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Vol.20 No.6 11-12 / 2010


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MRI Better Than CT Scans at Diagnosing Stroke


hysicians should use a diffusion magnetic resonance imaging (MRI) scan to diagnose stroke instead of a computed tomography (CT) scan, according to a new guideline. The guideline was issued from the American Academy of Neurology (Saint

Image: Colored magnetic resonance imaging (MRI) scans of axial sections through the brain of a patient after a cerebrovascular accident (CVA, or stroke) (Photo courtesy of Sovereign, ISM).

Paul, MN, USA; www.aan.com) and was published in the July 13, 2010, issue of Neurology, the medical journal of the American Academy of Neurology. While CT scans are currently the standard test used to diagnose stroke, the Academys guideline found that MRI scans are better at detecting ischemic stroke damage compared to CT scans, said lead guideline author Peter Schellinger, M.D., with the Johannes Wesling Clinical Center (Minden, Germany). Diffusion MRI measures molecular water motion in the tissue, revealing where water diffusion is restricted and therefore brain damage has occurred. According to the guideline, diffusion MRI should be considered more useful than a CT scan for diagnosing acute ischemic stroke within 12 hours of an individuals first stroke symptom. In one large study, among others, that was reviewed for the guideline, stroke was accurately detected 83% of the time by MRI versus 26% of the time by CT. Specific types of MRI scans can help reveal how severe some types of stroke are. These scans also may help find lesions early, Dr. Schellinger said. This is important because the research suggests finding lesions early may lead to better health outcomes. Moreover, the guideline found MRI scans more effectively detected lesions from stroke and helped identify the severity of some types of stroke or diagnose other medical conditions with similar symptoms. Dr. Schellinger reported that studies have validated the importance of using MRI in emergency rooms but said reservations still exist surrounding the use of stroke MRI scans in clinical settings. This guideline gives doctors clear direction in using MRI first, ultimately helping people get an acute stroke diagnosis and treatment faster. However, one situation in which CT may still be used first is when a person needs an emergency injection of drug therapy [also known as intravenous thrombolytic therapy] to break up blood clots, if MRI is not immediately available, to avoid delays in starting this treatment. MRI can be added later if more information is needed. Otherwise, MRI should be used first. The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is focused on promoting the highest quality patientcentered neurologic care.
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Digital Mammography System First to Receive Mammographic-Type Test Certification


ologic, Inc. (Bedford, MA, USA; www. hologic.com), a developer and supplier of diagnostics products, medical imaging systems, and surgical products focused on the healthcare needs of women, reported that the Hologic Selenia digital mammography system with a tungsten tube has received Mammographic-Type Test certification by the European Reference Organization Council for Quality Assured Breast Screening and Diagnostic Services (EUREF; www.euref.org). The Hologic system is the first mammography system of any type to receive this certification. The mission of the nonprofit EUREF council is to raise standards by bringing together at the European Union (EU) level the best examples of quality control in mammography screening from regional and national breast cancer screening programs. EUREF Mammographic Type-Test certification ensures hospitals and imaging centers that Hologics Selenia systems have passed a thorough series of physics and clinical tests demonstrating that the systems meet the image quality, radiation exposure, and stability standards initiated by EUREF for screening and diagnostic mammography equipment. Our customers tell us they buy the Selenia system for a number of reasons. Two reasons show up on almost everyones list exceptional image qual-

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ity and low patient dose, noted Peter Soltani, senior vice president of Breast Health at Hologic. "The EUREF mammographic type test confirms what we've learned through our own clinical trials and scientific investigations the Selenia system is optimal for use in mammography. With more than 6,000 systems installed, Selenia is the most popular digital mammography system in the world.
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CT Radiation Dose Reduced by 95% Using Image-Processing Algorithm


erfusion CT scanning, an emerging imaging technology, received bad press in 2009 when a machine set to incorrect radiation levels overdosed hundreds of people in Los Angeles (CA, USA). In the wake of that incident, researchers excited by the technologys potential for diagnosing stroke, cancer, and possibly heart disease, have developed a method to reduce the amount of radiation involved in the procedure, which, when performed correctly, already involves very little risk. At the correct dose, there should be no injury, said Dr. Cynthia McCollough, from at the Mayo Clinic (Rochester, MN, USA; www.mayoclinic.org). We believe in the clinical value of perfusion CT, so were trying to lower the dose and reduce the stigma. Dr. McCollough and her colleagues created a new image-processing algorithm that can give radiologists all of the information they need using as up to 20 times less radiation, depending on the diagnostic application. The research was presented July 20, 2010, at the 52nd annual meeting of the American Association of Physicists in Medicine (AAPM) in Philadelphia PA, USA. A typical CT perfusion procedure lasts approximately half a minute and scans the same tissue many times, each scan at a low dose. These scans both reveal the internal anatomy of the patient and show how levels of a contrast agent, such as iodine

injected into the bloodstream, change of over time. Changing concentrations of iodine can be used to calculate blood volume and flow in order to detect injuries to blood vessels or tumor responses to treatment. The new adaptive algorithm compares these 2030 scans and can distinguish between anatomic regions that do not change from moment to moment and those regions that carry the contrast agent effectively reducing image noise while preserving iodine signal. The quality of each scan improves through nonlinear comparisons with scans acquired earlier and later in the exam. When we use very low doses, the noise gets so high that its hard to tell what you are seeing, said Dr. Juan Carlos Ramirez Giraldo. With this algorithm, were trying to maintain both the image quality, so that a doctor can recognize the anatomic structures, and the functional information, which is conveyed by analyzing the flow of the contrast agent over the many low dose scans. At the AAPM meeting, the researchers presented animal data showing the effectiveness of the technique. They have also started to process data from clinical brain perfusion CT exams in patients. Were up to 15 or 20 cases that weve shown to the docs, and theyre all giving us the thumbs up, said Dr. McCollough.

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Optical Luminescence Imaging Could Lead to More Cost-Effective Radiotracers

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n innovative optical imaging technique called Cherenkov luminescence imaging (CLI) may soon lead to the faster and more cost-effective development of radiopharmaceuticals for the diagnosis and treatment of cancer and other disorders. The development of novel multimodality imaging agents and techniques could represent the frontier of research in the field of medical imaging science, said Jan Grimm, M.D., Ph.D., a professor and physician at Memorial Sloan-Kettering Cancer Center (New York, NY, USA) and Weill Cornell Medical Center (New York, NY, USA; www.nyp.org) and corresponding author for the study. Dr. Grimm explained that his groups work, along with current work from groups at the University of California Davis (USA; Simon Cherry, Ph.D.) and Stanford University (Stanford, CA, USA; Sanjiv Sam Gambhir, M.D., Ph.D.), may open a new avenue for optical imaging to move into the clinic. When light travels through water, its speed decreases. A particle that moves faster than light produces a shock wave (much like the sonic boom that broke the sound barrier), which emits a visible blue light known as Cherenkov radiation. The researchers reported that their study is among the first to investigate Cherenkov radiations applications for medical imaging using optical imaging techniques. Optical imaging is a molecular imaging procedure in which light-producing molecules designed to attach to specific cells or molecules are injected into the bloodstream and then detected by an optical imaging device. It typically requires either excitation by an external light source or by a biologic process. Cherenkov imaging produces the light from the radioactivity, so no external illumination is needed. Combining optical imaging with nuclear medicine presents a new path for imaging medical isotopes, according to Dr. Grimm said. It provides optical imaging with an array of approved nuclear tracers already in clinical use today, which can be used immediately, as opposed to fluorescent dyes, he added. For the study, researchers evaluated several radionuclides for potential use with CLI. Researchers used CLI and positron emission tomography (PET) imaging to visualize tumor-bearing mice. The results show that CLI visualizes radiotracer uptake in vivo. The resulting decrease of light over time correlates with the radioactive decay of the injected tracer. An added benefit of this technique is its ability to image radionuclides that do not emit either positrons or gamma rays a current limitation for nuclear imaging modalities. CLI brings to light isotopes that could not be visualized previously. Moreover, optical imaging techniques show potential for endoscopy and surgery applications because of the ability to visualize tumor lesions, which could provide real-time data to surgeons and help guide procedures. The benefits of optical imaging are numerous, and were on a path to realizing them, concluded Dr. Grimm. We are optimistic that these new techniques will one day be available to physicians as another tool for the diagnosis and treatment of disease. The study was published in the July 2010 issue of the Journal of Nuclear Medicine (JNM).
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Using Specialized PET/CT Scanning to Detect Cancerous Tumors


university medical center is the first in the United States to perform a specialized positron emission tomography/computed tomography (PET/CT) scan to locate the presence of tumors effectively. Researchers from Vanderbilt University Medical Center (Nashville, TN, USA; www. mc.vanderbilt.edu) and affiliated VA (Veterans Administration) Tennessee Valley Healthcare System (Nashville, TN, USA; www.tennessee valley.va.gov) conducted the study. The improved imaging allows surgeons to more easily locate and remove cancerous tumors, according to Ronald Walker, M.D., professor of radiology and radiological sciences. Dr. Walker and Jeffrey Clanton, associate in radiology and radiological sciences, performed the first U.S. diagnosis at Vanderbilt on a 49-year-old lung cancer patient. The current method of imaging tumors can best be described as trying to see the sun through the clouds, Dr. Walker said. But this new radiotracer removes all of the clouds. The 68Ga-DOTATATE PET/CT scan offers higher resolution and sensitivity locating tumors. Although performed in Europe, this specialized type of radiologic scan has been viewed in the United States as offering only limited benefit to a small number of cancer patients. However, a recent increase of neuroendocrine cancers seen at

Vanderbilt led Dr. Walker and his associates to more widely apply usage of this new technology. Eric Liu, M.D., assistant professor of surgery and a faculty member with the Vanderbilt-Ingram Cancer Center, is working with Dr. Walker and the department of nuclear medicine to assemble a team of physicians, including surgeons, medical oncologists, endocrinologists, radiologists and nurses, who are actively preparing studies to test its effectiveness in locating neuroendocrine lesions. Our goal is to offer our patients the comfort and security of knowing that soon we will be able to see much more clearly with this tracer, and can then surgically remove all of their tumors not just some of them, Dr. Liu said. We know that taking a comprehensive approach to both diagnostics and therapy will enable us to improve the lives of patients suffering from this all-too-often hidden disease. Vanderbilt expects to open an operational neuroendocrine center in early 2011. Once opened, Dr. Liu and colleagues will begin clinical trials using the radiotracer and other modalities. Already, Vanderbilt treats several hundred patients with neuroendocrine cancer. Once we have this technology in place, we will be able to offer patients what no one else yet can, said Naji Abumrad, M.D., professor and chair of the department of surgery. Accurately

diagnosing the disease is just the first step. Soon well be able to offer a variety of proven therapeutic treatments, including targeted chemotherapy, radiopeptide therapy, and surgery.
Image: Color-enhanced image obtained from a combined PET (positron emission tomography) CT (computerized tomography) scan. This patient has lung cancer and underwent PET/CT to look for metastatic disease (spread) (Photo courtesy of Living Art Enterprises).

