancing the delivery of treatment options and quality of care. Through its mode of presentation, NCoBC 2014 became a perfect platform to assemble, exchange information, network and learn from each other. The primary objective of the conference was to focus on the development; implementation and expansion of breast center programs, to allow these experts to become informed of the most up-to-date breast care techniques and options available to their patients. Unlike the earlier conferences, the event was also merger of private sector businesses and corporations. The center has the private sector and businesses as its memberships, enabling the health professionals to know more about the advancements in the equipment, technology, drugs and services available to them to improve patient quality care. Continuing Education Opportunities NCoBC 2014 has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education. It was fulfilled through a joint sponsorship of the University of Tennessee College of Medicine, an educational institution accredited by the ACCME to provide continuing medical education for physicians, and the National Consortium of Breast Centers, an international
member-based organization of medical and industry professionals. To take it from the words of a healthcare professional who attended the conference, â&#x20AC;&#x153;Each day offered ample time to network with peers, catch up with old friends and meet new people from around the world. Gained new perspectives and insights, learned from others, shared experiences and built reputation in the industry. Attended breakfast and lunch sessions, mingled and relaxed at daily receptions and took advantage of staying in the conference hotel with thousands of industry professionals.â&#x20AC;? Summing up below are some of the best conferences presented at NCoBC 2014 (Courtesy: newsletters and flyers of the conference): New Lease on Life: How to Overcome Breast Cancer and Get the Best Out of Life Marissa C Weiss, MD A breast cancer wake-up call can be a major motivational opportunity for a patient to lead a healthier and happier life moving forward. Identifying the life goals that ultimately bring patients meaning and happiness can help these women see past the hardships of testing and treatment, adhere to their medical follow-up, and find new and exciting ways to enjoy life. Current Challenges in International Breast Care Delivery John R Keyserlingk, MD, MSc, FRCS, FACS, chair, NCBC International Liason Committee A description on tried and potential solutions to better face a looming crisis as the number of cancer cases rapidly, while the vast majority of deaths will be in low
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[ eventful ] and middle income countries, mostly due delayed detection and treatment. Treatment of Hereditary Breast Cancer Steven Narod, MD, FRCPC Women with BRCA1 mutations and breast cancer face a number of treatment options. It is becoming increasingly clear the treatment of breast cancer in mutation carriers can be different from that of non-carriers. The recent findings were reviewed. Prevention of Breast Cancer Rena Callahan, MD New data regarding strategies to help prevent breast cancer were presented. Compassionate Care – A Survivor’s Perspective Becky M Olson, BA This session focused on the overall “survivorship” of a cancer patient. The session stressed on the significance of nursing in care team and catered more towards enhancing nursing skills. Tech’s Role in Risk Assessment Christine B Weldon, MBA This session reviewed the current guidelines for hereditary breast and ovarian cancer (HBOC) screening based on the American College of Surgeons Commission on Cancer Standard and NCCN guidelines for Genetic/Familial high risk assessment: Breast and Ovarian Oncology Triad of Care John L Bell, MD, FACS; Tina Rizack, MD, MPH; Reshma Jagsi, MD The session focused on updated and historic information on the oncology trio of treatment: surgical, medical, and radiation oncology. Managing Challenging Physicians Jay R Parikh, MD, FACPE, FACR Physicians are highly educated and trained health professionals who cherish autonomy and are capable of making independent decisions. However, the physician confidence and ego sometimes can pose an impediment for medical leaders in the breast centre, requiring active physician leadership management through performance feedback and communication of expectations. Breast Centre Players and Communication in Mammography Leadership COLOR DOPPLER | MAY, 2014
Amy Chatten, MPH This session offered suggestions about how to deal with communication challenges in a breast imaging department. Communication among team members in any environment is essential in establishing standards of excellence. Attendees gained practical, applicable information on how the ‘players’, or key personnel can work together effectively to create an efficient system for improved employee relations and the highest quality of patient care. The Bread and Butter: Diagnostic Mammography Yuri R Parisky, MD The diagnostic work-up of screen detected abnormalities remains the bread and butter of most mammography practices. This presentation, using illustrative cases, demonstrated the when, how and why of the basic diagnostic work-up of calcifications, masses and densities identified on screening mammography. Digital Tomosynthesis – What is the Data Really Showing? Gary m Levine, MD Digital tomosynthesis has been investigated for nearly a decade. In this presentation, the published data regarding clinical and operational outcomes will be presented in a way to help breast centres grappling with the acquisition of this technology. Genetic Risk Assessment at Breast Centres, What Works? Christine B Weldon, MBA This session reviewed the guidelines for Hereditary Breast and Ovarian Cancer (HBOC) screening and NCCN guidelines for genetic/familial high risk assessment. A brief review of genetic risk markers for breast cancer, beyond BRCA1/BRCA2 too were presented. Case studies of effective HBOC screening practices and case studies with opportunities for improvement were compared and discussed. Case in Point: Oncoplastic Cases that ‘Tell a Story’ Gail Lebovic, MA, MD, FACS In this session attendees received an opportunity to review specific cases of women with breast cancer diagnosis with the presenter and be able to learn through
didactic presentation and visuals why specific surgery was chosen in each case. Contrast Enhanced Spectral Mammography (CESM) Belinda Zaparinuk, RT (M), ARRT, CRT, CBEC Digital Mammography performed with an injection of contrast testing provides information within seven minutes. The benefits of this and how to incorporate into the patient flow. Intraoperative Radiation Therapy (IORT) for Early-stage Breast Cancer: Update and Challenges Julia White, MD The recently developed technique of intraoperative radiation therapy (IORT) delivered at the time of BCS has shown promising results as a form of partialbreast irradiation. Although early data is encouraging, controversies remain as to how to offer this innovative technology to patients given immaturity of IORT data. The challenges of doing less rather than more and how to engage patients in this shared decision.
Exhibitors at NCoBC 2014 FUJIFILM Medical Systems USA, Inc Driven by an unrivalled commitment to women’s health care, Fujifilm addressed today’s challenges with innovations that expand opportunities for breast imaging GE Healthcare Their broad expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery and biopharmaceutical manufacturing technologies were exhibited at the conference Hitachi Aloka Medical, Ltd. Hitachi Aloka Medical is known for unparalleled image quality, superior system reliability and intuitive use of innovative technologies Hologic Hologic is the first company to harness the power and promise of breast tomosynthesis to find invasive cancers earlier or dismiss false positives Siemens Siemens offered its customers products and solutions for the entire range of breast care from a single source – including prevention, early detection, diagnosis and aftercare.
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[ upcoming issue ]
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Role of IT in Medical Imaging
he technology channel of medical imaging speaks the language of PACS, RIS, DICOM, and other healthcare IT elements without which the contemporary clinical practice is impossible. The technology helps to unleash the power of clinical images enabling better informed decisions. In the June issue of magazine, Color Doppler evaluates this growing influence of technology in medical imaging sector, especially into the recent innovations incorporated in the segment. Best imaging IT solutions that has redefined the sector in a way that eased the jobs of clinicians, besides providing a high quality diagnostic results will be featured in the issue. Articles on green imaging techniques and safeguarding your medical imaging equipment during the monsoon are the other highlights of the issue. Regular columns including the event coverage of INSUOG, KSUM Open 2014 et cetera will also be featured.
June issue of Color Doppler will be focussed on the surging role of Information Technology in medical imaging sector The Future and Growth of Imaging IT Best imaging IT solutions 10 Imaging IT solutions that will have a huge impact on future Feature: Green imaging techniques Monsoon Special: How to safeguard your imaging equipment in the rainy season
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