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MedImaging
DAILY RADIOLOGY NEWS

Vol.22 No.6 11-12 /2012
ISSN 1068-1779

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IN THIS ISSUE
Clinical News . . . . . . . 2-33 PACS/IT Update . . . . 34-39 Product News . . . . . . 20-36 Technical Literature . . . . 28 Industry News . . . . . . . . 40 International Calendar . 42

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Novel Imaging Technology Improves Image Quality, Lessens Radiation
article physicists have created a novel imaging technology that includes combining the PET and MRI technologies in a way that involves much less radiation than current technology. Many cancer patients must be examined multiple times to check whether treatment is effective, resulting in very high total radiation exposure. PET (positron emission tomography) scans are harder to interpret if medical staff cannot situate the location of cancer cells in relation to the skeleton and soft tissue. This is done by comparing PET images with an anatomical picture such as CT or MRI scans. Currently, due to the high expense of MRI, most hospitals combine PET and CT, but this combination has a significant weakness. The team of physicists, at the University of Oslo (UiO; Oslo, Norway; www.uio.no), developed a high resolution, high sensitivity technolo-

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gy based on an idea connected to the experiment at CERN (the European Organization for Nuclear Research) in which enormous detectors are used

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in the largest physics experiment being performed to trace the smallest particles. “We have managed to double the sensitivity. In practice, we can take the pictures twice as fast, or only use half of the radioactive dose in order to get the same image quality as previously,” said Erlend Bolle, PhD and particle physics researcher at UiO. Also, Dr. Bolle and his three colleagues have constructed the PET machine to be so small that it can be placed inside an MRI machine. Both images can thereby be taken simultaneously, further reducing total radiation exposure for patients and providing higher accuracy in that medical personnel do not have to correct for errors that occur when the two images are taken separately and later combined. Presently the technology is in a format specially optimized for use on experimental animals for research. However, Dr. Bolle emphasizes that “it can easily be rebuilt for hospital use.” One of the great technical challenges that were overcome is that in order to trace the radioactive source, a PET scanner must find which parallel photons are linked. Current detectors have no depth information and therefore cannot reconstruct the positions of the many photons that release only part of their energy on first impact. In the new technology, identifying the locations of all photons is enabled by measuring the positions in three dimensions in a five-layer detector. The new detectors are made from entirely new crystals and light guides such that in each of the five layers of the detectors, crystal pins are placed on top of a transverse layer of light guide fibers. “This is a completely new way of measuring gamma particles,” notes Dr. Bolle. Another important technical improvement incorporated into the new PET scanner enables good image quality to be achieved even if the test animal is lying right next to the detectors. Among advantages are parts of the new PET scanner that are put together like lego bricks; the system digitalizes the data at an earlier stage than the current PET solutions; the data can be sent to any number of computers; and image processing takes place in parallel with the examination.
Image: Particle physicists Erlend Bolle, David Volgyes. Michael Rissi, and Kim-Eigard Hines developers of the new technology that enables multiple improvements, including 50% less radiation from a PET scanner (Photo courtesy of Yngve Vogt / University of Oslo).

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Portable Ultrasound Offers 13 Multifrequency Transducers, Image Optimization Technologies
new compact ultrasound system provides high performance and reliability in the compact portable ultrasound field. The Acuson P300 ultrasound system is a compact, portable device for a wide variety of clinical settings. The new system integrates high-performance hardware and software and offers 13 multifrequency transducers for high clinical versatility. The system also features advanced image optimization technologies to support both routine and specialty application needs. The Acuson P300 system is characterized by its comprehensive capabilities, compact design, and is ready for shipment The portable Acuson P300 ultrasound system is designed to meet the diverse imaging needs for a wide range of patients, body types, and clinical disciplines – from radiology, general imaging, cardiovascular imaging, obstetrics and gynecology (ob/gyn), to specialty imaging including muscoloskeletal, breast, and small parts. It encompasses cuttingedge ultrasound technology and imaging performance in one portable unit, thereby enabling comprehensive patient care everywhere and anytime. “We have a local presence in over 190 countries across the world. We want to ensure that portable ultrasound systems from Siemens are available in all the world’s regions,” said Dr. Jeffrey Bundy, CEO for ultrasound at Siemens Healthcare (Erlangen, Germany; www.medical. siemens.com). “The Acuson P300 is ideal when a physician needs to obtain a fast diagnosis under difficult conditions – for instance, where space is

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limited or a mobile solution is needed. The excellent image quality and broad spectrum of applications of our new portable unit is designed to meet the expectations of today’s healthcare environments in mobile ultrasound systems.”
Image: The Acuson P300 ultrasound system (Photo courtesy of Siemens Healthcare).

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MRI-Guided Radiotherapy System Under Evaluation for Cancer Treatment
ew technology is the first wide-ranging imageguided radiation therapy system, providing a patented combination of simultaneous radiotherapy delivery and continuous magnetic resonance imaging (MRI) for the treatment of cancer. Investigators from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine (St. Louis, MO, USA; www. siteman.wustl.edu), have begun studying the imaging capabilities of an innovative radiation therapy system from ViewRay, Inc. (Cleveland, OH, USA; www.viewray.com). The Siteman Cancer Center is a leader in the early adoption and use of sophisticated treatments for cancer patients. The Siteman Cancer Center’s clinical research started in January 2012, when imaging and simulated treatments were completed on the ViewRay system with a group of volunteer patients. The purpose of the study was to evaluate the quality of images captured by ViewRay’s MRI technology. The internal study involved 27 patients with various types of cancer, including lung, head and neck, breast, and prostate cancer. Most patients were scanned twice. “It is important to evaluate any new technology early to assess potential clinical impacts,” said Parag J. Parikh, MD, assistant professor of radiation oncology at the Siteman Cancer Center and lead investi-

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gator for the study. “We are comparing the new images with available radiation oncology imaging techniques and will report the results at upcoming scientific meetings.” High-quality soft-tissue imaging is a fundamental element of the ViewRay system: MR images are used to plan treatments, position patients for treatment, and track each patient’s position during treatment. “When physicians can clearly see the target, we are better able to adapt the treatment to changes in the patient’s anatomy,” said ViewRay chief medical officer Prabhakar Tripuraneni, MD, FACR, FASTRO. “By verifying the high quality of the ViewRay system’s images, the Siteman study establishes the potential value of MRI-guided radiation therapy.” ViewRay’s integrated imaging and radiotherapy delivery system received marketing clearance from the US Food and Drug Administration (FDA) in May 2012. ViewRay is a medical device company developing advanced radiation therapy technology for the treatment of cancer. The ViewRay system provides continuous soft-tissue imaging during treatment, using MRI-guided radiotherapy, so that clinicians are able to see where the actual radiation dose is being delivered and modify to changes in the patient’s anatomy.

SUBSCRIPTION INFORMATION
Medical Imaging lnternational is published six times a year and is circuIated worldwide (outside the USA and Canada) without charge, and by written request, to radiologists, medical specialists involved in imaging, and other qualified professionals allied to the field.
To all others: Paid Subscription is available for an annual subscription charge of US$ 100. Single copy price is US$ 20. Mail your paid subscription order accompanied with payment to Globetech Media, P.O.Box 800806, Miami, FL 33280, USA. For change of address or questions on your subscription, write to: Medical Imaging lnternational, Circulation Services, at above address; or visit www.LinkXpress.com

ISSN 1068-1779
Vol.22 No.6. Published, under license, by Globetech Media, LLC. Copyright © 2012. All rights reserved. Reproduction in any form is forbidden without express permission.
Teknopress Yayıncılık ve Ticaret Ltd. Sti. adına ¸ ˙mtiyaz Sahibi: M. Geren • Yazı is I ¸leri Müdürü: Ersin Köklü Müs ir Dervis ˙brahim Sok. 5/4, Esentepe, 34394 Sis li, ˙stanbul, Türkiye ¸ ¸ I ¸ ¸ I Faks: (212) 216-6997 • P. K. 1, AVPIM, 34001 ˙stanbul I Baskı: Promat Web Ofset Tesisi • Sanayi Mahallesi 1673. Sokak No: 34 • 34510 Esenyurt, B. Çekmece • ˙stanbul, Türkiye I Yerel süreli yayındır, iki ayda bir yayınlanır, ücretsiz dag ˘ıtılır.

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Spinal Cord Stimulator Receives CE Marking for MRI Head Scanning

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spinal cord stimulator (SCS) system has received the European CE marking for patients who require magnetic resonance imaging (MRI) head-only scans. The Precision Plus SCS system, developed by Boston Scientific Corp. (Natick, MA, USA; www.bostonscientific.com) is the world’s first rechargeable SCS device. This approval provides physicians with an additional diagnostic alternative for patients with chronic intractable pain. “As spinal cord stimulation becomes more widespread for control of severe disabling refractory pain, it is great to know that – should the need arise – head-only MRI scans can be safely performed in patients with the Precision Plus SCS system,” said Dr. Simon Thomson FFPMRCA, consultant in pain medicine and neuromodulation at Basildon and Thurrock University Hospitals in the United Kingdom. Chronic intractable pain is continuous pain that has lasted more than six months. Living in constant pain for an extended period of time can have a devastating impact on quality of life for many patients. Chronic pain affects one in five adults in Europe, or about 95 million people 15 to 64 years of age. “We are pleased to announce that patients implanted with the Precision Plus SCS system will now be able to undergo MRI head scans,” said Michael Onuscheck, senior vice president and president of Europe, Middle East, and Africa at Boston Scientific. “We understand the need to provide physicians the necessary options to be able to manage their patients’ care and believe this new MRI labeling will play a role for them.” Spinal cord stimulation is a reversible therapy that manages pain through an implantable pulse generator (IPG) and thin wires called electrodes (also known as leads) that are implanted in the spinal column. The device electrically stimulates specific nerves of the spinal cord to mask the brain’s perception of specific pain signals that move up the spinal cord. Up to now, approximately 350,000 patients with chronic pain have been treated worldwide with SCS therapy. The Precision Plus SCS system was approved in the United States in 2004 and received approval in Europe and Canada in 2005. The system is the world’s first rechargeable IPG. Today, more than 60,000 patients worldwide have been treated using this system. LINKXPRESS COM MII-12-12 105 When compared to nonrechargeable SCS systems, rechargeable SCS systems may offer clinical benefits by extending therapeutic longevity and therefore avoiding frequent replacement surgeries and complications that may arise from repeated surgeries.

Image: The Precision Plus Spinal Cord Stimulator (SCS) system (Photo courtesy of Boston Scientific).

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Bee Venom Compound Tested for Radioprotector Qualities
team of Spanish researchers conducted in vitro studies of cytotoxicity to evaluate the optimal concentration level of propolis, in which this natural substance extracted from bee resin would offer the maximum protection against ionized radiation and not be toxic for blood cells. According to the researchers, from the Technical University of Valencia (www.upv.es), the University Hospital La Fe (www.dep7.san.gva.es), the University of Valencia (www.uv.es), and the Universitat Autonoma de Barcelona (www.uab.es), this optimal concentration level is between 120-500 µg/mL. “Within this range can be found maximum protection against radiation-induced damage and the substance does not reveal either a cytotoxicity nor a genotoxicity effect on nonirradiated human lymphocytes,” said Dr. Alegria Montoro, head of the laboratory of biological dosimetry at the University Hospital La Fe. The conclusions of this study represent a starting

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point for future clinical applications using propolis. The results were published February 2012 in the journal Food and Chemical Toxicology, and a full revision of the study was presented at the annual International Conference of the IEEE Engineering in Medicine and Biology Society EMBC12, which was held in San Diego (CA, USA), in August 2012. In the study, the researchers utilized four genetic biomarkers, including the mytotic index and the cell proliferation kinetics, with the aim of determining whether propolis has cytotoxic effects on cells. “Using these biomarkers makes it possible to discover how a substance affects cell division: a substance which is cytotoxic and modifies the cell division stage would do so by accelerating, slowing down or even stopping the process, and all three effects are negative,” explained Dr. Alegria Montoro. The other two biomarkers used are the study of the possible induction of chromosome changesin

nonirradiated cultures at different concentration levels and sister chromatid exchanges (SCEs), a genetic biomarker of exposure to chemical agents. UAB lecturer Francesc Barquinero, currently on leave to work at the Institut de Radioprotection et de Sûreté Nucléaire (IRSN; Fontenay aux Roses, France), participated in the original planning of the study and its design, as well as the interpretation of the findings and posterior contextualization of other studies published. In 2008, researchers at the Institute for Industrial, Radiophysical and Environmental Safety (ISIRyM) of the Technical University of Valencia and the University Hospital La Fe demonstrated that propolis can reduce by half the damage inflicted on chromosomes by ionized radiations, thereby protecting the DNA from these effects. The new study is essential, according to the investigators, in finding the range of concentrations in which this compound can have a toxic effect on nonirradiated cells.

Ultrasound Contrast Agent Evaluated for Imaging Preexisting Cardiopulmonary Conditions
recent study found that a new ultrasound-imaging agent was well tolerated in patients of different types undergoing clinically contrast agent-enhanced echocardiography in a wide range of typical clinical settings. Lantheus Medical Imaging, Inc. (North Billerica, MA, USA; www.lantheus.com), a developer, manufacturer, and distributor of diagnostic imaging agents, announced

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the publication of the results from the CaRES multicenter safety registry for its ultrasound imaging agent Definity vial for (perflutren lipid microsphere) injectable suspension. The CaRES (Contrast Echocardiography REgistry for Safety Surveillance) study’s findings were published in the July 2012 issue of the Journal of the American Society of Echocardiography. “To our knowledge, the CaRES

study is the first multicenter prospective registry to evaluate the safety of Definity in a large and diverse patient population and now provides physicians a measure for understanding the safety and tolerability of Definity use in a real-world, routine clinical setting,” said Mark Hibberd, MD, PhD, senior medical director, global medical affairs, Lantheus Medical Imaging. “Across a broad range of patients with significant preexisting cardiopulmonary conditions and suboptimal baseline echocardiograms, Definity demonstrated a consistently strong safety profile. The conclusions of this study, coupled with the recommendations for the use of contrast echocardiography by the American Society of Echocardiography, reinforce the important role of Definitityin cardiac imaging.” The prospective, open-label, nonrandomized registry study was designed to assess the risk of adverse clinical events occurring within 30 minutes of Definity administration in a routine clinical setting. Among the 1,053 patients who completed the study, no deaths, life-threatening events, serious adverse events, or serious anaphylactoid (allergic) reactions were reported during or after administration. The overall adverse event (AE) rate was 10.8%, and drugrelated AE rate was 3.5%. Of the AEs that occurred during or after the agent’s administration, a substantial majority (96.5%) were mild to moderate in intensity. The CaRES study complements another recently published study on the hemodynamic effects of Definitiy in patients with pulmonary hypertension. Published in the May