Open Bore MRI Systems Increase Scanning Effectiveness and Productivity Levels
wo new magnetic imaging (MRI) systems innovative design integrates Tim (Total imaging matrix) and Dot (Day optimizing throughput) technologies, increasing efficiencies and in turn raising productivity levels through ease of use. Tim 4G provides excellent image quality and Dot removes the complexity inherent with MR scanning. Siemens Healthcare (Erlangen, Germany; www.medical.siemens.com) announced its first orders of the Magnetom Aera 1.5 Tesla and Magnetom Skyra 3 Tesla MRI systems following recent product launches into the UK market. The first hospitals to place orders include Wythenshawe Hospital, part of University Hospital of South Manchester NHS [(UK) National Health Service] Foundation Trust (UHSM), Guys Hospital (London, UK), part of Guys and St Thomas NHS Foundation Trust, Kidderminster Hospital (Worcestershire, UK), part of Worcestershire Acute Hospitals NHS Trust, and Royal Brompton Hospital (London, UK), part of Royal Brompton & Harefield NHS Foundation Trust. Both MRI systems have a 70-cm open bore design to accommodate a

variety of patient sizes, shapes, and conditions. Its open appearance also helps to reduce sedation rates and minimize stress for claustrophobic patients, and the option of an illuminated colored MoodLight on the front panel can be altered according to preference. The Aera is a great example of where MR imaging should be heading. The wide, short bore will make MR more accessible to patients who find conventional MR scanners too claustrophobic, said Nick Sanderson, lead radiographer for MR Imaging at UHSMs Wythenshawe Hospital. The integrated coil technology will also make a massive difference to our patient throughput, with an estimated 30% increase in patient exams done. Jane Kilkenny, MR product manager at Siemens Healthcare, said, The Aera and Skyra systems fundamentally transform the way hospitals are able to work with MR. We look forward to seeing the clinical results, patient service enhancements, and efficiency benefits once they are installed into these pioneering hospitals.
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MR Pacing System Reduces Ventricular Pacing and Allows Access to Critical Diagnostic Tool
new magnetic resonance imaging (MRI) pacing system provides patients with innovative exclusive technology called managed ventricular pacing (MVP), which reduces right ventricular pacing by 99%. Medtronic, Inc. (Minneapolis, MN, USA; www. medtronic.com) announced that the company received CE (Conformit Europenne) marking for the Ensura MRI SureScan pacing system. Ensura MRI is the companys new option in the secondgeneration pacing system, available in select European geographies, in a range of devices from Medtronic designed, tested, and approved for use as labeled with MRI machines. Patients with this new SureScan pacing system will have access to full body scans, without positioning restrictions in the MRI scanner. The pacing system currently is not approved for sale in the United States. Half of the worlds pacemaker implants are from Medtronic, and physicians say the number one unmet need is MRI compatibility, said Pat Mackin, president of the Cardiac Rhythm Disease Management business and senior vice president at Medtronic. We are pleased to offer physicians a third option from the worlds first portfolio of MR Conditional pacing systems with our exclusive technology for patients who may need access to the critical diagnostics available through MRI. Approximately 2 million Europeans have implanted pacemakers; however, these patients are strongly discouraged from receiving MRI scans, a widely practiced diagnostic method for many common diseases and conditions, such as cancer, neurologic disorders, and orthopedic injuries. It is possible current pacing systems could interact with MRI machines, potentially affecting the device or patient safety. According to estimates, 50% to 70% of patients worldwide with implanted cardiac devices are expected to need an MRI scan during the lifetime of their devices. Data show every incremental 1% of unnecessary right ventricular (RV) pacing increases the risk of atrial fibrillation (AF) by 1% and the risk of heart failure hospitalization by 5.4%. The European Society of Cardiology (ESC; Sophia Antipolis, France) guidelines state that in the selection of pacing mode and device, the trend is towards dual-chamber pacing with minimization of right ventricular stimulation. Recent research showed that a strategy of minimizing ventricular pacing led to a 40% reduction in the relative risk of developing persistent AF compared to conventional dual chamber pacing.

The Ensura MRI SureScan pacing system also features Atrial and Ventricular Capture management (ACM and VCM) with automatic threshold measurements and adjustments; and the pacing system is compatible with the Medtronic CareLink Network, which allows remote device follow-ups by transmitting arrhythmia and diagnostic device data to a physicians clinic.
Image: The Ensura MRI SureScan pacemaker (Photo courtesy of Medtronic).

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Ultrasound Tissue Characterization to Diagnose Prostate Cancer


ew innovative and proprietary tissue characterization technology has been designed to differentiate, characterize, and visualize solid organ tissue types based on the analysis of backscattered ultrasound. It was designed to support physicians in diagnosis and treatment decisions. Advanced Medical Diagnostics SA (AMD; Waterloo, Belgium; www.histoscanning.com), a privately held company focused on providing innovative computer-aided solutions (HistoScanning) that can improve the diagnostic interpretation of ultrasound scans, announced that it has appointed BK Medical UK, Ltd. as sole agent for Prostate HistoScanning in the United Kingdom. Prostate HistoScanning, available in Europe, may support the diagnosis and management of prostate cancer. HistoScanning products for breast, thyroid, and ovaries are in development. Advanced Medical Diagnostics SA and BK Medical UK, Ltd. (Herlev; www.bkmed.com) have been working closely together since the

commercial launch of Prostate HistoScanning in November 2008. These systems have been placed in four major teaching hospitals in the United Kingdom, most recently at Guys Hospital and Charing Cross Hospital in London. As agents, BK Medical Limited will be responsible for the day-to-day management of sales and for providing service support for UK customers. Over the last 18 months, BK has been instrumental in placing over 20 Prostate HistoScanning systems alongside the BK Pro Focus and Pro Focus UltraView ultrasound systems in leading urology departments across Europe. Toby Hamblin, VP sales of AMD, commented, BK Medical, with its strong base in ultrasound urology in the UK, is very well placed to help us realize the full potential of Prostate HistoScanning and to provide the NHS and private clinics alike with the service and support that they, and this exciting new technology, deserve. We are very pleased to have the support of BK Medical in this

important market. HistoScanning has not yet received market clearance by the U.S. Food and Drug Administration for commercial use in the United States.
Image: Colored axial ultrasound scan through a cancerous prostate gland (orange) (Photo courtesy of Sovereign, ISM).

Graphics Processors Help Lower CT Scan Radiation

newly devised way to process Xray data could lower by a factor of 10 or more the amount of radiation patients receive during cone beam computed tomography (CT) scans. Cone beam CT (CBCT) plays a cru-

cial role in image-guided radiation therapy (IGRT), a state-of-the-art cancer treatment. IGRT uses repeated scans during a course of radiation therapy to precisely target tumors and minimize radiation damage in surrounding tis-

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sue. Though IGRT has improved outcomes, the large cumulative radiation dose from the repeated scans has raised concerns among physicians and patients. Reducing the total number of X-ray projections and the mAs (milliampere second) level per projection (by decreasing the X-ray generator pulse rate, pulse duration, and/or current) during a CT scan can help minimize patients exposure to radiation, but the change results in noisy, mathematically incomplete data that takes hours to process using the current iterative reconstruction approaches. Because CBCT is chiefly used for treatment setup while patients are in the treatment position, fast reconstruction is a requirement, explained lead author Dr. Xun Jia, a University of California, San Diego (UCSD; USA; www.ucsd.edu) postdoctoral fellow. The research was presented July 2010 at the 52nd annual meeting of the American Association of Physicists in Medicine (AAPM) in Philadelphia, PA, USA). Based on recent advances in the field of compressed sensing, Dr. Jia and his colleagues developed an innovative CT reconstruction algorithm for graphics processing unit (GPU) platforms. The GPU processes data in parallel increasing computational efficiency and making it possible to reconstruct a cone beam CT scan in about two minutes. Modern GPU cards were originally designed to power threedimensional [3D] PC graphics. With only 20 to 40 total number of X-ray projections and 0.1 mAs per pro-

jection, the team achieved images clear enough for image-guided radiation therapy. The reconstruction time ranged from 77 to 130 seconds on an nVIDIA Tesla C1060 GPU card, depending on the number of projections an estimated 100 times faster than similar iterative reconstruction approaches, according to Dr. Jia. Compared to the currently widely used scanning protocol of about 360 projections with 0.4 mAs per projection, according to Dr. Jia the new processing method resulted in 36 to 72 times less radiation exposure for patients. With our technique, we can reconstruct cone beam CT images with only a few projections 40 in most cases and lower mAs levels, he said. This considerably lowered the radiation dose. The reconstruction algorithm is part of the UCSD groups effort to develop a series of GPU-based low dose technologies for CT scans. In my mind, the most interesting and compelling possibilities of this technique are beyond cancer radiotherapy, said Dr. Steve Jiang, senior author of the study and a UCSD associate professor of radiation oncology. CT dose has become a major concern of medical community. For each years use of todays scanning technology, the resulting cancers could cause about 14,500 deaths. Our work, when extended from cancer radiotherapy to general diagnostic imaging, may provide a unique solution to solve this problem by reducing the CT dose per scan by a factor of 10 or more.
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PET Imaging Could Aid in Predicting Alzheimers Progression


ecent research suggests that specific brain scans combined with memory tests could indicate whether people with mild cognitive impairment (MCI) will go on to develop Alzheimers disease. The study, compiled by Dr. Susanne Sorensen, head of research, and investigators from the U.K. Alzheimers Society (London; http://alzheimers. org.uk), revealed that individuals who showed abnormal results on a positron emission tomography (PET) imaging brain scan, which detects metabolic abnormalities and episodic memory tests, were nearly 12 times more apt to develop Alzheimers disease. The spokespersons for the Alzheimers Society commented, We dont currently know which people with MCI will go on to develop Alzheimers disease. This important study moves us a step closer to unraveling this mystery. The tests identified could have real benefits in our search

for a cause or cure for the disease, helping researchers identify suitable participants for drug trials. At this stage, it is a leap too far to say these tests can have immediate benefits for routine diagnosis. They are currently too expensive and the prognosis of Alzheimer's they provide is not 100% guaranteed. We need more investment into research and treatment if we are to move our knowledge forward and improve the lives of people with dementia. The study was published online in July 2010 in the journal Neurology.

Image: Positron emission tomography (PET) scan of the brain of a patient with Alzheimers disease (senile dementia) (Photo courtesy of the U.S. Department of Energy).

