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MedImaging
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Vol.22 No.1 1-2 / 2012

ISSN 1068-1779
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Innovative Solutions for Sustainable Cardiovascular Care Presented

iemens Healthcare (Erlangen, Germany; www.siemens.com/healthcare) presented a portfolio of cardiovascular care imaging technologies, in vitro diagnostics, information technology (IT) solutions, and consulting services at the European Society of Cardiology (ESC) congress, held during September 2011 in Paris (France). Among the systems presented was the updated ACUSON SC2000 volume imaging ultrasound system, setting new standards in fourdimensional (4D) echocardiography workflow. In
one heart cycle and without stitching or electrocardiogram (ECG) gating, the system acquires the full volume of the heart at a 90 x 90 degree angle, including volumetric quantification of color Doppler, as well as the left and right ventricles. Angiography solutions presented included the Artis zee and Artis zeego systems, designed to support complex cardiology interventions. The Artis zeego assists in the treatment of structural heart diseases with a unique positioning flexibility and quality 2D and 3D imaging; a new generation of X-ray tubes further optimize the images, resulting in image contrast being more readily visible than before, even in real-time imaging of adipose patients at the lowest achievable doses. Intraprocedural representations of anatomy using the syngo DynaCT Cardiac software also play a major role in reconstructing the images captured during rotational angiography into a virtual 3D reconstruction. The Cardiac Dot workflow engine, developed to reduce the complexity of cardiac magnetic resonance imaging (MRI) scanning and to increase productivity available in the MAGNETOM scanners was also showcased. The new technology guides the user step-by-step through cardiac procedures, which are widely regarded to be some of the most complex MRI examinations. Customized protocols are automatically selected based on the patients condition and clinical indication. Standardized long and short axis views are generated based on anatomical landmarks, and are automatically carried over for subsequent sequences. Through the user guidance, patient personalization, and exam automation provided by Dot, imaging departments can increase their productivity by up to 50%. Solutions for nuclear cardiology were also demonstrated via IQSPECT on the Symbia S and Symbia T series, SPECT, and SPECTCT systems; IQSPECT dramatically reduces the length of imaging protocols from 20 minutes to less than five minutes. The shortened exams enable a sustainable approach to nuclear cardiology to potentially decrease radiation dose and make procedures more tolerable for the elderly, providing high quality diagnostic information and enabling users to better utilize an imaging resource that is affected by the limited availability of the key radiotracer.
Image: The Acuson SC2000 volume imaging ultrasound system (Photo courtesy of Siemens Healthcare).
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Medical Imaging International January-February/2012
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MRI Screening for Breast Cancer Benefits High-Risk, Underserved Women

sing breast magnetic resonance imaging (MRI) screenings among targeted, high-risk, underserved women considerably decreases diagnostic cost and increases patient compliance rates with follow-up compared to using just general risk mammography screenings. However, a caveat to these findings was that the United States cost of a MRI scan was reduced from an average of US$3,500 to $649 by a grant specific to the study. Cost per diagnosis was $37,375 for mammography compared to $21,561 for MRI at the grant-based rate, according to the researchers. What we need is to lower the cost of MRI, and maybe that will happen as we do more of them, said lead researcher Anne C. Ford, MD, assistant professor in obstetrics and gynecology at Duke University Medical Center (Durham, NC, USA; www.dukehealth.org). Early findings of the study, conducted by Dr. Ford and colleagues from 2004 to 2011, were presented at the Fourth American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities, held in Washington DC (USA) from September 18-21, 2011. The researchers compared breast cancer mammography screening in 299 general risk, underserved women to MRI screening in 299 high-risk, underserved women. Women with abnormal mammogram or abnormal breast MRI underwent ultrasound, ultrasound guided biopsy and/or stereotactic biopsy for mammogram cases, and/or MRI-guided biopsy for MRI cases. Results showed that mammographic screenings detected one breast cancer case, while MRI screenings detected nine cases. Benign breast/total biopsies were found in 88% of mammographic screening cases and in 78% of MRI cases. In an underserved population, using this model, it is cost effective to screen
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with MRI because we found more breast cancers with MRI than we did with mammography in this population, Dr. Ford said. If you truly target high-risk women with MRIs, you can find the cancers, and you can find them early. Moreover, compliance with follow-up in mammographic screenings was 75% and 90% in MRI screenings. Critical to those findings was the utilization of a breast navigation team, which recruited study participants from the general population at health and screening fairs in central North Carolina (USA), according to Dr. Ford. The navigation team was key in helping the women and these are all uninsured or under-insured women negotiate the medical center, she said.
Image: Colored magnetic resonance imaging (MRI) scan of the breast of a 56-year-old woman with breast cancer (Photo courtesy of Zephyr / SPL).
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MR Tractography May Provide Insights into Human Brain Anatomy

agnetic resonance tractography (MRT) is a valuable, noninvasive imaging tool for evaluating human brain anatomy, and as MRT methods and technologies evolve, has the potential to yield new and revealing information on brain activity and connectivity. Vital information about the promise and limitations of this technology is explored in a review article published online September 2011 in the neuroscience journal Brain Connectivity. Diffusion tractography allows scientists to visualize and determine the location of white matter in the brain. If current technological challenges associated with MRT are recognized and overcome, such as limitations in its accuracy and quantification, this imaging technique could make a signifi-
cant contribution to the field of brain connectivity and to an understanding of how information and signals are transmitted across the brain, according to Drs. Saad Jbabdi and Heidi Johansen-Berg, from the University of Oxford (UK; www.ox.ac.uk). This emerging technology offers a new window into human brain anatomy. The technique has enormous potential for revealing the architecture of the human brain and its breakdown in disease. Recent developments mean that some of the limitations and challenges associated with this technique could be effectively tackled in the near future, said Heidi Johansen-Berg, PhD, coauthor and professor of cognitive neuroscience and a senior research fellow at the University of Oxford Center for Functional MRI of the Brain.
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Novel Tilting Table Performs All Radiography and Fluoroscopy Procedures on a Single System
technologically advanced, new generation remote-controlled tilting table for radiography and fluoroscopy brings about workflow and cost optimization. The Clinodigit Omega is the newest Italray (Florence, Italy; www.italray.it) product, a next-generation device for both radiography and fluorography procedures that performs, in just one limited-size equipment, all the work of four different diagnostic rooms: digital fluoroscopy, emergency, radiography, and chest rooms. The original design of the table has allowed procedures not as yet available on traditional radio-fluoro devices. The Clinodigit Omega differentiates itself because of two main characteristics: the tilting tabletop movement in which the patient table can be removed from the active X-ray area allows for more than the traditional dynamic examinations typical of remote-controlled tables all the X-ray examinations require minimal patient-detector distance. It also performs radiography and fluoroscopy examinations directly on the mobile table for trauma patients that are too risky to move from mobile table to system tabletop, or for handicapped/elderly/bariatric patients who are difficult to move from mobile table to system tabletop. Clinodigit Omega, according to company spokespersons, is the only one that can perform both fluoroscopy and radiography on a mobile table. The tube stand rise allows a focus film distance (FFD) source-image distance (SID) of 200 cm, once the table has been removed from the active area. This distance cannot be found in any other remote-controlled tilting table. The well-established filmless technology has been improved by Italray with the Clinodigit Omega, introducing new standards in both digital radiography and fluorography, using, as an image acquisition system, a dynamic flat panel (amorphous silicon) for image display immediately after patient X-ray exposure. Once acquired, the image can be directly exported, (Digital Imaging and Communications in Medicine [DICOM]-format) to the information technology (IT) system in order to be visualized anywhere in the hospital network (other review stations), or to be sent to a DICOM printer, either exported on a read only device as CD/DVD for both an additional back up and to be delivered to patient. With Clinodigit Omega, we can now perform all X-ray examinations, both radiography and fluoroscopy, in one single room; this allowed us to switch from two dedicated rooms [one for radiography and one for fluoroscopy] to just one multipurpose room where all X-ray examinations can be performed with flexibility, patient comfort, and the excellent image quality given by the dynamic flat panel detector, stated Dr. Andrea Stiatti, director of diagnostic imaging department, Leonardo da Vinci Institute (Florence, Italy). Rather than taking the old remote-controlled table architecture and just replacing the II [image intensifier] with the flat panel detector, like many vendors have done, with Clinodigit Omega we started completely from a blank sheet and designed a 100% new product, which, thanks to its unique features and functionalities, allows users to use the new dynamic flat panel detector at its full potential and without any legacy limitation, said Filippo Recchi, export manager at Italray.
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Image: The Clinodigit Omega, designed for both radiography and fluoroscopy procedures (Photo courtesy of Italray).
Computed Radiography Systems Improve Workflow Efficiency in Orthopedic Practices

wo new computed radiography (CR) systems offer rapid throughput and high image quality, even in limited-space environments. Mid County Orthopaedic Surgery & Sports Medicine (www.signaturehealth.net), a division of Signature Medical Group (St. Louis, MO, USA), is now benefitting from the enhanced image quality and increased efficiency for the 40to 50-thousand spine, bone, and joint imaging examinations the facility performs each year. With new digital X-ray systems from Agfa HealthCare (Rochester, NY, USA; www.agfahealthcare.com), clinicians at Mid County Orthopaedic are looking forward to improvements in the delivery of patient care. Imaging is a very important element of our
practice, and to remain competitive and assure our patients were receiving the best care, we knew it was critical to invest in high-quality digital Xray systems, said Mary Jones, Imaging Supervisor, Mid County Orthopaedic. We anticipate significant improvements in both workflow efficiency and image quality from our implementation of Agfa HealthCares imaging solutions; improvements that will enable us to focus more on the patient and enhance the overall level of care we provide. The CR 30-X tabletop X-ray digitizer enables a more convenient and faster workflow throughout the entire imaging process. The system offers
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the efficiency and excellence in image quality typically expected from a full-sized model. The size and ease of use of the CR 30-X is suitable for private practices such as Mid County Orthopaedic to meet all workflow requirements. The CR 35-X supports a broad range of applications and provides significant results to a facility experiencing a high volume of spinal examinations among other common orthopedic exams. The system is expected to improve efficiency for clinicians at Mid County Orthopaedic, who conduct thousands of exams monthly. Agfa HealthCares computed radiography [CR] imaging solutions are an excellent match for the advanced orthopedic care needs at Mid County or any other orthopedic practice, said Merry Guy, senior marketing manager, Agfa HealthCare US. By providing affordable solutions with rapid throughput and high image quality, even in limited-space environments, our customers can focus on providing excellent care while still managing costs. Both CR systems include Agfa HealthCares patented Musica2 image processing software, optimizing image quality and workflow. Musica2 consists of intelligent image processing technologies that independently adjust multiple levels of contrast and density within images. By producing a high image quality, independent of modality or acquisition technology, the clinician can now spend less time manipulating images and more time at the patients side. In addition to Musica2 technology, Mid County Orthopaedic will benefit from the CR systems use of Agfa HealthCares NX workstation. The NX workstation provides clinicians with the ability to streamline workflow for direct radiography (DR) and CR systems and includes a full complement of management tools to assure that staff and systems are operating as planned. The CR 30-X and CR 35-X support the NX Full Leg Full Spine application where up to three, 35.56 by 43.18-cm images are automatically stitched together to create accurate full leg or full spine images for orthopedic measurements. The NX workstation provides the tools to measure distances and angles and determine leg length differences and scoliosis angles.
Image: The CR 30-X tabletop X-ray digitizer (Photo courtesy of Agfa HealthCare).
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Angiography Navigation System Offers Reduced Radiation Dose

ew angiographic navigation technology has been developed that incorporates a medical positioning system to localize compatible devices without radiation as overlay on a prerecorded angio-scene with high accuracy. This has the potential to reduce dose for lengthy procedures by eliminating the need for patients to undergo continuous fluoroscopy in order to track the catheter. Siemens Healthcare (Erlangen, Germany; www.medical.siemens.com) has integrated the navigation technology MediGuide from St. Jude Medical (St. Paul, MN, USA; www.sjm.com) into its Artis zee angiography systems. The technology is also available as an upgrade for a number of existing Artis zee floor-mounted and biplane systems and the Axiom Artis dFC and Axiom Artis dBC. The MediGuide Technology uses a special electromagnetic tracking procedure to determine the position of medical devices during minimally invasive interventions. A miniaturized sensor incorporated into a catheter can be located by receiving electromagnetic positioning signals from MediGuide transmitters found in the Artis zees detector housing. MediGuide then calculates the position and orientation of the catheter and displays it in realtime on previously acquired fluoroscopic images from the patient. In order to display
the catheters position precisely, the technology also compensates for patient movement caused by respiration and heart motion. Siemens is the first to integrate MediGuide technology into its systems, demonstrating our ongoing commitment to lowering dose via our CARE initiative, said Jane Whittaker, UK angiography business manager at Siemens Healthcare. The MediGuide technology may provide significant benefits especially during longer interventions or examinations in the cath lab as the cardiologist does not need to take fluoroscopic images of the patient each time the catheter is repositioned. As a result, less dose is experienced and less contrast agent used. The Heart Center Leipzig (Germany) has already performed the first interventions with the Artis zee and MediGuide technology. The lowradiation, precise localization of the catheter tip onto the prerecorded fluoroscopy image is a most impressive function, because the system is able to compensate the motion from heart beat and breathing, said Prof. Dr. Gerhard Hindricks, director of the rhythmology department. For my
team and me, this is clearly the future in electrophysiology. Dr. Christopher Piorkowski, MediGuide project team leader at the Heart Center Leipzig, added, Our clinical experience now includes more than 50 patients. The technology will have a significant impact in the field of catheter ablation, but also for the placement of left ventricular leads for cardiac resynchronization.
Image: The Artis zee angiography system, with integrated MediGuide technology (Photo courtesy of Siemens Healthcare).
Link Between Cam-Type Deformities and MRI Detected Hip Damage in Asymptomatic Young Men
ip impingement (femoracetabular impingement) may be a risk factor of osteoarthritis (OA) of the hip. New research revealed that the presence of an underlying deformity, known as cam impingement, is linked with hip damage in young men without any arthritis symptoms and detected using magnetic resonance imaging (MRI).
The studys findings were published September 8, 2011, in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR). Medical evidence reports that hip OA is a major cause of pain and disability, and accounts for more than 200,000 hip replacements in the United States each year. Cam impingement restricts
full range of motion in the hip socket due to boney bumps on the femoral head. The cam-type deformity causes hip pain as the bump moves inside the socket, applying extreme pressure to cartilage and may eventually lead to OA in the hip. Studies have shown that cam impingement is frequently seen in young male athletes, referred to orthopedic specialists after experiencing groin pain, and hip rotation is found to be diminished. Given that cam-type deformities are common in young asymptomatic males, we examined whether the deformities were associated with early signs of MRI detected hip damage, explained lead author, Dr. Stephan Reichenbach, from the Institute of Social and Preventive Medicine at the University of Bern (Switzerland; www.unibe.ch). The investigators recruited participants from a population-based group of male individuals enrolling in the Swiss army at a single recruiting center. A total of 244 males with a mean age of 20 years reported having no hip pain and were qualified for the study. MRI scans were conducted and one hip in each participant was examined for cam-type deformities, labral lesions, signs of cartilage dam-
age, and impingement pits. Researchers detected 67 definitive cam-type deformities in study participants with these men having higher body mass index and decreased internal rotation. Labral lesions were seen in 85% of participants with cam-type deformities and in only 67% of those without the deformity. Labral avulsions were detected in 76% of participants with the deformity and 58% of those without. In participants with cam-type deformity versus those without, impingement pits were observed in 30% and 12%, respectively. The authors reported an adjusted prevalence of 24% for cam-type deformities in the study population along with a high frequency of signs of joint damage. The signs of joint damage seen in participants could be an outcome in the sequence from normal to osteoarthritic hips, they suggest. Our study is the first population-based MRI study to confirm the role of cam-type deformities of the hip as a potential risk factor for joint damage, concluded Dr. Reichenbach. Longer-term studies are needed to determine if cam-type deformity increases risk of developing hip OA.
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Worlds First Superconducting Synchrocyclotron Designed for Proton Therapy
new proton therapy system combines a patented, gantry-mounted proton source with highly integrated, image-based workflow and robotic patient-positioning, making proton therapy a practical clinical experience. Mevion Medical Systems (Littleton, MA, USA; www.mevion.com) announced it has delivered the worlds first superconducting synchrocyclotron to the S. Lee Kling Center for Proton Therapy at the Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine (St. Louis, MO, USA). This shipment marks the last phase of the manufacturing of the first Mevion S250 proton accelerator module and the first of many of this revolutionary cancer therapy device. It was a very rewarding day to see our first system leave our factory knowing that what we have achieved may affect and improve the lives of cancer patients, stated Joseph K. Jachinowski, chief executive officer of Mevion Medical Systems. The innovative design of the Mevion S250 makes adding proton therapy remarkably easier for our hospital partners than what was previously available. Powered by a triniobium core, the high-energy proton source of the Mevion S250 preserves all of the treatment benefits of conventional proton treatment systems while removing the obstacles of size, cost, and complexity that have limited the wide implementation of this promising cancer treatment modality. Similar to conventional radiation therapy systems in terms of footprint, workflow, and throughput, the system will easily incorporate within existing radiation therapy departments to deliver innovative cancer care in a very conventional way. Barnes Jewish Hospital prides itself in providing the most advanced technologies to its patients. We are delighted to add this latest development in radiation therapy to our cancer-fighting arsenal, said Jeff Bradley, MD, director of the S. Lee Kling Center for Proton Therapy at Siteman Cancer Center. This installation of the Mevion S250 at Barnes Jewish Hospital was planned for completion early in 2012. Two additional facilities are also in the midst of installation; Robert Wood Johnson University Hospital (New Brunswick, NJ, USA) and Oklahoma University (Oklahoma City, OK, USA). Both of these installations are also to be comMedical Imaging International January-February/2012
pleted in 2012. Mevion Medical Systems, Inc. (formerly Still River Systems, Inc.) is a radiation therapy company focused on advancing the treatment of cancer. The US Food and Drug Administration have not cleared the Mevion S250 proton therapy system for clinical use.
Image: The S250 proton therapy system (Photo courtesy of Mevion Medical Systems).
As Sponsored By Hologic
On a Mission to Detect Cancer Early