2012 issue of the Journal of the American Society of Echocardiography (Wei et al., 2012), this prospective study evaluated 32 patients, half of whom had elevated baseline pulmonary artery systolic pressures. The study found that Definity administration did not result in any clinically consequential changes in systemic and pulmonary artery hemodynamic measurements among patients with either normal or elevated pulmonary artery pressure. Moreover, no serious or fatal adverse events occurred. Overall, the agent demonstrated a positive safety profile, and was well tolerated. Both the CaRES study and the pulmonary hypertension study were developed in conjunction with the US Food and Drug Administration (FDA) in 2008 as part of a risk-assessment program for perflutren-based ultrasound contrast agents, such as Definity. “The CaRES study builds on a large and growing body of peerreviewed literature and a decade of real-world experience which support a well-characterized and favorable benefit-risk profile for Definity,” added Dana Washburn, MD, chief medical officer at Lantheus Medical Imaging. The CaRES study enrolled a total of 1,060 patients at 15 clinical sites in the United States. Of these enrollees, 1,053 received at least one dose of the contrast agent and completed the study. Definity vial for injectable suspension is an ultrasound contrast agent for use in patients with suboptimal echocardiograms. Since its launch in 2001, activated Definitity has been administered to more than 3.5 million patients.
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New Design Makes Ultrasound Imaging Cost-Effective Worldwide

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n ultra-low cost ultrasound scanner has been developed that can be plugged into any computer or laptop to reveal crucial information about fetal health. The hand-held universal serial bus (USB) device, which is about the size of a computer mouse, works in a similar way to existing ultrasound scanners, using pulses of high frequency sound to build up an image of the unborn child on the computer screen. However, in contrast to the technology utilized in most hospitals across the United Kingdom, costing anywhere from GBP 20,000-100,000, the scanner created by engineers Dr. Jeff Neasham and research associate Dave Graham at Newcastle University (UK; www.ncl.ac.uk) can be built for as little as GBP 30-40. Tested by experts in the regional medical physics department at the Freeman Hospital, part

of the Newcastle upon Tyne Hospitals NHS ([UK] National Health Service) Foundation Trust, the scanner produces an output power that is 10-100 times lower than traditional hospital ultrasounds. It is now hoped the device will be used to provide medical teams working in the world’s poorest nations with basic, antenatal data that could save the lives of hundreds of thousands of women and children. “Here in the UK we take these routine, but potentially lifesaving, tests for granted,” explained Dr. Neasham, a sonar expert based in the University’s School of Electrical and Electronic Engineering. “Imaging to obtain even the simplest information such as the child’s position in the womb or how it is developing is simply not available to women in many parts of the world. We hope the very low cost of this device and the fact

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that it can run on any standard computer made in the last 10 years means basic antenatal imaging could finally be made available to all women.” Dr. Neasham reported that the original objective had been to make something portable and easy to use that would be affordable in developing countries as well as for some applications in the UK where ultrasound is still considered cost prohibitive. “Cost was the key,” he explained. “The goal was to produce a device that could be produced for a similar cost to the hand-held Doppler devices [fetal heart monitors] used by most community midwives. Not an easy task when you consider a GBP 20,000 scanner is generally classed as low cost.” An expert in underwater sonar technology, Dr. Neasham has developed systems for imaging the seafloor – searching for shipwrecks or specific geographic features – as well as underwater communications and tracking systems. Drawing on his expertise in sonar signal processing, the design keeps components and hardware costs to an absolute minimum, and works by manually sweeping a transducer over the skin while a focused image is formed by the personal computer (PC) software. The scanner requires nothing more than a computer with a USB port in order to work. Dr. Neasham noted that the advantage of this device was that it would complement – instead of replace – the high performance scanners available in hospitals. “It was my own experience of becoming a father and going through the whole antenatal process that prompted me to start the project,” stated Dr. Neasham. “I was sat with my wife looking at our child on the screen, we realized how privileged we were to have access to this kind of care and it was my wife who suggested that I could apply my knowledge from sonar research to try to make this more affordable.” UN statistics estimate more than 250,000 women die yearly from complications during pregnancy or childbirth, almost all of them – 99% – in developing countries. Sadly, most of these deaths are avoidable and a lack of access to equipment is noted as one of the major factors. Dr. Neasham added, “There is obviously the potential to use it to go beyond obstetrics by using it to diagnose conditions such as gallstones, or other conditions that readily show up with ultrasound imaging. Even vets and farmers are interested in affordable imaging.”
Image: Jeff Neasham (L) and Dave Graham hold their low-cost ultrasound system (Photo courtesy of Reuters / Newcastle University).

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Hybrid OR Imaging System Moves Along Defined Pathways, Guided by Laser

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hybrid operating room (OR) imaging system is an innovative new laser-guided system that has been designed to capture the advantages of both floor- and ceiling-mounted systems, without the limitations of either. GE Healthcare (Chalfont St. Giles, UK; www.gehealthcare.com) has already received six orders for its Discovery IGS 730 since receiving US Food and Drug Administration (FDA) clearance in February 2012. The system uses the same digital flat-panel detector technology as GE Innova interventional imaging systems. However, instead of being fixed in position, the imaging device is on mobile gantry that moves along user defined pathways, guided by laser. At the touch of a button, clinicians can move the system to the table for imaging various anatomies, and then move it aside and place it, allowing room to position physicians, nurses, technologists, anesthesiologists, and other personnel optimally for surgery, with unobstructed access to the patient. St. Luke’s University Hospital (Bethlehem, PA, USA), the first to place an order world-wide, plans to install the system over the coming months. The Discovery IGS 730 is designed to provide high precision imaging with complete patient access, and optimal inroom mobility to accommodate a wide range of procedures – from complicated interventional to surgical procedures. Dr. Hal Folander, chairman of the radiology department and section chief of interventional radiology at St. Luke’s University Health Network, participated in early evaluations of the Discovery IGS 730. “After initially viewing the power of this system it was clear that this is an advancement that is on-par with the invention of flat panel technology for interventional procedures,” said Dr. Folander. “At St. Luke’s, we are constantly looking for solutions and systems that help us improve the efficiency of our procedures as well as the experience for our patients. The Discovery IGS system will not only help our providers access patients better during procedures, but will allow us to provide our patients a revolutionary development in imaging and quality care.” The Discovery IGS 730 is a first-of-its kind system in imaging, as it is neither floor- nor ceiling-mounted, but enables full patient access without the need to suspend the system above the patient. It has the mobility of a C-arm with the power and image quality of a fixed system. This laser-guided, motorized mobile gantry creates an interventional
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environment without boundaries. It allows complete access to the patient and unlimited parking capability, while creating sterility for a flexible and secure OR environment. The unique gantry has a new wide bore design, which allows for steep angles, ease in three-dimensional (3D) acquisition, especially for large patients. The Discovery IGS 730 is cleared by the US FDA.
Image: The Discovery IGS 730 system (Photo courtesy of GE Healthcare).

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16-Element MR Flexible Coil System Expands Exam Capabilities
new magnetic resonance (MR) coil system makes it easier for clinicians to complete high-quality exams and improve diagnostic effectiveness. To improve MR exam effectiveness and image quality, Toshiba Medical Systems (Tokyo, Japan; www.toshiba.co.jp) has received US Food and Drug Administration (FDA) clearance for its high-density 16-element flexible coil system, developed in partnership with NeoCoil (Pewaukee, WI, USA; www.neocoil.com). “The 16-element MR coils feature a flexible design, enabling clinicians to use the coils for various

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exam types,” said Steve Nichols, chief operating officer, NeoCoil. “The light-weight coils come in two sizes and wrap around a patient’s anatomy, accommodating patients of various sizes and providing greater patient comfort.” Available for the Vantage Titan 1.5T MRI system, the 16-element flexible coils conform more closely to the anatomy, greatly improving the signal-to-noise ratio. The coils are available in medium and large sizes and are ideally suited for general orthopedic and body imaging of both large and small patients. Where conventional coils are not suitable, the flexible coils can be utilized for general-purpose as well as head, neck, and spine imaging. Large patients are not forced into or pinched by the hard plastic of standard rigid coils. Image quality for small patients is not compromised due to fixed, oversized coil housings. “Toshiba is committed to developing and bringing new technologies to market for its MR systems,” said Stuart Clarkson, director, MR business unit, Toshiba. “The Vantage Titan systems are patientfriendly, and the new 16-element coils will continue to provide comfortable exams while improving image quality for accurate diagnoses.”
Image: The Vantage Titan 1.5T MRI system (Photo courtesy of Toshiba Medical Systems).

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Lower-Dose Molecular Breast Imaging Possible for Single-Head Imaging Systems
reast-Specific Gamma Imaging (BSGI) or Molecular Breast Imaging (MBI), a breast imaging procedure performed using a tracer, has demonstrated the ability to detect cancers missed by mammography and ultrasound. Now researchers are performing studies at lower doses in hopes of confirming a method to reduce the overall radiation exposure to the patient. High-risk women with dense breasts could benefit from lower radiation exposure during screening. According to a presentation at the European Society of Radiology Congress in Vienna (ESR; Austria; www.myesr.org), this spring, Dr. Marcela Bohm-Velez of Weinstein Imaging Associates in Pittsburgh (PA, USA; http://weinsteinimaging.com) concluded that low-dose studies are possible when conducted under a properly designed clinical protocol. These findings were obtained from an on-going study in which additional patients have been recently added. In their prospective trial, 60 patients had low-dose MBI followed by imaging at the standard

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dose. To date, the study revealed that the tracer washes out of the breast cells quickly with only half of the tracer remaining in the breast approximately 137 minutes after injection. “Our early results indicate that low-dose MBI is feasible and doses of 10 mCi [370 MBq] or less with the single head MBI imaging system can provide clinically useful images. However, the clinician needs to be aware of the pharmacokinetics of sestamibi, otherwise it can be challenging to implement low-dose protocols. The fairly rapid washout rate represents a potential stumbling block if the imaging is not managed properly; it is important to image very soon after injection to provide the best images,” said Dr. BohmVelez. “These are physiologic effects that detector technologies cannot overcome. While all of the currently available MBI/BSGI machines are capable of low-dose imaging, lowdose imaging presents us with new challenges. Proper clinical protocols are needed to ensure optimal image quality and patient care.”
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Coronary CT Angiography Noninvasively Detects Coronary Artery Disease

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mong patients with suspected or known coronary artery disease, use of a screening test that utilizes computational fluid dynamics to draw on specific data from computed tomographic (CT) angiography imaging demonstrated improved diagnostic accuracy vs. CT angiography alone for the diagnosis of ischemia. The results from the new study were published online August 26, 2012, in the Journal of the American Medical Association (JAMA). The study was released early to coincide with its presentation at the European Society of Cardiology Congress, held in Munich (Germany), August 2529, 2012. “Coronary computed tomographic angiography is a noninvasive anatomic test for diagnosis of coronary stenosis [narrowing of a blood vessel] that does not determine whether a stenosis causes ischemia. In contrast, fractional flow reserve [FFR] is a physiologic measure of coronary stenosis expressing the amount of coronary flow still attainable despite the presence of a stenosis, but it requires an invasive procedure. Noninvasive FFR computed from CT [FFRCT] is a novel method for determining the physiologic significance of coronary artery disease [CAD], but its ability to identify ischemia has not been adequately examined to date,” according to the article. James K. Min, MD, from the Cedars-Sinai

Heart Institute (Los Angeles, CA, USA; www.cedars-sinai.edu) and colleagues conducted a study to assess the performance of noninvasive FFRCT compared with an invasive FFR reference standard for diagnosis of ischemia. The study included 252 patients with suspected or known CAD from 17 centers in five countries who underwent CT, invasive coronary angiography (ICA), FFR, and FFRCT between October 2010 and October 2011. Approximately 77% of patients had experienced angina within the last month. Ischemia was defined by certain criteria. Anatomically obstructive CAD was defined by a stenosis of 50% or larger on CT and ICA. Among 615 study vessels, 271 had less than 30% stenosis and 101 had at least 90% stenosis. Among study participants, 137 (54.4%) had an abnormal FFR as determined by ICA. The researchers found that the diagnostic accuracy for FFRCT plus CT was 73%, which did not meet a prespecified primary end point for accuracy (as prespecified based on the lower limit of a calculated 95% confidence interval). By comparison, diagnostic accuracy of CT alone for detecting coronary lesions with stenosis of 50% or greater, was 64%. When comparing FFRCT alone with CT alone for identifying these lesions, FFRCT demonstrated better discrimination. “On a per-patient basis, diagnostic accuracy,

sensitivity, specificity, positive predictive value and negative predictive value of FFRCT plus CT were 73%, 90%, 54%, 67%, and 84%, respectively,” the authors wrote. They noted that the sensitivity and negative predictive value of FFRCT were high, indicating a low rate of false-negative studies. “These diagnostic features of FFRCT may encourage a greater sense of diagnostic certainty that patients who undergo CT who have ischemia are not overlooked, such that clinicians may be confident in not proceeding to invasive angiography in patients with stenoses on CT when FFRCT results are normal.”
Image: The coronary CT angiography of a 55-year old man, performed to exclude a stenosis of the pulmonary vein (Photo courtesy of PD Hausleiter, MD, German Heart Center).

Flexible Digital Radiography Room Designed to Improve Workflow
new digital radiography (DR) room is designed for busy technologists and their patients, while providing excellent image quality. It comes equipped with new automation and display features on the tube head. The new tube head includes a convenient touch screen for system adjustments traditionally found at the generator console. FujiFilm Medical Systems, USA, Inc. (Stamford, CT, USA; www. fujimed.com) announced the latest addition to one of the most diverse range of DR products currently available, the FDR D-EVO Suite II. The medical imaging and informatics company is now offering another cost effective, flexible, DR room solution designed to optimize workflow while utilizing any of Fujifilm’s FDR D-EVO portable detectors. “One of the highlights of this new system is having these controls at the tube head,” said Rob Fabrizio Fujifilm’s senior marketing and product development manager, digital radiography systems. “This allows the technologist to stay with the patient, at the table, while mak-

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ing simple exam adjustments. Then, the tech can simply return to the control area to take the exposure.” The system’s workflow enhancements also provide benefits in areas where speed during the exam is critical. Mr. Fabrizio continued, “the new system is perfect for everyday use to high volume, high stress emergency departments. It provides just the right balance of automation and manual movements for day in and day out reliability and time critical grab and go speed.” Any of Fujifilm’s FDR D-EVO detectors, including the 17x17 model, can be used interchangeably with the FDR D-EVO Suite II to maximize flexibility. By providing access to the 17x17 detector, the new system offers a full field of view that was conventionally only available with high-end, fixed detector systems. The lightweight wireless FDR D-EVO panels can additionally maximize return on investment by allowing clinicians to mix, match, and share sizes and capture-types throughout the radiology department, including other rooms and portables.
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Wireless Detector Offers Irradiation Side-Sampling Technology

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new 24 x 30-cm wireless detector panel provides excellent image quality in a variety of exams, including neonatal and orthopedic imaging. At the 40th annual Association for Medical Imaging Management (AHRA) meeting and exposition, held in August 2012 in Orlando (FL, USA), FujiFilm Medical Systems USA, Inc. (Tokyo, Japan; www.fujimed.com) announced the commercial availability of the FDR D-EVO 24 x 30 cm cesium iodide flat-panel detector, the latest addition to a diverse family of DR products. The first and only 24 x 30-cesium wireless flat panel detector on the US market will provide Fujifilm’s easeof-use, image quality, and dose efficiency in a lightweight, very compact design to accommodate neonatal, pediatric, and orthopedic imaging. The 24 x 30 cm, wireless FDR D-EVO flat panel detector combines the unique dose efficiency

advantages of Fujifilm’s patented irradiation sidesampling (ISS) technology with image performance of cesium iodide. The innovative ISS technology is designed to improve detective quantum efficiency (DQE) by reducing the distance for light signals to reach the sensing electronics. By reducing scatter and blur, it produces ultra-sharp detail even at very low X-ray exposure. As a result, the FDR D-EVO 24 x 30-cm cesium detector achieves as much as 20% higher DQE performance compared to conventional detectors, enabling potential for lower patient dose and enhancing diagnostic confidence for the radiologist. In addition to diagnostic benefits, the new detector provides the same ease-of-use as the entire FDR D-EVO product range, providing extended versatility and renewed ease of positioning for a the most common types of exams. “The size of the new 24 x 30 FDR D-EVO detector offers the versatility and maneuverability that every technologist has been hoping for. It’s the perfect addition for busy imaging departments where exams requiring a small field of view, like neonatal incubator trays, extremity and skull exams take place daily,” said Rob Fabrizio,

Fujifilm’s senior marketing and product development manager, digital radiography systems. “And its small size and lightweight make it an ‘absolute must’ for exams like sunrise views giving you peace of mind as the patient to holds the detector in position.”
Image: The FDR D-EVO portable detector (Photo courtesy of Fujifilm).