Low-Dose Radiation CT Scans Becoming Standard Practice in Hospitals


atients requiring a computed tomography (CT) scan will now be exposed to up to 40% less radiation than traditional CT scans. A U.S. hospital has acquired sophisticated equipment featuring adaptive statistical iterative reconstruction (ASiR), which uses a sophisticated image reconstruction technique that makes it possible to reduce drastically radiation dose without compromising image quality. We have the utmost concern for the safety of our patients, said John Smith, director, radiology services at Saint Francis Hospital (Evanston, IL, USA; www.sfh. reshealth.org). This technology will not only provide us with a higher level of image quality for our physicians, but it will also minimize the risk to all patients, particularly children and young adults, who are more susceptible to harm from overexposure to radiation. Radiation dose for a particular study depends on multiple unique factors such as patient weight/build, type of scan, image area, and resolution. Typically, the more radiation used, the sharper the images. However, this new technology does not sacrifice image quality with the reduced radiation dosage. CT technology is the diagnostic exam of choice when people are ill or injured, or when a physician suspects a medical problem that is not easily detectable with a conventional physical examination. The CT scanning technology used at the hospital was developed by GE Healthcare (Chalfont St. Giles, UK; www.gehealthcare.com).

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Method Devised for Detecting High-Risk Cardiovascular Disease


esearchers have for the first time developed a way to visualize coronary artery plaques susceptible to rupture using multicolor computed tomography (CT) imaging, a development that should lead to better and earlier diagnosis, and subsequently, treatment of cardiovascular disease. Ruptures of atherosclerotic plaques are the cause of nearly 70% of heart attacks. High-density lipoproteins (HDL), the good cholesterol, are drawn to plaques vulnerable to rupture and remove them from the arterial wall. The scientists, from Mount Sinai School of Medicine (New York, NY, USA; www.mssm.edu), harnessed HDL by encapsulating tiny gold particles within it and injected them into mice. By using an advanced multi-color CT scanner, the researchers were able to see the gold particles as the HDL was targeting macrophages, or the cells that cause inflammation in the arterial wall, therefore illuminating the location of the vulnerable plaques. The use of multicolor CT and gold nanoparticles to visualize plaque will revolutionize cardiac imaging, said the research team leader, Zahi A. Fayad, Ph.D., professor of radiology and medicine and the director of the Translational and Molecular Imaging Institute at Mount Sinai School of Medicine. The acquisition of this technology and development of this method will help

us improve cardiovascular disease diagnosis in our patients, furthering our commitment to translational research. We look forward to continuing our study of this technology in the clinical setting. Traditional CT detectors provide a gray image of the artery being examined, and do not provide contrast to differentiate types and density of tissue. In addition to showing the impact of the gold particles, spectral CT can simultaneously differentiate calcium deposits and contrast agents used such as iodine, which is frequently used to identify stenoses, or the narrowing of arteries, informing the severity of atherosclerosis and heart attack risk. Mount Sinai is the first institution in the world to use this scanner, developed by Phillips Medical Systems (Best, The Netherlands; www.medical.philips.com), in a preclinical setting. There is a significant unmet need for imaging technology that visualizes plaque vulnerable to rupture, said the lead author of the work, David Cormode, Ph.D., postdoctoral fellow, Translational and Molecular Imaging Institute, Mount Sinai School of Medicine. The fact that the multicolor CT technique shows the gold particles, iodine and calcifications, provides us with a more complete picture of the nature of the atherosclerotic arteries. Multicolor CT technology may also be advan-

tageous in imaging other biologic process and diseases, including cancer, kidney disease, and bowel diseases. The Mount Sinai team plans to continue assessing the new scanner in additional animal studies and in humans. Mount Sinai has a decades-long history of making advances in cardiac imaging that have had a significant impact on the field and in patient care, said Valentin Fuster, M.D., Ph.D., director of Mount Sinai Heart, the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, The Mount Sinai Medical Center. The studys findings were published in the September 2010 issue of the journal Radiology.
Image: Colored three-dimensional computed tomography (CT) scan of an atheroma plaque (orange, rippled) in the internal carotid artery in the neck (Photo courtesy of Zephyr / Science Photo Library).

Protocols for Low Dose CTA Pediatric Imaging Devised


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nsuring the safety of pediatric cardiovascular and vascular patients who require computed tomographic angiography (CTA) screening for diagnostic reasons means that employing methods of low dose CTA is crucial, according to a U.S. pediatric imaging specialist. Jeffrey C. Hellinger, M.D., from Stony Brook University Medical Center (Stonybrook, NY, USA; www. stonybrookmedicalcenter.org), expanded on these techniques in a review article in the August 2010 early online edition of Radiologic Clinics of North America. He has developed CTA protocols that balance lower doses of radiation and clear diagnostic images when using CTA on infants and children. As principal author of the study, Dr. Hellinger detailed the appropriate and safe use of noninvasive CTA, in the framework of other potential cardiovascular imaging modalities, including radiography, echocardiography, vascular ultrasound, magnetic resonance imaging (MRI), and angiography (MRA), and invasive catheter angiography (CA).

The use of any radiation in diagnostic methods carries a risk of causing cancer and of abnormal development, particularly in infants and children, said Dr. Hellinger. There is basically a medical necessity, if you are going to use radiation in your imaging, to use the lowest possible amount. I think its a controversial topic as to how much radiation will lead to increased cancer risk over the lifetime of a patient. As physicians and imagers, with CT angiography, it is our goal to use the lowest possible radiation without compromising imaging quality. There is a balance between how low you can go with the technology and rendering a diagnosis. If the radiation dose is too low and the image is poor, you have wasted the radiation. For each patient, Dr. Hellinger wrote, the risks, benefits, and alternatives to cardiovascular CT should be reviewed. The pediatric CTA protocols are uniquely designed to maximize the table speed, image at the lowest possible voltage, and use the lowest possible weight-based tube current.
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MR System Enables Medical Center to Image Bariatric Patients Successfully


magnetic resonance imaging (MRI) systems 71-cm aperture and large open bore enables a U.S. medical center to serve better its bariatric patient population with an MR system capable of imaging obese patients with comfort and effectiveness. Obesity is a growing problem in the United States, requiring hospitals to provide medical imaging technology designed to accommodate bariatric patients without compromising diagnostic confidence or patient comfort. To accomplish this goal, Central Mississippi Medical Center (CMMC; Jackson, MS, USA; www.centralmississippi medicalcenter.com), a specialized bariatric center, recently installed Toshiba Medical Systems, Inc.s (Tokyo, Japan; www.toshiba-medical.co.jp) Vantage Titan MR system. Before installing the Titan, we could not accommodate many of our bariatric patients using MR and had to send them elsewhere for MR imaging, said Donald Thomas, director, Imaging Services, Central Mississippi Medical Center. The Titan allows us to image bariatric patients easily and comfortably without sacrificing patient comfort or exam quality. The system helps us better serve the bariatric community. The Titan is the first large open-bore MRI system installed in the state of Mississippi. Titan's feet-first imaging and Pianissimo noise-reduction technology enable bariatric and claustrophobic

patients to be imaged in a relaxed setting. In addition to general MR exams, CMMC uses Toshibas proprietary noncontrast MR angiography (MRA) techniques for patients with renal insufficiencies who require MR exams. Gadolinium-based contrast agents, the most common contrast agents used for MRA, have been directly linked to nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy (NSF/NFD), a sometimesfatal skin disease that occurs in patients with renal insufficiency. Due to the link between obesity and type II diabetes, these noncontrast techniques are particularly beneficial for CMMC, which can now offer noncontrast MRA exams to diabetic patients and other patients with renal insufficiencies. CMMC is also utilizing the Titan MR system in the evaluation of nonhealing wounds in diabetic patients. Some diabetics have challenges with wounds healing appropriately, and infections can spread rapidly, which can result in amputations. With the high image quality of the Titan, physicians at CMMC can make the correct diagnostic decision by being able to visualize clearly the bone versus the tissue, and are able to identify if the infection has spread to the bone. Physicians can therefore make a more accurate decision if amputation is necessary or if other therapies can be used. In addition to bariatric and diabetic patient needs, CMMC also uses the Titan MR for general

patient imaging, including head, neck, spine, knee, and abdominal/pelvis exams. Central Mississippi Medical Centers utilization of Toshibas Vantage Titan and proprietary noncontrast MRA techniques demonstrates the realworld effectiveness in comfortably imaging bariatric patients while eliminating the risks of gadolinium-based contrast agents, said Doug Ryan, vice president, marketing and strategic development, Toshiba. Toshiba recognizes the challenges of imaging bariatric patients and develops imaging systems with features to more effectively serve the needs of these patients.
Image: The Vantage Titan magnetic resonance (MR) system (Photo courtesy of Toshiba Medical Systems).

Collaboration Initiated to Develop Scanning Devices for Pediatrics


E Healthcare (Chalfont St. Giles, UK; www.gehealthcare.com), a unit of General Electric Company (Fairfield, CT, USA), in collaboration with Cincinnati Childrens Medical Center (OH, USA; www.cincinnatichildrens.org) and the Davis Heart and Lung Institute of The Ohio State University (Columbus, USA; http:/ /heartlung.osu.edu), was awarded US$1 million for magnetic resonance imaging (MRI) and devices for the Pediatrics Population project. The Pediatrics Populations project, funded by the Third Frontier Program (http://thirdfrontier.com) through the State of Ohio, will address the lack of pediatric MRI coils and surgical stabilization devices with integrated imaging coils by creating industrial-academic collaboration. GEHC Coils, Inc.(Aurora, OH, USA), a wholly owned, subsidiary of the General Electric Co., is teaming up with clinicians and researchers at Cincinnati Childrens Hospital and Ohio State University to design, build, and validate new pediatric coils for use in the head, heart, and other anatomies as well as new solutions for surgical magnetic resonance pediatric fixation.

MRI has become the diagnostic imaging modality of choice for many disease states. The modality has the ability to display anatomy in exquisite detail and provides radiologists multiple ways to examine living tissue without surgery or radiation. The grant will allow us to explore the development of coils that will give us the ability to visualize a wide range of anatomy that varies in size, said Mr. Davis. Specialized imaging coils and surgical stabilization devices specifically targeting anatomy for young children would be extremely valuable in enhancing the ability to obtain diagnostic images, and improve the quality of healthcare for sick children. This project reinforces GEs commitment to healthymagination, which works to bring new technologies and solutions to more people. GE Healthcares expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, biopharmaceutical manufacturing technologies, performance improvement and performance solutions services help to deliver better care to more people worldwide.
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Anthro

The Digimax DG8000 is designed to turn X-ray films and paper reports into DICOM 3.0-compliant images. Key benefits include an automatic calibration feature, which activates before every scan, along with the capacity to process and deliver 65,536 shade of gray at full 16 bits.
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Fluroscopy/Radiography Technology Developed for Fast, Flexible Pediatric Imaging


ne of the leading pediatric teaching centers in the United Kingdom has installed an interventional imaging system and combined fluoroscopy and radiography unit to strengthen its imaging services for young patients. The Artis zee Multipurpose interventional system, developed by Siemens Healthcare (Erlangen, Germany; www.medical.siemens. com), will be used for angiograms, venous and barium studies at Birmingham Childrens Hospital NHS [National Health Service] Foundation Trust (www.bch.nhs.uk). It is a flexible system featuring ergonomically designed controls to enable users to operate it smoothly and easily, which streamlines workflow and keeps primary focus on the patient. The second installation, a Luminos dRF, is a

two-in-one solution for fluoroscopy and radiography and it was selected by the hospital for its versatility. It is also being used as a screening facility, performing barium studies when the Artis zee MP is in use. With a minimum table height of 48 cm, excellent image quality, and low dose it is highly suited for pediatric imaging. The Artis zee MP and Luminos dRF installations mark the continuation of a good relationship with Siemens, said Steve Burris, advanced pediatric radiographer at Birmingham Childrens Hospital. We now have an advanced interventional service and can offer procedures previously unavailable to patients. It is also great to be working with faster exposures and excellent quality images. We are delighted that the new systems are being used successfully at Birmingham Childrens

Hospital, said Mark Hall, regional sales manager at Siemens Healthcare. The versatility of the systems will ensure consistency of service to deliver the best possible experience for the young patients and their carers.
Image: The Artis zee multipurpose system (Photo courtesy of Siemens Healthcare).