reast imaging has long been a major focus of the radiology department at Cerrahpasa Medical Faculty, a top teaching hospital in Istanbul, Turkey, and one of 17 medical departments of Istanbul University. Three fulltime radiologists and four fulltime technicians, all dedicated breast imagers, perform 8,000 mammograms annually. Last year, as part of the Universitys commitment to provide leading- Professor Altug examines the tomosynthesis slices individually or in edge medical technology, Cerrah- dynamic cin mode on a diagnostic workstation. pasa Medical Faculty built a dedInitially, we plan to implement projects to detericated Breast Radiology Unit, investing in the latest technologies to detect and diagnose breast cancer at mine the women who will benefit most from tomosynthesis, explains Professor Altug. It is our its earliest stages. Breast cancer is the most common type of cancer expectation that breast tomosynthesis will be better for women in Turkey. It is estimated that 20,000 than 2D mammography to find multifocal and multinew cases of breast cancer are diagnosed each year. centric foci in women with dense breast parenchyFor Professor Altug and her staff at the Medical ma. Says Professor Altug: We perform all of the Faculty, early detection is the key. Our mission is to image guided interventional breast procedures detect breast cancer at the earliest stage, using inno- including stereotactic, MRI-guided and ultrasound vations in technology, to provide better treatment for guided biopsies, and wire localizations. We chose Hologics MultiCarePlatinum prone patients and to reduce mortality, states Professor breast biopsy table and Hologic vacuum-assisted breast Altug. Toward this end, the radiology department biopsy equipment because of the excellent image qualworked with Hologic to install a Selenia ity and the user friendliness of the systems. Hologic is Dimensions breast tomosynthesis system. We are helping us achieve our mission of detecting and diagvery pleased to have tomosynthesis technology nosing breast cancer at an early stage. because it is better for the detection of small tumors, less than 1 cm, and microcalcifications, obscured by Using technology, detecting earlier, dense breast parenchyma, enabling us to detect more saving lives Since the diagnosis of breast cancer is basically DCIS, states Professor Altug. Cerrahpasa Medical Faculty is using tomosynthe- dependent on a comprehensive imaging, its sensitivsis to screen younger women between the ages of 40 ity, image quality, and user friendliness are critical. and 50, women with dense breasts and high-risk In our clinical practice, detecting small lesions and women. The Breast Unit is also using tomosynthesis obtaining biopsies of them are the main challenges. for diagnostic purposes. In the first three months of says Associate Professor Mehmet Halit Yilmaz, the installation, the Breast Unit performed over 500 Director of Breast Imaging. The earlier we detect the lesions, the more we save lives. mammograms using the technology.
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Digital Radiography Detectors Provide Increased Sensitivity for Higher Image Quality
hree new flat panel digital radiography (DR) detectors have been designed to extend the mobility, versatility, and high-resolution diagnostic imaging capabilities available to medical institutions. Each of the new Canon (Tokyo, Japan; www. canon.com) DR detectors has an improved resolution of 125 m and an increased level of sensitivity to deliver higher image quality. They have been developed to improved portability and ease of use for the benefit of users, as well as convenience and improved imaging capabilities that directly benefit the patient. As Canons first compact wireless DR system, the CXDI-80C Wireless builds on the success of Canons CXDI-70C Wireless DR system, while achieving reductions in size and weight. Combining versatility, very high image quality and sensitivity in a more convenient and compact size, the CXDI-80C Wireless is a small area detector that delivers added convenience and freedom during diagnostic examinations. With its lightweight but strong design and an imaging area of 27 cm x 35 cm, which is similar in size to a traditional imaging cassette, the CXDI80C Wireless is suitable for extremity imaging and has the added benefit that it can fit into an incubator X-ray cassette tray in neonatal intensive care
units (NICU). When the CXDI-80C Wireless is used with the CXDI-70C Wireless DR system, the combination of sophisticated wireless DR detectors cover all high quality imaging requirements in low dose general radiography, including imaging of the skull, chest, abdomen, and extremities. With their new glass substrate, image quality, and portability, the new Canon CXDI-501 series DR detectors allow radiographers to deliver efficient diagnosis and excellent patient care, with the added convenience that low detector weight and very slim design brings. Versatility is increased as the Canon CXD-501 series detectors not only include a detachable cable but can also fit into most existing bucky cassette trays. The CXDI-501C and CXDI-501G DR systems feature a 35 cm x 43 cm imaging area and each weigh 3.1 kg. Providing excellent X-ray photon conversion efficiency, the CXDI-501 series detectors also integrate a high quality 9.5 megapixel Canon LANMIT (large area new-MIS [microwave imager-sounder] sensor and TFT [thinfilm transistor]). image sensor with a pixel pitch of 125 m and are available with either a cesium iodide (CsI) scintillator (CXDI-501C) or gadolini-
um oxysulphide (GOS) scintillator (CXDI-501G). The CXDI-501 DR system produces ultra-fast image output, allowing radiographers and medical staff to view an image only three seconds after Xray exposure. The latest Canon CXDI-NE imaging software, also supplied, helps users to streamline workflow by reducing the number of operational steps required to complete a patient examination to the absolute minimum, automating many actions, and presenting data in a clear and concise manner.
Image: The CXDI-501G flat-panel digital radiography detector (Photo courtesy of Canon Medical Systems).
Wireless Digital X-Ray System Receives US Clearance

new digital X-ray systems wireless capability facilitates examinations of patients with limited mobility, and its unique rotating swivel arm helps increase ease of use for clinical staff. Siemens Healthcare (Erlangen, Germany; www.medical.siemens. com) has announced that the Mobilett Mira, the companys first mobile digital X-ray system with a wireless detector, recently received 510(k) clearance from the US Food and Drug Administration (FDA) and is now commercially available in the United States. The process of having an X-ray can be stressful for patients with mobility challenges. The Mobilett Mira addresses that challenge with its ability to move to wherever the patient is most comfortable, explained Gerhard Schmiedel, vice president, X-ray products, Siemens Healthcare. At the same time, the new rotating swivel arm is an important benefit for radiologists and technologists, giving them more flexibility to access patients and capture highquality images with greater ease.
Mobile X-ray systems are used frequently when patients cannot be moved to an X-ray room for example, when they are in the intensive care unit. Until now, a mobile units X-ray detector was connected to the system via a data cable that could lengthen the exam process, cause patient discomfort, and hamper the imaging efforts of clinical staff. With the Mobilett Mira, Siemens combines the advantages of mobile X-ray imaging with the flexibility of a wireless detector. One of the smallest existing mobile X-ray systems, the Mobilett Mira can easily navigate small spaces such as elevators due to its integrated drive. With a resolution of more than seven million pixels, its new detector delivers image quality comparable to high-resolution stationary systems. The system works with very short exposure times beyond 1 ms, reducing patient radiation exposure. Moreover, Siemens has redeveloped its mobile X-ray swivel arm system for the Mobilett Mira so that it not only moves vertically but also rotates up to 90, simplifying the examina-
tion process for clinical staff. Moreover, the swivel arm incorporates all electric connection cables that traditional mobile X-ray systems usually carry externally. This feature, combined with the wireless detector, makes the Mobilett Mira a mobile system that is not only more flexible, but also more hygienic, since every cable on a medical device is a potential germ carrier that requires regular
maintenance and cleaning. The Mobilett Mira is the first mobile X-ray system that can be maintained and updated via remote monitoring. Siemens Remote Services (SRS) regularly provides the system with recommended software updates.
Image: The Mobilett Mira mobile digital X-ray system (Photo courtesy of Siemens Healthcare).
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Imaging Technologies Evaluate Effectiveness of Heart Drug

esearchers for the first time have used several imaging techniques to prove the efficacy of a promising new treatment for atherosclerosis. Using positron-emission tomography (PET)/computed tomography (CT) and magnetic resonance imaging (MRI), the research team showed that dalcetrapib, an innovative treatment for atherosclerosis, prevented the progression of disease, and reduced vascular inflammation over 24 months. The studys findings were published in the September 12, 2011, issue of the Lancet. The dalPLAQUE (dalcetrapibs effects on vascular function [dal-VESSEL] and on atherosclerotic disease progression [dal-PLAQUE]) study is the longest placebo-controlled, active-drug MRI study to date, and the first to use a variety of noninvasive imaging techniques to visualize arterial plaque. In this phase IIB, double-blind, multicenter trial, Mount Sinai School of Medicine (New York, NY, USA; www. mssm.edu) researchers assessed 130 study participants with atherosclerosis who were randomized to receive dalcetrapib or placebo for 24 months. To determine the efficacy of dalcetrapib, the team used MRI to analyze plaque progression in the arterial wall and PET/CT to assess arterial inflammation. The images revealed that dalcetrapib considerably reduced atherosclerotic disease progression and inflammation. This milestone study shows that MRI and PET/CT are highly useful in assessing the safety and efficacy of dalcetrapib, and that this novel therapy may address a significantly unmet need in cardiovascular disease, said Zahi A. Fayad, PhD, a professor of radiology and medicine in the division of cardiology, and the director of the Translational and Molecular Imaging Institute at Mount Sinai School of Medicine, and lead author on the study. We are excited about the results obtained in this trial, which could have a great impact on the treatment of patients with cardiovascular disease. Lowering of the so-called bad cholesterol (low-density lipoprotein) through statin use, is a highly effective technique of improving cardiovascular outcome in a wide range of patients. However, despite optimal use, significant risk remains. Dalcetrapib is part of a class of drugs called cholesteryl ester transfer protein inhibitors that raise high-density lipoprotein (HDL) commonly known as good cholesterol. Research has shown that raising HDL cholesterol may reduce coronary artery disease risk. In the dal-PLAQUE study, patients who received dalcetrapib saw a 31% increase in HDL cholesterol levels, as examined through MRI scanning. The PET/CT scans showed that inflammation levels in the carotid artery of patients taking dalcetrapib were significantly reduced yet stayed the same in the placebo group. Considering the concerns surrounding this class of drugs, MRI and PET/CT imaging are valuable biomarkers for assessing safety and efficacy, said Dr. Fayad. The
first drug in this class, torcetrapib, effectively increased HDL cholesterol but caused a significant increase in mortality due to vascular inflammation. Through noninvasive imaging, we were able to determine that the inflammation associated with torcetrapib was not found in dalcetrapib. The success of this trial indicates that noninvasive imaging may be a critical tool for evaluating other investigational treatments for heart disease as well. Mount Sinai is establishing a center that will use state of the art imaging technology to help treat and prevent atherosclerosis, heart attack, and heart failure. In collaboration with the Mount Sinai Cardiovascular Institute and Mount Sinai Heart, the new Translational and Molecular Imaging
Institute will continue to innovate, validate, and translate new tools for the improvements of patients care. Cardiovascular disease impacts millions of people, and costs billions of dollars each year in the United States alone, said Valentin Fuster, MD, PhD, director of Mount Sinai Heart, the Zena and Michael A. Wiener Cardiovascular Institute, and the MarieJosee and Henry R. Kravis Center for Cardiovascular Health at The Mount Sinai Medical Center. As demonstrated in the dal-PLAQUE study, Dr. Fayad has brought Mount Sinai to the forefront of using noninvasive imaging to help study, prevent, and treat heart disease. We look forward to using MRI and PET/CT in future clinical trials.
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Cause of Vertigo from MRI Scanning Identified

team of researchers reported that it has discovered why so many people undergoing magnetic resonance imaging (MRI), particularly in newer high-strength scanners, get vertigo, or the dizzy sensation of free falling, while inside or when coming out of the tunnel-like machine. In a new study published online September 22, 2011, in the journal Current Biology, a team led by Johns Hopkins Universitys (JHU; Baltimore, MD, USA; www.jhu.edu) scientists suggests that MRI scanners strong magnet pushes on fluid that circulates in the inner ears balance center, leading to a feeling of unexpected or unsteady movement. The finding could also call into question results of socalled functional MRI studies designed to detect what the brain and mind are doing under various circumstances. To determine the mechanism behind MRIinduced vertigo, Dale C. Roberts, MS, senior research systems engineer in the laboratory of David Zee, MD, within the department of neurology at the Johns Hopkins University School of Medicine, and his colleagues placed 10 volunteers with healthy labyrinths and 2 volunteers who lacked labyrinthine function into MRI scanners. They tracked vertigo not only by the volunteers reports, but also by looking for nystagmus. Because visual clues can help suppress nystagmus, the researchers conducted their experiments in the dark. Footage from night vision cameras revealed that all the healthy volunteers had nystagmus in the MRI, but those without labyrinthine function did not a definite sign that the labyrinth plays a key role in MRI-related vertigo. To determine how MRIs magnetic field acts on the labyrinth, the researchers tested the healthy volunteers in MRI scanners of different strengths for various periods of time. They also tracked the study participants nystagmus as they were moved in and out of the scanners tunnels, called bores, both from the
usual entryway and from behind research designed to assess the impact of motion or direction of magnetic field on the volunteers balance centers. Mr. Roberts team discovered that higher magnetic field strengths caused considerably faster nystagmus. These eye movements persisted throughout the time volunteers spent in the machine, no matter how long the experiments lasted. Moreover, the direction of the eye movements changed depending on which way the volunteers entered the bores, suggesting that the effect on the labyrinth was directionally sensitive. Combining their findings with what is known about the inner ear, the researchers deduced that MRI-related vertigo most likely relates to interplay between electrical currents flowing through the salty fluid in the canals of the labyrinth and MRIs magnetic field. Through an effect well known to physicists called the Lorentz force, the magnetic field apparently pushes on the current of charged particles in the inner ears fluid. This exerts a force on cells that use the fluids flow as a way to perceive motion. Mr. Roberts noted that the finding not only answers a decades-long scientific question, but also has implications for research that uses MRI. In one technique, known as functional MRI (fMRI), researchers measure brain activity by tracking blood flow in the brain as participants perform tasks. The new findings suggest that the scanner itself could be causing previously unnoticed brain
activity related to movement and balance, potentially affecting results. Weve shown that even when you think theres nothing happening in the brain while volunteers are in the scanner, theres actually a lot happening because MRI itself is causing some effect, Mr. Roberts said. These effects must be taken into account in the way we interpret functional imaging. The researchers added that physicians already use methods that stimulate the labyrinth to diagnose and treat inner ear and balance disorders, but these methods can be uncomfortable. They note that MRI scanners strong magnetic field could eventually be used for the same purpose, providing an innovative approach that is more comfortable and noninvasive.
Image: A patient undergoing an MRI as part of a study to determine the cause of MRI-related vertigo (Photo courtesy of Johns Hopkins University).
Intensity-Modulated Radiotherapy Has Less Harmful Rectal Side Effects

en with localized prostate cancer treated with a newer technology, intensity-modulated radiation therapy (IMRT), have more than onequarter (26%) fewer late bowel and rectal side effects and a statistically improved lower dose of radiation to the bladder and rectum, compared to those who undergo three-dimensional conformal radiotherapy (3D-CRT), according to a randomized study. The studys findings were presented at the plenary session October 3, 2011, at the 53rd annual meeting of the American Society for Radiation Oncology (ASTRO), held in Miami Beach, FL, USA. Findings also show there is a significant increase (15%) in rectal side effects associated with white men, compared to other races, regardless of the radiation treatment. The racial differences were definitely surprising and we are still unsure as to why this exists, stated Jeff Michalski, MD, a radiation oncologist at Washington University Medical
Center in St. Louis, (MO, USA; http://medschool. wustl.edu). While it could be a real difference in the tolerance to treatment, it could also represent cultural differences in reporting side effects and physician interpretation of patient descriptions. This will be the topic of further investigation. 3D-CRT is a type of external beam radiation therapy that uses computers and special imaging techniques to tailor precisely the radiation beams so that neighboring normal tissue receives less radiation and is able to heal more rapidly. IMRT is a newer, specialized form of 3D-CRT that allows radiation to be more precisely shaped to fit the tumor and further limits the amount of radiation received by healthy tissue near the tumor. This may also safely allow a higher dose of radiation to be delivered to the tumor, potentially increasing the chance of a cure. This study was a preliminary analysis of acute and late toxicity in men receiving high dose radiation therapy on a phase III Radiation Therapy
Oncology Group (RTOG) dose-escalation trial. The researchers goal was to compare the toxicity rates of high dose radiation therapy to standard dose radiation treatment, using IMRT and 3D-CRT. The toxicities were scored from the grade of zero (no toxicity) to four (severe toxicity). The study also examined what patient characteristics might be associated with toxicity. The study involved 748 men who were randomized to the high dose arm of the trial. Of this group, 491 were treated with 3D-CRT and 257 with IMRT. Findings revealed that IMRT is associated with a statistically significant decrease in acute grade 2+ rectal/bowel and urinary toxicity. There was also a trend for a 26% reduction in grade 2+ late rectal and bowel side effects. This study supports the continued use of IMRT in the management of prostate cancer. It is a safe and very well-tolerated therapy with fewer complications than 3D-CRT, Dr. Michalski concluded.
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New Imaging Technique Visualizes Cancer During Ovarian Cancer Surgery

new study performed on nine patients with ovarian cancer in Germany has shown that new multispectral fluorescence technology can be used to localize cancer cells during surgery. Ovarian cancer is one of the most frequent forms of cancer that affect women. As tumors can initially grow unchecked in the abdomen without causing any major symptoms, patients are usually diagnosed at an advanced stage and have to undergo surgery plus chemotherapy. During the operation, surgeons attempt to remove all tumor deposits as this leads to improved patient prognosis. To do this, however, they mostly have to rely on visual inspection and palpation an enormous challenge especially in the case of small tumor nests or remaining tumor borders after the primary tumor excision. However, surgeons could now be getting support from a new multispectral fluorescence imaging system developed by a team of researchers from the Technische Universitt Mnchen (Munich, Germany; www.tum.de), headed by Vasilis Ntziachristos, a professor of biologic imaging. Before the operation, the patients were injected with folic acid chemically coupled to a green fluorescent dye. Most ovarian tumors have a protein molecule on their surface that bonds with folic acid and transports it inside the cell. This protein is known as the folate receptor alpha. During abdominal surgery, the surgeon can then shine a special laser light onto the patients ovaries, causing the green-labeled folic acid
inside the cancer cells to emit light. Healthy tissue remains dark. The fluorescent cancer cells, however, cannot be detected by the naked eye. Three cameras, mounted on a pivoting support arm over the operating table, detect optical and fluorescent signals at multiple spectral bands and then correct for light variations due to illumination and tissue discolorations in order to provide truly accurate fluorescence images that can be simultaneously displayed with corresponding color images on monitors in the operating room. The surgeon can therefore check whether all the cancer cells have been removed by inspecting for remnant fluorescence light. In eight of the nine patients, physicians were able to remove small clusters of tumor cells that might otherwise have gone undetected. The multispectral fluorescence imaging system has thus passed its first operating room (OR) evaluation. However, it will have to validate its benefits to improve clinical outcome in further operations before it can be deployed for routine surgical procedures. The researchers also want to develop additionally the camera system so it can be used to detect other forms of tumors during operations. Of considerable importance in future developments is the ability to offer accurate fluorescence imaging so that data collected reflect the accurate presence of disease.
The use of advanced, real-time optical technology will allow us to standardize data collection and accuracy so that studies performed at multiple clinical centers can be accurately compared and analyzed, explained Prof. Ntziachristos. This is important for the clinical acceptance of the technology and its approval by regulatory agencies. In the future patient selection through customized medicine approaches, for example, by obtaining a molecular profile of the tumor of each patient, would further enable customized surgical treatment of improved accuracy. The team is also planning to construct a version for minimally invasive operations.
Image: The multispectral fluorescence imaging system designed to visualize tumor cells during surgery (Photo courtesy of Technische Universitat Munchen).
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New Molecular Imaging Technology Presented at European Medical Meeting