SPECT/CT Imaging Agent Helps Diagnose Difficult Cases of Infectious Endocarditis
hen combined with conventional diagnostic tests, functional imaging procedures have been shown to reduce the rate of misdiagnosed instances of infectious endocarditis. According to new research, single photon emission computed tomography (SPECT)/computed tomography (CT) with 99mTc-hexamethylpropleneamine oxime-labeled white blood cells (99mTc-HMPAO-WBC) imaging can improve the diagnosis of infectious endocarditis in hard-to-diagnose instances. Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by fungi, bacteria, or other infectious substances. It affects two to four people per 100,000 each year, with 25%-50% of the cases occurring in patients older than 60 years. Mortality from infectious endocarditis remains high when this disorder is undiagnosed, and therefore, not sufficiently treated. The diagnosis of infectious endocarditis is becoming increasingly more difficult in the past years because of a range of factors: the haphazard use of antimicrobial agents in some clinical environments, the increased number of individuals with predisposing or underlying conditions (such as the frail and elderly, immune-suppressed individuals), and the increasing number of interventional cardiovascular procedures and placement of valve prostheses, intravascular devices, and cardiac devices. “SPECT/CT with 99mTc-HMPAO-WBC is a nuclear medicine technique currently used for the management of patients with infection; its application in infectious endocarditis has been restricted to few reports,” said Paola A. Erba, MD, from the Regional Center of Nuclear Medicine, University of Pisa Medical School (Pisa, Italy; www.unipi.it), and lead author of the study. “With this work we aimed

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to open new perspective for the application of this technique.” The study’s findings were published in the August 2012 issue of the Journal of Nuclear Medicine, single photon emission computed tomography (SPECT)/computed tomography (CT) with Researchers conducted 99mTc-HMPAO-WBC SPECT/CT scans on 131 consecutive patients with suspected infectious endocarditis. Patients with permanent cardiac devices were excluded from the research as the devices might have introduced the infection. Findings from the scans were compared to diagnostic tests for standard infectious endocarditis – transthoracic or transesophageal echocardiography, blood cultures and the modified Duke Endocarditis Service criteria, which are recommended for classification. Of the 131 patients, 97 were found to have uptake indicating infection. The 99mTc-HMPAOWBC SPECT/CT scan was true-positive in 46 of 51 patients and false-negative in five of 51 cases (90% sensitivity, 94% negative predictive value and 100% specificity and positive predictor value). In addition, septic embolism was detected in 41% of the patients. “When the results of the 99mTc-HMPAO-WBC SPECT/CT scan were associated with either positive echocardiography or a positive blood culture, no cases of infectious endocarditis went undiagnosed,” noted Dr. Erba. “This demonstrates the added value that 99mTc-HMPAO-WBC SPECT/CT scans can provide to assist physicians in their diagnosis and treatment decisions. Cardiologists and infectivologists dealing with infectious endocarditis should consider using 99mTc-HMPAO-WBC when they are facing difficult situation.”
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Toshiba Launches Advanced Features Cardiovascular Package for Aplio
oshiba Corporation (Tokyo, Japan), via its medical systems subsidiary in Europe Toshiba Medical Systems Europe (TMSE; Zoetermeer, The Netherlands, www.toshibamedical.eu), launched its cardiovascular package for the new Aplio series ultrasound systems at the ESC Congress in Munich (Germany) during August 25-28, 2012. Toshiba Medical Systems Europe introduced “Picture Perfect Ultrasound” to the cardiovascular segment on Aplio 300, 400, and 500. Enhancement for the ultrasound systems includes advanced features such as Tissue Enhancement and Wall Motion Tracking. Toshiba’s Cardiovascular Package developed with ideas contributed from Japan, Europe, and the US, includes features such as Tissue Enhancement for extreme image quality in transthoracic and transesophageal imaging, flexible M-Mode, comprehensive measurement programs, an onboard reporting module, a user-friendly stress echo-imaging tool, and software for automatic measurement of intimamedia thickness (IMT). Wim van Ingen-Schenau, Product Manager for Cardiac Ultrasound at TMSE explains, “The new Aplios can operate a wide range of high performance transducers, so we can offer for many applications in the areas of echocardiography and vascular imaging very powerful, user friendly, and flexible workflow solutions.” “A highlight of the Cardiovascular Package is the new Wall Motion Tracking application” as Willem Gorissen, Clinical Market Manager for Echocardiography at Toshiba Medical Systems Europe emphasizes, “we have migrated ‘high-fidelity’ raw data based speckle-tracking technology from the latest version of the Artida, our flagship product in echocardiography, to the new Aplio series. Our customers immediately benefit from the experience we have gained over time with Wall Motion Tracking on the Artida. We are fully supporting the initiative of the American Society of Echocardiography (ASE) and the European Association of Echocardiography (EAE) to achieve a standardization of speckle tracking measurements, and our engineers are closely following their recommendations and guidelines. Wall Motion Tracking on the new Aplio is easy-to-operate, contains comprehensive measurement capabilities, including various strain and strain rate parameters, and can be evaluated directly on the ultrasound system or offline on the post-processing workstation.” Cardiovascular Ultrasound is playing

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an increasingly important role in the management of Cardiovascular disease. “It is a noninvasive, highly accurate, and comprehensive diagnostic modality that gives quickly critical information regarding the structure and function of the heart and the cardiovascular system. Innovations in speckle tracking and increasingly sophisticated image analysis algorithms enable us to assess the heart more effectively and efficiently with ultrasound,” said Dr. Christoph Simm, Senior Manager of the Business Unit Ultrasound at TMSE.

Image: Regional strain analysis in posterolateral infarction: Apical long axis view shows normal contraction of the anterior wall segments with the red and orange color. The posterior wall segments (green) show a typical low systolic longitudinal strain value of the inner myocardial layer with a delayed peak in early diastole in the posterolateral infarcted zone (Photo courtesy of Toshiba Medical Systems).

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New Invasive Imaging Technique Devised to Monitor Brain Function

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ew technology employs an innovative way to track brain function and help in functional mapping of patients with disorders such as epilepsy. The procedure includes the use of preplaced electrodes for cortical mapping in the brains of patients who are undergoing surgery to lessen the frequency of seizures. This technique, although invasive, provides real-time examination of brain function at a much higher resolution than existing technologies. The video article was published July 2012 in the Journal of Visualized Experiments (JoVE). Typically, functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) are used in neuroimaging studies but these techniques suffer from low temporal and spatial resolution. By using electrodes implanted in the brain of an epileptic patient already undergoing treatment, scientists can now image the brain with a much higher spatial resolution, lower signal interfer-

ence, and a higher temporal resolution than fMRI or EEG. The leading author of the study, Dr. Gerwin Schalk, from the New York State Department of Health (Albany, NY, USA; www.health. ny.gov) and Albany Medical College (New York, NY, USA; www.amc.edu), stated, “Essentially, we have created a new imaging technique. Our procedure is innovative because it is prospective, meaning, it can image brain function as it occurs. Moreover, it does not require an expert to derive meaningful information concerning brain function.” Dr. Schalk also remarked that it was crucial for this procedure to be demonstrated in a video format. “The procedure is a very visual process. The ancillary information such as the spatial relationships of different components, the set-up of the hospital room, and the set-up of the equipment itself cannot be represented in a typical print article.

The video capacities of JoVE were an excellent vehicle to demonstrate both the general set-up and the specific implementation of the mapping system.” By relying on an epileptic patient’s neural implants, scientists can gain extraordinary clues into the brain’s function. Dr. Schalk’s procedure provides a technologic advance that can be utilized in many applications, including stroke patient monitoring and rehabilitation, signal mapping, and transduction for movement of prosthetic limbs, and enhancement of communication in

individuals with paralysis of the vocal musculature. JoVE editor, Dr. Claire Standen, stressed, “The new imaging technique demonstrated in this article is very important. There is a definite need for better, more accurate, imaging to monitor brain function. This technique can be applied to a wide range of clinical areas within the neuroscience field.”
Image: Gerwin Schalk studies brain images at the Wadsworth Center in Albany (Photo courtesy of the New York State Department of Health / Albany Medical College).

Safer Radiologic Imaging to Help Children with Otolaryngologic Disease
ecent developments in diagnostic imaging have benefited children with otolaryngologic disease, resulting in fewer invasive procedures, shorter hospital stays, more targeted surgical procedures, and earlier and more precise diagnoses. However, in spite of improved technology, worries about exposure of

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children to ionizing radiation have recently come to the forefront. Children have more radiosensitive body tissues than adults, and also tend to live longer, giving the effects of radiation exposure time to manifest. According to sources mentioned in the study, approximately seven million computed tomography (CT)

scans are performed on children yearly in the United States alone and medical source radiation exposure accounts for almost half of the total radiation exposure in the United States. A commentary, written by David E. Tunkel, MD, associate professor of otolaryngology-head and neck surgery and pediatrics division director, Johns Hopkins School of Medicine (Baltimore, MD, USA; www.hopkins medicine.org ); Sandra L. WoottonGorges, MD from the department of radiology, University of California, Davis Medical Center (Sacramento, California, USA; www.ucdmc. ucdavis.edu), and Julie L. Wei, MD, from the department of otolaryngology-head and neck surgery, University of Kansas, School of Medicine (Kansas City, USA; http://medicine. kumc.edu) and published in the July 2012 issue of the journal Otolaryngology-Head and Neck Surgery, discussed efforts “to reduce the exposure of children to radiation from diagnostic imaging, with focus on the responsibilities of the otolaryngologist in such efforts.” The problem lies, according to the authors, in determining when CT scans are nec-

essary, and making this information widely available to otolaryngologists and others. Several suggestions and resources are provided. The authors discussed the ALARA principle (as low as reasonably achievable) and suggest that reducing radiation dosage is as simple as scanning only the targeted region. Two online resources exist: The American College of Radiology (Reston, VA, USA; www.acr.org) has provided Appropriateness Criteria and the Alliance for Radiation Safety in Pediatric Imaging has created the site www.imagegently.org. Other sources cited in the study provide three strategies to reduce radiation exposure from CT scans (1) order fewer CT scans, (2) use another imaging modality that does not use ionizing radiation when possible, and (3) reduce the radiation dose of each study. The authors concluded, “Safer imaging of children is a shared responsibility.” It is imperative to order the right test at the right time, and to “consider the appropriateness of imaging, assuring that the best modality is being ordered, that the imaging actually influences management, and that the timing of imaging is ideal.
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Hybrid Medical Imaging May Provide New Window into Cancer Mechanisms
cientists have developed a new type of medical imaging that gives medical professionals with a new view of live internal organs. The imaging integrates two existing forms of medical imaging – photoacoustic and ultrasound – and employs them to generate a combined high contrast, high-resolution image that could help clinicians locate tumors more rapidly, according to the investigators, from the University of Southern California (USC; Los Angeles, USA; www.usc.edu) and Washington University in St. Louis (MO, USA; http:// wustl.edu). “Photoacoustic endoscopy provides deeper penetration than optical endoscopy and more functional contrast than ultrasonic endoscopy,” said Lihong Wang, PhD, lead investigator and corresponding author of a study on the new technology that appeared in Nature Medicine on July 15, 2012, and professor in the department of biomedical engineering in engineering & applied science at Washington University in St. Louis. Dr. Wang collaborated with Drs. Qifa Zhou, Ruimin Chen, and K. Kirk Shung of USC as well as Joon-Mo Yang, Christopher Favazza, Junjie Yao, Xin Cai, and Konstantin Maslov from Washington University. “This is a first time that we have had small endoscopy with two imaging

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modalities,” said Dr. Qifa Zhou, one of the lead investigators and coauthors of the study, and a professor at the US National Institutes of Health (NIH) Resource Center for Medical Ultrasonic Transducer Technology at USC Biomedical Engineering. Currently, physicians regularly employ ultrasound endoscopy to examine internal organs. This technology positions an ultrasound camera, similar to ones used to create images of fetuses, on a flexible scope that can be inserted internally. Although these images are typically high-resolution, they are also low-contrast – generating a dim image, similar to a photograph taken in a dimly lit room. To tackle this obstacle, the scientists added a photoacoustic-imaging device to the ultrasound endoscope. The resulting camera hits organ tissue with a light. When the light is absorbed by tissue, the tissue gets slightly hotter and expands. That expansion produces a sound pressure wave that the ultrasound device on the endoscope picks up. “This technology combines the best of both worlds,” said Dr. Kirk Shung, director of the NIH Resource Center and a professor of biomedical engineering at USC. The researchers have evaluated their new device inside the gastrointestinal tract, generating in vivo images detailed enough to show

blood vessels as well as the density of the neighboring tissue. “This imaging has fine resolution and high contrast,” said Joon-Mo Yang, PhD, a postdoctoral researcher in Dr. Wang’s group. With a more precise image of what is happening inside the gastrointestinal tract, physicians could potentially target colon and prostate cancers earlier.
Image: The image at the bottom is a composite of the first two taken of a rabbit esophagus in vivo (Photo courtesy of Qifa Zhou).

Canadian CT Head Rules Superior to New Orleans Criteria in Predicting Neurosurgical Intervention
n a head-to-head competition between the New Orleans Criteria and the Canadian Computed tomography (CT) Head Rules, the Canadian rules demonstrated higher sensitivity and specificity in predicting neurosurgical intervention for mild head injury. The results of the study, conducted in Tunisia, were published online August 21, 2012, in the journal Annals of Emergency Medicine. “Although clinical decision rules may not perform exactly the same way in all populations, our study suggests that, at least in Tunisia, emergency physicians should use the Canadian CT Head Rule in their routine clinical practice for patients with mild head injury,” said lead study author Semir Nouira, MD, from Fattouma Bourguiba University Hospital (Monastir, Tunisia). “Application of the Canadian rule could potentially lead to reductions in CT scans for mild head injury, one of the most common injuries seen in emergency departments.”