Nanoparticles Employed As Lethal Beacons to Kill Tumors


group of researchers is developing a way to treat cancer by using lasers to light up nanoparticles and destroy tumors with the ensuing heat. On July 22, 2010, at the 52nd annual meeting of the American Association of Physicists in Medicine (AAPM) in Philadelphia, PA, USA, investigators from Wake Forest University Baptist Medical Center (Winston-Salem, NC, USA; www.wfubmc.edu) presented their findings on the latest development for this technology: ironcontaining, multiwalled carbon nanotubes (MWCNTs), which are 10,000 times thinner than a human hair. In laboratory experiments, the team revealed that by using a magnetic resonance imaging (MRI) scanner, they could image these particles in living tissue, see as they approached a tumor, and target them with a laser, thereby destroying the tumor. The research builds on an experimental tech-

nique for treating cancer called laser-induced thermal therapy (LITT), which uses energy from lasers to heat and destroy tumors. LITT works by virtue of the fact that certain nanoparticles such as MWCNTs can absorb the energy of a laser and then convert it into heat. If the nanoparticles are zapped while within a tumor, they will heat and kill the cancerous cells. The problem with LITT, however, is that while a tumor may be distinctly visible in a medical scan, the particles are not. They cannot be tracked once injected, which could put a patient in peril if the nanoparticles were zapped away from the tumor because the aberrant heating could destroy healthy tissue. Now the Wake Forest Baptist researchers have shown for the first time that it is possible to make the particles visible in the MRI scanner to allow imaging and heating at the same time. By loading the MWCNT particles with iron, they become vis-

ible in an MRI scanner. Using tissue containing mouse tumors, they showed that these iron-containing MWCNT particles could destroy the tumors when hit with a laser. To find the exact location of the nanoparticle in the human body is very important to the treatment, said Xuanfeng Ding, M.S., who presented the research at the meeting. It is really exciting to watch the tumor labeled with the nanotubes begin to shrink after the treatment. An earlier study by the same group showed that laser-induced thermal therapy using a closely related nanoparticle actually increased the long-term survival of mice with tumors. The next step in this project, according to the investigators, is to see if the iron-loaded nanoparticles can do the same thing. If the work proves successful, it may one day help people with cancer, though the technology would have to prove safe and effective in clinical trials.
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The Vita CR system is designed to provide rapid image access to help increase both the speed and accuracy of patient diagnosis. The compact Vita CR is ideal for a range of imaging applications, and can be bundled with optional Image Suite software for a complete mini-PACS solution.
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The fully featured scanner is a fully portable and easy-to-use ultrasound. System highlights include low weight, minimum power consumption, high resolution, three probes, 200-image memory, and high efficiency cine-loop for 119 frames.
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Ultrasound System Uses Cell Processor Technology

new ultrasound systems powerful imaging electronics with unique ergonomics are integrated into a compact, easy to use system. It is the first ultrasound system to use cell processor technology and Smart Touch operation featuring a touch screen integrated with the liquid crystal display (LCD) display for increased scanning efficiency. Hitachi Medical Systems America, Inc. (Twinsburg, OH, USA; www.hitachimed.com) announced the availability of the HI Vision Preirus ultrasound scanner to the U.S. market. Although it is just being released to the U.S. market, Preirus has been available in Europe and Japan for more than a year now and is proving to be one of the most successful scanners in Hitachis long history of ultrasound products, said Matthew Ernst, marketing manager for ultrasound. The award-winning design of Preirus is com-

plemented by a wide selection of transducers for every clinical need. Each probe is engineered with application-specific crystal array characteristics and architecture, from Hitachis V53W transvaginal probe with its slender design and 200 field of view to its four-dimensional (4D) volumetric imaging probes, both linear and curved, or its laparoscopic probe with a thin insertion shaft enabling the use of a 10-mm trocar. The Preirus also supports advanced imaging with optional features of real-time tissue elastography, which applies the essential concept of palpation to ultrasound imaging and real-time virtual sonography that correlates magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound volumes to a live ultrasound exam, and displays them both side by side in real-time during scanning.

Image: The HI Vision Preirus ultrasound scanner (Photo courtesy of Hitachi Medical Systems).

Virtual Colonoscopies Help Identify Additional Tumors Outside of the Colon


lthough medical specialists has already accepted that colorectal cancer (CRC) screening is cost-effective and saves lives, investigators have found that computed tomography colonography not only identifies CRC but also doubles the yield of detecting significant early extracolonic lesions, resulting in lives saved. CTC is an emerging noninvasive rapid imaging technique developed for CRC screening. It is less invasive than optical colonoscopy and may improve patient adherence and CRC screening.The ability of CTC to identify significant extracolonic lesions at an early treatable stage may increase the yield of CRC screening, thus enhancing CTC as a major screening technique, said Ganesh R. Veerappan, M.D., lead

author of the study, published in the September 2010 issue of the American Journal of Roentgenology (AJR). The study, performed at Walter Reed Army Medical Center (Washington, DC, USA; www.wramc.amedd. army.mil) included 2,277 patients who underwent CTC. Of those patients, extracolonic findings were identified in 1,037 patients, with 787 insignificant and 240 significant findings. When considering extracolonic findings, CTC increased the odds of identifying high-risk lesions by 78%. CTC should be considered as an alternative to optimal colonoscopy for colorectal cancer screening or as a onetime procedure to identify significant treatable intracolonic and extracolonic lesions, concluded Dr. Veerappan.
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Digital Radiography Enhanced to Produce Soft-Tissue Images of the Chest


ew enhanced chest-imaging software automatically suppresses the ribs and clavicles to improve the visibility of soft tissue structures in the lungs, allowing the physician to interpret pulmonary nodules with greater confidence. As the SoftView technology developed by Riverain Medical (Dayton, OH, USA; www.riverainmedical.com) uses the existing chest X-ray to produce the soft tissue image, it eliminates additional dose and motion artifacts commonly associated with dual energy solutions. Ribs and clavicles on a chest X-ray frequently make it problematic for the physician to obtain a clear evaluation of the lung tissue. Until now, radiologists have used dual energy technology to improve the visibility of the lungs. The technique involves the successive acquisition of two images consisting of a low and a high-energy spectrum. The physician can then use these two images to visualize the soft tissue in the lung. Siemens Healthcare (Erlangen, Germany; www.medical.siemens.com) is now offering Riverain Medicals SoftView technology in conjunction with Ysio, Siemens latest digital radiography system. SoftView enables the physician to acquire a soft tissue image faster and without any additional radiation dose for the patient. Patient positioning, radiation dose, and inspiration can make the interpretation of a chest X-ray challenging. SoftView suppresses the ribs and clavicles on a chest X-ray to improve the clarity of the image, even when image quality is low, explained Dr. Stefan Palmers, Ghent Hospital, Belgium, who is already working with the technology. Siemens Healthcares Ysio and Riverain Medicals SoftView technologies together produce optimal image quality. SoftView is available from Siemens as a one-stop solution with Ysio, but can also be acquired as an upgrade for other digital radiography systems from Siemens. The software can easily be integrated and requires no adaptation of the clinical protocols for chest X-rays.

Image: Comparison of a standard digital X-ray (left) and SoftView images (right) when visualizing a lung nodule. SoftView increases the clarity of chest X-rays by suppressing bone on the digital image (Photo courtesy of Riverain Medical).
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Hepatocellular Carcinoma Response to Chemoembolization May Be Predicted by Functional MRI


arly knowledge of hepatocellular carcinoma (HCC) response to transcatheter arterial chemoembolization (TACE) is crucial for determining treatment success, timing of repeat treatment, and patient prognosis. Currently, magnetic resonance imaging (MRI) is used one to three months after treatment to assess anatomic tumor response, based upon changes in tumor size and contrast-agent enhancement. Alternatively, diffusion-weighted imaging (DWI) can be used as a functional imaging technique to depict thermally induced motion of water molecules. The extent of water mobility within biologic tissues can be quantified by a parameter called the apparent diffusion coefficient (ADC). Recently, ADC values

have been shown to change within days to weeks after therapy, which is earlier than changes seen by conventional HCC anatomic size assessment. However, no studies to date have reported the intraprocedural characteristics of ADC and whether these values can predict future tumor response at the time of chemoembolization. A research article on the topic was published on July 7, 2010, in the World Journal of Gastroenterology. The research team led by Prof. Reed A. Omary, from the department of radiology, Northwestern University (Chicago, IL, USA; www.northwestern.edu) used functional magnetic resonance imaging (fMRI) to measure alterations in tumor activity at the time of treatment,

and compared them to tumor structural changes on traditional MRI scans at standard one- and three-months follow-up periods. The studys findings suggest that patients whose intraprocedural ADC values increase or decrease by > 15% are more likely to have a positive anatomic tumor response one month later. This result is promising because early knowledge of HCC response after initial therapy is critical to revise prognosis and guide future therapy. Use of DWI and ADC mapping used with conventional anatomic imaging evaluation could additionally improve tumor response interpretation and subsequent treatment planning. At present, MR/interventional radiology suites permit the acquisition of immediate quantitative functional imaging changes, in both tumor perfusion and now diffusion. Which of these two functional parameters is more effective as an intraprocedural biomarker to customize HCC therapy awaits verification by future studies, according to the investigators.