ew molecular imaging technology was presented at a European medical meeting that included detailed information on molecular magnetic resonance (mMR) technology in which a 3-Tesla MRI and molecular imaging incorporates as a single system. The mMR powers the simultaneous acquisition of MR morphologic and functional details in human tissue and positron emission tomography (PET) cellular activity. In addition to offering full resolution with HDPET and time of flight technologies, it has a large 78-cm bore and 227-kg capacity table that are optimized for large patients. Siemens Healthcare (Erlangen, Germany; www.siemens.com/ healthcare) displayed its range of solutions for nuclear medicine at the annual congress of European Association of Nuclear Medicine (EANM) in Birmingham, UK, on October 15-19, 2011. This included the Biograph mCT (computed tomography) and mMR hybrid molecular imaging systems; the Symbia T TruePoint single photon emission computed tomography (SPECT)CT, a hybrid dual-detector variable angle gamma camera with multislice CT; Symbia.net, a clinical workflow server; and syngo.via, the application for multimodality clinical image reporting. The worlds first molecular CT, the Biograph mCT, offers HDPET to provide detailed depth of data including cell metabolism within tumors, plus has a large bore and short tunnel for a more comfortable scanning experience for the patient. Due to its dual functionality, the system can be used as a combined molecular CT or as a standalone, high power CT scanner if required, saving the time, costs, and space restrictions associated with multiple imaging installations. Traditionally in hybrid imaging, the topics of dose reduction and increased efficiency have been regarded almost as opposing goals, but Siemens has constantly innovated in this area, introducing solutions that truly address the topics of dose and workflow, said Britta Fuenfstueck, chief executive officer, molecular imaging business unit, Siemens Healthcare. These solutions, which are customizable to every patient need, enable clinicians to maintain the highest level of image quality while minimizing dose levels and increasing speed. The Symbia T TruePoint SPECTCT, a hybrid dual-detector variable angle gamma camera with multislice CT was also presented at EANM 2011. The system provides fast, accurate attenuation correction and anatomic mapping to accelerate workflow and give imaging confidence. Lastly, Symbia.net, a fully functional thin client application to assist hospitals to conduct remote processing and reporting of nuclear medicine images and data; and syngo.via, a client-server, advanced visualization software for PETCT that Visit us at speeds up the reading and sharing of images were demonstrated. Symbia.net provides staff access to the full processing and reading capabilities of SPECT and SPECTCT studies from a standard networked PC that has the client software Expo C 321 installed, even if placed on different floors to the scanning equipment. LINKXPRESS COM
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Image: The Biograph mCT molecular imaging system (Photo courtesy of Siemens Healthcare).
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Study: Yearly Mammogram Leads to High Rate of False Positives

uring 10 years of receiving mammograms, more than half of cancer-free women will be among those called back for more testing because of false-positive results, and approximately 1 in 12 will be referred for a biopsy. Screening every other year lowers a womans changes of having one of these false-positive episodes by approximately one-third from 61% to 42% over the time line of a decade. A new study probing into false-positives in mammography looked at almost 170,000 women between the ages of 40 and 59 from seven regions around the United States, and nearly 4,500 women with invasive breast cancer. Because of the added decade of testing alone, it found, women who begin mammogram screening at 40 instead of 50 are more likely to have false-positive results that lead to more testing. This study provides accurate estimates of the risk of a false-positive mammography and breast biopsy for women undergoing repeat mammography in community practice, and so provides important information about the potential harms of undergoing regular mammography, said coauthor Dr. Karla Kerlikowske, a professor of medicine at the University of California, San Francisco (UCSF) School of Medicine (USA; http:// medschool2.ucsf.edu). The studys findings are slated be published in the journal Annals of Internal Medicine. The research was led by Group Health Research Institute of Seattle (WA, USA; www.grouphealth research.org) for the Breast Cancer Surveillance Consortium (Bethesda, MD, USA; http:// breastscreening.cancer.gov). Recalls for a second mammogram for what turn out to be falsepositives may cause inconvenience and worry. Recommendations for fine-needle aspiration or surgical biopsy are less common, but can lead to unnecessary pain and scarring. The additional testing also contributes to rising medical costs.
Dr. Kerlikowske is the lead author of an additional report to be published in the same issue of Annals that for the first time in the United States evaluates the accuracy of film mammography against digital, which has increasingly replaced older film screening. That study examined nearly 330,000 women between the ages of 40 and 79. The information was gathered from the Breast Cancer Surveillance Consortium, a collaborative network of mammography registries in the United States. The researchers found that overall cancer detection rates were similar for both techniques. However, digital screening may be better for women between the ages of 40 and 49 who are more likely to have extremely dense breasts associated with lower cancer detection. The study also found new evidence that digital mammography is better at detecting estrogen receptor-negative tumors; specifically in women aged 40 to 49 years. Breast cancer may not be found, the researchers warned, if a radiologist cannot detect a visible breast lesion or if a tumor is hidden by normal breast tissue. Moreover, an indiscernible tumor may grow rapidly and be found through a clinical exam prior to the next mammogram. Digital mammography was developed in part to improve the detection of breast cancer in dense breasts by improving the ability to distinguish normal dense breast tissue from isodense invasive cancer. The investigators noted that for every
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10,000 women 40 to 49 who is given digital mammograms, two more cases of cancer will be identified for every 170 additional false-positive examinations. Healthy women will undergo 12 screening mammograms in their lifetimes if they follow US Preventive Services Task Force guidelines that recommend biennial screening starting at age 50 and continuing until age 74. This is debatable, with many practitioners recommending annual mammograms. If women start biennial screening at 40, they will undergo 17 exams; those who start annual screenings at age 40 will undergo 34 exams. For the false-positive study, the investigators discovered that after 10 years of yearly screening, a majority of women will receive at least one falsepositive result, and 7% to 9% will receive a falsepositive biopsy recommendation. We conducted this study to help women know what to expect when they get regular screening mammograms over the course of many years, said study leader Rebecca Hubbard, PhD, an assistant investigator at Group Health Research Institute. The researchers reported that screening every other year would likely decrease the chance of false-positive findings but could also delay cancer diagnosis. However, for those diagnosed with cancer, the researchers found women screened every two years were not considerably more likely to be diagnosed with late-stage cancer compared to those screened at one-year intervals. The study emphasizes the importance of radiologists being able to review a patients earlier mammograms because it may halve the odds of a false-positive recall.
Image: A physician using a magnifying glass to examine a series of breast mammograms on a lightbox (Photo courtesy of Geoff Tompkinson / SPL).
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MRI Safe for Patients with Implanted Cardiac Devices When Specific Guidelines Followed
agnetic resonance imaging (MRI), an important diagnostic modality, has conventionally been off limits to more than 2 million people in the United States alone who have an implanted pacemaker to regulate heart rhythms or an implanted defibrillator to prevent sudden cardiac death. Now, cardiologists reported that a protocol they developed has shown to be effective in enabling patients with implanted cardiac devices to safely undergo an MRI scan. The studys findings were published in the October 4, 2011, issue of the journal Annals of Internal Medicine. We believe this is the largest prospective study of MRI in patients with implanted devices, said lead author Dr. Saman Nazarian, a cardiac electrophysiologist and an assistant professor of medicine at the Johns Hopkins University School of Medicine (Baltimore, MD, USA; www. hopkinsmedicine.org). The guidelines we have published can be used to make MRI more available to people who could benefit from early detection of cancer and other diseases and for guiding surgeons during procedures. MRI is considered superior to CT scans in many clinical scenarios, especially for brain and spinal cord imaging. To date, more than 700 patients with implanted cardiac devices have safely undergone MRI exams at Johns Hopkins. Their prospective study followed 438 people with implanted cardiac devices who had 555 MRI scans. Almost all of the exams, 94%, were conducted at The Johns Hopkins Hospital. The rest were performed at Rambam Medical Center (Haifa, Israel; www.rambam.org.il). The researchers discovered that with appropriate precautions, patients with pacemakers and defibrillators can have an MRI scan with very low risk of the device malfunctioning, moving, heating, or causing abnormal heart rhythms due to the magnetic and radiofrequency energy generated by the
imaging. The devices implanted in three of the patients in the study (1.5%) had a power-on reset event during an MRI scan, meaning that the energy emitted from the scanner caused the devices to return to default settings. This is a rare occurrence that necessitates close expert monitoring during the test, but is easily remedied after the test is completed. None of the three had device dysfunction during the long-term follow-up of between 15 and 66 weeks. One of those patients completed four repeated MRI examinations during the study without any problems. Johns Hopkins cardiac electrophysiologist and biomedical engineer Dr. Henry Halperin began researching the issue of MRI safety with implanted devices about 15 years ago, testing a range of devices. The safety protocol he developed is now being adopted by institutions worldwide. The newer pacemakers made after 1998 and defibrillators manufactured since 2000 come with electromagnetic interference protection, said Dr. Halperin, who is a professor of medicine at the Johns Hopkins University School of Medicine and the senior author of the study. In addition to the age of the device, the Hopkins team checks the type and configuration of the leads attached to the device. For example, if a lead is disconnected and is not part of the devices function, an MRI would not be recommended because the tip of the wire could get very hot. We reprogram the device to a safe mode while the patient is having the MRI scan, said Rozann Hansford, RN, MPH, a study author who
monitors patients at Johns Hopkins during the scans. We carefully monitor the patients blood pressure, electrical activity of the heart and oxygen saturation, and look for any unusual symptoms. After the test, we reprogram the device and carefully check its function. The patients devices are examined again in three to six months. The researchers concluded that with a protocol based on device selection, programming, and careful patient monitoring, MRI can be performed safely in many patients who have a pacemaker or a defibrillator. With the advancing age of the population and the expanding indications for pacemakers and defibrillators, this has become an increasingly important issue, and a lifesaving one for some patients, noted Dr. Nazarian. He added that many of the patients with cardiac devices who have come to Hopkins for an MRI scan had tumors and other serious problems diagnosed and treated, whereas those problems had been missed by an earlier imaging test, such as a CT or ultrasound exam.
Image: A patient with a pacemaker about to undergo a magnetic resonance imaging procedure (Photo courtesy of Johns Hopkins University School of Medicine).
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Virus Shows Potential for Imaging and Treating Pancreatic Cancer

esearchers are investigating a potential treatment and noninvasive imaging modality for pancreatic cancer. The Vaccinia virus construct GLV-1h153, engineered to encode for the human sodium iodide symporter gene (hNIS), is a promising candidate for virotherapy of cancer and for long-term noninvasive monitoring of therapeutic response via deep tissue imaging modalities such as positron emission tomography (PET). This virus construct can also be used for targeted radiotherapy, according to study results presented at the Second AACR International Conference on Frontiers in Basic Cancer Research, held September 14-18, 2011, in San Francisco (CA, USA). Dana Haddad, MD, PhD, who at the time of the study was a postdoctoral research fellow at Memorial Sloan-Kettering Cancer Center (New York, NY, USA; www.mskcc.org) and is now a resident at the Mayo Clinic (Scottsdale, AZ, US),
reported that GLV-1h153-treated pancreatic tumors from more than 50 mice were treated and imaged to provide insight into tumor therapeutic response. The combination of GLV-1h153 and radioiodine (131I) was promising for targeted radiotherapy and destruction of pancreatic tumors. We expected that we would be able to noninvasively detect virus replication in tumors using this imaging system, but we could not predict the timing of this, how long we could repeat serial imaging and whether this would actually provide information about therapeutic response, said Dr. Haddad. The researchers, who also included scientists from Genelux Corp. (San Diego, CA, USA; www.genelux.com), were initially discouraged when the PET signal in pancreatic tumors began to fade about two weeks after treatment with the virus, according to Dr. Haddad. However, she said they investigated what could be the cause of this loss of signal and were pleased to ascertain that
it was likely due to tumor kill and necrosis. The investigators found that hNIS-mediated radio-uptake noninvasively imaged with PET initially provided information into the presence of viral replication in the tumor, and later provided insight into the therapeutic response and biologic activity of cancer cells. When the tumor began to die due to the effects of the virus, the PET signal began to decrease, noted Dr. Haddad. We were further pleased to observe that although tumor kill with a very low dose of virus was not very impressive, we could achieve potent tumor kill when we combined virus treatment with systemic radiotherapy. Using lower doses of virus and radiotherapy could minimize potential toxicity and side effects associated with both treatments. Additional research of viral and radiotracer dosing, and their effects on therapeutic response and imaging potential is currently being planned, according to Dr. Haddad.
Liver Elastography Provides Good Strain and Contrast Imaging Capability

iver stiffness evaluation has been made possible with a second-generation implementation of new radiation force impulse (ARFI) ultrasound technology. The Royal Liverpool University Hospital (UK; www.rlbuht.nhs.uk), part of The Royal Liverpool and Broadgreen University Hospitals NHS [National Health Service] Trust, is conducting strain and contrast imaging of the liver for the first time following delivery of its third Acuson S2000 diagnostic ultrasound system, developed by Siemens Healthcare (Erlangen, Germany; www.medical. siemens.com). Located in the ultrasound department, apart from the general imaging applications, it is being used to measure the stiffness of liver tissue using its advanced liver tissue analysis package. The liver stiffness evaluation has been made possible via Siemens second-generation implementation ARFI technology in the S2000s Virtual Touch high-definition (HD) application. Using the 4C1 transducer, which the hospital has also purchased, ARFI uses an acoustic push pulse to provide both qualitative and quantitative analysis of the strain properties or stiffness of deep tissue. With the further addition of Siemens Cadence contrast agent imaging and contrast quantification package, the hospital anticipates being able to characterize focal liver lesions utilizing the ultrasound scan and contrast examination. A nonlinear imaging technique to separate and display tissue or contrast effectively, Cadence is suitable for border and lesion detec-
tion and characterization. Staff at the hospital hope its use will prevent the need for a follow up magnetic resonance imaging (MRI) or computed tomography (CT) scan, which in turn will speed up the patient pathway, reduce cost impact on the hospital and radiation dose for the patient. We chose the S2000 to replace our old system because of its superb image quality and capability for performing advanced elastography, said Colin Griffin, ultrasound lead at The Royal Liverpool University Hospital. Staff are already familiar and very happy with the other S2000s we have in the department so Siemens was the logical choice especially due to the ARFI quantification package for giving specific values for tissue stiffness. It is very pleasing that the installation of the S2000 has enabled the Royal Liverpool University Hospital to improve the service offered to its patients, said Bernadette Leonard, regional sales and clinical applications manager for ultrasound at Siemens Healthcare. Its capacity for yielding penetrating insight into complex anatomy will enable clinicians to offer confident diagnosis on liver lesions, plus its versatility as a general imaging system is advantageous for various other procedures. The hospital will also use the S2000 for vascular work including renal transplant imaging, dialysis patients, DVT imaging, and carotid examinations. In addition to the 4C1, the hospital has also purchased a number of Siemens other lightweight, ergonomic transducers including the 9L4, 9EVF4, and 14L5.
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Microwaves Used to Create Medical Images

Swedish research team has developed new cancer diagnosis and treatment techniques with the help of microwaves, which could play a groundbreaking role in the fight against cancer. This new technology could save many lives and are more effective, less invasive, and simpler than currently available alternatives. Clinical studies are now being planned. The Chalmers University of Technology (Gothenburg, Sweden; www.chalmers.se) researchers expect to be able to evaluate two different techniques on patients within the next six months. One method is an alternative to mammography, such as using X-rays to detect breast cancer. The other aims to treat tumors in the head and neck by heating the cancer cells. Microwaves can be used to create medical images a new technique known as microwave tomography. Andreas Fhager, associate professor of biomedical electromagnetics, has developed a system to detect breast cancer with the new technique. He pointed out that the technology has several advantages over mammography. We obtain three-dimensional images showing significantly better contrast between healthy and malignant tissue compared to X-rays. That makes it easier to detect even really small tumors that may currently be obscured by healthy tissue, thus creating the preconditions for much more reliable diagnosis. Unlike X-rays, the technique also emits negligible doses of nonionizing radiation less than a hundredth of the radiation to which you are exposed when talking on a mobile phone. The strategy is to use the technique in combination with a treatment couch, equipped with holes for the breasts, to which the approximately 30 antennas required by the examination are connected. It should be significantly more comfortable for patients than mammography. The method is also much less costly, not only because microwave equipment is not so expensive, but also because the clearer images make interpretation easier for the clinicians. In the second Chalmers project, the microwaves are essentially used to destroy the tumors by heating them, a process known as hyperthermia. Clinical studies have shown that treatment with conventional radiotherapy and chemotherapy in combination with hyperthermia may double the long-term ability to cure certain forms of cancer, such as soft-tissue sarcoma and cervical cancer. We are now developing a new hyperthermia system that can reach deep-seated tumors in the head and neck with high accuracy, said Hana Dobsicek Trefn, a PhD in biomedical engineering. In this way, higher temperatures can be reached in the tumor without affecting the surrounding tissue. With time, the Chalmers investigators hope to be able to combine both methods. As soon as a tumor is detected, the already connected antennas could be used to start treating the tumor directly while at the same time monitoring that the right tissue is heated up. The method should also be applicable for other parts of the body than breasts, head, and neck. Theranostics is a growing area of study, and the Chalmers team believes that microwaves have a lot of possibilities in the field. The underlying microwave technology is already being used in the Strokefinder, a helmet that can differentiate between blood clots and bleeding in the brain. The Strokefinder is currently undergoing clinical trials at Sahlgrenska Hospital (Gothenburg, Sweden).
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Optimization Models Improve Radiation Therapy for Cancer Patients