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Researchers examined medical records for 1,592 patients with mild traumatic brain injury. Patients were chiefly evaluated on the need for neurosurgical intervention and the evidence of traumatic lesions on head CT scan. Sensitivity was 100% and specificity was 60% on the need for neurosurgical intervention for the Canadian CT Head Rules (CCHR). Sensitivity was 82% and specificity was 26% on the necessity for neurosurgical intervention for the New Orleans Criteria (NOC). Sensitivity and specificity on clinically significant head CT findings were 95% and 65% for CCHR and 86% and 28% for NOC. “There is still debate over whether these decision rules could be applied worldwide because they haven’t been validated across populations with different demographics and ethnic characteristics,” said Dr. Nouira. “Therefore, more research is warranted to clearly establish the benefit of the Canadian rule in real life clinical practice.”

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CT SCANNER
Siemens Healthcare The Somatom Perspective 128-slice CT scanner is designed to improve efficiency while reducing costs. The eMode feature, created to determine and automatically select system scan parameters so the CT operates with as low a load as possible, minimizes wear and increases the scanner’s life cycle.
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Swissray Medical The ddRVersa features a motorized ceiling suspension, fixed positioning table with elevating base, and a separate wall stand. The system is designed to provide fast digital imaging, deliver enhanced image quality, increase productivity, and improve patient care.
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Aurora Imaging Technology The Aurora 1.5 T dedicated breast MRI system offers 3-D bilateral breast imaging for enhanced detection, diagnosis, and biopsy of breast cancer. The system is designed for low risk of patient harm in both the screening and diagnostic environments.
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Viztek The wall-mounting configuration is available for the Opal CR II, providing a low-footprint set-up for smaller environments. The CR weighs only 29.5 kg and can be easily mounted to a wall surface in a variety of healthcare settings as needed.
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Ultrasound System Features Large Image Dataset for Instant Biometric Measurements of the Fetus
ew ultrasound systems are being used in a UK hospital for all obstetric examinations, including first, second, and third trimester scans. Croydon University Hospital (UK; www.croydonhealthservices.nhs.uk), part of the Croydon Health Services NHS [National Health Service] Trust, has installed two Acuson S2000 ultrasound systems from Siemens Healthcare (Erlangen, Germany; www.medical.siemens.com). The systems, which replace an older unit, also include the syngo Auto OB application to automeasure the six major fetal structures required for

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biometric measurements. The Acuson S2000 is an ultrasound system suitable for routine ob/gyn imaging. The system offers powerful imaging, flexible workflow, and added diagnostic confidence, even in the most challenging cases. It is designed to reduce repetitive strain injury with extended reach zones to put the most frequently used controls in easy reach. In addition to its ergonomic design, a flexible articulating arm and high-resolution 19-inch flatpanel display ensure the best possible images are achieved in all lighting environments.

Siemens’ syngo Auto OB application draws on a large database of ultrasound images to provide instant and automated biometric measurements of the fetus without the need for manual calculations. The excellent image quality also means that patients do not need to be brought back for repeat anomaly scans, helping to streamline workflow. The system allows for image storing, also helping departmental workflow and efficiency. “The installation was very smooth and the image quality is leaps and bounds ahead of our last system – it’s like seeing the images through a new pair of glasses,” said Sue Newman, senior sonographer at Croydon University Hospital. “Because the image quality is so great, each examination is taking less time and we are able to see

more patients every day. It is also allowing us to pick up any abnormalities much earlier than we did in the past. The patients love it as well – they can see their babies clearly on the large screen.” “The S2000 offers an adaptable solution for obtaining highly detailed obstetric scans,” said Bernadette Leonard, regional sales manager and application for ultrasound products at Siemens Healthcare. “The system is designed to offer more anatomical information to enable a quicker and more confident diagnosis. We are delighted that Croydon University Hospital is enjoying the benefits of the image quality, speed, and applications
Image: The Acuson S2000 ultrasound system for routine ob/gyn imaging (Photo courtesy of Siemens Healthcare).

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MRI and Multidimensional Brain Measurements Can Calculate Child’s Age

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US team of researchers has developed a multidimensional set of brain measurements that, when combined together, can effectively assess a child’s age with 92% accuracy. “We have uncovered a ‘developmental clock’ within the brain – a biological signature of maturation that captures age differences quite well regardless of other kinds of differences that exist across individuals,” said first author Timothy T. Brown, PhD, a developmental cognitive neuroscientist in the department of neurosciences at the University of California (UC), San Diego (USA; www.ucsd.edu) School of Medicine. This study of the anatomy of the developing human brain published in the September 25, 2012, issue of the journal Current Biology, addresses a long-standing scientific query about individual biologic variability in children. The findings revealed that, for specific structural measures, maturational differentiations in the developing human brain are much smaller than was earlier thought – providing the first merged profile of different phases of brain development from ages three to 20 years. Dr. Brown and lead investigators Terry Jernigan, PhD, professor of cognitive science at UC San Diego and Anders Dale, PhD, UC San Diego professor of neurosciences, collaborated with colleagues nine other major US universities. The study, the first published research from the group’s Pediatric Imaging, Neurocognition, and Genetics Study (PING), was supported by a twoyear stimulus grant from the US National

Institutes of Health (Bethesda, MD, USA). The researchers developed a structural set of brain measurements including features of neuroanatomic development such as the shape, size, and tissue properties of various parts of the brain, resulting in what the researchers call a multidimensional phase metric. The investigators exploited on major developments in structural magnetic resonance imaging (MRI), employing a standardized MRI protocol implemented at nine different institutions, using 12 different MRI scanners. Data were collected in a diverse sample of 885 typically developing children and teens, including information on anatomical brain features known to change over age; for example, measurements of cortical thickness and area, the volume of deep structures, tissue characteristics and signal intensities. “No individual measurement closely reflects a child’s age across the childhood years, because changes of different kinds cascade dynamically as development progresses. But taken together, the measurements reveal a phenotype that is tightly linked to the child’s chronological age,” said Dr. Jernigan. She added that this collection of multimodal, multisite imaging developments now makes it possible for researchers across institutions to establish large-scale, shared databases. “Since this multidimensional MRI method is entirely objective, quantitative, and noninvasive,

and can powerfully distinguish among different phases of maturity, we hope it might also be useful for the early detection of developmental brain disorders,” said Dr. Brown.
Image: “Developmental clock” shows increases and decreases in brain’s cortical surface, as well as the dynamic cascade of many other brain measures, all changing with increasing age (from age 3-20) (Photo courtesy of the University of California, San Diego School of Medicine).

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Basda Medical The BTI-050 features a full digital spectrometer, four receiving channels, and a field strength of 0.50 T. The system offers a full open magnet, higher SNR, enhanced resolution, and a reduction of scanning time for users and patients.
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High-Definition Fiber Tracking Effectively Reveals Brain Anatomy
igh-definition fiber tracking (HDFT) provides full-color, precise images of the brain’s fiber network that accurately reflect brain anatomy observed in surgical and laboratory studies, according to a new report. Investigators from the University of Pittsburgh (Pitt) School of Medicine (UPMC; PA, USA; www.medschool.pitt.edu) published their findings in the August 2012 issue of the journal Neurosurgery, which supported the idea that HDFT scans can provide valuable insights into patient symptoms and the prospect for recovery from brain injuries, and can help surgeons plan their approaches to remove tumors and abnormal blood vessels in the brain. When performing deep brain surgery, the neurosurgeon may need to cut or push brain fiber tracts, meaning the neuronal cables connecting the key brain areas, to get to a mass, according to Juan Fernandez-Miranda, MD, assistant professor, department of neurological surgery, Pitt School of Medicine. Depending on the location of the tumor and the surgical path, the surgeon takes to get to it, fiber tracts that control abilities such as memory, language, and motor function could be injured. “Standard scans such as MRI [magnetic resonance imaging] or CT [computed tomography] can show us where a mass lies in the brain, but they cannot tell us whether a lesion is compressing or pushing aside brain fibers, or if it has already destroyed them,” Dr. Fernandez-Miranda said. “While the symptoms the patient is experiencing might give us some hints, we cannot be certain prior to surgery whether removing the mass will disrupt important brain pathways either near it or along our surgical route through brain tissue to get to it. Our study shows that HDFT is an imaging tool that can show us these fiber tracts so that we can make informed choices when we plan surgery.” A sophisticated MR scanner is used to obtain data for HDFT images, which are based on the dif-

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fusion of water through brain cells that transmit nerve impulses. Similar to a cable of wires, each tract is comprised of many fibers and contains millions of neuronal connections. Other MR-based fiber tracking techniques, such as diffusion tensor imaging [DTI], cannot accurately follow a set of fibers when they cross another set, nor can they reveal the endpoints of the tract on the surface of the brain, said coauthor Walter Schneider, PhD, professor, Learning and Research Development Center (LRDC), department of psychology, University of Pittsburgh, who led the team that developed HDFT. For the new study, Dr. FernandezMiranda and his colleagues obtained HDFT scans of 36 patients with brain lesions, including cancers, and six neurologically healthy individuals. They also dissected the fiber tracts, such as the language and motor pathways, of 20 normal postmortem human brains. The investigators discovered that HDFT accurately replicated important anatomic features, including the topography of brain tissue; a region called the centrum semiovale, where multiple fiber tracts cross; the sharp curvature of the optic radiations that carry information to the visual cortex; and the endpoints on the brain’s surface of the branches of the arcuate fasciculus, which is involved in language processing. For the second part of the study, the team conducted HDFT scans in 36 patients prior to surgery, along with the imaging studies that are typically done as part of the preoperative planning process. They then compared fiber involvement predicted by HDFT with what they found during surgery. “The scans accurately distinguished between displacement and destruction of fibers by the mass,” said study coauthor Robert Friedlander, MD, professor and UPMC chair in Pitt’s depart-

ment of neurological surgery. Dr. Friedlander added it is not yet known how much fiber loss must occur to appear as a disruption or to cause symptoms, or what constitutes irreversible brain damage. “Although there is more work we must do to optimally develop the technique, HDFT has great potential as a tool for neurosurgeons, neurologists and rehabilitation experts,” Dr. Friedlander said. “It is a practical way of doing computer-based dissection of the brains of our patients that can help us decide what the least invasive route to a mass will be, and what the consequences might be of being aggressive or conservative in the removal of a lesion.” The team is continuing to assess HDFT’s potential in a range of studies.
Image: High definition fiber tracking, or HDFT, images of the brain’s fiber network that accurately reflect brain anatomy observed in surgical and laboratory studies (Photo courtesy of the University of Pittsburgh School of Medicine).

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SPECT/CT Technique Provides Improved Detection of Lymph Node Metastasis in Patients with Melanoma
reoperative three-dimensional (3D) visualization of sentinel lymph nodes (SLNs) used with single-photon emission computed tomography/ computed tomography (SPECT/CT) imaging was associated with a higher rate of identification of positive SLNs and a higher rate of disease-free survival among patients with melanoma, according to new findings. The study’s findings were published in the September 12, 2012, issue of the Journal of the American Medical Association (JAMA). “Melanoma has become an increasing interdisciplinary public health challenge worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Melanoma is the third most common cancer in Australia and the fifth most common cancer in the United States. The American Cancer Society estimated that approximately 70,230 new melanomas were diagnosed in the United States during 2011, resulting in approximately 8,790 deaths,” reported the authors. “Because melanoma, depending on tumor depth, metastasizes early into regional lymph nodes, sentinel lymph node excision [SLNE] is probably the most important diagnostic and potentially therapeutic procedure for patients with melanoma. The histological status of the sentinel lymph node is the most relevant prognostic factor for overall survival in patients with melanoma, independent of primary tumor thickness.” The investigators added that the recently introduced hybrid SPECT/CT imaging technology could help reduce the high false-negative rate of SLNE by providing additional anatomic data to the surgeon. Ingo Stoffels, MD, of the University of Essen-Duisburg (Essen, Germany; www. uni-due.de), and colleagues conducted a study to compare the link between SLNE with versus without preoperative SPECT/CT imaging and metastatic node detection and disease-free survival in patients with cutaneous melanoma. The study included use of a melanoma patient database to identify a group of 464 patients eligible for SLNE between March 2003 and April 2011. A total of 403 patients with clinically negative lymph nodes, who underwent SLNE with or without preoperative SPECT/CT, qualified for subsequent analysis. Between March 2003 and October 2008, 254 patients with melanoma underwent SLNE without preoperative SPECT/CT. Between November 2008 and April 2011 all sentinel node scintigraphies were performed as SPECT/CT in 149 patients. Using SPECT/CT allowed SLNE in the head and neck area more frequently (2.0% for standard vs. 23.5% for SPECT/CT). A total of 833 SLNs were removed from 403 patients. The researchers

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detected 2.40 SLNs per patient in the SPECT/CT group and 1.87 SLNs per patient in the standard group; 51 of 358 excised SLNs (14.2%) in the SPECT/CT cohort and 54 of 475 SLNs (11.4%) in the standard cohort showed metastatic involvement. The scientists were able to identify 41 patients (27.5%) with positive SLNs in the SPECT/CT cohort and 48 (18.9%) with positive SLNs in the standard cohort. The number of positive SLNs per patient was significantly higher in the SPECT/CT cohort than in the standard cohort (0.34 vs. 0.21). “The local relapse rate in the SPECT/CT cohort was lower than in the standard cohort (6.8% vs.

23.8%), which prolonged four-year disease-free survival (93.9% vs. 79.2%),” reported the researchers. The researchers noted that with the SPECT/CT technique, they were able to use smaller incisions in the head and neck area as well as alternative entry points due to the exact anatomic localization of the SLN. “In conclusion, the preoperative visualization of SLN with SPECT/CT is technically feasible and facilitates the detection of additional positive SLNs. The use of this technique offers the physician the preoperative possibility of determining the exact location and visualization of the SLN [...]," the researchers wrote in their article.