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Image: Colored magnetic resonance imaging (MRI) scan of an axial section through the abdomen of a 42-year-old woman with liver cancer (Photo courtesy of Simon Fraser / SPL).
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Noninvasive Fusion Imaging Technique May Reduce Number of Breast Biopsies


y combining two comparatively inexpensive technologies based on sound and light waves, researchers hope to lower the rate at which women undergo breast biopsies for suspicious lesions. The goal of our study was to investigate the potential of diffuse optical tomography in the near-infrared spectrum with ultrasound localization as a means of differentiating early-stage cancers from benign lesions of the breast, said lead researcher Quing Zhu, Ph.D., professor of bioengineering at the University of Connecticut (Storrs, USA; www.uconn.edu). When mammography and ultrasound cannot determine whether a suspicious breast lesion is malignant or benign, physicians typically recommend a needle biopsy to extract samples of the suspicious tissue for laboratory testing. In current clinical practice, 70% - 80% of biopsies performed reveal benign lesions, leading to unnecessary expense and worry for women. Diffuse optical tomography (DOT) is an emerging noninvasive imaging technique that measures light absorption within tissue to quantify blood content (hemoglobin level) and blood oxygen levels. Because cancerous lesions have many more blood vessels than normal tissue, hemoglobin levels can help distinguish malignant from benign lesions. In Dr. Zhu's study, 178 consecutive women underwent ultrasound-guided DOT on a previously identified solid lesion, followed by a biopsy. The study, which included women between the ages of 21 and 89 years, was conducted between 2004 and 2008 at the University of Connecticut Health Center and Hartford Hospital, both in Hartford, CT, USA. Performing ultrasound-guided DOT involves the use of a handheld probe consisting of a commercial ultrasound transducer located in the middle and an optical source and detector fibers around the periphery. Once ultrasound locates the lesion, DOT is performed by shining infrared light into the area and measuring light absorption at two optical wavelengths. Infrared light penetrates deep into tissue, up to 4 cm, Dr. Zhu said. Researchers computed total hemoglobin levels from the light absorption measured at two wavelengths and correlated the measurements with biopsy results. Laboratory examination of tissue samples revealed two in situ carcinomas, 35 carcinomas that measured less than 2 cm, 24 carcinomas greater than 2 cm, and 114 benign lesions. Both maximum and average total hemoglobin levels were significantly higher in the malignant groups than in the benign group, Dr. Zhu said. The sensitivity and specificity of the technique (92% and 93%, respectively) were greatest when assessing tumors less than 2 cm in size. Based on our results, we believe that ultrasound-guided diffuse optical tomography holds promise as an adjunct to diagnostic mammography and ultrasound for distinguishing

early-stage invasive breast cancers from benign lesions, Dr. Zhu said. We expect this technology will be used to help radiologists evaluate small to intermediate size lesions that are harder to diagnose with conventional imaging technologies. Ultrasound and near infrared procedures cost considerably less than magnetic resonance imaging (MRI), another methodology used to assess suspicious breast lesions that cannot be diagnosed using mammography. The next phase of Dr. Zhus research is to design multi-institution clinical trials for ultrasound-guided DOT. The studys findings on ultrasound-guided optical tomography were published in the online edition and the August 2010 print issue of the journal Radiology.

Image: Quing Zhu, professor of electrical and computer engineering, with her device for early detection of breast cancer lesions (Photo courtesy of Peter Morenus).

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B-MODE ULTRASOUND SCANNER


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MEDICAL LCDS
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The KX5500 features a 26.4 cm high resolution TFT LCD with adjustable contrast and background light. Other key benefits include two probe ports, USB and DICOM compatibility, and backup battery.
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MR Nanosized Contrast Agents Used to Visualize, Quantify Tumor Angiogenesis

cientists have incorporated nanotechnology, material science, and the clinical imaging modality magnetic resonance imaging (MRI) to create a nanosized probe capable of noninvasively visualizing and quantifying the blood vessel growth in tumors in a preclinical model. Angiogenesis is vital for sustained tumor growth and cancer metastasis. Clinically available therapies to suppress the growth of these vessels have been available to improve patient survival in some cancer types. Accurate detection and quantification of blood vessel growth using nonsurgical methods would greatly complement current therapies and allow physicians to quickly

assess treatment regimens and adjust them as necessary. In new research published in the August 2010 issue of the journal Experimental Biology and Medicine, scientists have incorporated nanotechnology, material science, and the clinical imaging modality MRI, to create a nanosized probe capable of noninvasively visualizing and quantifying the blood vessel growth in tumors in a preclinical model. The study was conducted by Chase Kessinger, as part of his Ph.D. thesis in cancer molecular imaging, working with Dr. Jinming Gao and other colleagues, at the University of Texas (UT) Southwestern Medical Center at Dallas (USA;

www.utsouthwestern.edu). Dr. Gao stated, Imaging tumor angiogenesis is important in early detection, tumor stratification, and post-therapy assessment of antiangiogenic drugs. Current clinical modality for angiogenesis imaging utilizes dynamic contrast enhancement MRI by small molecular contrast agents. The method is based on the measurement of permeability of the contrast probes in well-established solid tumors and is not very specific to detect the early on-set of vessel formation. The dual functional nanoprobes aim to image angiogenesis-specific tumor markers that are overly expressed in the tumor vasculature during the early phase of angiogenesis. Together, the research team relied on nanotechnology and established superparamagnetic micellar nanoprobes (50 nm - 70 nm in diameter) with greatly improved MRI sensitivity over conventional small molecular agents. The nanoprobe surface was functionalized with a cyclic peptide that can specifically bind to v3 integrins that are overexpressed on the tumor endothelial cells. The nanoprobes also had a fluorescent moiety employed for the validation of targeted delivery to the tumor endothelial cells. Studies in cancer cells confirmed the increased uptake of nanoprobes compared to nontargeted-nanoparticles. In collaboration with Dr. Masaya Takahashi and coworkers in the Advanced Imaging Research Center at UT Southwestern

Medical Center, the research team utilized a three-dimensional (3D) high-resolution acquisition method to visualize the accumulation of the micelle nanoprobes in tumors. Conventional image analysis of angiogenesis relies on the evaluation of hot spot densities in 2D images. The 3D high resolution method allowed for the connection of the isolated hot spots in 2D slices into 3D network structures, which greatly improves the accuracy of vessel identification and quantification, noted Dr. Gao. In preclinical animal tumor models, MR imaging of the targeted contrast probes yielded vascularized network structures in 3D tumor images. The enhanced visualization allowed for a more accurate quantification of tumor angiogenesis. The studys findings demonstrated a considerable increase of contrast specificity of angiogenic vessels by the targeted nanoprobes over nontargeted micelles. These targeted nanoprobes may provide a useful contrast probe design for the clinical diagnosis of tumor angiogenesis. Steven R. Goodman, editor-inchief of Experimental Biology and Medicine, commented, Kessinger et al working at the interface of nanotechnology, material science, and the clinical imaging modality MRI have created a nanosized probe capable of noninvasively visualizing and quantifying the blood vessel growth in tumors in a preclinical model. This should be an important tool for clinical observation of tumor angiogenesis.
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Portable Ultrasound Provides Octal-Beam Imaging for High Temporal Resolution

new ultrasound platform is based on breakthrough systemon-chip (SOC) technology, bringing a new level of imaging performance to a compact portable system. Mindray Medical International, Ltd. (Nanshan, Shenzhen, China; www.mindray.com), announced the launch of the companys new M7 ultrasound system in the United States. The new M7 platform brings high-end imaging capabilities to an ergonomically designed portable system, said Michael Thompson, vice president of sales and marketing, Mindray U.S. This segment of the ultrasound market is experiencing significant growth as more healthcare facilities are requiring premium performance in a compact form. We believe this, coupled with the superb economical value, will support substantial demand for the M7 platform. The M7 platform provides a variety of sophisticated imaging features. These include octal-beam imaging technology, which provides excellent temporal resolution along

with an innovative implementation of multiple tissue harmonic imaging technologies to improve image quality for technically difficult patients. iZoom enables the user to view images from a longer distance by increasing the size of the clinical image display area on the screen and iTouch provides a single button image optimization. Tissue Doppler imaging (TDI), Cine Compare, and real-time three-dimensional (3D) are part of the platform as well. The system has an on-board workstation for patient information management and the ability to transmit information wirelessly for a wide range of applications. The M7 system received a 2010 best of the best award from red dot for product design. The red dot design award is a large and coveted international product design prize awarded by the Design Zentrum Nordrhein Westfalen (Essen, Germany). In addition to launching the M7 platform, Mindray recently introduced a significant new upgrade for

its M5 system. The new 3.0 release features full Digital Imaging and Communications in Medicine (DICOM) capability, networking, work list, MPPS (modality performed procedure step), query, retrieve, and structured reporting. Automatic measurement of the carotids intimamedia thickness (IMT) and wireless data transfer are included (regulatory clearance pending for IMT and wireless). Three new transducers curved, linear and cardiology are also options in the new upgrade. Part of Mindrays commitment to supporting excellence in patient care is providing an ongoing stream of upgrades to our clinicians, said Mr. Thompson. This significant new upgrade to the M5 system is

another example of offering our customers continuous, state-of-the-art imaging, resulting in greater diagnostic confidence.
Image: The M7 ultrasound system (Photo courtesy of Mindray Medical International).

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Contract Awarded for State-of-the-Art Medical Imaging in Spain


he Ministry of Health of the Spanish region of Murcia has placed an order worth EUR 132 million to Siemens Healthcare (Erlangen, Germany; www.medical.siemens.com) for medical technology, service, and financing. Within the framework of a public private partnership, Siemens will provide two hospitals in the region with more than 100 imaging systems, including computed tomography (CT) scanners, mammography systems, and ultrasound systems. Siemens ensures that the hospitals work with state-ofthe-art technology for the next 15 years. This includes both maintenance and an innovation assurance: The systems will be replaced in predefined intervals with the newest model of the respective product line. Siemens Financial Services developed the financing solution for the initial equipment and for the regular technological replacements. The Cartagena and Mar Menor public hospitals in the Murcia region will have a total of more than 1,000 beds and will be completed by the end of 2010. However, the Ministry of Health faced a considerable challenge

when it was required to provide the latest medical technology for two large hospitals all at once. For this reason, the authorities looked for a private investor. With public private partnership tenders, we aim at advancing the quality of our health services and simultaneously improve the relationship between costs and benefits, said Maria Angeles Palacio, Health Minister of the Murcia region. For this project, the Siemens solution proved to be most competitive both in technological and economical terms. The contracts key player is the Managed Equipment Services (MES) business model that Siemens Healthcare has already applied to various successful projects, especially in the United Kingdom, where the publicly financed healthcare system largely depends on the commitment of private companies. With MES contracts, customers have the benefits of using the most advanced technology while they need not worry about system maintenance and management. Simultaneously, they can count on planning effectively for a fixed period of time.
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Global Definition of Interventional Radiology Advances Technology, Benefits Patients


he first global statement defining interventional radiology (IR) one designed to benefit medical treatment for individuals has been issued that addresses the evolution, impact, and future direction of this minimally invasive specialty, emphasizing the worldwide availability of this specialized medical care. The collaborative statement was issued by the Society of Interventional Radiology (SIR; Fairfax, VA, USA; www.sirweb.org), with the support of 41 international societies representing 10,000 interventional radiology physicians. It is the result of more than two years of collaborative work, and is being copublished in the August 2010 issue of the SIRs Journal of Vascular and Interventional Radiology and in the Cardiovascular and Interventional Radiological Society of Europes journal. Until now, there has been no single document no blueprint defining interventional radiology that has had broad international support. It was time for interventional radiology to organize itself, worldwide, as a single family, said SIR president James F. Benenati, M.D., FSIR, who represents the U.S. organization of nearly 4,500 doctors, scientists, and allied health professionals dedicated to improving healthcare through minimally invasive treatments. Interventional radiologists offer the least invasive and most advanced treatment options for major health problems (includ-