ngineering researchers have developed mathematical optimization models that will make radiation treatment plans safer and more efficient than conventional plans. Conventional radiation therapy uses a single, cumulative treatment plan that disregards changes in tumor geometry and biology over time. However, recent technologic developments have made it possible to capture these changes throughout the course of treatment. Working with geometric and biologic data gathered from the most advanced technology used to capture tumor changes, the University of Arkansas (Fayetteville, USA; www.uark.edu) researchers achieve optimization in terms of delivering the maximum dose of energy to the tumor without undue risk to surrounding healthy tissues. By integrating the most recent data about tumor geometry and biology, the researchers models will help optimize radiation treatment on a per-session and cumulative basis. This is one of the first efforts to develop a method of radiation therapy optimization that uses biological information while maintaining both cumulative and per-fraction, or per-session, dose constraints, said Dr. Behlul Saka, who recently completed his doctorate in industrial engineering. Our optimization models may be used to generate treatment plans based on tumor biology prior to treatment, but also may react to changing tumor biology throughout treatment. More than one million people in the United States alone are diagnosed with cancer yearly, and more than half of these patients receive radiation therapy at some point during treatment. This type of therapy destroys cancer cells or slows their rate of growth by applying high-energy rays to tumors. Traditional radiation therapy involves shooting radiation from different beam angles with a linear accelerator that rotates around the patient. The variety of beam angles limits radiation exposure and thus spare healthy tissues exposed from particular angles while concentrating their combined effect on the tumor. Care is usually taken to ensure homogeneous distributions of radiation across the tumor. Intensity-modulated radiation therapy (IMRT) addresses the limitations of conventional radiation therapy by delivering small parts of rays, called beamlets, directly to specific sections or specific points on a tumor while also sparing healthy tissue. To clarify, with IMRT, the radiation dose conforms more precisely to the three-dimensional (3D) shape of the tumor. Dr. Sakas research adds to the advantages of IMRT by developing optimized treatment plans in response to changes in tumor geometry measured against cumulative and per-session doses. To build the models, he relied on anonymous, archived patient data. Dr. Saka tested the models on two simulated cases of lung cancer. These
cases demonstrated clinically significant improvements in tumor response over time. On a different simulated test case, by comparing tumor hypoxia information, the models demonstrated considerable improvements in controlling a tumor. These gains in tumor control and average doses were significant throughout treatment. The models also displayed the volatility of tumor control in relation to emerging alterations in tumor hypoxia values. This work suggests that a homogeneous approach to dose distributions across the tumor can be greatly improved upon, Dr. Saka said. Dr. Saka continues his research on improved cancer treatment planning as a research scientist at Elekta, AB (Stockholm, Sweden; www.elekta.com),
a healthcare company that develops clinical solutions for treating cancer and brain disorders. His work at the University of Arkansas was completed under the direction of Ron Rardin, professor also director of the Center for Innovation in Healthcare Logistics at the University of Arkansas. Prof. Rardin and his students have been working on radiation planning optimization for more than a decade. I believe Behluls work points the way to much more refined treatment planning, by exploiting more of the information available as the tumor changes through 25 to 50 daily treatment sessions, Prof. Rardin said. Prof. Rardin is also director of the Center for Innovation in Healthcare Logistics at the University of Arkansas.
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Early Diagnosis of Osteoarthritis with MRI

new method is set to help clinicians diagnose osteoarthritis at such an early stage that it will be possible to delay the progression of the disease by many years, or maybe even stop it entirely. The joint disease osteoarthritis is one of our most common chronic diseases and one of the primary causes of disability for people around the world. Osteoarthritis often attacks the knee and hip joints and breaks down the impact absorbing cartilage found there. For those affected, the progression of the disease usually takes many years, with gradually increasing pain which often leads to disability, said Carl Siversson, who has just defended his thesis in medical radiation physics at Lund University (Sweden; www.lunduniversity.lu.se). One of the difficulties with osteoarthritis has been diagnosing and tracking the disease before symptoms become evident. It has therefore been difficult to change or delay the course of the disease. Several years ago, researchers from Lund University and Harvard Medical School (Boston, MA, USA; http://hms.harvard.edu) developed a method to measure the degree of osteoarthritis using an MRI scanner, even at a very early stage. The method is called dGEMRIC (delayed gadolin-
ium-enhanced MRI of cartilage). This was major progress, but one problem was that the measurements could only be performed in a limited part of the cartilage. We have now improved the method so that we can study all the cartilage in the joint at once. We have achieved this by solving the problem of how to correct all the irregularities in the MRI images, said Mr. Siversson. The improved technique has now been assessed both on healthy individuals and on individuals with osteoarthritis, and the findings show that the disease can now be monitored in ways that were not previously possible, according to Mr. Siversson. Now we are continuing our work to make the method easy for doctors to use in their practice. Our hope is that the method will also be significant for future drug development, he said, who after completing his PhD will continue his research at Harvard Medical School (Boston, MA, USA).
Image: Colored Magnetic Resonance Imaging (MRI) scan of a side view of the knee joint of a 33year-old male with osteoarthritis (Photo courtesy of Simon Fraser / SPL).
High-Definition CT Scans Reduce Radiation Exposure in Cardiac Testing

-ray-based imaging approaches have greatly improved the diagnosis of heart disease, but they can generate considerable levels of radiation exposure. New imaging methods, however, offer the possibility of much safer external imaging for conditions that previously required potentially dangerous probes within the body (such as wires or tubes within blood vessels). One example is high-definition computed tomography (CT) scans to visualize the arteries of the heart and diagnose coronary artery disease. However, such procedures have required radiation levels that could themselves be potentially
dangerous. Dr. Bobak Heydari, from Brigham and Womens Hospital (Boston, MA, USA; www.brighamandwomens.org) and colleagues has published an article in the September 2011 issue of the Canadian Journal of Cardiology (CJC) on the safety of cardiac imaging modalities. It is the first report of high-definition CT scans with the simultaneous application of several techniques to reduce the level of radiation to much safer values. In an accompanying editorial in the same issue of CJC Paul Galiwango, MD, from Rouge Valley Health System (Toronto, ON, Canada) comment-
ed that although the study has limitations, the results demonstrate that reduction techniques are feasible and should be adopted whenever possible. They offer the challenge, Do we need to go even lower? Previous studies have shown that radiation exposure during cardiac diagnostic tests can increase cancer risk. This paper reports how various new methods can be applied to reduce radiation exposure during cardiac diagnostic tests by about 75%-85%. The procedures they describe can greatly reduce patient risk, noted Stanley Nattel, MD, editor-in-chief of CJC.
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Rotational Dose Control Developed for Helical Radiotherapy System

new radiotherapy approach provides high precision with excellent dose stability throughout complex rotational treatments. Static delivery provided by the dose control option also benefits from a more stable and consistent dose rate at every gantry angle. Accuray, Inc. (Sunnyvale, CA, USA; www.accuray.com), a radiation oncology company, announced that the US Food and Drug Administration (FDA) has granted the company 510(k) clearance to market the dose control system (DCS), a new feature for Accurays TomoTherapy system that improves system performance. The TomoTherapy system transformed radiation therapy with the introduction of helical delivery, providing precise application of dose to target structures while sparing healthy tissue. With the advent of the dose control system, the TomoTherapy system is the first dose servo-controlled helical delivery system. The new DCS feature provides
these gains by automatically adjusting controls earlier handled through a manual process. This means small variations in dose rate are immediately corrected by the system, resulting in fewer interruptions. The DCS application also provides a more stable output over longer duration treatments, such as total marrow and total body irradiation. The result of this new feature is a better patient experience and improved overall system performance. FDA clearance of the new dose control system is a positive step toward improving TomoTherapy system performance and customer satisfaction, said Euan S. Thomson, PhD, president and chief executive officer of Accuray. We are dedicated to offering our customers technological advancements that help streamline their workflow and expand the capabilities of their systems.
Image: The TomoTherapy system, designed for radiotherapy procedures (Photo courtesy of Accuray).
Light Interferometry Detects Precancerous Cells
ngle-resolved low coherence interferometry (a/LCI) is capable of detecting precancerous cells in the lining of epithelium of various tissues, including the esophagus and colon. Researchers at Duke University (Durham, NC, USA; www.duke.edu) used a/LCI technology to examine samples of colon tissue that were removed from 27 patients suspected have having colon cancer. The technique was used to isolate scattering from subsurface tissue layers using spectroscopy, thus obtaining structural information at sub-wavelength scales. This allows the examination of cellular structure and the measurement of quantitative changes in the size and texture of cell nuclei, measurements that are characteristic of different pathological states. The researchers also evaluated a/LCI performance by comparing the nuclear morphology measurements with pathological assessment of colocated physical biopsies. A significant correlation was noted between increased average nuclear size, reduced nuclear density, and the presence of dysplasia at the basal layer of the epithelium, 200 m to 300 m beneath the tissue surface. Using a decision line determined from a receiv-
er-operating characteristic, a/LCI was able to separate dysplastic from healthy tissues with a sensitivity of 92.9%, a specificity of 83.6%, and an overall accuracy of 85.2%. The study was published in the October 3, 2011, issue of the Journal of Biomedical Optics. When light is directed at these tissues, it scatters, said lead author associate professor of biomedical engineering Adam Wax, PhD, of the School of Engineering, who developed the device. We can collect and analyze that scattered light looking for the telltale signs of dysplasia. Significantly, the technique is noninvasive, so no tissue is taken, and no dyes or contrast agents are needed. An Angle-resolved scattering measure captures light as a function of the scattering angle and then inverts it to deduce the average size of the scattering objects. Using a computational algorithm, the average scatter size is compared at various depths within a tissue sample. The technique is similar to optical coherence domain reflectometry (OCDR) and optical coherence tomography (OCT), but uses a broadband light source to achieve optical sectioning with a depth resolution based on far-field-diffraction patterns.
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Study: Spinal Digital Subtraction Angiography Safe and Effective

adiologists have reviewed the patient records of 302 men and women who had a much-needed Xray of the blood vessels near the spinal cord and found that the procedure, frequently feared for possible complications of stroke and kidney damage, is safe and effective. Reporting in the journal Neurology online September 14, 2011, the Johns Hopkins University (Baltimore, MD, USA; www.jhu.edu) researchers found that none of the study participants, all of whom underwent a spinal digital subtraction angiography (SpDSA) at Johns Hopkins Hospital between 2000 and 2010, had suffered either a stroke or kidney damage as a result of the procedure, considered the gold stan-
dard modality for differentiating among many types of vascular disorders near the spine. These include strokes, hematomas, aneurysms, fistulas, and tumors. Patients and their physicians can now look with confidence to our study and see for themselves the real as opposed to perceived risks and complications from spinal angiography, said study senior investigator and interventional neuroradiologist Philippe Gailloud, MD, Advances in the procedure have made it much safer today than before, and neurologists and patients really should consider this valuable diagnostic tool based on the actual medical evidence and not on whatever unsubstantiated rumors they might hear secondhand
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or read on the Internet, added Dr. Gailloud, an associate professor at the Johns Hopkins University School of Medicine. Dr. Gailloud noted that reports of stroke and kidney damage had been rather high, in as many as 3% of people, in the 1970s when the procedure was first introduced. Then, preparing patients for testing and injecting a dye to make the blood vessels more visible frequently took hours instead of the routine half-hour it now takes, increasing the chances that a clot could dislodge in the blood vessels and cause a stroke. The earlier process also used up more than twice as much of the potentially toxic contrast agent than is needed today. Another major finding in the latest study was that spinal angiography could accurately rule out suspected cases of spinal inflammation, a condition known as transverse myelitis. Fourteen of 45 patients diagnosed and treated with steroids or other immune-suppressing drugs for transverse myelitis were later confirmed by SpDSA to have a vascular malformation instead. All of these patients were successfully treated for their actual spinal problem, and none of them suffered any complications as a result. According to Dr. Gailloud, who is also director of interventional neuroradiology at Johns Hopkins, this demonstrates physicians that anyone who is diagnosed with transverse myelitis and who does not show improvement after drug treatment but is still probably suffering from a spinal problem should consider having a SpDSA to either confirm the original diagnosis or determine if it is in reality a vascular malformation. Both conditions have similar symptoms, he reported, with people often
complaining of a weakening in the legs, even temporary paralysis, sudden and uncontrolled urination, and back pain. Lead study investigator and Hopkins medical student James Chen, MSc, began the study with encouragement from experts at the Johns Hopkins Transverse Myelitis Center after noticing continued reluctance by other specialists and patients to use spinal angiography. They believed the procedure to be too dangerous, despite growing acceptance of its efficacy. To counter medical rumor and historical perception, we simply had to put some current numbers on its safety and risk, stated Mr. Chen, who is also a research fellow in interventional neuroradiology at Johns Hopkins. The investigators have already started the next phase of their research, a prospective study to track people after they have had a SpDSA for any possible complications months or even years after the procedure. Initial results are expected in 2012. In the SpDSA procedure, a catheter tube is inserted into the larger blood vessels near the groin and gently threaded, one by one, into each of the major arteries branching from the aorta to the spine. Dye is released into each artery to help form multiple images of each artery, as taken by X-ray. The test is typically performed to identify specifically the source of the vascular problem after a magnetic resonance imaging (MRI) scan has ruled out any other physical disorders to the spine.
Image: A patient undergoing a spinal digital subtraction angiography, or SpDSA, an X-ray of the blood vessels near the spinal cord (Photo courtesy of Johns Hopkins Hospital).
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Diagnostic Accuracy for Detection of Non-Small-Cell Lung Cancer Metastases

or patients with non-small-cell lung cancer (NSCLC), the accurate determination of the lymph node status before therapy is critical to develop a customized treatment plan. New findings have highlighted a new approach for this information to be collected a virtual fly-through, threedimensional (3D) 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) bronchoscopy that has high diagnostic accuracy for the detection of regional lymph node metastases. The studys findings were published in the October 2011 issue of the Journal of Nuclear Medicine. According to Till A. Heusner, MD, from the department of radiology, University of Dusseldorf (Germany; www. uni-duesseldorf.de), and senior author of the study, this is one of the first studies dealing with a virtual-bronchoscopy program that integrates functional information and anatomical data. To determine the effectiveness of the virtual bronchoscopy, researchers performed whole-body 18F-FDG PET/CT scans on 61 consecutive NSCLC patients. From the data collected, virtual 18F-FDG PET/CT bronchoscopies were reconstructed and diagnostic accuracy of detection of regional lymph node metastases was evaluated using the 18F-FDG PET/CT scans as a standard of reference. Researchers conducted their evaluation by measuring the mean duration time from the start of the virtual bronchoscopy until the images were displayed, maximum standardized uptake value (glucose metabolic activity) (SUVmax), SUVmean, short-axis diameter, and the distance of the airways of the regional lymph nodes. Results from the virtual fly-through bronchoscopy showed that the diagnostic accuracy for the detection of lymph node metastases was 8%. The mean duration from the start of the virtual 18F-FDG PET/CT bronchoscopy tool until image display was 22 seconds, and the mean smallest diameter of accessible bronchi was 3 mm. The differences in the SUVmax, SUVmean, short-axis diameter, and distance to the airways among both true- and false-positive and true- and false-negative lymph nodes also were statistically significant. As such, the authors concluded that virtual 18F-FDG PET/CT bronchoscopy enables a noninvasive fly-through even in comparatively small airways in the periphery of the lung with high diagnostic accuracy. According to Dr. Heusner, as a complement to PET/CT imaging, the software may be used in the future to virtually visualize the bronchial system before interventional procedures, to plan optical bronchoscopies and define regions where a bronchoscopy-guided biopsy may be most promising for sampling of malignant tissue. He added, With the virtual fly-through three-dimensional 18F-FDG PET/CT bronchoscopy, nuclear medicine
physicians may be able to present images that better meet the needs of the referring clinicians, as the tool simulates the bronchoscopic view a pulmonologist is accustomed to. This technique may also improve the process of acquiring tissue samples for characterization with emerging molecular diagnostics that can guide application of new targeted therapies in lung cancer.
Image: Colored computed tomography (CT) scan in axial section through the chest of a patient showing non-small-cell lung cancer (NSCLC) highlighted (yellow) by an F18-FDG positron emission tomography (PET) scan (Photo courtesy of SPL).
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ELECTRONIC BRACHYTHERAPY SYSTEM

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Research Shows MRI Poses No More Than Minimal Risk in Children

roviding insights on an issue that has perplexed research ethics review boards, a new analysis of the use of magnetic resonance imaging (MRI) in pediatric clinical trials found that the risks of physical and psychological harm tied to this procedure are no greater than the risks that healthy children face from everyday activities, such as playing soccer or riding in motor vehicles. However, adding an intravenous contrast dye or sedation to an MRI increases the chances of harm and makes them unacceptably high. These findings are significant because they clarify which kinds of MRI studies meet the minimal-risk standard, which ethics review boards use to determine if a study can continue. The report was published in the September/October 2011 issue of the IRB: Ethics & Human Research, a journal of the Hastings Center. MRI offers researchers exceptional views inside the human body, but it also poses risks, including physical injury from the strong magnetic forces and psychological harm such as anxiety. For their risk analysis of the procedure, the authors considered the risks from MRI alone, as well as the risks from contrast-enhancing agents and sedation, which are sometimes used with MRI scans. The researchers also evaluated systematic reviews of the risks from several everyday activities of healthy children. The researchers discovered that the risk of physical injury from MRI is 17 per 100,000 examinations and that the risk of death is four per 100 million examinations. In contrast, the risk of injury in children under the age of 16 from a wide variety of sports and recreation activities ranges from 4 per 100,000 hours of participation in soccer to 12,730 per 100,000 hours of playing ice hockey. Assuming that an MRI examination lasts an hour, the risk of injury associated with an MRI falls within the lower end of this range, the authors wrote.
The investigators also compared the death rates of children undergoing MRI scans versus children riding in motor vehicles, which poses the highest risk of mortality to healthy children. The motor vehicle risk ranges from six deaths per 100 million car trips for children ages 14 years and younger to 40 per 100 million for children ages 15 to 19. Thus, the risk of death from an MRI examination [four per 100 million] is clearly less than the risk of death from a car trip, the authors concluded. As for psychologic harm, in studies of children ages 10 to 18 years old who had MRI scans, 12% reported that they felt disturbed by the confined space, 16% said they were bothered by the noise, and 1.2% could not complete their MRI scan due to claustrophobia. But these percentages were lower on average than the percentages of children who report fears associated with anxiety disorders in one study of children 8 to 13 years of age, for example, 49% reported fears associated with subclinical anxiety and 22% met the full criteria of an anxiety disorder. When an MRI scan calls for the injection of a contrast dye, there is the risk of allergic reactions, such as fever, headache, and anaphylaxis. The authors compared these risks with the risk of allergic reactions following routine vaccinations: while the risk of local and minor systemic reactions from MRI contrast dyes (4% to 6%) is comparable to the risk of minor reactions from routine vaccinations, the risk of anaphylaxis from MRI contrast dyes (7.5 per 100,000 doses) is higher than the risk of anaphylaxis from vaccinations. MRI with contrast enhancement therefore does not meet the minimal-risk standard, they stated. The investigators also concluded that the risk from sedation in MRI protocols, which includes gastrointestinal complaints (18% to 37%) and motor imbalance (66% to 85%), does not meet the minimal-risk standard, based in the risks posed by sedating medications such as over-the-counter
cold medicines. We urge researchers and REBs [research ethics review boards] to collaborate in the ongoing effort to minimize the risk of harm and discomfort associated with pediatric MRI research, wrote the authors: Matthias H. Schmidt, MD, FRCP, of Dalhousie University (Halifax, Nova Scotia, Canada; www. dal.ca); Jennifer Marshall, MSc, of the University of Toronto (Canada; www.utoronto.ca); Jocelyn Downie, LLB, LLM, SJD, of Dalhousie University, and Michael R. Hadskis, LLB, LLM, of Dalhousie University.
Image: Coloured magnetic resonance imaging (MRI) whole body scan of a 9-year-old boy (Photo courtesy of Simon Fraser / SPL).
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Computed Radiography Upgrade Generates Productivity Gains, Cost Savings