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Hemodynamic Transesophageal Ultrasound System Released Worldwide
new hemodynamic transesophageal (TEE) system provides real-time visualization of the heart for up to 72 hours. ImaCor, Inc. (Garden City, NY, USA; www. imacorinc.com), a developer of hemodynamic transesophageal echocardiography (hTEE) management devices, released the Zura EVO ultrasound system, a next-generation imaging platform that is used with ImaCor’s miniaturized, disposable ClariTEE probe. “The EVO and ClariTEE probe are unlike conventional ultrasound in that they are built for critical care workflow, bringing direct visualization and image monitoring to intensivists. This enables hemodynamic management capabilities that reduce cost and improve quality of care.” hTEE technology includes a purpose-built ultrasound imaging system consisting of the ClariTEE probe and Zura platform. The ClariTEE has a unique piezoelectric design with a highly efficient structure to provide quality imaging at 7 MHz with 15-cm penetration. Featuring optimized signal processing, thermal management, and Adaptaflex, the ClariTEE probe on the Zura system provides real-time visualization of the heart for up to 72 hours indwelling. This capability makes hTEE technology ideal for hemodynamic management of critically ill or injured patients over a period of time. The new Zura EVO imaging system combines

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all of the intuitive components of the current Zura platform in an ergonomically compact design with a large touch screen. Additional new features include an enhanced hTEE measurement package specific to area changes of the superior vena cava, and the right and left ventricles of the heart. The Zura EVO incorporates ImaCor’s newly released software, which includes enhanced Auto-Q for optimal image quality and resolution. “My department started the use of hTEE technology early this year,” commented Jukka Takala, MD, PhD, professor of intensive care medicine and director of the department of intensive care medicine at University Hospital Bern (Switzerland). “We were impressed with the ease of learning to use this new monitoring technology, even by intensive care specialists without prior echocardiography experience. Already the earlier version of the hTEE technology proved very helpful in patient management – we look forward with excitement to gain experience with the improved new platform.” “Our company imperative to provide the future in critical care monitoring is realized again today through the global release of the Zura EVO,” said Peter Pellerito, president/CEO. “The EVO and ClariTEE probe are unlike conventional ultrasound in that they are built for critical care workflow, bringing direct visualization and image monitoring to intensivists. This enables hemody-

namic management capabilities that reduce cost and improve quality of care.”
Image: The Zura EVO Ultrasound for Transesophageal Echocardiography (Photo courtesy of ImaCor).

Radiation from Cardiac Imaging Procedures May Pose Cancer Risk

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rocedures for diagnosing and treating heart disease that use ionizing radiation can potentially damage cells and increase the risk of cancer. Although no one test is expected to be harmful, radiation from cardiac tests, dental X-rays, chest X-rays, mammograms, and tests performed for other purposes can add up, rapidly reaching or surpassing the recommended lifetime medical radiation limit of 100 milliSieverts (mSv) set by the American College of Radiology (AR; Reston, VA, USA). There is growing concern about computed tomography (CT) scans because the popularity of these tests has greatly expanded, exposing large numbers of people to at times considerable doses of radiation. Imaging tests that emit ionizing radiation include: chest X-ray: 0.04 mSv; mammogram: 0.07 mSv; calcium scoring test: 1-2 mSv ; cardiac catheterization: 7 mSv ; chest CT: 10 mSv; coronary CT angiogram: 314 mSv; radionuclide sestamibi stress test: 10-12 mSv; and radionuclide dual-isotope myocardial perfu-

sion imaging: 25 mSv. “One or two CT scans over a lifetime is appropriate. But if you have a condition that requires repeated monitoring, a test that does not expose you to ionizing radiation may be preferred,’ stated Dr. Warren Manning, chief of noninvasive cardiac imaging and testing at Beth Israel Deaconess Medical Center (Boston, MA, USA) and a professor at Harvard Medical School (Boston, MA, USA; http:// hms.harvard.edu). Cardiac tests that pose no radiation risk include electrocardiogram (ECG), echocardiography, ultrasound, and magnetic resonance imaging (MRI). Radiologists in Harvard-affiliated hospitals, as well as those in many other leading medical centers, take precautions to minimize radiation exposure. This includes using regimes that allow cardiac CT scans to be performed with one-sixth the traditional radiation dose. The report’s findings were published in the July 2012 issue of the Harvard Heart Letter.
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No Evidence that PET and PET/CT Offers Advantages in Screening for Ovarian Cancer
ecause of the lack of relevant research, there is currently no substantial evidence that patients with ovarian cancer can benefit from positron emission tomography (PET) imaging alone or in combination with computed tomography (CT) imaging. As regards diagnostic accuracy, in certain cases, recurrences can be detected earlier and more accurately with PET or PET/CT than with conventional imaging techniques. This is the conclusion of the final report by the German Institute for Quality and Efficiency in Healthcare (IQWiG; Cologne; www. iqwig.de), which was published on May 23, 2012. Ovarian cancer is the fifth most common malignant tumor in women. Every year 15.9 women in every 100,000 are diagnosed with the disease in Germany and it claims the lives of eight in 100,000 women per year. Since the ovaries lie deep in the abdomen and an ovarian tumor typically causes no symptoms for a long time, it is frequently only discovered at a late stage. Many medical experts hope that a study utilizing PET or PET/CT alone or in combination with other modalities would be better able to distinguish between benign and malignant tumors when ovarian cancer is suspected. It could also help categorize cancerous tumors into the accurate stage, make it easier to assess whether they respond to treatment and to show earlier and with greater certainty, whether a recurrence or secondary tumor (metastasis) has occurred. This information should then enable patients to be given better treatment recommendations. IQWiG therefore searched the international literature for studies investigating the effects of diagnosis using PET or PET/CT on health aspects of direct relevance to patients. For example, the results of this research – and an appropriately personalized treatment – could contribute to patients having better chances of survival, spare them unnecessary operations or other diagnostic procedures, or improve their quality of life. However, the search for such studies was unsuccessful, so the question as to the patient-relevant benefit of PET or PET/CT had to remain unanswered. PET can better detect recurrences in certain cases. Moreover, IQWiG searched for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT were compared with other diagnostic methods. The basic question is how often a PET investigation gives a correct result. On the one hand, it should overlook true, cancerous tumors as rarely as possible, but on the other, it should not awake any false suspicions. The results of a total of 40 individual studies on this topic were evaluated. However, these studies permit a robust conclusion only in respect of the detection (or exclusion) of a recurrence, where PET or PET/CT appears to be more effective than other methods. Neverthe-

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less, it is still unclear whether this only applies to patients in whom symptoms (e.g., pain) have already occurred, or also to those in whom routine screening has shown an abnormal blood test result. This is because only very few studies give exact information on this point. Since even these patients have not been studied to determine whether the higher-assess accuracy of PET or PET/CT has positive effects on mortality, the burden of disease or the quality of life, IQWiG assumes that a patient-relevant benefit of PET or PET/CT is not proven. For instance, it is particularly questionable whether a recurrence detected by PET or PET/CT can actually be better treated – and the patient thereby has a noticeable advantage. Therefore, it is imperative that doctors fully

inform their patients not only of the possible benefits in the form of an earlier diagnosis, but also of the possible hazards. The latter can arise from an earlier start to second-line treatment associated with considerable side effects, but not with a prolongation of survival. Therefore, studies are urgently needed to assess the patient-relevant benefit of PET or PET/CT in the diagnosis of ovarian cancers in direct comparison with conventional diagnostic techniques. IQWiG published the early findings in the form of the preliminary report in July 2011 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee (G-BA), in March 2012. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.

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Portable Oscilloscope Easily Performs Complex Data Analysis to Test Imaging Equipment
ith a new handheld oscilloscope, the complicated data analysis required to test imaging equipment is simple to learn, easy to use, and quick to complete. It combines the capabilities of a digital multimeter with the performance of a bench oscilloscope and digital data storage/analysis of a paperless recorder so that a field technician can rapidly identify the true cause in complicated problems. Fluke Biomedical (Everett, WA, USA; www.flukebiomedical.com), a global provider of medical device test and safety equipment, recently announced the debut of its new 190M Medical ScopeMeter. “Avoiding one unnecessary board change or even half a day of downtime saves a facility more dollars than the entire cost of a 190M,” explained Hongbo Chen, product manager for Fluke

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Biomedical. “To minimize downtime and repair costs, you need to get to the root cause of problems as quickly as possible. The 190M Medical ScopeMeter test tool offers a number of unique features that help you quickly set up the scope and diagnose difficult problems like intermittent events, signal fluctuations, or drift. Troubleshooting is easier with the 190M.” Imaging equipment now utilizes sophisticated, interrelated technologies such as digital networking and video. In turn, this equipment needs equally sophisticated test equipment to ensure proper functionality and patient safety. Designed for equipment imaging and power quality troubleshooting, the 190M measures short-duration pulses, time-based signals, three-phase power meas-

urements, and transient and electrical noise systems. High-resolution waveform analysis makes visual performance inspection fast and easy, while ideal waveform overlays allow for immediate pass/fail analysis of machine performance. The ability to record signals over time captures defects not visible to simple multimeters,

and due to the record function, the 190M can be set to record when the machine is on.
Image: With the 190M Medical ScopeMeter handheld oscilloscope, the complicated data analysis required to test imaging equipment is simple to learn, easy to use and quick to complete (Photo courtesy of PRNewsFoto / Fluke Corporation).

Pretreatment PET Imaging of Lymph Nodes Predicts Recurrence in Breast Cancer Patients
isease-free survival for invasive ductal breast cancer (IDC) patients may be simpler to predict with the help of F-18-fludeoxyglu-

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cose positron emission tomography (PET)/computed tomography (CT) imaging scans, according to new research.

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The study’s findings were reported in the September 2012 issue of the Journal of Nuclear Medicine, published by the Society of Nuclear Medicine and Molecular Imaging (Reston, VA, USA). New data revealed that high maximum standard uptake value (SUVmax) of F18-FDG in the lymph nodes prior to treatment could be an independent indicator of disease recurrence. “Many studies have revealed that breast cancer patients with axillary lymph node metastasis have a significantly poorer prognosis than those without nodal metastases,” noted Sang-Woo Lee, MD, PhD, from the department of nuclear medicine, Kyungpook National University Hospital (Daegu, Korea; http:// med.knu.ac.kr), and one of the authors of the study. “However, the prognostic value of F-18-FDG uptake in metastatic axillary lymph nodes with PET/CT has not been investigated in IDC patients,” he added. In the study, researchers monitored 65 female patients with IDC who had undergone pretreatment F18-FDG PET/CT and who had pathologically confirmed axillary lymph node involvement without distant metastases. Factors such as age, TNM (tumor, lymph node, and metastases) stage, estrogen receptor status, progesterone receptor status, human epidermal growth factor

receptor 2 status, and SUVmax for the primary-tumor and axillary lymph nodes were analyzed. Patients underwent treatment and were followed for 21-57 months (median of 36 months). Among the patients, 53 were disease-free and 12 had disease recurrence during the follow-up period. While both the primary-tumor and nodal SUVmax were higher in patients with recurrence, the nodal SUVmax was significantly higher. Moreover, compared to the other factors that were analyzed, only nodal SUVmax was found to be an independent determinant of diseasefree survival. Using a receiver-operating-characteristic curve, the researchers demonstrated that a nodal SUVmax of 2.8 was the optimal cutoff for predicting disease-free survival. “One of the important roles of molecular imaging in cancer research is to noninvasively predict precise prognosis. Our results showed significant improvement in the accuracy of risk prediction for disease-free survival rates when nodal SUVmax was added to wellknown established risk factors,” stated Dr. Lee. “Our study suggests that 18 F-FDG PET/CT could yield useful information for risk stratification and treatment strategies in IDC patients with axillary lymph node involvement.”
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MRI Identifies High Prevalence of Abnormalities in Osteoarthritis Patients
new study’s findings revealed that magnetic resonance imaging (MRI) detected a high incidence of abnormalities associated with knee osteoarthritis in middle-aged and elderly patients that had no evidence of knee osteoarthritis in Xray images. Ali Guermazi, MD, PhD, a professor of radiology at Boston University School of Medicine (BUSM; Boston, MA, USA; www.bumc.bu.edu) and chief of musculoskeletal imaging at Boston Medical Center (BMC), led this study in collaboration with researchers from Lund University (Sweden; www.lunduniversity.lu.se), Brigham and Women’s Hospital (Boston; www. brighamandwomens.org), and Klinikum Augsburg (Germany; www.klinikum-augsburg.de). The findings were published online August 2012 in the British Medical Journal (BMJ). Osteoarthritis, the most typical form of arthri-

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tis, is characterized by a degeneration of cartilage and the underlying bone and other soft tissues in the joints, leading to pain and stiffness. It is responsible for a considerable portion of primary care visit and hospitalizations and has a large financial impact on healthcare. With the aging population, it is predicted that the prevalence of osteoarthritis will continue to increase. Earlier imaging research has shown that only half of those with knee pain will have X-ray findings of osteoarthritis. This study looked at how to further evaluate a patient’s knee pain if X-rays do not show evidence of osteoarthritis. It also examined whether MRI, in these cases, is of clinical value. This observational study looked at the prevalence of MRI-detected abnormalities in a group of adults over the age of 50 who had no signs of knee osteoarthritis in X-ray images. The

researchers looked at right knee MRI scans of 710 ambulatory patients from the Framingham Osteoarthritis Study. Further analysis was performed on groups by age, gender, body mass index and the presence or absence of knee pain. The study’s findings revealed demonstrates that approximately 90% of the knees that showed no signs of osteoarthritis using X-ray showed clear signs of osteoarthritis using MRI. Moreover, MRI abnormalities were highly prevalent even in persons whose knees were not painful, suggesting that MRI was not a useful diagnostic test in this age group to evaluate knee pain. “These data demonstrate a very high prevalence of MRI-detected osteoarthritis features in knees with no X-ray evidence of the disease,” said Dr. Guermazi. The researchers noted that MRI would be too costly to perform as a routine imaging investigation.

MR Imaging, Motor Score Modeling Predicts Recovery After Spinal Cord Injury
or people suffering with spinal cord injuries (SCIs), the time following the injury are filled with uncertainty about their potential for recovery and future independence. A new model based on motor scores at admission and early imaging studies may allow clinicians to predict functional outcomes and guide decision-making for therapy and care-giving needs. These new findings were published August 10, 2012, in the Journal of Neurotrauma. The innovative prediction model, which combines acute functional measures and evidence of injury on magnetic resonance imaging (MRI) including swelling and bleeding around the spinal cord, and which was gathered from two large clinical datasets, could help guide treatment decisions, classification of patents for clinical trials, and counseling of patients and families. Jefferson Wilson, MD, Michael Fehlings, MD, PhD, from University of Toronto (Canada; www. utoronto.ca) and Toronto Western Hospital (Canada), and colleagues from the US described the prediction model and its potential applications. “An important goal of medical research is to identify early surrogate markers that could assist treating physicians in determining appropriate therapeutic strategies,” said W. Dalton Dietrich, III, PhD, The Miami Project to Cure Paralysis, University of Miami (FL, USA) and deputy editor of the journal. “This article provides important information that could help predict the potential for recovery after SCI and thereby direct treatment options.”