ing cancer, cardiovascular and venous disease, spine fractures, stroke, and uterine fibroids), but many may not be aware of these advances, he noted. In the United States, IR is a recognized subspecialty with its own board certification exam, and IR is defined by its strong practice of innovation and adaptation. However, the need for a universal statement became evident because there are countries where interventional radiology may not be recognized formally as a real specialty or subspecialty, explained Dr. Benenati. Continuously increasing numbers of patients are being treated by interventional radiologists without the need for open invasive surgery, without the need for a scalpel. When you have an inclusive, multinational document that represents more than 10,000 doctors worldwide, it is hard to deny their existence, added Dr. Benenati, an interventional radiologist and medical director for the Noninvasive Vascular Laboratory at Baptist Cardiac & Vascular Institute (Miami, FL, USA). Interventional radiology is a unique specialty distinct from all other radiologic, medical, and surgical specialties. While IR has been helping patients for more than 40 years, it is still a relatively new specialty; however, it has become integral to the delivery of health care worldwide. The Global Statement Defining Interventional Radiology puts into

writing the basic elements of IR that apply to interventional radiologists anywhere in the world. It stresses that IR doctors provide patient evaluation and management relevant to image-guided interventions in collaboration with other physicians or independently. The collaborative statement evolved over time, with input from IRs from nearly every continent. Work on the collaborative statement began two years ago by John A. Kaufman, M.D., FSIR, FCIRSE, then SIR president, and his European counterpart, Jim A. Reekers, M.D., FCIRSE, FSIR, then president of Cardiovascular and Interventional Radiological Society of Europe (CIRSE). It was important to include input from as large a representation of interventionalists as possible to make sure the statement was universally useful, according to Dr. Kaufman, professor at the Dotter Interventional Institute, Oregon Health & Science University (Portland, OR, USA). Every country will find that what they do is a little different, but the goal is a document backed by interventional radiology societies all over the world stating, This is what constitutes the specialty of interventional radiology. We expect that the document will be translated and published widely throughout the world, said Dr. Kaufman. The statement details that interventional radiologists have expert-

ise in diagnostic imaging and radiation safety, in image-guided minimally invasive procedures and techniques as applied to multiple diseases and organs, in the evaluation and management of patients suitable for the image-guided interventions included in the scope of IR practice, and in continual invention and innovation of new techniques, devices, and procedures. The unified statement defines and identifies the common features of IR. It provides background and outlines common elements found in the specialty, including clinical practice and scope, training, certification, research, practice quality, and professionalism. Interventional radiologists are responsible for much of the medical innovation and development of minimally invasive treatments that are commonplace today. IR treatments offer less risk, less pain and less recovery time than traditional surgery. Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. They use X-ray, magnetic resonance imaging (MRI), and other imaging to advance a catheter in the body, such as in an artery, to treat at the source of the disease internally. Today, interventional oncology is a growing specialty area of interventional radiology. Interventional radiologists can deliver treatments for cancer directly to the tumor without significant side effects or damage to nearby normal tissue.
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Photoacoustic Tomography Technique Developed for Earlier Detection of Melanoma


wo new applications devised by two researchers have resulted in an imaging technique and a contrast agent that produce images of melanoma with remarkable three-dimensional (3D) clarity. The five-year survival rate for early stage melanoma is very high (98%), but the rate drops precipitously if the cancer is detected late or there is recurrence. So a great deal rides on the accuracy of the initial surgery, where the goal is to remove as little tissue as possible while obtaining clean margins all around the tumor. So far, no imaging technique has been able to define the melanomas boundaries accurately enough to guide surgery. Instead, surgeons tend to cut well beyond the visible margins of the lesion in order to be certain they remove all the malignant tissue. Two scientists at Washington University in St. Louis (MO, USA; www.wustl.edu) have developed technologies that together promise to solve this difficult problem. Their solution, described in the July 2010 issue of the journal ACS [American Chemical Society] Nano, combines an imaging technique developed by Lihong Wang, Ph.D., a professor of biomedical engineering, and a contrast agent developed by Younan Xia, Ph.D., a professor of biomedical engineering. The imaging technique is based on the photoacoustic effect discovered by Alexander Graham Bell 100 years ago. Bell exploited the effect in what he considered his greatest invention ever, the photophone, which converted sound to light, transmitted the light, and then converted it back to sound at the receiver. In Bells effect, the absorption of light heats a material slightly, typically by a matter of millikelvins, and the temperature rise causes thermoelastic expansion. Much the same thing happens, said Dr. Wang when you heat a balloon and it expands. If the light is pulsed at the right frequency, the material will expand and contract, generating a sound wave. We detect the sound signal outside the tissue, and from there on, its a mathematical problem, noted Dr. Wang. We use a computer to reconstruct an image. Were essentially listening to a structure instead of looking at it. Using pure optical imaging, it is hard to look deep into tissues because light is absorbed and scattered. The useful photons run out of juice within 1 mm. Photoacoustic tomography (PAT) can detect deep structures that strongly absorb light because sound scatters much less than light in tissue. PAT improves tissue transparency by two to three orders of magnitude, remarked Dr. Wang. Moreover, it is a lot safer than other means of deep imaging. It utilizes photons whose energy is only a couple of electron-volts, whereas X-rays have energies in the thousands of electron-volts. Positron emission tomography (PET) also requires high-energy photons, according to Dr. Wang. Photoacoustic images of biologic tissue can be made without the use of contrast agents, particularly if tissues are pigmented by molecules such as hemoglobin or melanin. However, photoacoustic images of melanomas are fuzzy and vague around

the edges. To improve the contrast between the malignant and normal tissue, Dr. Xia loads the malignant tissue with gold. Gold is much better at scattering and absorbing light than biological materials, Dr. Xia stated. One gold nanocage absorbs as much light as a million melanin molecules. Dr. Xias contrast agent consists of hollow gold cages, so small they can only be seen through the color they collectively lend to the liquid in which they float. By altering the size and geometry of the particles, they can be tuned to absorb or scatter light over a wide range of wavelengths. In this way, the nanoparticles behave quite differently than bulk gold. For photoacoustic imaging, Dr. Xias team tunes the nanocages to absorb strongly at 780 nm, a wavelength that falls within a thin window of tissue transparency in the near-infrared. Light in this sweet spot can penetrate as deep as several inches in the body. Once injected, the gold particles naturally tend to accumulate in tumors because the cells that line a tumors blood vessels are jumbled and leaky. However, Dr. Xia has dramatically increased the uptake rate by embellishing the nanoparticles with a hormone that binds to hormone receptors on the melanomas cells. The molecule is alphamelanocyte-stimulating hormone, slightly modified to make it more stable in the body. This hormone normally stimulates the production and release of the brown pigment melanin in the skin and hair.

As is the case in many types of cancers, this hormone seems to trigger the growth of cancerous cells, which produce more hormone receptors than normal cells. In experiments with mice, melanomas took up four times as many functionalized nanocages than nanocages coated with an inert chemical. With the contrast agent, the photoacoustic signal from the melanoma was 36% stronger. Subcutaneous mouse melanomas barely visible to the unaided eye show up distinctly in the photoacoustic images, their areas of malignancy starkly revealed.
Image: Photoacoustic image of melanoma With the help of nanoparticles that are designed to absorb light strongly and to bind to proteins on cancerous cells, a melanoma is revealed in stunning clarity. To capture the overlaying blood vessels, the imaging system is then tuned to a different wavelength that is absorbed strongly by hemoglobin (Photo courtesy of Lihong Wang, PhD / Washington University in St. Louis).

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Orion Electric

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Molecular Imaging Identifies High-Risk Patients with Heart Disease


ew research revealed that molecular imaging could identify high-risk patients with potentially life-threatening cardiovascular conditions and help physicians determine suitability for implantable cardioverter defibrillator (ICD) therapy. If the molecular imaging techniques are used for appropriate selection of ICD candidates, not only overuse but also underuse of ICD could be avoided and the assessment may be shown to be more cost-effective, said Kimio Nishisato, M.D., a physician in the cardiology division of Muroram City General Hospital (Japan), and corresponding author for the study. According to researchers from Sapporo University (Japan), the study revealed that molecular imaging could play a key role in diagnosing and guiding the treatment strategy for arrhythmia, coronary artery disease, and heart failure. This research holds significant potential

for the detection, diagnosis, and treatment of many common cardiovascular conditions, said Tomoaki Nakata, M.D., Ph.D., an associate professor at the Sapporo Medical University School of Medicine and director of the Hokkaido Prefectural Esashi Hospital, Japan. With molecular imaging, physicians can improve patient care by pinpointing the precise location of the disease in order to eliminate the need for invasive medical devices and unnecessary surgical techniques. Dr. Nakata added that molecular imaging can also decrease unnecessary medical costs by better targeting treatment for each individual patient. In this study, published in the August 2010 issue of the Journal of Nuclear Medicine (JNM), researchers theorized that both the impairment of myocardial perfusion and/or cell viability and cardiac sympathetic innervations are responsible for heart arrhythmia and sudden car-

diac death. However, there was no established effective technique, including a molecular imaging technique, which is highly objective, reproducible, and quantitative. The researchers studied the prognostic implications of cardiac presynaptic sympathetic function quantified by cardiac metaiodobenzylguanidine (MIBG) activity and myocyte damage or viability quantified by cardiac tetrofosmin activity in patients treated with prophylactic use of ICD, by correlating with lethal arrhythmic events that would have been documented during a prospective followup. Based on these features, the study is the first to show the efficacies of the method for more accurate identification of patients at greater risk of lethal arrhythmias and sudden cardiac death (SCD). Sudden cardiac death due to lethal arrhythmia represents an important healthcare problem in many developed countries, said

Ichiro Matsunari, M.D., Ph.D., director of the clinical research department at the Medical & Pharmacological Research Center Foundation (Hakui, Japan) and author of an invited perspective also published in the August 2010 JNM. While implantable cardioverter defibrillator therapy is an effective option over antiarrhythmic medications to prevent SCD, the balance of clinical benefits, efficacy, and risks is still a matter of discussion. Dr. Matsunari added that better, more precise strategies such as the molecular imaging technique used in this study are needed to identify high-risk patients for SCD, who are most likely to benefit from ICD therapy. SCD is frequently the first manifestation of an underlying disease but one that current treatments such as ICD cannot always detect. Molecular imaging helps guide diagnosis and treatment as well as helps avoid unnecessary ICD treatment.