ith healthcare budgets under pressure, replacing computed radiography (CR) technology with the latest digital radiography (DR) is expensive, and is estimated to cost approximately GBP 250,000 per room and involve significant physical disruption. Research conducted in the United Kingdom concluded that adding DRX detectors to existing CR capacity is not only a more cost-effective option, but that the upgrade can also generate productivity gains and cost savings to justify the investment. An economic analysis commissioned by Carestream Health (Rochester, NY, USA; www. carestreamhealth.com) in the United Kingdom has concluded that upgrading to the Carestream DRX compared to continuing to use CR technology generates productivity gains and cost savings. Data were drawn from Brighton and Sussex University NHS [National Health Service] Trust, earlier research by Carestream and expert opinion and the analysis was carried out by Matrix Evidence (London, UK; www.matrixknowledge. co.uk/evidence). Two analytic models were run, for the Carestream DRX-1 designed for an X-ray setting and the Carestream DRX mobile retrofit kit designed for mobile environments. In summary, the findings of the report were for an X-ray room unit operating at full capacity levels (100% of its potential capacity or 10,057 procedures per year): (1) upgrading to DRX, compared to continuing to use CR, reduces radiographer time; (2) required by up to 43% or 664 hours. These hours amounted up to 0.43 full time; (3) radiographer savings, which in monetary terms equals GBP 18,585 per room per year; (4) assuming the hours of radiographer time saved are used to see more patients, an additional 7,543 procedures per room per year could be delivered (an increase in capacity of 75%); (5) Lastly, taking into account the cost of the investment, DRX can save up to GBP
10,453 per room per year. In addition to the economic analysis, evidence also suggests that the DRX detectors provide improved image quality and reduced radiation dose, in comparison to CR technology benefits that can potentially lead to improved health outcomes. The results of the research clearly show that investment in Carestream DRX offers a number of benefits both in financial and workflow terms, said Jane Grimsley, European marketing manager for digital capture, Carestream Health. Customers across the world are eagerly implementing innovative DRX solutions to help boost productivity and enhance patient care. To-date the company has sold more than 2,500 DRX detectors worldwide.
Image: The DRX Transportable System - Universal Mobile Retrofit Kit (Photo courtesy of Carestream Health).
Shorter Radiation Treatment Times for Breast Cancer Adds to Patient Convenience
US medical center has launched research into accelerated whole breast radiation treatment for women with early-stage breast cancer. The study, RTOG 1005, was developed by the Radiation Therapy Oncology Group (RTOG), a cancer therapy research cooperative group funded by the US National Cancer Institute at the National Institutes of Health (Bethesda, MD, USA), part of the US Department of Health and Human Services. Frank Vicini, MD, Beaumont Health Systems (Royal Oak, MI, USA; www.beaumont.edu) chief of oncology services, and the studys national lead investigator, reported that this approach could eventually shorten treatment time for the majority of women with breast cancer. Beaumont has enrolled the United States first patient in the study a 51year-old schoolteacher from Royal Oak, MI, USA. Earlier studies have shown that giving radiation therapy after breast-conserving surgery (lumpectomy) helps keep cancer from coming back in the
breast. Radiation therapy is given to the whole breast on a Monday through Friday basis for five weeks. It can be followed by a boost a higher dose of radiation to the site of the tumor adding another one to one-and-a-half weeks of treatment time. This new research study will compare radiation therapy given with a higher daily dose over three weeks plus a boost administered each day with traditional whole breast radiation followed by a boost given on separate days extending over six to six and-a-half weeks. We dont expect to see a difference in survival by changing the number of daily treatments and shortening the length of time for treatment, said Dr. Vicini. But shortening the length of treatment will greatly enhance convenience and quality of life for patients, while saving time and money. A total of 2,312 patients across the United States will take part in the study. Beaumont expects to enroll 100 patients.
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Contrast-Enhanced Spectral Mammography Offers Dual-Energy Image Acquisition

ontrast-enhanced spectral mammography (CESM) is a new technology that is designed to generate contrast-enhanced images of the breast using an approved X-ray contrast agent and a dual-energy acquisition technique. GE Healthcare (Chalfont St. Giles, UK; www. gehealthcare.com), a unit of General Electric Company (Fairfield, CT, USA), announced US Food and Drug Administration (FDA) 510(k) clearance of the innovative technology to aid the physician in breast cancer diagnosis. GE estimates that by 2020, more than one million women worldwide will be examined using SenoBright CESM, and this technology can help lead to more productive diagnosis paths for nearly 250,000 women. Launched in 2010, SenoBright is already in use at 17 major mammography centers in France, Spain, Italy, Belgium, Germany, Austria, and Japan. SenoBright uses X-rays at multiple energies to create two separate but almost simultaneous exposures. The resulting images specifically illuminate and highlight areas of iodinated con-
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trast. CESM presents two images per mammographic view, one that looks like standard mammography and a second image that showed the contrast enhanced areas that can help localize a lesion. As the images are familiar, it can therefore be easily reviewed by surgeons and oncologists. Moreover in Image: A standard mammography image (left), and a breast examined terms of workflow, a CESM using SenoBright CESM (right) (Photo courtesy of GE Healthcare). exam takes from 5 to 10 minutes, said Dr. Clarisse SenoBright is intended to allow for a procedure Dromain, Gustave Roussy Cancer Institute to be conducted by the same staff, using the same (Villejuif, France). mammography equipment, potentially on the Worldwide, more than 1.2 million people same day as a traditional screening exam, thereby annually are diagnosed with breast cancer. Since helping medical professionals to cut the critical 1965, GE Healthcare has made significant time patients often have to wait from detection to progress in providing solutions for breast cancer diagnosis. GE Healthcare estimates that 2500 digdetection and diagnosis that really bring a change ital mammography systems upgradeable to to peoples lives. Today through healthymaginaSenoBright are in clinical use today. Given our tion, we continuously develop innovations to proven history of breast imaging innovations, GE reduce costs, increase access and improve quality is proud to showcase another innovative technoland efficiency of healthcare delivery around the ogy, designed to be compatible with our digital globe, said Anne LeGrand, GE Healthcares vice installed base. We are one of the only companies president and general manager of the companys today to engineer and manufacture the entire global X-ray business. mammography imaging chain from tube, and Digital mammography is considered an impordetector to review workstation, coupled with tant means of breast cancer screening, delivering integration of the comprehensive local requireproven clinical outcomes. The sensitivity and speciments for each customer, added Ms. LeGrand. ficity of images can, however, be affected by a range CESM technology is intended to work as an of factors. Dense breast tissue can overlap with upgrade to GE Healthcares Senographe DS and lesions, which are not always visible on an X-ray, Senographe Essential digital mammography and radiologists interpretation of images can vary. equipment. GEs Senographe platforms are fullInconclusive digital mammography presents a field digital mammography systems designed to range of challenges to healthcare professionals and meet a wide range of clinical needs, from screenpatients. Ambiguity can result in diagnostic error. ing to diagnostic and interventional procedures.
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CR Readers, Software Receive FDA Clearance

ovel, upgradable computed radiography (CR) readers are designed to fit any environment, especially in facilities with limited space availability. 3DISC Imaging (Dulles, VA, USA; www. 3discimaging.com), a manufacturer of CR systems, has received 510(k) clearance from the US Food and Drug Administration (FDA) to market its line of FireCR Medical readers and QuantorMed imaging software in the United States. The unique FireCR readers can be quickly upgraded to higher speeds with a simple smart card update, giving users flexibility to start with an entry?level reader and increase productivity as their needs change. 3DISCs FireCR readers represent the next generation in CR reader technology providing maximum flexibility and a fast return on investment for hospitals, busy clinics, specialty practices, and satellite facilities. They can be configured for most medical and chiropractic applications and are designed for full Digital Imaging and Communications in Medicine (DICOM) connectivity, allowing users to capture high quality X-ray images of any body part. 3DISCs companion QuantorMed imaging software provides optimized image acquisition, processing, and management capabilities. Autocalibration technology ensures stability and consistency, even when the
readers are wheeled around a busy clinic on a cart or transported in a mobile imaging unit. According to Sigrid Smitt-Jeppesen, CEO of 3DISC Americas, the company is the first manufacturer to offer the ability to upgrade its CR readers. Busy hospitals, clinics, and practices today need maximum flexibility in selecting imaging equipment and also need to ensure that their technology investment is protected, Ms. Smitt-Jeppesen said. 3DISC answered that call by developing the first line of CR readers that can be quickly upgraded in the field without having to replace equipment, ensuring no disruption in workflow and providing maximum value. We are committed to bringing the benefits of digital imaging to healthcare facilities of all sizes and types, and the recent FDA clearance of our FireCR readers and software is an important milestone along this journey. The compact, lightweight FireCR readers are designed to fit into any environment, with a wallmount option for facilities with limited space availability. At only 12.7 cm deep and 29.5 kg, they can fit in the smallest of X-ray rooms, so technologists no longer have to leave the room and the patient in order to scan X-rays, preventing
workflow disruptions and improving patient care and satisfaction, added Thomas Weldingh, CEO at 3DISC Europe. The FireCR Medical product line, which is being used by a growing number of facilities in Europe, is available in the United States immediately through a global network of distributors. It includes a range of compact, portable CR readers designed for specific clinical applications, including: FireCR Medical-80 for hospitals, back-up units, and private clinics; FireCR Medical-60 for private clinics and high-volume practices; FireCR Medical-40 for mid-volume practices; and FireCR Medical-20 for lower-volume practices.
Image: The FireCR medical computed radiography scanner (Photo courtesy of 3DISC Imaging).
Radiation Therapy Technology Provides Simultaneous MRI Scanning, Treatment

new research radiation-therapy system is being developed to feature a patented combination of radiotherapy delivery and simultaneous magnetic resonance imaging (MRI). The University of California, Los Angeles (UCLA) Health System and Jonsson Comprehensive Cancer Center (JCCC; www.cancer.ucla.edu) will soon become the third oncology research center in the world to acquire a radiotherapy system from ViewRay, Inc. (Cleveland, OH, USA; www.viewray.com), a medical device company. Nearly two-thirds of all cancer patients receive radiation therapy during their illness. The ViewRay system is being designed to provide continuous soft-tissue magnetic resonance imaging (MRI) during treatment so that clinicians can see where the radiation is being delivered, as it is being delivered. The ViewRay system will enable researchers at UCLA to continue to meet our mission of fostering patient-centered care while pursuing better treatments and cures for cancer, said Michael Steinberg, MD, chair of the UCLA department of radiation oncology and director of
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clinical affairs at JCCC. One of the largest comprehensive cancer centers in the United States, JCCC has an international reputation for developing new cancer therapies, providing the best in experimental and traditional treatments. JCCCs radiation oncologists are highly regarded as both researchers and clinicians, said ViewRay President and CEO Gregory M. Ayers, MD, PhD. JCCC joins ViewRay research partners at the University of Wisconsin Carbone Cancer Center (Madison, USA), and the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine (St. Louis, MO, USA), where the first ViewRay research system is currently being installed. Pending 510(k) premarket notification review with the US Food and Drug Administration (FDA), the ViewRay system is currently available only as a non-human use research system. UCLAs Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment, and education.
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PRODUCT NEWS
IMAGING DESKS
Anthro The Steves Station line of imaging desks adjusts for either sitting or standing while maintaining comfortable focal depth for display monitors. The ergonomic design is intended to improve productivity, and can be easily shared by multiple radiologists.
ULTRASOUND TABLE
Biodex Medical Systems The Echo/Vasc Pro table features a wide range of convenient solutions and ergonomic benefits including variable height range, extra-wide patient capacity, and motorized positioning. The table is designed for vascular scanning and echocardiography applications.
WIRELESS DR DETECTOR
Canon The CXDI-501C features a 14-inch by 17-inch imaging area, and weighs 3.2 kg. The detector incorporates a high-quality, approximately 9.5 million MP image sensor with a pixel pitch of 125 microns, allowing for fast exam output and enhanced image viewing.
INTRAVASCULAR IMAGING SYSTEM

InfraReDx The TVC Imaging System is designed as an enhanced version of the LipiScan IVUS coronary imaging system. The multimodality system offers improved image resolution, and combines both IVUS and near-infrared spectroscopy for compositional assessment.
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Pelvic Endo Coil Developed for MRI Systems
magnetic resonance imaging (MRI) endo coil array for pelvic imaging provides a new solution for analysis of the region. Moreover, a new breast coil array is designed to provide excellent signal-to-noise ratio as well as optimal access for breast biopsies. Hologic, Inc. (Bedford, MA, USA; www.hologic.com), a developer, manufacturer diagnostics, medical imaging systems and surgical products, announced today that the US Food and Drug Administration (FDA) has cleared two Hologic MRI products: the Sentinelle two-channel endo coil and Sentinelles 16-channel breast coil for several Siemens Healthcare (Erlangen, Germany) platforms. The Sentinelle MRI endo coil employs Hologics innovative technology designed to provide high signal-to-noise imaging to help visualize and localize cancers in the pelvic region, and especially prostate cancer. Siemens and Toshiba (Tokyo, Japan) are completing final release processes to enable product shipments in 2012. Hologics new 16-channel Sentinelle breast coil builds on the companys strength in breast MRI interventional and analysis solutions for
managing breast cancer. The 16-channel array is pending validation by Siemens and will initially be available on the Siemens TIM (total imaging matrix) platforms, followed by validation on the Siemens Aera and Skyra MRI platforms. We are excited about the possibilities these new products bring healthcare professionals for finding and treating breast and prostate cancer at the earliest stage possible, said Peter Soltani, PhD, senior vice president and general manager of Hologics breast health division. Hologic offers imaging, interventional, and analysis solutions for breast MRI. Unlike competitive breast coils, Hologics variable coil geometry feature allows for the diagnostic coils and biopsy grid positioning to conform to each patient. This advance can improve image quality, decrease set-up time, increase patient accommodation, and improve access to lesions for biopsy. When combined with the Hologic ATEC minimally invasive breast biopsy device for MRI and Hologic Aegis software for image analysis and interventional planning, a unique suite of products is provided. The companys MRI endo coil array for pelvic
imaging provides a new system for imaging and analysis of the pelvic region including the prostate, cervix, colon, and the surrounding tissues in the pelvis. Complementing the endo coil array, MRI solutions offer a prostate plug in for analysis of prostate MR images to the Aegis software platform. Hologic, Inc. is a developer and manufacturer of diagnostics products, medical imaging systems, and surgical products dedicated to serving the healthcare needs of women. Hologics core business units are focused on breast health, diagnostics, gynecologic surgical, and skeletal health.
Image: The Sentinelle Vanguard breast MRI coil system (Photo courtesy of Hologic).
FDG-PET Predicts Prognosis of Patients with Inoperable Non-Small-Cell Lung Cancer
he prognosis for patients with stage II and III inoperable non-small-cell lung cancer (NSCLC) is poor, with only about 15% of patients surviving at five years after treatment for the disease. Whereas new treatment strategies are being intensely studied, timely assessment of their efficacy has proven difficult. In a presentation on October 2011 at the annual meeting of the American Society for Radiation Oncology (ASTRO) in Miami Beach (FL, USA), Mitchell Machtay, MD, lead investigator of the ACRIN 6668/RTOG [Radiation Oncology Therapy Group] 0235 trial and RTOG deputy chair, reported that posttreatment F-18 fluorodeoxyglucosepositron emission tomography (FDG-PET) imaging scans show promise for predicting the prognosis of
patients with inoperable disease. These results are encouraging, said Dr. Machtay. Definitive prognostic information after a patient completes therapy has not been available for making decisions about further treatment options, and these preliminary results suggest that FDG-PET may play an important role in that regard. Twenty American College of Radiology Imaging Network (ACRIN; Reston, VA, USA; www.acrin.org) and RTOG participating sites enrolled 251 patients into the phase III trial that gathered pre- and posttreatment FDG-PET scans treatments, which included both chemotherapy and radiation therapy. Specifically, investigators sought to determine if the standardized uptake value (SUV), a quantitative measure of how rapidly tumor cells are using the glu-
cose-based FDG radiotracer, obtained on posttreatment FDG-PET scans was predictive of a patients survival. As Dr. Machtay reported, The posttreatment scan was predictive for patients prognosis by identifying that patients with high levels of FDG uptake following treatment had more aggressive tumors that were more likely to recur, and the higher the SUV measure in the primary tumor, the greater the recurrence rate and the lower a patients corresponding survival outlook. The FDG-PET scan findings provided for this analysis were interpreted by physicians at the participating sites. Further analyses are ongoing evaluating scan data interpreted by central review at the ACR Imaging Core Laboratory and using other semiquantitative measures.
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Lung Cancer CT Screening Helpful in Detecting COPD
mong men who were current or former heavy pants comprised 54% (150 of 277) of all particismokers, undergoing lung cancer screening pants with mild obstruction, 73% (99 of 135) of with computed tomography (CT) scanning detectall participants with moderate obstruction, and ed a considerable percentage who had chronic 100% (25 of 25) of all participants with severe obstructive pulmonary disease (COPD), suggesting obstruction. The researchers added that this posthat this modality may be beneficial as an additionsible approach of using quantitative CT for detecal application in detecting COPD, according to tion of airflow limitation is not suggested as a prirecent research. The studys findings were pubmary screening method for COPD, for which pullished in the October 26, 2011, issue of the Journal monary function testing is the preferred method. of the American Medical Association (JAMA). Image: False color computed X-ray tomography Smoking is annually projected to cause more than (CT) scan of the chest of a man aged 56 years, eight million deaths worldwide in the coming showing lung cancer of the left bronchus (Photo decades. Besides cardiovascular disease and cancer, courtesy of Simon Fraser / SPL). chronic obstructive pulmonary disease is a major cause of death in heavy smokers. Nevertheless, COPD is considerably underdiagnosed. In spite of a decrease in cardiovascular mortality and stabilization of cancer mortality worldwide, mortality from COPD is increasing, according to the authors. Early termination of smoking can prevent COPD progression, highlighting the importance of early detection. CT-based lung cancer screening may provide an opportunity to detect individuals with COPD at an early stage. Onno M. Mets, MD, from the University Medical Center Utrecht (The Netherlands; www.umcutrecht.nl), and colleagues conducted a study to explore whether low-dose lung cancer screening CT scans could be utilized to identify participants with COPD. The study, performed within an ongoing lung cancer screening trial, included prebronchodilator pulmonary function testing with inspiratory and expiratory CT scans performed on the same day from 1,140 male study participants between July 2007 and September 2008. The pulmonary function tests were used as the reference standard in determining the COPD diagnostic accuracy of the CT scans. The average age of participants was 62.5 years. Data for self-reported respiratory symptoms were available from 1,085 participants; a total of 566 participants were symptomatic, and 519 participants were asymptomatic. Forty-one participants (3.6%) reported physician-diagnosed emphysema and 93 (8.2%), bronchitis. Based on the results of pulmonary function testing, 437 participants (38%) were classified as having COPD. The final diagnostic model for the study included five factors independently associated with obstructive pulmonary disease: CT emphysema, CT air trapping (an abnormal retention of air in the lungs), body mass index, pack-years (the number of packs of cigarettes smoked per day multiplied by the number of years the person has smoked), and smoking status. Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63%, a specificity of 88%, and a positive predictive value of 76%, which corresponds to 63% (274 of 437) of all parLINKXPRESS COM MII-02-12 131 ticipants with COPD. These 274 partici-
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PRODUCT NEWS
POC ULTRASOUND SYSTEM