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GENERAL IMAGING SYSTEM
GE Healthcare The LOGIQ E9 is designed to integrate real-time ultrasound with previously acquired CT, MR, PET or ultrasound images. Additional benefits include visual tracking of position during a scan, full-sized floating keyboard, intuitive control layout, scan assistant option, and a customizable panel.
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Specialized Noninvasive Imaging Technology Successfully Examines Epilepsy Patients
study outlines how a new type of noninvasive brain scan taken immediately after a seizure gives important insight into possible causes and treatments for epilepsy patients and may lead to means of meeting the long-sought challenge of locating the brain regions responsible for seizures in individual patients. Most research has focused on studying patients during seizure, (technically, the “ictal” phase of a seizure) and some of these studies involved invasive methods such as surgery to collect data. In the new study, published online ahead of print August 24, 2012, in the journal Brain, a team of University of Minnesota (Minneapolis / St. Paul, MN, USA; www.umn.edu) biomedical engineers and researchers from Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org) used a novel approach by studying the brains of 28 patients immediately after seizures (technically, the “postictal” phase). A specialized type of noninvasive

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EEG with 76 electrodes was attached to the scalp for gathering data, in contrast to most previous research that used 32 electrodes. Specialized imaging technology was used to gather data about the patient. The findings show that important data about brain function can be gathered through noninvasive methods, not only during a seizure, but immediately after a seizure. Specifically, the study shows that the frontal lobe of the brain is most involved in severe seizures, and that seizures in the temporal lobe are most common among adults. The new technique will further help determine the side of the brain where the seizures originate. “This is the first-ever study where new noninvasive methods were used to study patients after a seizure instead of during a seizure,” said Bin He, PhD and biomedical engineering professor in the University of Minnesota’s College of Science and

Engineering and senior author of the study; “It’s really a paradigm shift for research in epilepsy. The imaging technology that we developed here at the University of Minnesota allowed us to tackle this research and gather several thousand data points,” he added.
Image: Brain scans of test patients using new technology and methods show that the frontal lobe of the brain is most involved in severe seizures (Photo courtesy of the University of Minnesota).

Small Bowel X-Rays, CT Enterography May Be Replaced by MR Enterography for Children with Crohn Disease
arents with children nine years old and older who have Crohn disease should ask their child’s physician about magnetic resonance (MR) enterography as a replacement for small bowel Xrays or computed tomography (CT) enterography, a new study revealed. Children with inflammatory bowel disease must often undergo repeated examinations, which, with X-rays and CT, could lead to significant radiation exposure, reported William A. Faubion, Jr., MD, one of the authors of the study. “MR enterography does not require any radiation, however the patient does have to drink an oral contrast agent, must hold their breath at times and must limit their motion during the examination, all which can be difficult for pediatric patients,” stated Dr. Faubion.

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The study, which is the largest North American study of its kind, examined 70 pediatric patients who underwent MR enterography to review the quality of MR enterography scans and to determine if pediatric patients could tolerate the examination. The study, performed at the Mayo Clinic College of Medicine (Rochester, MN, USA; www.mayo.edu/mms), discovered that “MR enterography performs as well in children as it does in adults. MR enterography could accurately identify inflammation 80% of the time in the terminal ileum, 79% of the time in the right colon and 90% of the time in the left colon,” said Dr. Faubion. Whereas a similar study using CT in children has not been performed, in adults MR and CT enterography have been demonstrated to be similar methods of

small bowel imaging, according to Dr. Faubion. “In addition, we found that MR enterography could be successfully completed in the majority of children nine years old and older, without having to sedate them,” he said. The number of patients who suffered side effects was low; two patients experienced nausea and one patient fainted, however, no ongoing care was required, he said. One patient refused to drink the contrast material. Tolerance to the procedure was related to the amount of contrast the patient had to drink; the study found that younger children could drink a smaller amount of contrast material without negatively affecting the MR enterography image quality, according to Dr. Faubion. The study was published in the September 2012 issue of the American Journal of Roentgenology.
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Ultrasound Proves Effective Diagnostic Tool for French Athletes at London Olympics
ltrasound was used as an extension to the clinical examination for the French elite sportsmen and women at the London 2012 Olympic Games. The two GE Healthcare (Chalfont St. Giles, UK; www.gehealthcare.com) ultrasound systems available to them on an exclusive basis are GE Healthcare’s Logiq S8 and the Venue 40. These systems are in addition to the numerous technologies also available and all other competing athletes at the Olympic Polyclinic. French athletes if unwell will go to the “French clinic,” housed within their living quarters at the Olympic Village to describe where it hurts. In turn, the doctor will use the probe to examine the affected area, in particular in correlation with different movements that the athlete will be asked to make. Dr. Laurence Bellaiche, a radiologist specialized in sports medicine commented, “There is an incredible dynamic aspect with the use of ultrasound that we don’t have with other modalities. For example, I’ve just conducted an ultrasound on one of the French Olympic athletes which showed that his Achilles tendon had a fibrous nodule with an apparently recent tear. In addition, I conducted an MRI [magnetic resonance

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imaging] scan to have the complete picture for this elite athlete. With the MRI scan, the tear showed up well, but not the nodule. Only the excellent spatial resolution of the ultrasound could do this. So I was able to use both methods to help facilitate a complete diagnosis – which is vital for us.”
Image: The Logiq S8 multipurpose ultrasound system (Photo courtesy of GE Healthcare).

Ultrasound-Based Renal Denervation Treats Resistant Hypertension
medical company released three-month data from the company’s first-in-human clinical study (SOUND-ITV) to treat resistant hypertension using catheter-based ultrasound. In addition to office-based blood pressure measurements, patients in the study underwent 24hour ambulatory blood pressure monitoring (ABPM) prior to the ultrasonic renal denervation procedure, and subsequently three months after the procedure. The office-based blood pressure measurement results showed an average decrease of -25.6/-12.5 mm Hg. Consistent with these results, and even more impressive, the 24-hour mean blood pressure decreased by -23.1/-11.9 mm Hg. Patients were treated at Holmolka Hospital (Prague, Czech Republic; www.homolka.cz). Patients enrolled in the study were selected based on a history of hypertension that could not be controlled with medical therapy. The SOUND-ITV study was designed to evaluate the safety and effectiveness of the company’s volumetric dosimetry-controlled application of unfocused ultrasound (patents pending). “These results demonstrate the ability of Sound Interventions’ ultrasound technology to significantly lower blood pressure in patients whose blood pressure was unable to be controlled by conventional pharmaceutical therapy,” stated Dr. MUDr. Petr Neuzil, CSc., FESC, chairman, department of cardiology of Holmolka Hospital Dr. Vivek Reddy, of Mt. Sinai Medical Center

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(New York, NY, USA), who collaborated with Dr. Neuzil and who is an advisor to Sound Interventions, Inc. (Stony Brook, NY, USA; www.sounditv.com), commented, “The use of 24hour monitoring to assess results of renal denervation procedures is a more accurate measurement of effectiveness than office-based blood pressure. The favorable results seen on the ABPM fortify our confidence in the efficacy of this technology.” “These results, demonstrate the efficacy of Sound Interventions’ ultrasound dosimetry-controlled approach to renal denervation. Before initiation of the SOUND-ITV study, the company performed extensive in vitro and in vivo testing to refine the ultrasound dosimetry. The preclinical testing has demonstrated that the Sound Interventions technology is unique in its ability to ablate the target nerve fibers while sparing the arterial wall,” said David Smith, president and CEO of Sound Interventions. “The success of the acute procedures in the SOUND-ITV Study, along with these very strong clinical results validate this research and indicate that we are well on the way to developing the state-of-the-art renal denervation technology.” Findings from the SOUND-ITV study was presented at the TCT 2012 Conference in Miami Beach (FL, USA), October 22-26, 2012. Sound interventions is an emerging medical technology company focused on the development of therapeutic ultrasound for the treatment of resistant hypertension.
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FLAT PANEL DETECTOR
iRay Technology The Venu 1417 amorphous silicon detector is equipped with traceless automatic exposure control function, and offers image acquisition in less than 0.8 seconds. The detector is intended for general radiographic applications, including mobile DR systems and DR upgrades.
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Fujifilm Medical Systems The FDR D-EVO Suite II is designed to optimize workflow while utilizing any of the FDR D-EVO portable detectors. Key features include new automation and display features on the tube head, along with a convenient touch screen for system adjustments traditionally found at the generator console.
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3T MR SCANNER
Siemens Healthcare The Magnetom Spectra is designed to provide premium imaging at a reduced total cost of ownership compared to other scanners in the same price range. The system is designed for easy and efficient operation, and delivers crisp, high-resolution images in a wide range of imaging applications.
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Automated Breast Ultrasound System Receives FDA Approval
n automated breast ultrasound system is first device approved specifically for cancer screening of women with dense breasts in United States, Canada, and Europe. U-Systems (Sunnyvale, CA, USA; www.u-systems.com), a developer of automated breast ultrasound system, announced that the somo•v automated breast ultrasound (ABUS) system has been approved by the US Food and Drug Administration’s (FDA) for breast cancer screening as an adjunct to mammography for asymptomatic women with dense breast tissue. With the approval, the somo•v ABUS system becomes the only device approved specifically for screening women with dense breasts. “The FDA approval of the somo•v ABUS device is an exciting and important development in the detection of early, curable breast cancer. The use of somo•v for screening women with dense breasts will undoubtedly have a positive impact for women currently being underserved by mammography,” said Rachel Brem, MD, director of breast imaging at The George Washington University Hospital (Washington DC, USA). “Mammography is an effective tool at finding breast cancer, but it doesn’t work equally well in everyone. Recently completed studies demonstrated [that] with the addition of ABUS we find about 30% more cancers in women who have normal mammogram, normal physical examination,

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and dense breasts. For the more than 40% of women who have dense breasts, this is a significant advancement in their breast healthcare.” FDA approval comes after a Radiological Devices Panel of the FDA’s Medical Devices Advisory Committee unanimously recommended approval of U-Systems’ premarket approval (PMA) application in April 2012. The somo•v ABUS system is the only ultrasound device approved for breast cancer screening in the United States, Canada, and 27 European Union countries as an adjunct to mammography for asymptomatic women with dense breast tissue. “We are proud to announce that the somo•v ABUS system has received FDA approval for breast cancer screening and U-Systems can offer radiologists and breast imaging experts an important new tool to improve early detection in women with dense breasts,” said Ron Ho, president and CEO of U-Systems. “Enabling radiologists to use the information obtained from mammography and integrate that with the information obtained with ultrasound, leverages the potential of ABUS in a screening environment to find the 30% additional cancers that would not have been found with mammography alone. Research shows that ABUS can help find cancer in women with dense breasts, and that the cancers are smaller and early stage. With formal approval,

we are moving rapidly from development to commercialization and look forward to making the somo•v ABUS system more widely available across the United States.” Dense breast tissue not only increases the risk of breast cancer up to four to six times but also makes cancer more difficult to detect using mammography, according to multiple large studies. One study, published in 2007 in the New England Journal of Medicine (NEJM), showed 35% of breast cancer goes unidentified by mammography in women with dense breasts because density masks the appearance of tumors. As

breast density goes up, the accuracy of mammograms declines. Using proprietary technology to automate the ultrasound imaging process, the U-Systems’ somo•v ABUS system was developed specifically for the high-volume, breast cancer screening environment. The somo•VIEWer Advanced threedimensional (3D) Workstation enables fast, accurate review, and archiving of patient exams, optimizing breast ultrasound screening workflow.
Image: The somo•v ABUS device (Photo courtesy of U-Systems).
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for latest news updates visit www.MedImaging.net

Radiation After Lumpectomy Better for Most Older Early-Stage Breast Cancer Patients
or the majority of older, early-stage breast cancer patients, radiation therapy following breast-conserving surgery may help prevent the need for a later mastectomy. The findings, published August 15, 2012, in the journal Cancer, are contrary to current US treatment guidelines, which recommend that older women with early stage, estrogen-positive disease be treated with lumpectomy followed by estrogen blocker therapy alone – and skip altogether radiation therapy postsurgery. The potential benefit of radiation in this patient population has been the focus of much research over the past 10 years, according to Benjamin Smith, MD, assistant professor in the department of radiation therapy at the University of Texas MD Anderson Cancer Center (Houston, TX, USA; www.mdanderson.org), and the study’s corresponding author. In 2004, a major study revealed that women who received tamoxifen alone, compared to tamoxifen and six weeks of radiation, had a slightly higher incidence of breast cancer recurrence. Nevertheless, there was no difference in mastectomy rates or survival between the two cohorts, according to Dr. Smith. Based on these findings, the US National Comprehensive Cancer Network (NCCN; Fort Washington, PA, USA; www.nccn. org), adjusted its treatment guidelines, and radiation therapy following lumpectomy was no longer recommended. Dr. Smith then followed up this guideline-changing research with a population-based study, confirming the earlier findings with respect to breast cancer recurrence. “The motivation for this new research was to do a similarly designed study with longer term follow up,” stated Dr. Smith. “We wanted to do a 10-year update, focusing specifically on the mastectomy question. The fundamental reason it was determined that women didn’t need radiation was because the additional therapy did not change mastectomy rates.” For the population-based study, Dr. Smith and his colleagues derived a cohort of US Medicare patients from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) registry who would have been eligible for the 2004 study. The researchers identified 7,403 patients ages 70-79 treated with a lumpectomy for early-stage estrogenpositive breast cancer. All were diagnosed between 1992 and 2002, with follow-up through 2007. Of the

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7,403 women, 88% received radiation after their lumpectomy. Within 10 years of their treatment, 6.3% of the women who did not receive radiation therapy had a mastectomy, likely because of a breast cancer recurrence, according to Dr. Smith, compared to 3.2% who had the further treatment. In patients with high-grade tumors, irrespective of other factors such as age and/or tumor characteristics, radiation appeared to be very beneficial. The researchers also discovered a subset of women for whom radiation did not benefit, and

therefore could be omitted from care regimen: those 75-79 years of age who had their lymph nodes assessed and did not have high-grade tumors. “I think the national guidelines, while well intended and important, may gloss over the certain nuances needed for making critical decisions with patients,” concluded Dr. Smith. “Our study may shed additional light on some of those nuances and provides data that physicians can use when talking to their patients about whether to go forward with radiation. Personally, having this data point, together with the previous findings, gives me the confidence to not routinely recommend radiation in women age 75 and over with non-high grade tumors.”