fMRI Assessment of Pancreatic Cancer Differentiates Living from Dead Tumor Cells
tilizing a rabbit model of pancreatic cancer that allows for arterial catheterization, researchers tested the theory that sophisticated functional magnetic resonance imaging (fMRI) could be used to evaluation regional differences in tumor function in this model. They found that the two types of functional MRI technologies evaluated (diffusion-weighted MRI and transcatheter intraarterial perfusion MRI) could be used to differentiate living tumor cells from dead tumor cells and thus can be used to assess tumor viability. Pancreatic ductal adenocarcinoma (the disease

typically referred to as pancreatic cancer) carries the worst prognosis of any cancer. As current treatments offer minimal benefit, completely new approaches are needed. Given the effectiveness of local therapies, as opposed to intravenous systemic therapies, for liver diseases (such as hepatocellular carcinoma), it is believed that similar local therapies may benefit patients with pancreatic cancer. To develop such therapies, it would be useful to design targets that are easy to obtain and can indicate the efficacy of these new therapies in models of pancreatic cancer. This research was led by Dr. Robert Lewandowski

and colleagues at Northwestern Universitys Feinberg School of Medicine (Chicago, IL, USA; www.feinberg.northwestern.edu), and the studys findings were published in the July 14, 2010, issue of the World Journal of Gastroenterology. Many models of pancreatic cancer currently exist, but this research is the first to evaluate functional MRI in the VX2 rabbit model of pancreatic cancer studied in this study. According to the investigators using these findings, it may be possible in the future to assess therapeutic efficacy in this animal model using fMRI as opposed to more invasive techniques such as biopsy or necropsy.
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Up to 70% Reduction in Radiation Dose Achievable for Positron Emission Mammography Imaging

he radiation a patient receives from positron emission mammography (PEM) may be reduced by as much as 70% without altering image quality. The studys findings were presented at the American Association of Physicists in Medicine (AAPM) 52nd annual meeting in Philadelphia (PA, USA) in August 2010 by researchers from the University of Washington (Seattle, USA; www.washington.edu). PEM scanners are high-resolution breast PET systems that show the location as well as the metabolic phase of a lesion. The metabolic image helps clinicians to make the optimal cancer care decision by providing an unprecedented ability to differentiate between benign and malignant lesions, what researchers term specificity. PEM is different from X-ray mammography in that it is currently not used as a screening modality, instead is utilized to confirm extent of disease in a patient already diagnosed with a primary breast cancer. We have several tools to help us make better patient care choices. Mammography is our primary screening tool. PEM is used in women with known breast cancer in order to plan treatment, said Wendie Berg, M.D., a breast-imaging radiologist based in Lutherville (MD, USA). Radiation for treatment of breast cancer uses doses which are roughly 5,000 times higher than a diagnostic PEM study. Minimizing radiation dose is still important for any patient, and we can likely cut the dose of PEM in half, but the benefit to proper treatment exceeds the still low risk from the radiation dose of PEM. Dr. Lawrence MacDonald, research assistant professor in the department of radiology at the University of Washington, and his team presented findings of a study to detect lesions with very low doses of radiation using the Naviscan PEM scanner. Early results using phantom images suggest that PEM lesion detection can be reduced down

to approximately 3 mCi injected dose of 18FDG or three to four times lower than the dose typically used in clinical practice, while maintaining lesion detectability. These results are the basis of an ongoing clinical trial at Swedish Cancer Institute (Seattle, WA, USA) with the goal of determining the optimized dose levels of FDG required to produce high quality PEM images in patients with breast cancer. Naviscan believes that the radiation dose to patients who undergo PEM can be cut at least in half, if not more as suggested by the University of Washington study, said Judy Kalinyak, M.D., medical director, Naviscan, Inc. Our site in Japan is already injecting 5 mCi of FDG compared to the 10 mCi in the US and a recently published abstract in the Journal of Nuclear Medicine further validates the reduction in dose down to 5 mCi. Results from a recent presentation at the Society of Nuclear Medicine on findings from an U.S. National Institutes of Health (NIH; Bethesda, MD, USA)-sponsored clinical study comparing PEM with breast magnetic resonance imaging (MRI) further demonstrate PEMs clinical appropriateness. This multisite study of hundreds of women with newly diagnosed breast cancer revealed that PEM demonstrated a 6% improvement in specificity at comparably high sensitivity, and also recommended fewer unnecessary biopsies. These results are particularly significant for women who cannot tolerate an MRI exam and require an alternate imaging tool. The Naviscan PEM scanner is currently installed and available in breast and imaging centers throughout the United States and other parts of the world. The company is the first to obtain U.S. Food and Drug Administration (FDA)-clear-

ance for a high-resolution PET scanner designed to image small body parts and for breast biopsy image guidance.
Image: The Naviscan PEM scanner (Photo courtesy of Naviscan PET Systems).

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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

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Nuclear Breast Imaging Technologies Tied to Higher Cancer Risks


ome nuclear-based breast imaging scanning may increase a womans risk of developing radiation-induced cancer, according to new findings. However, the radiation dose and risk from mammography are very low. A single breast-specific gamma imaging [BSGI] or positron emission mammography [PEM] examination carries a lifetime risk of inducing fatal cancer greater than or comparable to a lifetime of annual screening mammography starting at age 40, said the studys author, R. Edward Hendrick, Ph.D., clinical professor of radiology at the University of Colorado-Denver, School of Medicine (Aurora, CO, USA; www. u c d e n v e r. e d u / a c a d e m i c s / colleges/medicalschool). The risks and benefits of screening mammography are under constant scrutiny. Meanwhile, newer breast imaging technologies, such as BSGI and PEM, have been approved by the U.S. Food and Drug Administration (FDA) and introduced into clinical practice. Early studies have shown both to be promising at detecting cancer; however, both involve the injection of radioactive material into the patient. BSGI uses a high-resolution gamma camera that allows for imaging with mild compression of the breast along with an injection of a nuclear radiotracer, which is absorbed at a higher rate by can-

cerous cells. In PEM, radioactive material is injected into the body to measure metabolic activity and determine the presence of disease. Other technologies, not yet approved by the FDA, include dedicated breast computed tomography (CT) and digital breast tomosynthesis. Dr. Hendrick reviewed recent studies on radiation doses from radiologic techniques and organ doses from nuclear medicine procedures, along with Biologic Effects of Ionizing Radiation (BEIR) VII age-dependent risk data, to estimate the lifetime risk of radiationinduced cancer incidence and death from breast imaging exams using ionizing radiation. Two-view digital mammography and screen-film mammography were found to have an average lifetime risk of fatal breast cancer of 1.3 and 1.7 cases, respectively, per 100,000 women aged 40 years at exposure and less than one case per one million women aged 80 years at exposure. Annual screening mammography (digital or screen-film) performed in women from age 40 to age 80 is associated with a lifetime risk of fatal breast cancer of 20 to 25 cases in 100,000. Two-thirds of mammography units in the U.S. are now digital, which, on average, exposes the patient to an even lower radiation dose than screen-film, Dr. Hendrick said. Manufacturers and

breast centers continue to take steps to lower radiation doses on digital mammography systems without negatively affecting image quality. Dedicated breast CT and digital tomosynthesis were both found to have an average lifetime risk of fatal breast cancer of 1.3 to 2.6 cases, respectively, per 100,000 women 40 years of age at exposure. A single BSGI exam was estimated to involve a lifetime risk of fatal cancer 20 to 30 times that of digital mammography in women aged 40 years, while the lifetime risk of a single PEM was 23 times greater than that of digital mammography. Moreover, while mammography only slightly increases a womans risk for breast cancer, BSGI and PEM may increase the risk of cancers in other organs as well, including the intestines, kidneys, bladder, gallbladder, uterus, ovaries, and colon. People are exposed to radiation from natural sources all the time. The average person in the United States receives an effective dose of about three millisieverts (mSv) per year from naturally occurring radioactive materials and cosmic radiation from outer space. The median effective dose from twoview screen-film (0.56 mSv) or digital mammography (0.44 mSv) is equivalent to approximately two months of natural background radiation, while the effective doses

from BSGI (6.2 mSv) and PEM (9.4 mSv) exams equal approximately two to three years of natural background radiation exposure. Currently, no one is advocating using PEM or BSGI as a screening modality to replace mammography. These scans are typically performed on women with suspicious breast lesions and in women with dense breasts who are difficult to examine with other techniques. In spite of the increased radiation dose, these exams have shown potential in detecting cancer accurately and may have a good risk-benefit ratio for some specific indications. The primary tool for breast cancer screening is still mammography, which has a very low radiation dose and a very low lifetime risk of cancer induction, Dr. Hendrick said. The risk of missing a breast cancer because mammography is not done far outweighs the tiny risk of mammography causing a breast cancer. He added that the subset of women under 40 who are known to be at higher risk of breast cancer should think about being screened with breast ultrasound or breast magnetic resonance imaging (MRI), both of which deliver no ionizing radiation and have sensitivities to breast cancer that are not affected by higher breast density. The study was published in a special report appearing online in August 2010 and in the October 2010 issue of the journal Radiology.
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Open Bore MRI Unit Provides 3 Tesla


high-performance magnetic resonance imaging (MRI) system combines a range of innovative features, including a 70-cm open bore design and 32-channel Tim (Total imaging matrix) technology. With the same footprint as a 1.5 Tesla system, the system provides the considerable benefits of 3 T field strength to the clinical environment in a patient-friendly package. Nuada Medical (http://nuadamedical. com), an independent imaging services provider based in London (UK), has installed a Magnetom Verio 3 Tesla MRI system to offer highly detailed diagnostic imaging to its patients. Routine neurology, oncology, and musculoskeletal imaging needs are accommodated for by the system. Other complicated MR techniques such as diffusion, perfusion, and spectroscopy are also being employed. The systems Tim technology provides a very high level of flexibility, accuracy, and speed. With more options for coil combinations, Tim technology helps to reduce examination times by up to 50%, creating a more streamlined imaging process. The Verio is a fabulous scanner that has enabled us to offer more complex imaging and work with a stunning new level of detail, said St John Brown, chief executive at Nuada Medical. The full range of syngo software applications selected has allowed us to maximize our use of the equipment. We can also offer patients the best quality, most comfortable examinations due to the systems design.

With the addition of this top-of-the-range system, Nuada Medical sited in Queen Anne Street will be able to offer patients the very best quality diagnostic service with wide bore comfort for the patients, said Gary Cook, regional sales manager at Siemens Healthcare (Erlangen, Germany; www.medical.siemens.com), the developer of the system. A comprehensive team of experts from healthcare management will help to make best use of the innovative technology on site. The systems ease-of-use and small footprint enable the considerable 3 Tesla imaging benefits to be enjoyed by the clinical and research environment alike.
Image: The Magnetom Verio 3T MRI system (Photo courtesy of Siemens Healthcare).