SonoSite The EDGE system is designed as a diagnostic tool for point-of-care (POC) assessment at the hospital bedside and in the physicians office. The system features a high-luminance LED, a high-resolution 12-inch display, and an easy-to-clean sealed silicone pad.
TEST PHANTOM
Pehamed The Slanted Edge test phantom offers intersystem comparability, absolute limits, automatic analysis, and reproducibility. The system provides enhanced performance based on several factors including incident dose, dose detector, curve, MTF, NPS, and quantum flux density.
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MOBILE X-RAY SYSTEM

Siemens Healthcare The Mobilett Mira mobile digital X-ray system with a wireless detector is designed to facilitate exams of patients with limited mobility. The system gives users greater flexibility and access to the patient, and it can be maintained and updated via remote monitoring.
LAPTOP IMAGING SYSTEM

Toshiba Medical Systems The Viamo offers a portable imaging solution that can be used as a laptop or in tablet mode. The flexible system features a rapid boot-up option that takes the unit from standby to scan mode in seconds, and it is considered ideal for various mobile clinical, outpatient, and ER applications.
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Hybrid Imaging Technology Shows Potential in Identifying Hard-to-Detect Ovarian Cancer

y combining three previously distinct imaging modalities into one new device, a team of researchers has proposed a new way to diagnose early-stage ovarian cancer in high-risk women through minimally invasive surgery. The new technique may be better than the current standard procedure of preemptively removing the ovaries. Ovarian cancer has a low survival rate because a lack of effective screening techniques typically means the disease remains hidden until the later stages. Now researchers from the University of Connecticut (Storrs, USA; www.uconn.edu) and the University of Southern California (USC; Los Angeles, USA; www.usc.edu) have drawn on the unique advantages of multiple imaging approaches to evaluate a new way of spotting early-on the tissue irregularities that are hallmarks of cancer. For their diagnostic device, the researchers combined the contrast provided by photoacoustic imaging, the high-resolution subsurface imaging provided by optical coherence tomography
(OCT), and the deeper tissue imaging provided by pulse-echo ultrasound. They assessed their device, described by the team in the September 2011 issue of the Optical Societys (OSA) open-access journal Biomedical Optics Express, by imaging both pig and human ovarian tissue, and accurately identified malignant tumors that were later validated by staining the tissue and examining it under a microscope. These early tests were performed on tissue that had been surgically removed, but the diameter of the device at only 5 mm is small enough that it could potentially be inserted through a small slit to image tissue in live patients.
Image: A malignant postmenopausal ovary (A). Coregistered ultrasound and photoacoustic images of two different locations are shown in B and C. (B1 and C1) H&E stains (A-40) of the corresponding areas showing extensive high-grade tumors. (B2 and C2) CD31 stains (A-100) of the corresponding areas showing extensive thin-walled microvessels. White bar, 5 mm (Photo courtesy of the University of Connecticut School of Engineering).
Proton Treatment Facility to Provide Therapy and Research

n addition to treating patients, a new proton therapy facility being built in the United States will serve as a research center for particle therapy. Construction on the 9,476-square meter Scripps Proton Therapy Center (www.scripps.org) building on a 28,328-square meter site in Mira Mesa area of San Diego (CA, USA), is approximately 80% complete. Major components of Varians ProBeam system for this site are already manufactured and en route to the new facility, where installation is scheduled to begin in the middle of October 2011. The center hopes to begin treating patients in 2013. Varian Medical Systems, Inc. (Palo Alto, CA, USA; www.varian.com) reported that it has logged a US$88 million order to provide its ProBeam system for the Scripps Proton Therapy Center, being
developed through collaboration between Scripps Health, Scripps Clinic Medical Group, and Advanced Particle Therapy (Minden, NV, USA). The equipment order for the five-room center that will be operated by Scripps Health was issued by the California Proton Treatment Center (CPTC), a special purpose entity formed by Advanced Particle Therapy, which is acting as developer for the $225 million project. Concurrent with the order booking in the fourth quarter of fiscal year 2011, Varian has also recorded revenue for this equipment under the percentage of completion method. Varian has also signed a 10-year agreement valued at approximately $60 million to service its ProBeam system for the center. Service revenue will be recorded in the future over the life of the contract and has not been added to the companys
backlog. This is an exciting step forward for the Varian particle therapy business, said Tim Guertin, president and CEO of Varian. The Scripps Proton Therapy Center will be our first full installation for managing, planning, and delivering intensity-modulated proton therapy. Proton therapy makes it possible to treat certain types of cancer more accurately and with potentially fewer side effects than with traditional radiation therapy. With proton therapy, the risk of damage to healthy tissues is reduced. The method can be applied for many of the most common types of cancer and offers advantages when treating tumors close to radiosensitive tissues. In pediatric patients, the risk of developing a new, radiation-induced cancer later in life can be reduced.
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Radiotherapy Innovations Presented at Cancer Summit

ancer specialists from around the world gathered in Berlin, Germany, on October 20, 2011, to hear of the latest developments in radiotherapy that are bringing additional treatment possibilities for cancer patients. More than 450 oncologists, physicists, and radiotherapy practitioners were at the two-day Berlin Oncology Summit, organized by Varian Medical Systems (Palo Alto, CA, USA; www.varian.com), to share knowledge and discuss the expanding use of radiotherapy and radiosurgery to treat an increasingly wide range of cancers. Key sessions at the event looked at 10 years worth of data since the first intensity-modulated radiotherapy (IMRT) treatments in Europe, as well as sophisticated clinical applications using higher dose delivery systems such as Varians TrueBeam linear accelerator and the growing practice of hypofractionated stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) treatments for prostate cancer. SBRT, a type of radiosurgery that is different from conventional radiotherapy in that higher doses are given over a shorter number of treatments, is an emerging treatment for prostate cancer and a viable alternative, in some cases, to more invasive surgical procedures that require hospitals stays and long recovery periods. Potential benefits of SBRT include fewer side
effects and greater patient convenience. Prof. Volker Budach, head of the Clinic for Radio-oncology and Radiotherapy at the Campus Virchow-Klinikum and Campus Charite Mitte of the Charite Universitatsmedizin Berlin, who is delivering the keynote address at the oncology summit, said, We continue to see great strides in radiotherapy technology and treatment delivering techniques that improve precision, bring down treatment times and make radiotherapy a feasible treatment for many more tumor sites. Events such as this summit enable oncologists from around the world to reveal outcomes and share best practices. Among the highlights at the event was a presentation by Dr. Simona Castiglioni of the Humanitas Clinic (Milan, Italy), describing groundbreaking work using the TrueBeam system to deliver SBRT for metastatic liver lesions and nonmetastatic pancreatic cancer, as well as the use of RapidArc image-guided IMRT for total marrow irradiation. Other major presentations describe using RapidArc to treat primary liver cancer from Dr. Po-Ming Wang at the Cheng-Ching General Hospital (Taiwan), and the use of SBRT with RapidArc for spinal tumors from Dr. Wilko Verbakel at VU University Medical Center (Amsterdam, Netherlands).
The Oncology Summit also featured presentations on A Vision for Radiosurgery, by Prof. Dr. John Adler, Varians chief of new clinical applications; Varians Long Term Vision, by chief executive officer Tim Guertin; and a welcome address by Dow Wilson, Varians chief operating officer. Rolf Staehelin, international head of marketing operations for Varians oncology systems group, said, This is the 12th time we have held a gathering such as this and this is the best attended yet. There has been tremendous interest shown by the oncology community. Many of the major advances in radiotherapy and radiosurgery described at this event are in routine clinical use on a daily basis for the benefit of cancer patients worldwide. Whats particularly noticeable is the growing use of SBRT to treat cancers that would previously have only been treatable using surgery. These new techniques are offering patients an efficient, noninvasive outpatient alternative to invasive surgical approaches which entail anesthetic and long recovery periods in hospitals. Varian Medical Systems, Inc. is a world-leading manufacturer of medical devices and software for treating cancer and other medical conditions with radiotherapy, radiosurgery, and brachytherapy. The company supplies informatics software for managing comprehensive cancer clinics, radiotherapy centers, and medical oncology practices.
Cardiac CT Knowledge Sessions Designed for Visiting Iraqi Radiologists
cardiac computed tomography (CT) level II1 course has been developed in the United Kingdom for visiting radiology professionals from Iraq. The course has been initiated by the British Institute of Radiology (BIR; London, UK; www.bir.org.uk), with technical support from Siemens Healthcare (Erlangen, Germany; www.siemens.com/healthcare). The BIR works in partnership with the Baghdad Medical College (Iraq; www.thebcmf.com). The Baghdad Teaching Hospital in Iraq is funded by the UK Department for International Development and managed by British Council. The four-day course delivered training on the skills required to produce and interpret clinical cases and included the study of 150 cases using the Siemens CT syngo.via imaging workstation application. Cardiovascular disease remains one of the worlds leading causes of premature death and the figures from Iraq show it is no different to the rest of the world. The ability of cardiovascular CT to detect coronary artery disease [CAD] noninvasively allows early detection or exclusion of CAD and appropriate primary and secondary prevention strategies to be put in place to
address this issue. Training senior colleagues from the Baghdad Medical College and Teaching Hospital will allow them to pass down these new skills to colleagues throughout Iraq and put them in a stronger position to address the growing global epidemic of cardiovascular disease, commented Dr. Ed Nicol, consultant cardiologist at Royal Brompton (UK) and Harefield NHS [National Health Service] Foundation Trust (UK) and BIR cardiac CT course director. 2012 courses run by the British Institute of Radiology are open to delegates from home and abroad and will offer similar agendas focused on building knowledge of cardiovascular CT diagnosis. Additional cardiac CT courses run by the BIR and supported by Siemens will be open to interested parties in February, July, and September 2012. All the sessions are designed to build knowledge of how to analyze and interpret cardiac CT data sets, provide learning on how to handle common pitfalls in routine practice and provide instructive teaching sessions on pathology and technology. Russell Lodge, CT business manager at Siemens Healthcare stated, The hands-on sessions involving
real-to-life cardiac CT cases help delegates to analyze and interpret major pathology groups including normal anatomy, anatomical variants, normal CT angiography, atherosclerotic CAD, as well as post-PCI and postsurgery assessment. This extends knowledge that individuals can take back into their clinical institutions to enhance a confident
and swift diagnosis. The cardiac CT courses are suitable for delegates that are performing cardiac imaging on any suitable CT platform and prior experience on Siemens syngo.via or CT scanners are not expected. For further information on the planned courses for 2012, please visit the BIR online.
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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
PACS WORKSTATION
CHILI The CHILI/Workstation is a diagnostic PACS workstation with features for teleradiology. The system also offers a multilanguage user interface, and conforms to IHE standards.
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MRI-TABLE DEVICE
Invivo The DynaTRIM device is a removable device designed for TRIM of the prostate gland. The device can be affixed to a MR imaging table, and allows for patient comfort and easy cleaning.
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DR SYSTEM
Landwind Medical The DR2800F is intended to conduct more exams per hour, allowing for immediate access to images within seconds, and transmission to multiple locations.
HEALTHCARE DISPLAYS
NEC Display Solutions The hospital-wide display solutions are designed to help facilities improve performance and diagnostic accuracy, while streamlining patient care.
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TELERADIOLOGY SOLUTIONS
RamSoft Tele Plus and Tele Lite are designed to streamline workflow with universal worklists for multisite reading, while providing consistent viewing environments for radiologists.
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DR/DRF SYSTEM
Italray The Clinodigit Omega is a multifunctional system designed to perform all types of DR and DRF exams with one single compact unit. The system features a dynamic flat panel detector, and enhanced images.
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Ultra-Low Dose CT Technology Provides Extreme Image Clarity

utting-edge computed tomography (CT) imaging technology may help physicians accurately diagnose with high image clarity at previously unattainable low dose levels. GE Healthcare (Chalfont St. Giles, UK; www.gehealthcare.com) announced US Food and Drug Administration (FDA) 510(k) clearance of its new CT technology, called Veo, which may help physicians deliver accurate diagnoses by enabling profound CT image clarity at dramatically lower dose. Veo represents the CT industrys first model-based iterative reconstruction (MBIR) technique, and is already available on GE Discovery CT750 HD (high definition) systems in Europe, Canada, and regions of Asia. The radiological community continues to demand maximum CT image clarity at optimized dose levels to help best serve our patients, said Dr. William Shuman, professor and vice chairman, department of radiology at the University of Washington (Seattle, USA). A superb image quality, sub-millisievert CT exam has in many ways been seen as CTs holy grail making powerful new diagnostic tools like Veo all the more vital as we seek to minimize patient dose while maximizing diagnostic confidence. The Veo reconstruction option may also improve the image quality of low dose, nondiagnostic CT images [filtered back projection], such that they become diagnostic.
Veo has already been clinically shown to offer profound image clarity at yet unseen low dose levels. Current Veo users in Europe report successful chest CT scans performed with an equivalent amount of medical radiation dose as a chest X-ray, or less than one-tenth of one mSv. With a clinical chest CT at 0.05 mSv, we produced images where we could see and analyze pathology, said Prof. Johan de Mey, chair of the radiology department at University Hospital (Brussels, Belgium). With Veo, we can conduct lower dose CT scans in children, too, and this is particularly important in groups that require continued follow-up, such as those with cystic fibrosis or lymphoma. While complementing the imaging capabilities of GEs adaptive statistical iterative reconstruction (ASiR) technique, Veo represents a significant technologic step forward just as the topic of diagnostic medical radiation levels has come into the national spotlight. In fact, the US Joint Commissions recent Sentinel Event Alert on minimizing medical radiation specifically suggested that healthcare organizations invest in technologies that optimize or reduce dose. According to GE spokespersons, Veo is a first-of-its kind dose-optimizing technology; the most profound since ASiR which, itself, was the worlds first iterative reconstruction technology and is now employed on more than 1,000 GE
CT systems globally for an estimated 10 million examinations to date. GE is committed to equipping radiologists and technologists with breakthrough CT technologies that can help reduce patient dose and improve image clarity in their daily practice, said Steve Gray, vice president and general manager of CT and Advantage Workstation for GE Healthcare. Veos revolutionary capabilities change the rules of CT imaging, and represent our promise to help eliminate the traditional trade-off between image clarity and low dose levels as we help healthcare professionals offer the best patient care possible.
GE Healthcare is coordinating a multicenter study to investigate further improvements including substantially lower dose levels which Veo may offer across a range of applications. Developed in partnership with leading academic researchers and experts from GEs Global Research Center, Veo is available on the Discovery CT750 HD system.
Image: Compared to FBP, these Veo images illustrate more small order arteries and a sharper depiction of all the arteries. Scan protocol: 100 192 mAs, 120 kVp Slice Thickness: 0.625 mm. FBP reconstruction (left), Veo reconstruction (right) (Photo courtesy of GE Healthcare).
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New Ultrasound Technology Improves Diagnostics in Womens Healthcare
series of new ultrasound enhancements are designed to increase diagnostic effectiveness in womens healthcare. GE Healthcare (Chalfont St. Giles, UK; www.gehealthcare.com) announced the availability of HDlive and Volume SRI (speckle reduction imaging) for womens health imaging products within its Voluson Expert series platform. These innovations were presented for the first time in the United States at the 2011 International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) congress in Los Angeles (CA, USA), in September 2011. HDlive is one of the new key rendering tools on the new dynamic rendering engine on the Expert Series platform. This tool provides exceptional anatomic realism and helps increase depth perception. This novel imaging capability can help medical professionals achieve a deeper understanding of relational anatomy, help enhance diagnostic effectiveness, and ultimately improve patient communication. This is available on the Voluson E8 and E8 Expert. Instead of single slice imaging, Volume SRI uti-
lizes volumetric, multiplane imaging to enhance the speckle reduction in clinical images. The tool helps improve three-dimensional (3D)/4D image quality in multiplanar studies and rendered mode, and also provides an enhanced smoothing effect on rendered images. The imaging potential of these latest GE Healthcare innovations is unlike anything weve developed in the past, said Karl-Heinz Lumpi, general manager of womens health ultrasound for GE Healthcare. Through the HDlive and Volume SRI technologies, we intend to make advanced womens health imaging through ultrasound more prevalent and accessible. These technologies have the potential enables better diagnosis for more patients around the world. Complementing the latest hardware additions to the Voluson Expert series new advanced transducer technology. Optimized for ob/gyn purposes, the following 2D and 3D/4D probes enable quality images across a wide range of gen-
eral and specialized exams. With the RAB6-D new ultra-light volume transducer, user fatigue is not a problem. GE Healthcares next-generation volume transducer, which is 40% lighter than the previous version, has an ergonomic design that provides excellent image quality in 2D and 3D/4D, while sitting comfortably in the operators hand. The C4-8-D new wideband transducers high frequency and small footprint helps provide high-resolution obstetrical images during each trimester.
Image: The Voluson E8, designed for womens healthcare, in use (Photo courtesy of GE Healthcare).
Reducing Planning-CT Dose Lowers Dose of CT Fluoroscopy for Spine Injections