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TECHNICAL S T G R AT I S • S E RV I C I O G R AT U I TO • S E RV I Z I O G R AT U I TO LITERATURE F R E E S E RV I C E • S E RV I C E G R AT U I T • K U N D E N D I E N

ULTRASOUND SYSTEM
Chison Medical Imaging The portable 8300 system features full-digital beam former, harmonic imaging, clear images, an ergonomic keyboard, multifunctional ports, and powerful software.
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PRODUCT CATALOG
Codonics Products available include Integrity medical image importer, Infinity medical image server, Virtua medical disc publisher, Clarity viewers, and Horizon multimedia imager.
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DIAGNOSTIC SYSTEM
Haiying The HY6000Pro color doppler is designed for accurate blood flow imaging, multibeam parallel processing, speckle reduction, ease of use, and tissue harmonic imaging.
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BREAST IMAGING CUSHION
Hologic The MammoPad is a soft, warm breast cushion designed for use during a mammogram that helps relax the patient, often resulting in better tissue acquisition.
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DR PANEL ACCESSORIES
Reina Imaging The accessories are for use with CXDI mobile DR panels. Products include grid encasements, DRP transformer holders, weight distribution caps, and mobile and tabletop holders.
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INTERVENTIONAL SUITE
Ziehm Imaging The Vision RFD combines the full flexibility of a mobile C-arm with fixed room imaging capabilities for a userfriendly, cost-effective option for a wide range of imaging applications.
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Intervention Makes it Easier for Children to Complete MRI Scanning Without Sedation

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US children’s research hospital reported success using a targeted educational strategy to teach young patients to remain motionless during magnetic resonance imaging (MRI) scans, making the process safer and less scary for the child. Sitting still is difficult for children, which makes MRI scanning a challenge. The scans require that patients remain motionless for extended periods. New findings revealed that a short-term, targeted intervention dramatically increases the likelihood that children as young as five years old will be able to undergo scanning without sedation. That is promising news for children with sickle cell disease, who were the focus of this study. Patients with sickle cell disease frequently undergo brain and liver MRI scans to monitor for complications related to their disease or treatment. However, the blood disorder puts patients at increased risk for serious anesthesia-related complications; therefore, sedation is avoided when possible. This study of 71 patients with sickle cell disease ages 5 through 12 found that children who completed the short preparation program prior to their MRI scan were eight times more likely to complete the scans without being sedated than patients of the same age who did not receive the preparation. The study’s findings were published online September 2012 in the journal Pediatric Radiology. The intervention implemented by the Child Life Program at St. Jude Children’s Research Hospital (Memphis, TN, USA; www.stjude.org) involves educating patients and families about exactly what to expect during an MRI, assigning patients jobs to focus on during the scans and working to identify strategies to help them remain motionless during the scanning process. “Some patients chose to listen to music or to squeeze a ball to help them remember not to move,” said Dr. Katherine Cejda, a St. Jude Child Life specialist and the study’s first author. “Some patients had the option of watching movies or having parents or other adults in the room with

them during the test.” This study is the first designed to determine the effectiveness of this approach and the first to focus on children with sickle cell disease. Dr. Cejda reported that similar programs are used by child life specialists throughout the United States to help prepare children for MRI scanning and other medical procedures. The article’s senior author, Jane Hankins, MD, an associate member of the St. Jude department of hematology, reported that avoiding sedation reduces the risk to the patients, especially those with sickle cell disease. Sickle cell disease is caused by a mutation in the gene for assembling hemoglobin. Hemoglobin is the protein red blood cells use to transport oxygen throughout the body. While red blood cells are typically pliable discs, the inherited error results in red blood cells becoming stiff and assuming a banana shape that can trigger intense pain and lead to organ damage. Dr. Hankins noted that the disease also makes anesthesia riskier. General anesthesia can lead to a decrease in temperature, blood oxygen levels, and dehydration. In patients with sickle cell disease, dehydration can result in a painful and hazardous accumulation of sickled cells. Patients can end up hospitalized, occasionally in the intensive care unit, for treatment of severe pain or acute chest syndrome, a pneumonialike illness, according to Dr. Hankins. To reduce that risk, a sickle cell patient scheduled for anesthesia is hospitalized overnight to receive extra fluids and possibly a blood transfusion. The combination of factors creates problems and added risk for the patient. It also adds to health care costs. Whereas no family ever pays St. Jude for the care their child receives, controlling costs remains important to the hospital. The program could also be adopted by other health care institutions worldwide to help manage cost. The intervention is now routinely offered to all St. Jude patients undergoing MRIs. Dr. Cejda noted that the program has been

used to help children as young as age four complete scans without sedation. “This preparation program offers a real advantage to patients,” Dr. Hankins added. The study included children scheduled for brain or liver MRI scans that usually last 30 to 60 minutes. Researchers reported that 30 of the 33 children, or 91%, in the intervention group underwent successful MRI scans without sedation. That compares to 71%, or 27 of 33 patients, who did not participate in the program prior to undergoing MR scanning without sedation. St. Jude Children’s Research Hospital has played a pivotal role in pushing overall US pediatric cancer survival rates from 20%-80%. No family ever pays St. Jude for the care their child receives.
Image: Colored magnetic resonance imaging (MRI) whole body scan of a 9-year-old boy (Photo courtesy of Simon Fraser / SPL).
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for latest news updates visit www.MedImaging.net

CT Angiography and Perfusion Effective in Assessing Coronary Artery Disease
n imaging strategy that incorporates noninvasive computed tomography angiography (CTA) and CT myocardial perfusion (CTP) imaging has been shown in a recent study to have high level of diagnostic accuracy for identifying patients with flow-limiting coronary artery disease in need of myocardial revascularization. The findings of the CORE320 study presented at the European Society of Cardiology (ESC) August 28, 2012, held in Munich, Germany, by Dr. Joao AC Lima, from Johns Hopkins [University] Hospital (Baltimore, MD, USA; www.hopkinsmedicine.org). The CORE320 study is a prospective multicenter international trial, which evaluated the diagnostic accuracy of combined noninvasive CTA, and CTP as compared with invasive angiography (ICA) and single photon computed tomography-myocardial perfusion imaging (SPECT-MPI). The primary objective was to determine whether combined noninvasive CTA and CTP could effectively determine the presence or absence of flow limiting coronary stenoses as defined by the combination of ICA and SPECT-MPI. Patients between 45 and 85 years of age with suspected or known coronary artery disease and clinically referred for ICA were eligible for participation. The study enrolled 436 patients, of whom 381 successfully completed all imaging at 16 centers in eight countries (Canada, USA, Brazil, The Netherlands, Germany, Denmark, Japan, and Singapore). The study design included four imaging components: CTA, stress CTP, ICA, and SPECT-MPI. Images were evaluated in double-blinded core laboratories. The area under the receiver operating characteristic curve (AUC) was used as the primary diagnostic parameter. The study was sponsored by Toshiba Medical Systems (Tokyo, Japan; www.toshiba-medical.co.jp). Sixty-six percent of the study participants were male, the median (interquartile range [IQR]) age was 62 [56, 68], body mass index 27 [24, 30], and Agatston calcium score 162 [9, 530]. Participants had a history of traditional risk factors for coronary artery disease – 34% were diabetic, 26% had a history of previous myocardial infarction, 29% had prior percutaneous coronary intervention, 78% were positive for hypertension, 68% were positive for dislipidemia, and 45% had a family history of coronary artery disease. The prevalence of obstructive coronary artery disease defined by combined ICA and SPECT/MPI was 38% and for ICA alone 59%. The patient-based diagnostic accuracy (AUC) of combined CTA and CTP for detecting or excluding flow-limiting CAD was 0.87 (95% CI 0.83-0.91), and 0.89 (95% CI 0.860.93) when the ICA stenosis reference standards were 50% and 70%, respectively. CTP increased the diagnostic accuracy of CTA alone to delineate flow-limiting disease (AUC 0.87 [95%CI 0.83-0.91] vs. 0.81 [95%CI

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0.77-0.86], respectively, p < 0.001). The combination of CTA and CTP had similar diagnostic power to the combination of ICA and SPECT-MPI in identifying revascularized patients at 30 days. “We found the addition of CT myocardial perfusion to CT angiography allows clinicians to distinguish between anatomic and flow limiting stenoses in patients with suspected coronary artery disease,” concluded Dr. Lima. The European Society of Cardiology (ESC) represents more than 75,000 cardiology professionals across Europe and the Mediterranean. Its goal is to reduce the burden of cardiovascular disease in Europe.

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PRODUCT NEWS

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

DATA EXCHANGE SYSTEM
eMix/DR Systems The Version 1.3 includes a zero-download, browser-based clinical viewer, along with new options and workflow enhancements. Features include improved image viewing, added password security, exam storage throughout local network, and greater control of package access.
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ALL-IN-ONE MEDICAL MONITOR
Gammatech The A22i can be securely docked onto a medical cart or carried by its ergonomic handle for instant patient file access. Key features include a full 22-inch touch screen display, high-resolution 2 MP web camera, and Intel WiFi with a Bluetooth option available.
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CANCER DETECTION SOFTWARE
iCAD The SecondLook Premier offers enhanced detection and includes clinical decision support tools such as CAD Metrics and CAD iNSIGHT. Key features include increased sensitivity, reduced false positives, and user preference for optimal reading efficiency.
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PNEUMONIA SOFTWARE
Riverain Technologies The ClearRead Bone Suppression software allows radiologists to detect more small lung opacities representing pneumonia than when reviewed with standard chest X-rays alone. The software also improves the detection of modules that may be lung cancer.
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Free Medical Film Digitization Service Cuts Costs from Healthcare Facility Budgets

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n on-site scanning service provides an earthfriendly, cost-effective archiving system for a cash-strapped medical industry. With hospitals continually looking for new ways to slash costs while keeping customers satisfied, anything that can achieve this – especially for free – is helpful. Moreover, when that product or service is good for the environment, and that is precisely why more and more healthcare facilities are utilizing Bayland Digital, Inc. (Houston, TX, USA; www.baylanddigital.com), a free medical scanning service that converts film X-rays into digital format and then recycles the old X-rays. “Without a doubt, this is a win-win for all involved,” said Rudy Nematzadeh, Bayland Digital’s founder. “Patients are pleased because they can instantly receive high-quality, digital images of their older X-rays, and health care professionals can provide these digital scans while simultaneously cutting traditional archive-associated costs. As if that’s not enough, our no-cost service is earth-friendly. When X-rays are left to decompose in landfills, they are actually quite toxic, and so we’re trying to prevent that from happening through our complimentary recycling efforts.” Bayland Digital specializes in scanning film such as X-rays, computed tomography (CT) scans, ultrasounds, magnetic resonance Imaging (MRIs), mammograms. Once scanned, the images are loaded into a fully searchable Digital Imaging and Communications in Medicine (DICOM) format, which works with picture archiving and communication system (PACS) and electronic medical record (EMR) systems. Bayland Digital, which can complete the entire conversion process onsite at no charge to the client, will then recycle the original films. A HIPPA (Health Insurance Portability and Accountability Act of 1996)-compliant company,

Bayland Digital adheres to HIPPA’s stringent privacy policies and ensures an error-free, secure transfer process. Bayland Digital also has a thorough regimen for verifying digitized X-rays – each patient’s name and/or identification number is validated three separate times. Only then are scanned digital files safely stored either on the client’s server or on a complimentary server provided by Bayland Digital. “Everything we’re doing is part of an effort to support the conversion from analog to digital while reducing needless expenditures for our clients, their patients and everyone else who is affected by the physical, logistical, administrative, HR [human resources], and financial deadweight associated with outdated or traditional archiving,” stated Ash Attar, Bayland Digital’s cofounder. “Our solution eliminates the need for film storage,

retrieval service fees, per-scan costs and so much more. With hospitals and other medical organizations struggling to trim fat from their budgets, this free film scanning process is a financial no-brainer for all.” Bayland Digital, Inc. offers free medical film digitizing services. Founded by a team of information technology (IT) professionals, entrepreneurs, and medical equipment experts, Bayland Digital’s operates cutting-edge digital scanning equipment that is capable of digitizing and then recycling up to one million medical film sheets a month and on site, providing as fast, secure, and accurate final product.
Image: As part of the on-site scanning service, patient information is reverified and films are scanned into Bayland’s PACS server to be pushed to client’s PACS (Photo courtesy of Bayland Digital).
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for latest news updates visit www.Medimaging.net

IT/PACS UPDATE

Image-Enabled EHR Now Features Cloud-Hosted Imaging Clinical Information System
n imaging clinical information system (ICIS) consolidates image capture, storage, exchange, and access through the electronic health record (EHR), providing enterprise-wide access and viewing capabilities. Agfa HealthCare’s (Mortsel, Belgium; www. agfahealthcare.com) ICIS is now available as a cloud-based solution that provides true enterprise imaging data management. With options for organizations of all sizes, Agfa HealthCare has made image-enabled EHRs a reality, integrating record workflow, capture, storage, exchange, and access. Anytime, anywhere data access supports health information exchange (HIE) connectivity across the medical imaging enterprise and the continuum of patient care. Designed on open standards, ICIS is a vendor-neutral platform that provides facilities and departments the ability to utilize existing legacy infrastructure to access a distinctively integrated and communicative dataset. Agfa HealthCare Impax customers, similarly, can also integrate with the company’s line of Impax regional and departmental solutions, including Xero technology and Impax radiology information system (RIS), picture archiving and communication system (PACS), and reporting features have been designed to realize operational efficiencies and develop a unified view of the patient. “We’re excited about what ICIS is doing to advance medical imaging, and how it fits into healthcare delivery of the future,” said Lenny J. Reznik, director of enterprise imaging and information for Agfa HealthCare. “We’ve taken imaging data out of disconnected silos and made cloud-based connectivity attainable, which ultimately increases ROI [return on investment] and improves the delivery of patient care.” Electronically managing radiology operations from end-to-end, the Impax RIS system encompasses patient registration, worklist generation, medical reporting, transcription, and business intelligence, integrating key elements of medical imaging workflow. The fully embedded Impax Reporting system provides radiologists with the image, data, and reporting tools they need to streamline their reporting task and enable them to work more efficiently. Recently added are extended addendum workflows and customizable templates, along with more on the on-the-fly personalization of standard texts. The Impax Mobile Worklist allows the technologist to be mobile within the hospital and maintain full tech workflow throughout the patient experience. From signing consent forms to real-time procedure status, the patient wait time will be greatly reduced while still maintaining a streamlined and integrated workflow within the Impax range of products.

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Image: A screenshot from the ICIS EHR platform (Photo courtesy of Agfa HealthCare).

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PRODUCT NEWS

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

TRIGGERING DEVICES
Tekscan The TT-1 and TR-1 allow users to synchronize data recordings frame by frame with devices that provide a pulseper-frame signal, like 3-D motion analysis systems. The devices allow for a complete remote picture of human gait and foot function, and serve to help choose treatment options.
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VENDOR NEUTRAL ARCHIVE
TeraMedica The Evercore VNA is designed to neutralize data for sharing across disparate PACS solutions in the HIE, while also retaining a site’s original content to support ongoing use in the originating institution. Evercore also offers a full range of attributes including analytics, trending, and unlimited scalability.
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MEDICAL DISPLAYS
Totoku The i2 line includes three grayscale displays (2, 3, and 5 MP) and two color displays (2 and 3 MP). All models offer the new display port interface that enables users to connect to DVI signals and video cards, as well as the latest display port cards from various vendors.
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ELECTRONIC HEALTH RECORD
Viztek The Opal-EHR enables facilities to streamline schedule management by predicting insurance authorization time windows, based on procedure type and specific insurer policies. The system can also delay exam scheduling if authorizations have not been received.
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Web/Mobile Universal Medical Image Viewing Software Supports 10 Languages

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web and mobile universal medical image viewing software, already in use globally, now supports 10 languages. Calgary Scientific, Inc. (Calgary, Alberta, Canada; www.calgaryscientific.com), recently introduced ResolutionMD 3.1 to the global medical community. ResolutionMD is known for its US Food and Drug Administration (FDA) clearance for diagnosis on mobile iOS and web, web and cloud scalability, data security, comprehensive collaboration capability, and rapid access on both iOS and Android devices. The company will continue to expand its market share through partnerships with many of the world’s most notable global original manufacturer equipment (OEM) partners. All of these factors have led to increased global demand. The ability to locate and access patient images and reports in real time, without any of that data remaining resident on the computer or mobile device is one of the key ways the company has differentiated itself. The application also demonstrates sophisticated collaboration functionality embedded within the product, allowing multiple users to share and interact with the application in real time from multiple locations and devices simply by clicking on an embedded link within an email or text. Patient data access made accessible from anywhere, on high and low bandwidth networks, gives clinicians the full picture needed to make a diagnosis from anywhere. Highlights of the 3.1 enhancements include: Expanded language support: ResolutionMD will now be supported in English, French, Italian, German, Spanish, Portuguese, Japanese, Korean, Simplified Chinese, and Traditional Chinese for both ResolutionMD Web and ResolutionMD Mobile. iPad and Android Tablet users can now view images side-by-side with ResolutionMD, for effective review of a study and comparing of images.

Earlier releases introduced new layout options on the web, now they are available on various mobile devices. The software has expanded its multisite data access abilities, and can now view the Digital Imaging and Communications in Medicine (DICOM) GSPS (giga-samples per second) from multiple picture archiving and communications system (PACS) solutions, based on a single simultaneous geographical search. GSPS can be viewed on web and mobile devices, making image and results distribution even more significant to the physician. ResolutionMD 3.1 is now completely configurable, flexible, and customizable at the Information technology (IT) and license management level. The software can now be configured to progressively add in levels of increased capability and sophistication to suit the needs of each site install. A user can begin with basic two-dimensional (2D) capabilities and then build upon that to include MIP/MPR (maximum intensity projection/multiplanar reformat) and full 3D; mobility; and real time collaboration, with each incremental level of sophistication and capability available to suit the makeup and needs of the end users, and the budgets of the enterprise. “Over the past four years, ResolutionMD has grown from a great viewer into a powerful integrated component of healthcare interconnected enterprise [HIE] platforms used to securely access images, reports and patient data needed to make a whole-picture diagnosis of a patient, regardless of where the data resides geographically, or which

vendor’s storage system it is housed,” said Pierre Lemire, president and CTO of Calgary Scientific. “We have grown strong relationships with leading luminary partners and those relationships have helped guide our product development so we are constantly leading the market with customerfocused technology innovations.”
Image: A screenshot from ResolutionMD 3.1 mobile software (Photo courtesy of Calgary Scientific).

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for latest news updates visit www.Medimaging.net

IT/PACS UPDATE

IT Certification Program Simplifies Patient-Specific Simulation
ew technology allows clinicians to rapidly, and as part of their operative preplanning, create virtual patient cases, on which realistic procedures can be practiced in a safe, simulated environment. Mentice (Gothenburg, Sweden; www. mentice.com), a leader in medical cardiovascular and endovascular simulation, announced that Pie Medical Imaging (Maastricht, the Netherlands; www.piemedicalimaging.com) will be the first company to join its VIST Case-It “Segmentation to Simulation” certification program. VIST Case-It lets users of Mentice’s VIST range of high-fidelity full-physics simulators easily import anatomy data from real patients to a simulator, using professional computed tomography/magnetic resonance imaging (CT/MRI) segmentation tools and standard hospital workflows. To ensure flawless workflow integration and operation between third-party segmentation solutions and the VIST medical simulators, Mentice has launched an open certification program for

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validating compatibility with the VIST Case-It technology. Pie Medical Imaging is the first company to obtain this certification for their 3mensio Vascular segmentation suite and can now under the certification program offer verified compatibility with Mentice’s VIST simulators. “In the future we will undoubtedly continue to see medical simulation becoming more directly integrated into existing hospital workflows. With our exciting new VIST Case-It technology, physicians have the ability to themselves create patientspecific simulated cases using the industry standard segmentation tools they are already familiar with. We are extremely pleased to welcome Pie Medical Imaging to our certification program, their products are some of the most innovative and appreciated on the market and are a perfect match for this technology,” stated Göran Malmberg, CEO of Mentice. René Guillaume, director of sales and marketing at Pie Medical Imaging, “We are proud to be

the first to offer verified compatibility of our product to Mentice’s customers. Our 3mensio Vascular suite is essential for patient-specific planning of endovascular procedures. Using both 3mensio Vascular and Mentice’s VIST will ensure every physician to be fully prepared for every procedure with the most advanced technologies.” Mentice presented the VIST Case-It technology at the CIRSE congress in Lisbon (Portugal) during September 14-19, 2012.
Image: The VIST Case-It features technology that allows physicians to create and treat virtual patient cases (Photo courtesy of Mentice).

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IT/PACS UPDATE

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

Healthcare IT Alliance to Provide Medical Image Access, Exchange, and Management
NAX Health (Dallas, TX, USA; www.gnaxhealth.com), Acuo Technologies (Minneapolis, MN, USA; www.acuotech.com), and Client Outlook (Allen, TX, USA; www.clientoutlook.com) reported on the formation of a new strategic alliance to provide an integrated and simplified system for medical image access, exchange, and management. The cloud-based, clinical content management solution delivered through this alliance offers healthcare providers a cost-effective way to implement a best-of-breed solution that includes a vendor-neutral archive (VNA) platform, an integrated universal medical image viewer, and image exchange strategies that fit the needs of healthcare organizations. The solution, available through a single contract, combines Acuo’s universal clinical platform (UCP) with Client Outlook’s eUnity clinical image visualization, sharing, and collaboration toolset, hosted within GNAX’s healthcare-focused cloud infrastructure and tier-4 data centers – all supported by a interconnected customer support program. This collective offering provides necessary components critical to building a highly secure disaster recovery and business continuity solution for medical imaging without the infrastructure and costs associated with a traditional model. This solution also provides a cost-effective way to store and protect data by freeing up primary local storage, reducing the

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total amount of storage needed, and changing from a capital-intensive local archive to a pay-as-you-go operational service. GNAX Health is also in the final stages of developing a web-based image exchange service, called SDEX (secure DICOM exchange). Integrated into the foundation of Acuo’s UCP and data structure as well with the Client Outlook viewer, SDEX provides customers with the advantages of a single, best-of-breed exchange solution. It meets the challenge of complicated workflows by integrating with the provider‘s employee and patient identification systems to secure access and simplify patient searches. Studies are retrieved from any of the connected picture archive and communication system (PACS), local edge devices or from the cloud archive, making the location of the image transparent to the end user. Providers are able to securely exchange and view images with other GNAX VNA and nonGNAX customers seamlessly, creating a health information exchange (HIE) platform with a workflow for medical imaging. Acuo’s UCP simplifies the process of managing clinical content, providing virtualization and normalization of medical images and non-DICOM (digital imaging and communications in medicine) data, service orchestration, data replication, clinical workflow, compliance and contextual data management services, with a built-in

performance management environment and dashboard. Client Outlook’s eUnity product provides a universal viewer that allows healthcare professionals access, manipulate, and collaborate in real-time with diagnostic quality medical images utilizing a webbrowser and a mobile application for tablets that enables “on-the-go” viewing of all image modalities, including X-ray, computed tomography (CT), magnetic resonance imaging (MRI), color ultrasound, and X-ray angiography. “The integration of these solutions solves a wide range of problems for our healthcare customers,” said Jeff Hinkle, chief executive officer for GNAX Health. “This offering tightly integrates world-class clinical content viewing, abstraction and life cycle management applications, data

migration, cloud-computing, and customer support services into a single bundle, greatly simplifying the process of administering enterprise medical image access, exchange, and management while reducing IT [information technology] costs.” All healthcare systems, including hospital networks, university hospitals, community hospitals, physician offices, and other organizations with complicated use-case requirements should benefit greatly from the interoperability and economies of scale offered by this alliance. The ability to accelerate access to patient information at the point of care along with the collaborative benefits of having an integrated viewing platform improves clinical decision-making, enhances quality of care, and speeds up treatment for patients.

New Imaging Management and Digital Templating Technology Developed for Orthopedics
new image management and digital templating solution for orthopedics has been developed that permits orthopedic surgeons access images taken at multiple locations in a single viewer, diagnose from anywhere at any time, plan for surgery with digital templating, and securely archive studies. Merge Healthcare, Inc. (Chicago, IL, USA; www.merge.com), a provider of clinical systems, announced the release of Merge OrthoPACS, a comprehensive image management and digital templating solution for orthopedics. “Merge’s OrthoPACS solution successfully demonstrates our large investment and commitment to the orthopedic market,” said Jeff Surges, CEO of Merge Healthcare. “We’ve combined new and innovative functionality with proven underlying technology to deliver a truly unified orthopedicspecific PACS [picture archiving and communication system] solution. Additionally, we’re excited to now offer OrthoPACS in a subscription model that will address clients’ requirements for pricing that more closely aligns with their long-term operating plans.” “We’ve already begun upgrading our practice to Merge OrthoPACS,” said Bradley Dick, chief information officer at Resurgens Orthopedics,

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Georgia’s largest orthopedic practice. “With Merge OrthoPACS, we’ll migrate from a legacy product to true Digital Imaging and Communications in Medicine (DICOM) archive technology which will make it easier to share and manage images across our 21 offices in metro Atlanta [GA, USA].” Orthopedic surgeons will find that the new solution fits into and enhances their current workflow. For example, orthopedic-specific workflows are built into Merge OrthoPACS, from clinic use to the operating room. The Merge OrthoPACS zero-footprint client viewer can be the only viewer for an orthopedic practice. That means reading images will be no different whether a surgeon reads from their workstation, their iPad, or another device. The viewer also provides access to presurgical templating, including advanced measurements and automated hip templating. Merge’s enterprise and cloudbased solutions for image intensive specialties provide access to any image, anywhere, any time. Merge also provides health stations, clinical trials software, and other health data and analytics solutions that engage consumers in their personal health.
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for latest news updates visit www.Medimaging.net

IT/PACS UPDATE

3D Workstation Visualizes Thrombi Previously Not Seen with Traditional Imaging
ew technology provides a groundbreaking, three-dimensional (3D) visualization tool that could enable a virtual angioscopy of the inside of cardiac structures using noninvasive computed tomography (CT) scanning. Intrinsic Medical Imaging (Bloomfield, MI, USA; www.intrinsic-mi. com), a developer of 3D medical imaging software, reported it has received US Food and Drug Administration (FDA) premarket notification clearance for its groundbreaking IMI Spectrum 3D imaging workstation (K121023). The company’s next-generation 3D capabilities will provide visualization and quantification tools designed to overcome errors, inconsistencies, and challenges associated with evaluating images utilizing existing conventional 2D and 3D methods. “Intrinsic provides revolutionary, advanced 3D visualization which could enable a virtual angioscopy of the inside of cardiac structures through a simple, noninvasive CT scan,” said Arie Blitz, MD, director, Heart Transplantation and Mechanical Circulatory Support, University Hospitals Case Medical Center (Cleveland, OH, USA). “For example, we processed a patient’s standard 2D CT images using the IMI technology and saw thrombi in 3D previously undetected in 2D. This is amazing technology.” Intrinsic employs uncompressed rendering techniques that preserve the integrity of the data from 2D to 3D, while enabling the user to navigate in real time, anywhere in the volume, while allaying visual artifacts and creating a more natural and user-friendly environment. High-performance algorithms process more than 100 times more operations per second than existing 3D systems, creating an order-ofmagnitude improvement in spatial resolution and image detail over existing standards. The IMI Spectrum 3D image visualization platform provides clinicians with diagnostic, planning, and treatment solutions to boost clinical effectiveness and speed the objective of saving lives. “Receipt of this clearance is a significant step for our company and we look forward to improving patient outcomes while reducing unnecessary healthcare expenditures through the introduction of the IMI Spectrum later this year,” said Jorey Chernett, CEO of Intrinsic Medical Imaging. “Engaging clinicians throughout the development process is core to our commercialization strategy and clinical feedback has been extremely positive on the potential of the IMI Spectrum technology. Intrinsic has attracted a highly accomplished team with deep domain expertise

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focused on revolutionizing 3D medical imaging.” Intrinsic Medical Imaging is a medical software company focused on the marketing of high-performance rendering techniques. The IMI Spectrum workstation, built around IMI’s Authentic 3D software, is an imaging system that enables the real-time processing, review, and analysis of volumetric data generated by conventional CT scanners.
Image: Aortic outflow, isolated in the Intrinsic 3D visualization software (Photo courtesy of Intrinsic Medical Imaging).

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Medical Imaging International November-December/2012

INDUSTRY NEWS

Philips in Alliance to Develop Catheterization Lab Integration for Vessel Characterization
hilips Healthcare (Best, the Netherlands; www.healthcare.philips. com) and Infraredx, Inc. (Burlington, MA, USA; www.infraredx.com), a medical device company focused on the diagnosis and management of coronary artery and other vascular diseases, have signed a joint development and collaboration agreement that involves incorporating Infraredx’s true vessel characterization (TVC) imaging system with Philips’ Allura Xper catheterization (cath) lab imaging systems. This collaboration is intended to enable seamless access to the TVC imaging system with Philips’ Allura Xray systems. “Philips is the premier provider of X-ray imaging technology

Global Refurbished Medical Equipment Market Forecast at USD 8.45 Billion by 2017

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for interventional cardiologists and we are pleased to partner with them on developing this integrated solution,” said Don Southard, president and chief executive officer of Infraredx. “Our goal is to offer physicians easier access to the TVC imaging system’s near-infrared spectroscopy and intravascular ultrasound technology for use in determining the true extent of cardiovascular disease, especially the presence of lipid core plaques [LCPs]. The imaging system is experiencing accelerated adoption in the United States and Europe. We believe this growth is the result of mounting clinical evidence around the role of LCP and continuous system enhancements.”

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he global refurbished market has seen challenging and dynamic market conditions, but still remains strong, with a size of approximately USD 8.45 billion in 2017 and an estimated annual growth rate of 7.8% over the next five years. A new market research report analyzed and studied the major market drivers, restraints, and opportunities in North America, Latin America, Europe, Asia, and the rest of the world. Refurbishing of medical device refers to restoring used equipment or systems into a condition of safety and effectiveness comparable to new including actions such as repair, rework, update, and replacement of worn parts with original parts. The new report studied the global refurbished medical equipment mar-

ket over the forecast period 20122017, published by market research company MarketsandMarkets (Dallas, TX, USA; www.marketsandmarkets. com). The global refurbished devices market is categorized into imagingdiagnostic-monitoring devices, minimally invasive surgical devices, radiation oncology devices, biotechnology instruments, and so others. Refurbished medical devices market is expected to grow at a more rapid rate with a compound annual growth rate (CAGR) of 7.8% from 2012 to 2017. Cost-effective offerings of used branded products and enhanced access to replacement parts and repair technology are contributing to widespread adoption of the refurbished medical devices by healthcare institutions worldwide.

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Carestream’s Preclinical in Vivo Imaging Business to Be Acquired by Bruker
arestream Health (Rochester, NY, USA; www.carestream health.com) and Bruker Corp. (Billerica, MA, USA; www.bruker.com) have entered into an agreement in which Bruker will purchase the preclinical in vivo imaging equipment product range and related assets from Carestream’s molecular imaging business. Financial terms of the agreement were not disclosed. Carestream will retain the remaining assets of its molecular imaging business, including its life science X-ray film product lines and its Gel Logic and Image Station in vitro imaging equipment-product range. Carestream will continue operating its life science X-ray film business, and will continue to support its in vitro product customers with service and parts. New production of its Gel Logic and Image Station in vitro products will be discontinued. Dr. Werner Maas, president of Bruker BioSpin Corp., commented,

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Medical Imaging International November-December/2012

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APRIL 2013
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