he radiation dose for a computed tomography (CT) fluoroscopy is approximately half that for traditional fluoroscopy to guide epidural steroid injections; however, the dose is substantially more than conventional fluoroscopy when a full lumbar planning CT scan is performed as part of the CTguided procedure, a new study revealed. Physicians may hesitate to use CT fluoroscopy because of concerns about radiation dose, reported Jenny K. Hoang, MD, from Duke University Medical Center (Durham, NC, USA; www.dukehealth.org), and one of the authors of the study. However, the study found that since CT fluoroscopy itself takes less time than conventional fluoroscopy (4.7 seconds versus 37 seconds on average), the radiation dose is actually much lower. The study found that absorbed radiation dose to the skin, small bowel, large bowel and bone marrow was greater for conventional fluoroscopy compared with CT fluoroscopy. However, when you combine the dose of the planning CT (scan range from L2 to S1) with that of the CT fluoroscopy itself, the dose is four times higher when compared to conventional fluoroscopy, according to Dr. Hoang. The main source of radiation dose from CT-guided lumbar pain injections is the lumbar spine preliminary planning CT, said Dr. Hoang. Radiologists performing CT fluoroscopy should consider techniques to reduce radiation dose for the planning CT such as reducing the coverage to only areas of interest and reducing the tube current or peak kilovoltage. In this study, we considered the maximum z-axis possible for the planning CT. In most cases this can be reduced to one intervertebral level if there is a good history that identifies the level affected and/or if there is prior diagnostic imaging, she said.
CT fluoroscopy has several advantages over conventional fluoroscopy, added Dr. Hoang. CT fluoroscopy is better able to show soft tissue so the needle can be more accurately positioned for the spine injection; in addition, less iodinated contrast media is needed, she said. Dr. Hoang emphasized that the study results are
based on the protocols they use at her institution. Radiation dose values are highly dependent on the fluoroscopy time used by the individual doing the procedure and the dose settings that are used at his or her institution, she said. The study was published in the October 2011 American Journal of Roentgenology.
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PRODUCT NEWS
PACS/RIS SYSTEM
Bahia Software The BayRIS is a multi-PACS radiology integrated information system. It is designed to enable complete management of an imaging diagnostic department from the order request to the report.
WORKSTATION SOLUTION
iCAD The VersaVue Enterprise features reporting templates, multiple breast biopsy capability, and enhanced motion correction for breast, prostate, and abdominal applications. The workstation is designed for accurate imaging diagnoses, along with earlier and faster patient treatment decisions.
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IMAGING SYSTEM
Toshiba Medical Systems The HDR-08A for Kalare offers a more intuitive user interface and advanced image processing, increasing the range of fluoroscopy. The features are intended to enable clinicians to obtain more information from the images, resulting in quicker, more accurate diagnoses.
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VIEWING SOLUTION
Viztek The Opal-RAD PACS now offers the ability to view images anytime, anywhere on any computer with a zerofootprint DICOM viewer. The OpalRAD PACS also offers expanded support for PET/CT viewing with a full range of features, as well as now providing a Turn-Around-Time (TAT) feature. LINKXPRESS COM MII-02-12 232
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Software Provides Integrated Care to the Nuclear Medicine Department

new nuclear medicine application supports the patients entire exam flow, from order entry to the final distribution of nuclear medicine results. It includes specialized functionalities to process, read, and report all nuclear medicine, single photon emission computed tomography (SPECT), positron emission tomography (PET), and multimodality images with only the click of a button, from a single workstation. Images and diagnoses can be shared with referring physicians within or outside the hospital walls. Agfa HealthCare (Mortsel, Belgium; www.agfa healthcare.com) presented the newest version of its Impax for Nuclear Medicine solution at the 2011 Congress of the European Association of Nuclear Medicine (EANM) held October15-19, 2011, in Birmingham, UK. The solutions advanced new features focus on usability, workflow, and productivity. Prior to the congress, Erik Gielen, business manager Nuclear Medicine EMEA for Agfa HealthCare, said, At the EANM congress, we
will demonstrate how Impax for Nuclear Medicine offers clinicians a unique solution that fully integrates the nuclear medicine departments workflow and optimizes interdepartmental communications. Impax for Nuclear Medicine, which is built on one of the most advanced picture archiving and communication systems (PACS), consolidates images and data across a wide range of modalities and departments, integrating them into a single information technology (IT) platform. The system delivers increased efficiency to the nuclear medicine department, handling complex scheduling requirements, including comprehensive resource planning and scheduling across multiple departments. It can be integrated with the departments hot lab management solution to digitize and automate preparation of radiopharmaceuticals and registration of radiation dose.
Impax for Nuclear Medicine includes Oasis for Impax, developed in collaboration with Segami Corp. (Columbia, MD, USA; www.segamicorp. com), which brings an integrated, fully featured nuclear medicine image processing and viewing package to the Impax workstation. Clinicians no longer have to switch between workstations, or manually synchronize patient study lists.
Image: A physician utilizing the IMPAX for Nuclear Medicine solution (Photo courtesy of Agfa HealthCare).
Speech Recognition Beset by High Error Rates in Breast Imaging Reports

reast imaging reports generated using an automatic speech recognition system are nearly six times more likely to contain major errors than those generated with conventional dictation transcription, a new Canadian study revealed. The study reviewed 615 reports of complex cases discussed on multidisciplinary team rounds: 308 reports generated with automatic speech recognition and 307 reports generated with traditional dictation transcription. Our study found that at least one major error was found in 23% of automatic speech recognition [ASR] reports compared to 4% of conventional dictation transcription report, said Anabel Scaranelo, MD, from the University Health Network (Toronto, Canada; www.uhn.ca). Key errors were
described as those errors that had an impact on the understanding of the report and errors affecting patient management, such as an incorrect unit of measurement (for example, millimeter instead of centimeter) or a missing or added no. The error rate was even higher if breast magnetic resonance imaging (MRI) reports were looked at separately, reported Dr. Scaranelo. The major error rate was 35% for ASR reports and 7% for conventional reports. We think this is because MRI reports are more complex, with more description, Dr. Scaranelo said. Native language had no effect on the ASR report error rate, according to Dr. Scaranelo. We thought that there may be a higher error rate for non-native
English speakers because the software works with voice recognition, but that didnt happen, she said. The ASR system is fed with several hours of dictation from the radiologists, and it appears to have learned from the voice data that was input, she reported. ASR is typically used in several countries, according to Dr. Scaranelo. The results of our study emphasize the need for careful editing of reports generated with ASR. They also show a strong need for standardized templates and use of structured reports, especially for breast MRI, she said. The studys findings were published in the October 2011 issue of the American Journal of Roentgenology.
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IT/PACS UPDATE
Free Cloud-Based Image-Sharing Network Reduces Need for Duplicative Exams, Exposure to Radiation
n innovative cloud-based service has been devised to enable users to upload, download, view, and share medical images at no cost. Merge Healthcare (Chicago, IL, USA; www.merge.com), a leading provider of enterprise imaging and interoperability solutions, announced Merge Honeycomb, With Merge Honeycomb, were harnessing the cloud in a way that encourages and enables faster collaboration among all healthcare stakeholders, resulting in a true improvement in the delivery of care and reduction of costs, said Jeff Surges, CEO of Merge Healthcare. With the largest network of imaging clients by far, Merge is taking this important step to connect the healthcare industry and expand interoperability. Announced October 5, 2011, at the Merge Live 2011 Client Conference, attended by over 500 healthcare professionals, Merge Honeycomb will be the USs largest medical imaging sharing network and is open to anyone. Merge Honeycomb will officially be launched at the Radiological Society of North America (RSNA) Conference in Chicago, IL, USA, in November, 2011. Users can preregister now for this free service at www.merge.com/honeycomb.aspx. Merge Honeycomb should answer a variety of expensive healthcare challenges. It will reduce the need for duplicative scans, which costs the industry an average of US$35 billion per year and exposes patients to harmful and unnecessary radiation. (According to a 2010 study by the Center for Devices and Radiological Health and the US Food and Drug Administration, the radiation level in one computed tomography [CT] scan of the abdomen is approximately the same as 400 chest X-rays.) Merge Honeycomb will also eliminate the archaic practice of using patients as transport vehicles. The need to burn X-rays, CT scans, magnetic resonance imaging (MRI) scans, and other images onto CDs will be outdated. When a physician needs to view images, they can log into the image-sharing network via any web browser. It also speeds the time to treatment. Referring physicians will be able to view images in real-time and make diagnoses accordingly. Moreover, because the network is permission based, images can only be viewed by those who have been granted privilege. As a long-time partner with Merge, we believe in the value of image sharing, said Gregory Veltri, CIO of Denver Health. Were excited about the technology and business possibilities, in addition to the potential quality benefits that may result from Merge moving to the cloud.
Image: A screenshot from Merge Honeycomb cloudbased image-sharing service (Photo courtesy of Merge Healthcare).
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PRODUCT NEWS
IMAGE SHARING SOLUTION

Merge Healthcare The Honeycomb image-sharing solution allows users to upload, download, view, and share medical images at anytime. The Honeycomb is part of the iConnect integrated comprehensive suite of software products.
MRI ENTERTAINMENT SYSTEM

Resonance Technology The CinemaVision video goggles deliver visuals inside the MRI environment with 1280 x 1024 resolution. The goggles feature a diagonal micro display of .7, offer enhanced contrast and brightness, and are compatible with an MRI of up to 9.4T in magnet strength.
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MEDICAL MONITOR
Sony Medical The PVM-2551MD display features a high-definition OLED panel that produces a high-contrast image, and delivers a wide color range. The monitor is designed to allow medical professionals to observe very subtle details when viewing radiology images.
DICOM STORAGE SOLUTION

SourceCorp The multitiered, vendor-neutral storage solution provides a full range of options with all data stored in multiple secure tier IV data centers. The data is stored in the strictest HIPAA and HITECH compliance, and is available as needed for authorized healthcare organizations.
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Mobile App for Diagnostic Image Viewing on Smart Phones, Tablets

new medical app (application) ensures the security of confidential patient diagnostic images and information. Calgary Scientific, Inc. (Calgary, Alberta, Canada; www.calgaryscientific.com) has received clearance from the United States (US) Food and Drug Administration (FDA) to market its medical imaging application, ResolutionMD Mobile, as a mobile diagnostic application, in the United States. With this secure, highly scalable, serverbased software solution, physicians located anywhere can rapidly access, view, and interact with patient images and reports stored within any healthcare facility, and render a clinical diagnosis using their mobile devices. Prior nondiagnostic versions of this product are currently distributed and licensed under original equipment manufacturer (OEM) agreements with global leaders in medical imaging and information technology. In addition to the recent FDA clearance, ResolutionMD Mobile has also been licensed by Health Canada and it bears the CE marking for distribution in Europe. The ResolutionMD mobile product was purpose-built from the existing ResolutionMD software, which first received FDA clearance in 2006. ResolutionMD Mobile utilized the power of Calgary Scientifics PureWeb platform technology, which allows ResolutionMD to support simultaneously multiple mobile devices and operating systems. This initial FDA clearance applies to versions of the solution running on Apple (Cupertino, CA, USA; www.apple.com) iPhone and iPad devices. The mobile app offers excellent performance, advanced capabilities, and complete security, utilizes minimal bandwidth and offers strong performance even on 3/4G wireless, and ensures that no highly sensitive or confidential patient information is ever retained on the mobile device. The patient image data cannot be lost or stolen, as
in the case of conventional mobile-device rendered software, which requires that data to be sent to the mobile device. The flexible, highly scalable, and easily installed environment of ResolutionMD Mobile expands the delivery of Calgary Scientifics image rendering technologies to empower healthcare organizations, physicians, and patients to view images and reports, provide considerably enhanced levels of patient care, and reduce healthcare system costs. We worked very closely with the FDA to identify and address the challenge of delivering the advanced visualization and integrated PACS [picture archiving and communication system] functionality of our ResolutionMD server to various mobile devices, said Kyle Peterson, director of regulatory and corporate affairs of Calgary Scientific. Extensive bench testing results and reads performed by practicing radiologists using typical but highly challenging cases for CT [computed tomography] and MR [magnetic resonance] were amongst the wide variety of supportive materials and studies submitted to the FDA during the course of this extensive process, which validated the primary diagnostic use of ResolutionMD Mobile. This is a landmark moment for the Calgary Scientific organization and its family of global and regional OEM and other partners, said Dr. Byron Osing, chief executive officer and chair, Calgary Scientific. ResolutionMD Mobile incorporates many advanced capabilities including: Interactive twodimensional (2D), maximum intensity projection/ multi-planar reformat (MIP/MPR), and 3D sophisticated visualization and anywhere, anytime access to and fully interactive use of MR and CT images. The app also supports Health Insurance Portability and Accountability Act (HIPAA) compliance provides user authentication and encrypted communications further protect
confidential patient information. The concurrent support for multiple devices and mobile operating platforms enables ResolutionMD Mobile capabilities on devices such as the Apple iPhone and iPad, as well as Android devices. Future versions of the server-based software solution will support an expanded list of mobile devices and operating systems, and supplementary applications to the FDA for clinical diagnostic imaging approval on those devices other than the iPhone and iPad will occur in the near future. The ambient light user assessment provides sample images to the user to assess the viewing suitability of current lighting conditions.
Image: The ResolutionMD mobile medical application for iPhone (Photo courtesy of Calgary Scientific).
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IT/PACS UPDATE
fastest route available, speeding up access and distribution of images and associated information. (2) The upgrade to the National Archive will implement new compression, storage and retention plans according to the latest guidance from the Royal College of Radiologists (London, UK), which will significantly reduce storage requirements and operational costs. It seems only yesterday that we were completing the installation and roll out of the NSS Scotland PACS Program, yet here we are embarking on this huge and complex upgrade program, said Charlie McCaffrey, cluster leader Northern Europe and managing director, Carestream Health UK. Carestream Health is a worldwide provider of dental and medical imaging systems and healthcare IT solutions; molecular imaging systems for life-science research and drug discovery/development; Xray film and digital X-ray systems for nondestructive testing; and advanced materials for the precision films and electronics markets.
Major PACS Upgrade Program Initiated Across Scotland

cotland (UK) now has a national healthcare solution that encompasses all types of hospitals including city, district, rural, and the highlands and islands. It remains the largest and only countrywide picture archiving and communications system (PACS) implementation anywhere in the world. National Services Scotland (NSS; Edinburgh, Scotland, UK; www.nhsnss.org) has commenced a major PACS upgrade program strengthening its successful relationship with Carestream Health (Rochester, NY, USA; www.carestream.com) with the signing of a change control notice (CCN) to the current contract held between the two organizations. The new agreement will see Carestream upgrade and migrate PACS across the countrys 34 hospitals, replacing all hardware with new WinTel platforms configured with the latest Carestream Vue PACS V11 software and new compression, storage and retention plans implemented on the National Archives. Carestream completed the initial PACS installation across the country in 2009
and the upgrade is scheduled for completion in November 2013. PACS V11 will allow quicker treatment for our more urgent cases as clinicians will be able to access other sites images directly, said Alan Fleming, PACS project manager NHS National Services Scotland. Global worklists, tunneling, and streaming and push are added functions in PACS V11 which have widespread clinical support as developments. Finally, V11 PACS has a strong financial component for NHS Scotland by allowing development of sophisticated models for storage management and retention in the archive. The latest Carestream Vue PACS V11 architecture provides significant enhancements in (1) information sharing by consolidating data into a global workflow with a global worklist. All authorized users have the ability to view on demand a patients entire imaging history from anywhere in Scotland, regardless of where they were imaged. Images are intelligently streamed and tunneled through the
Three-Test Combo Helps Predict Risk of Alzheimers Disease

ith age, forgetfulness and other signs of memory loss sometimes appear, motivating older individuals to seek a medical evaluation amid worries that they may be experiencing early symptoms of Alzheimers disease (AD), the most common type of dementia among individuals in the United States aged 65 and older. However, even when early memory problems suggest the potential for impending AD, the actual risk is variable. Some patients are at high risk while others are not. The challenge for doctors has long been to differentiate that risk so they can determine the appropriate course of management. In an article published in the October 25, 2011, issue of the journal Neurology, a team of physicians and scientists from the University of California (UC), San Diego School of Medicine (USA; http://med.ucsd.edu) and other institutions worldwide described using a combination of widely available medical tests to generate a much improved predictive picture of the likelihood of impending AD in patients with mild cognitive impairment (MCI) an intermediate stage between the expected cognitive decline of normal aging and the more marked decline of dementia. Im extremely excited about these results, said neurologist James Brewer, MD, PhD, an associate professor of radiology and neurosciences and part of the Alzheimers Disease Neuroimaging Initiative research team at UC San Diego. The good news is that we can partially reassure those folks who are negative on these tests, at least regarding their next
three years. We have never been able to do that before. These individuals, despite having a real memory problem, have no greater risk of near-term dementia than a similarly aged healthy person without a memory complaint. To determine the probability of developing AD, the UC San Diego researchers compared risk factors based on magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), and neuropsychologic testing. Unlike other efforts that have evaluated the predictive capabilities of researchbased biomarkers, MRI, CSF and neuropsychologic tests are all technologies widely available to clinicians. The researchers discovered that these available biomarkers considerably improved accuracy in predicting near-term conversion to dementia. In combination, their prediction rate was almost perfect: None of the individuals who tested negative on all three measures went on to develop AD in the three-year follow-up. By comparison, almost 90% of individuals who tested positive on all three measures were demented at the end of three years. The presence of medial temporal atrophy, determined by automated analysis of MRI using a US Food and Drug Administration (FDA)-approved software package, was associated with the likeliest chance of near-term dementia, with a median dementiafree survival time of only 15 months. Dr. Brewer reported that the findings forecast a paradigm shift in the diagnosis of AD. Instead of saying, Lets wait a year and see if this gets
worse, our neurologists can say, Lets get a volumetric MRI and check back in a month to see if your complaint is due to neurodegeneration. That ability makes a huge difference in how we proceed. Maybe the memory complaint isnt due to neurodegeneration, but rather its a
side effect of a medication, a sign of depression or someone is simply anxious and worried. Being able to reassure at least some patients that they are not at significant near-term risk of AD is something we never could do in the past, given the high prevalence of the disease.
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PRODUCT NEWS
ECG MANAGEMENT SYSTEM

Agfa HealthCare The IMPAX HeartStation features automated ECG processing and storage, enabling faster access to ECG exams and increasing productivity. The system allows clinicians to quickly and easily display, edit, confirm, print, and archive ECGs, and make them part of the patients Web-accessible record.
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MEDICAL IMAGE SERVER

Codonics The Infinity LX is a DICOM storage appliance that offers a simple solution for storing and retrieving medical images. The server is considered an ideal solution for storing large, temporary datasets from CT, MR, and other DICOM modalities.
IMAGE ACQUISITION SOFTWARE

iCRco The XC solution provides ease-of-use and workflow-driven functionality to simplify a transition to the digital environment. Key features include reliability, affordability, easy installation and training process, touch screen capability, and its easy maintain and upgrade.
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LUNG VOLUME MEASUREMENT TOOL

Intrasense The Myrian XP-Lung module is designed to complete and document thorax radiology diagnoses. The tool can be easily integrated into the Myrian workstation, and offers 3D rendering, report builder, snapshot scrapbook, and exportability to PACS or CD.
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Joint Program Established to Maximize Opportunities of Evolving PACS Technology
gfa HealthCare (Mortsel, Belgium; www. agfahealthcare.com) announced the launch of a new joint program with Barco (Kortrijk, Belgium; www.barco.com) to refresh the diagnostic display systems that are running Impax picture archiving and communication systems (PACS) solutions. The display refresh program will provide customers with access to the latest diagnostic display technology, to meet the demands of new trends in healthcare information technology (IT). As PACS technology progresses, so does the technology used in diagnostic displays. Agfa HealthCare is committed to enabling its customers to take full advantage of advances and new applications. Currently, most diagnostic imaging is still done on conventional monochrome liquid crystal displays [LCDs]. But with
the explosive growth in image data, new ways to present the images must be found, explained Al Dyer, imaging informatics global business manager for Agfa HealthCare. This means more advanced image presentation techniques, including, for example, an increased use of color. To make sure our customers get the most from our PACS solutions, we want to support them in transitioning to the latest display technology. Diagnostic color displays allow customers to use Agfa HealthCares color-enabled PACS features and advanced visualization capabilities. Furthermore, they offer the flexibility and efficiency radiologists need to streamline their workflow and accelerate their clinical performance. The color displays also allow the reading of grayscale images, providing the same level of
grayscale image quality as the conventional displays. In addition to enabling customers to make optimal use of the advanced PACS features and visualization applications, such as registration and fusion, nuclear medicine, cardiology and volume viewing, the program will support the optimal clinical performance of the healthcare enterprises PACS system, as customers will have access to a secure, online, enterprise-wide quality assurance service. Finally, the LCD upgrade opportunity in the program provides customers with both the latest technology and increased performance. We are pleased that this program will enable us to better serve our existing customers, commented Mr. Dyer. Thanks to the embedded quality assurance service, our customers will enjoy higher system uptime and greater diagnostic confidence, while freeing up valuable IT resources.
RIS Receives Complete EHR Certification for Meaningful Use for Radiology
radiology information system (RIS) has received the US governments Meaningful Use stamp of approval, thereby becoming the only major RIS with complete electronic health record (EHR) ambulatory certification. In 2009, the US Congress enacted the American Recovery and Reinvestment Act (ARRA), which provided for US$20 billion in funding for healthcare technology (referred to as the HITECH Act). Within that, more than $1.5 billion is estimated to be available to radiologists who use certified electronic health-record technology in a meaningful way. However, options in radiology have been very limited to date, as current EHRs are either not built specifically for radiology workflow, or they are modularly certified products that require the radiologist to purchase additional applications to meet the remaining requirements, even if they are not used. Merge Healthcare (Chicago, IL, USA; www. merge.com), a provider of enterprise imaging and interoperability solutions, developed the Merge RIS v7.0. With this system, radiology providers can now utilize a single product for radiology-specific
workflow to qualify for up to $44,000 in funding under the HITECH Act. We are thrilled to be leading the radiology market with complete EHR certification for our radiology information software, said Jeff Surges, CEO of Merge Healthcare. This certification means that the radiology industry has a new option for participating in the HITECH Act without having to sacrifice radiology workflow. We have been able to learn from our large install base of radiology customers and build a solution that is custom made for their specific needs and workflow. At the end of the day, weve worked together to ensure our solution benefits both patients and providers. Merge RIS v 7.0 integrates core Meaningful Use functionality and can capture all necessary and relevant patient information to meet the guidelines of Meaningful Use, without disrupting the traditional radiology workflow. Functionality includes ePrescribing, enhanced reporting that enables physicians to automatically trend clinical data and report on Meaningful Use measures, new clinical decision support, the clini-
cal exchange of health information through industry standard formats, and a patient portal that empowers patients to access their records at their convenience. This new functionality was built natively within the intuitive, web-based Merge RIS so that any radiology practice can achieve Meaningful Use attestation in a manner that works for their specialty. Regional Medical Imaging (RMI), a large outpatient radiology group in the state of Michigan, has participated in the testing of Merge RIS v7.0, and is currently collecting the required data to attest to Meaningful Use and receive 2011 reimbursement. Meaningful Use is an important initiative that carries a significant reimbursement opportunity for our organization, said Randy Hicks, MD, owner of Regional Medical Imaging (RMI; Flint, MI, USA). Therefore its been imperative for us to work with an organization that understands our needs and can provide a solution that will seamlessly integrate within our existing applications. I continue to be impressed with Merges ability to build those kinds of solutions for imaging IT [information technology].
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INDUSTRY NEWS
improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services.
Acquisition Brings New Healthcare Coordination Capabilities

cKesson (Atlanta, GA, USA; www.mckesson.com) has acquired peerVue, Inc. (Sarasota, FL, USA; www.peervue.com), a provider of solutions that simplify diagnostic medical imaging workflow, expedite communications for improved quality and efficiency, and support customer efforts to improve patient safety. The acquisition extends McKessons range of enterprise imaging and information management systems with flexible workflow capabilities that address site-specific needs such as critical results management, peer review, and emergency department communication for multiple disciplines. Supporting those decisions is
peerVues QICS (qualitative intelligence and communication system). A web-based technology platform, QICS provides the functionality to engage, analyze data, alert users, and facilitate workflow at every point throughout the exam life cycle. Together, McKesson and peerVue will connect the entire care team and speed the diagnostic process across the continuum of care--helping healthcare organizations achieve better care, business, and connectivity. McKesson Corp. is a healthcare services and information technology company dedicated to making the business of healthcare run better. The company partners with payers, hospi-
tals, physician offices, pharmacies, pharmaceutical companies, and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers
Canon to Acquire Delft Medical Imaging

anon Europe (London, UK; www. canon-europe.com), a world-leading developer of imaging technology, has strengthened its product range in the medical imaging field by acquiring medical solutions company Delft Diagnostic Imaging (Delft DI; Veenendaal, The Netherlands; www .delftdi.com). Delft DI specializes in two business fields. The first is software solutions for sharing digital images and medical records. This business will become a future platform for the development of new healthcare information and communication technology (ICT) system including cross enterprise document sharing for imaging (XDSI) solutions. The second is digital X-ray imaging systems, systems integration, and service of a wide variety of customized complete
Eased Financing to Promote PACS Expansion in Eastern Europe

he East European picture archiving and communication system (PACS) market lags behind its western counterpart in pace and size. Although it is growing, most of the trends seen in the market are reminiscent of the trends in Western Europe 10 to 15 years ago, according to a market report. New analysis from Frost & Sullivan (Mountain View, CA, USA; www. medicalimaging.frost.com), an international growth consultancy company, revealed that the market earned revenues of USD 18 million in 2010 and estimates this to reach USD 36.4 million in 2017. Up to now, governments have allocated only a small portion of the gross domestic product (GDP) to healthcare. They still adopt the conventional
approach, wherein a single modality fulfills the fundamental extent of imaging and reporting needs. End users are also beginning to realize the benefits of information technology (IT) in the healthcare sector and are demanding more solutions, as the database of images can be used for referrals across different hospitals and countries. As East Europe is a highly pricesensitive market, the high costs of integrated PACS solutions are a key adoption barrier. Unfortunately, the concept of leasing is still new to this market. Therefore, participants need to develop simpler financing and payment policies. Financing services such as easy loan payments and funding by private sectors or major vendors are expected to improve product uptake.
solutions for radiology departments. Delft DI has been an important distribution partner for Canon digital radiography systems for over 10 years in The Netherlands and Belgium. Building on this partnership, where Delft DI has already integrated Canon digital radiography products in their services, this business will become a platform for developing future digital radiography services. Following the completion of the acquisition, Delft DI will become a subsidiary of Canon Europa NV. Yoshiyuki Masuko, senior director, medical imaging group, will join the board of Delft DI. Delft Imaging Systems, currently a subsidiary of Delft DI, will become a separate company, will no longer be part of Delft DI group, and is not part of this acquisition.
3Disc Imaging Buys Korean Radiology Software Provider

Disc Imaging (Dulles, VA, USA; www.3discimaging.com), a manufacturer of medical imaging products, has acquired CoreWare (Gangwon, Korea; www.coreware.co.kr), a provider of digital radiography software, in an effort that solidifies 3Discs position as an emerging leader in the medical imaging arena. CoreWare offers a range of image processing software solutions for computed radiography (CR), digital radiography (DR), and picture archiving and communication system (PACS) to customers throughout Korea, as well as in other Asian countries and the United States. CoreWares innovative software powers 3Discs suite of highly flexible, cost-effective X-ray imaging systems
for human and animal use. According to Sigrid Smitt-Jeppesen, chief executive officer of 3Disc Americas, CoreWare is a perfect fit for the company. 3Disc is a technology company with significant expertise in building quality medical imaging devices, Ms. Smitt-Jeppesen said. 3Discs range of CR readers is built on pioneering technology that provides high-quality images for viewing, enhancement, duplication, archiving, and distribution. Its next-generation FireCR+ medical product line includes a range of compact, portable CR readers suitable for use in hospitals, clinics, specialty practices, and satellite facilities, while separate product lines serve the dental and veterinary markets.
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INTERNATIONAL CALENDAR
For a free listing of your event, or a paid advertisement in this section, contact: International Calendar Medical Imaging International P.O.Box 800806, Miami FL 33280-2410, USA Fax: 1-954-893-0038 E-mail: info@globetech.net Yellow-highlighted listings are available at US$ 300 for a one-year period. Please mail check with your events details to above address.
APRIL 2012
71st Annual meeting of Japan Radiological Society. April 12-15; Yokahma, Japan; Web: www.radiology.jp 35th National Conference on Breast Cancer. Apr 13-15; Hollywood, FL. USA; Web: www.acr.org 67th CMEF- China Medical Equipment Fair. April 14-17; Shenzhen, China; Web: http://en.cmef.com.cn Society for Pediatric Radiology (SPR) 2012 Annual Meeting. Apr 16-20; San Francisco, CA, USA; Web: www.pedrad.org 2012 Symposium on Multimodality Cardiovascular Molecular Imaging. Apr 19-21; Bethesda, MD, USA; Web: https://interactive. snm.org 7th Clinical Update on Cardiac MRI & CT. Apr 20-22; Cannes, France; Web: www.escardio.org EUROSON 2012. Apr 22-24; Madrid, Spain; Web: www.euroson2012.com 74th Annual Scientific Meeting of the Canadian Association of Radiologists. Apr 26-29; Montreal, QC, Canada; Web: http://car. ca/en/education The 2012 Annual Meeting of the American Roentgen Ray Society. Apr 29-May 4; Vancouver, BC, Canada; Web: www.arrs.org
MARCH 2012
ECR 2012 European Congress of Radiology. Mar 1-5; Vienna, Austria; Web: www.myesr.org Neuroimaging Update at Mont Tremblant. Mar 2-4; Mont Tremblant, Canada; Web: www. ottawaradcme.com Ultrasound 2012: Pearls and Pitfalls. Mar 1114; Naples, FL, USA; Web: www.iicme.net 2012 Annual Meeting of the Society of Thoracic Imaging. Mar 11-14; Huntington Beach, CA, USA; Web: www.thoracicrad.org Breast Imaging 2012. Mar 15-18; Naples, FL, USA; Web: www.iicme.net/events.asp ChinaMed 2011 - International Medical Instruments and Equipment Exhibition. Mar 23-25; Beijing, China; Web: www.chinamed.net.cn ACC 2012 61st Annual Scientific Session and Expo of the American College of Cardiology. Mar 24-27; Chicago, IL, USA; Web: www.accscientificsession.org SIR 37th Annual Scientific Meeting - Society of Interventional Radiology. Mar 24-29; San Francisco, CA, USA; Web: www.sirmeeting.org Abdominal Radiology Course 2012. Mar 2530; Scottsdale, AZ, USA; Web: www.sgr.org 2012 AIUM - American Institute of Ultrasound in Medicine Annual Convention. Mar 29-Apr 1; Phoenix, AZ, USA; Web: www.aium.org
MAY 2012
ICR / JPR 2012. May 3-6; Sao Paulo, Brazil; Web: www.spr.org.br/jpr2012 19th Scientific Meeting and Exhibition of the International Society for Magnetic Resonance in Medicine (ISMRM). May 5-11; Melbourne, Australia; Web: www.ismrm.org 93rd Deutscher Rntgenkongresses und des 6. Gemeinsamen Kongresses von DRG und RG. May 17-19; Hamburg, Germany; Web: www.roentgenkongress.de
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INTERNATIONAL CALENDAR
Hospitalar 2012. May 22-25; Sao Paulo, Brazil; Web: www.hospitalar.com ESPR 2012. May 28-Jun 1; Athens, Greece; Web: www.espr2012.org Russian National Congress of Radiology. May 30-Jun 1; Moscow, Russia; Web: www.rejr.ru/english-version/congresses.html Argentinian Congress of Radiology. Sep 7-9; Buenos Aires, Argentina; Web: www.congresosar.org.ar European Society of head and neck Radiology - ESHNR 2012. Sep 13-15; Leipzig, Germany; Web: http://eshnr.eu/c ontent/e147/e345 CIRSE 2012 - Cardiovascular and Interventional Radiological Society of Europe. Sep 15-19; Lisbon, Portugal; Web: www.cirse.org 36th Congress of the European Society of Neuroradiology (ESNR). Sep 19-23; Edinburgh, Scotland; Web: www.esnr2012.org
JUNE 2012
45th Congress SIRM. Jun 1-5; Turin, Italy; Web: www.congresso.sirm.org Society for Imaging Informatics in Medicine Annual Meeting. Jun 7-10; Orlando, FL, USA; Web: www.siimweb.org ASCI 2012 6th Congress of the Asian Society of Cardiovascular Imaging. Jun 7-9; Bangkok, Thailand; Web: www.asci2012.org 2012 SNM Annual Meeting. Jun 9-13; Miami, FL, USA; Web: https://interactive.snm.org 23rd Annual Meeting of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Jun 12-15; Edinburgh, UK; Web: www.esgar.org UKRC UK Radiology Congress. June 2527; Manchester, UK; Web: www.ukrc.org.uk
OCTOBER 2012
46th Annual Meeting of the American Society of Head and Neck Radiology (ASHNR). Oct 3-7; Miami Beach, FL, USA; Web: www.ashnr.org ESMRMB 2012 European Society for MR in Medicine and Biology. Oct 4-6; Lisbon, Portugal; Web: www.esmrmb.org FIGO 2012 - The 20th World Congress of the International Federation of Gynecology and Obstetrics. Oct 7-12; Rome, Italy; Web: www.figo.org/congress 2012 Congress of the European Society of Breast Imaging (EUSOBI). Oct 12-13; Barcelona, Spain; Web: www.eusobi.org JFR 2012 - Journes Franaises de Radiologie. Oct 19-23; Paris, France; Web: www.sfrnet.org EANM 2012 - Annual Congress of the European Association of Nuclear Medicine. Oct 27-31; Milan, Italy; Web: www.eanm.org
AUGUST 2012
FIME 2012 Florida International Medical Exhibition. Aug 8-12; Miami, FL, USA; Web: www.fimeshow.com ESC 2012 - Annual Congress of the European Society of Cardiology. Aug 25-29; Munich, Germany; Web: www.escardio.org The Asian Oceanian Society of Radiology AOCR 2012. Aug 29-Sep 2; Sydney, Australia; Web: www.aocr2012.com
NOVEMBER 2012
Medica 2012. Nov 14-17; Dusseldorf, Germnay; Web: www.medica.de RSNA 2012 - Radiological Society of North America. Nov 25-30; Chicago, IL, USA; Web: www.rsna.org
SEPTEMBER 2012
The European Society for Molecular Imaging - ESMI 2012. Sep 5-8; Dublin, Ireland; Web: www.e-smi.eu
Medical Imaging International
Vol. 22 No.1 1-2/ 2012

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V I S I T

Vol.22 No.1 1-2 / 2012

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Innovative Solutions for Sustainable Cardiovascular Care Presented

Medical Imaging International January-February/2012

MRI Screening for Breast Cancer Benefits High-Risk, Underserved Women

Cover Image: Courtesy of Carestream Health

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MR Tractography May Provide Insights into Human Brain Anatomy

Medical Imaging International January-February/2012

for latest news updates visit www.MedImaging.net

SIGN U FOR F P REE

Medical Imaging International January-February/2012

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Computed Radiography Systems Improve Workflow Efficiency in Orthopedic Practices

INTERACTIVE DIGITAL EDITION

Medical Imaging International January-February/2012

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Angiography Navigation System Offers Reduced Radiation Dose

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Worlds First Superconducting Synchrocyclotron Designed for Proton Therapy

On a Mission to Detect Cancer Early

Visit us at ECR 2012 Expo C - 316

for latest news updates visit www.MedImaging.net

Wireless Digital X-Ray System Receives US Clearance

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Imaging Technologies Evaluate Effectiveness of Heart Drug

Medical Imaging International January-February/2012

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Cause of Vertigo from MRI Scanning Identified

Intensity-Modulated Radiotherapy Has Less Harmful Rectal Side Effects

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New Imaging Technique Visualizes Cancer During Ovarian Cancer Surgery

Medical Imaging International January-February/2012

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New Molecular Imaging Technology Presented at European Medical Meeting

Medical Imaging International January-February/2012

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Study: Yearly Mammogram Leads to High Rate of False Positives

Medical Imaging International January-February/2012

INTERVENTIONAL X-RAY SYSTEM

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Virus Shows Potential for Imaging and Treating Pancreatic Cancer

Liver Elastography Provides Good Strain and Contrast Imaging Capability

Visit us at: Expo C 328

Medical Imaging International January-February/2012

STAY ON TOP OF IMAGING NEWS!

Microwaves Used to Create Medical Images

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Optimization Models Improve Radiation Therapy for Cancer Patients

Medical Imaging International January-February/2012

Early Diagnosis of Osteoarthritis with MRI

High-Definition CT Scans Reduce Radiation Exposure in Cardiac Testing

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Rotational Dose Control Developed for Helical Radiotherapy System

Light Interferometry Detects Precancerous Cells

Medical Imaging International January-February/2012

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Study: Spinal Digital Subtraction Angiography Safe and Effective