Combination of MRI and Radiation Therapy Technology Improves Treatment, Reduces Side Effects
ew technology has been designed to improve the accuracy of cancer treatments through a combination of medical imaging and radiotherapy delivery. Researchers at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis (MO, USA; www. siteman.wustl.edu), a U.S. leader in the early adoption and use of advanced treatments for cancer patients, will soon become the first in the world to test an innovative radiotherapy system from ViewRay, Inc. (Cleveland, OH, USA; www.viewray.com). Radiation therapy is critical in the fight against cancer, and nearly two-thirds of all cancer patients receive radiation therapy during their illness. However, patients and their internal organs move naturally and continually during treatment, preventing clinicians from determining precisely where the radiation is going in a patients body. The ViewRay system is being designed to provide continuous soft-tissue magnetic resonance aiming (MRI) during treatment so that clinicians can see precisely where the radiation is being delivered, potentially improving treatment success, and reducing side effects. This is a tremendous opportunity for us to lead the region in the implementation of real-time MRI guidance for radiation therapy for cancer patients, said Dennis Hallahan, M.D., FASTRO, head of radi-

ation oncology at the Siteman Cancer Center. The problem of patient organ motion is one that needs to be solved. We believe the ViewRay technology holds great potential for treating patients with cancers in parts of the body that are sensitive to motion, such as the head and neck, lung, prostate, and cervix. The technology fits perfectly with our mission to advance the field of cancer therapy. We couldnt have asked for a better partner for our technology, said ViewRay president and CEO Gregory M. Ayers, M.D., Ph.D. Washington University researchers are known for their groundbreaking scientific investigation and for their translation of new discoveries into meaningful clinical treatments. We are excited to be working with them to test and refine a system we believe will offer a significant advancement in radiation therapy. At this time, the ViewRay system is for nonclinical research use only. ViewRay is a medical device company developing advanced radiation therapy technology for the treatment of cancer. Using MRI-guided radiotherapy, the ViewRay system is intended to provide continuous soft-tissue imaging during treatment. The system is being designed so that clinicians for the first time will be able to see where the actual radiation dose is being delivered and adapt to changes in the patient's anatomy, potentially improving outcomes, and reducing side effects.

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Medical Imaging International November-December/2010

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WEB-BASED PORTAL
Carestream Health

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Intelerad

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The zero-footprint, Web-based portal enables viewing of imaging data and patient information by remote users. The portal integrates with the vendor-neutral Clinical Data Archive, and links to SuperPACS Architecture to expedite access by authorized clinicians.
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The Print-in printer makes it possible to quickly and easily link any printable document to a study and send it to the PACS. The printer joins a PACS solution import line of products that includes DICOM Izer, CDin, and Open LiteBox.
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The InteleViewer for Mac combines the ability to cache DICOM images at the workstation in combination with the capability to stream JPEG 2000 images on-demand from the server. InteleViewer is powerful yet easy to use, and can be customized for functionality depending on needs.
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The VoXcell is a cloud-based imaging suite with complete RIS, PACS, image archiving and communication functionalities accessible through a standard browser. The VoXcell suite is designed to eliminate the need for software purchases, downloads, and IT staff maintenance.
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Direct Radiography Technology Provides High Image Quality and Fast Previews
wo new direct radiography (DR) systems have been designed to deliver high productivity, with high image quality and workflow efficiency to the radiography department. Agfa HealthCare (Mortsel, Belgium; www. agfahealthcare.com), a provider of diagnostic imaging and healthcare information technology (IT) solutions, reported that both its DX-D 500n and DX-D 300 direct radiography (DR) systems now are available for sale in the United States. The DX-D 300 universal arm DR solution and the ceiling-mounted DX-D 500n DR system, provide users with new DR solutions in addition to the companys complete range of computed radiography (CR) systems. The DX-D 500n and DX-D 300 systems have been specifically developed to support a wide range of exams, while at the same time meeting

the facilitys need for high image quality. The DXD 500n and DX-D 300 are Digital Imaging and Communications in Medicine (DICOM)-compliant allowing for radiology information system (RIS), picture archiving and communications system (PACS), and hospital information system (HIS) compatibility. The DX-D family of products blends Agfa HealthCares award-winning Musica2 image processing with high-resolution flat panel detectors designed to deliver exceptional image quality and productivity. Musica2 image processing analyzes image data before applying contrast and density algorithms to enhance image details. The solution enables the DX-D 500n and DX-D 300 to deliver high quality images on the NX acquisition workstation without user interaction. The DX-D 500n and DX-D 300 systems deliver fast cycle times and a unified look-and-feel for both CR and DR exams. Especially in combination with Agfa HealthCares latest needle-based CR solutions, a very high and consistent standard of quality is reached for all X-ray images in the radiology department, to maximize diagnostic confidence while at the same time minimizing patient dose. The DX-D 500n and DX-D 300 are both available in several different configurations that can be customized to meet a wide range of workflow requirements. The ceiling-mounted room, DX-D 500n, comes with a choice of cesium iodide or gadoliniumbased DR detectors. Rooms may be configured with fixed or removable panels to meet patient workflow and added positioning flexibility. With a touch-screen monitor located at the head of the Xray tube, the system includes image preview and exam control directly next to the table, giving radiographers the ability to preview images and complete studies in a limited number of steps. The wall stand allows fast and efficient upright cassette-less imaging, while the table is designed

with an extra wide, smooth, and durable surface with four-way float-top movement for added patient comfort, safety, and versatility. The universal arm DX-D 300 is a highly versatile DR solution with the quality and productivity benefits of cassette-less workflow. The compact size requires only a 3 m x 3 m x 2.8 m space to operate and the floor mounting reduces installation costs making the DX-D 300 a suitable option for smaller practices. The fully motorized DX-D 300 can handle a broad range of X-ray studies, including lateral exams. This adaptability makes it ideal for use with all patients, even those less mobile, whether in sitting, standing, or lying positions. The high-quality detector technology available in the DX-D 300 offers excellent image quality and very rapid image availability.
Image: The DX-D 500n digital radiography system (Photo courtesy of Agfa HealthCare).

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IT/PACS UPDATE

Search Tool Developed to Help Physicians Retrieve EMR Data


esearchers at one of the top five hospitals in the United States have developed an advanced search tool called the Queriable Patient Inference Dossier (QPID) that helps radiologists and other physicians extract useful data from a patients electronic medical record (EMR) in a timely and efficient manner. Even in its simplest implementation, the presence of an EMR system presents considerable challenges to the radiologist, said Michael Zalis, M.D., from Massachusetts General Hospital (MGH; Boston, MA, USA; www.mgh. harvard.edu), and lead author of the study. For example, radiologists commonly encounter each patient with little prior familiarity with the patients clinical situation. As a result, the time and effort required to retrieve, review, and assimilate EMR data relevant for the case at hand

becomes an important consideration for use of EMR in busy clinical practice. In order to address this issue, in 2005, researchers at Massachusetts General Hospital initiated the development of the programmable search system QPID for their institutions EMR. QPID is a search engine that serves as an adjunct to our hospital's EMR system; it was developed separately from the EMR and operates in a readonly fashion in relation to it. Thus, QPID is not a source of new EMR data, but serves as a method to extract useful patterns of EMR data from the separately curated clinical data repositories at our institution, said Dr. Zalis. QPID currently serves 500 registered users at Massachusetts General and posts 7-10 thousand pages of medical record data daily. Advanced search tools can extend the radiologists aware-

ness of a patients clinical history and care record, and in some instances automating these tools may augment the value, quality, and safety of practice. The potential impact of advanced EMR search tools is by no means limited to radiology and in fact, many departments in the hospital and outpatient clinic may benefit from these capabilities. In our own institution, with the QPID search system, we have catalyzed a growing base of enthusiastic users, many of whom have contributed their own insights and content to the systems catalogue of search modules, each of which is potentially applicable at more than one site. The future for advanced search of the EMR looks to be exciting and full of potential, concluded Dr. Zalis. The studys findings were published in the August 2010 issue of the Journal of the American College of Radiology.

Integrated Teleradiology System Combines PACS with Virtual Radiology Assistants


ew technology combines conventional teleradiology services with picture archiving and communication systems (PACS) and live support from virtual radiology assistants with radiologist productivity in mind. StatRad (San Diego, CA, USA; www.statrad. com), a provider of teleradiology services, announced the introduction of Stat360. As a complete teleradiology platform, the technology offers radiology groups a true, centralized work list across disparate platforms, multiple sites, live virtual assistants, lightning fast transfer rates, and an integrated reporting module with voice recognition. The integrated use of internal employees as virtual radiology assistants improves radiologists efficiency by bringing a vital component to the workflow the human element. Radiology assistants are vital in optimizing radiology workflow by facilitating phone calls, gaining access to referring physicians, and acquiring patient records and images. As a result, there is no need for radiologists to hire on-site staff. Moreover, streamlining the reading process allows the radiologists to focus only on interpreting studies. At the simple touch of a button, from the clinic or at home, radiologists can request that an assistant complete various tasks, including pulling additional images or prior reports. It is our belief that equipping radiology groups with superior technology and services will enable them to compete in the teleradiology market without a large capital investment, said StatRad managing partner, Joe Moock. StatRads core business is afterhours teleradiology service. We have found that many group practices, like any business, are looking for better ways to reduce expenses and increase revenue. StatRad enables their teleradiology clients to leverage the already installed Stat360 infrastructure to internally provide after-hours coverage and increase their business by providing remote reading services during the day. StatRads U.S.-trained, board-certified radiologists and staff deliver interpretations and reliable programs that increase efficiency and improve patient care. Their services allow hospitals and healthcare groups to save money, supplement staffing, satisfy hospital clients, and maintain control.

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PRODUCT NEWS

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AUDIO/VIDEO SYSTEM
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The K_Specs A-V system is designed for fMRI and features a user-friendly interface for both the operator and the patient. The lightweight and compact K_Specs work in nearly all MRI environments, offer high contrast picture quality, as well as enhanced energy efficiency.
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The OrderRight 2.0 is designed to reduce unnecessary radiation exposure for patients, ensure the most accurate diagnoses, and mitigate costs. The software also provides physicians and radiologists with extensive reference text and clinical citations for further research.
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The Qualitative Intelligence and Communications system directly interfaces with HIS, RIS, PACS, and related systems. The system addresses a wide range of unmet workflow and communication needs beyond the scope of these applications.
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Database with Physician Input and Innovative Eye-Tracking Techniques Devised


igital archives of biomedical images could soon put vital data at physicians fingertips within seconds, demonstrating how computers can improve the manner in which medicine is practiced. The current reality, however, is not quite there yet, with databases virtually overwhelmed by the explosion of medical imaging. Rochester Institute of Technology (NY, USA; www.rit.edu) professor Anne Haake recently won grants from the U.S. National Science Foundation (NSF; Arlington, VA, USA) and the U.S. National Institutes of Health (Bethesda, MD, USA) to address this problem. Prof. Haake foresees an image database built on input from the intended end-users and designed from the beginning with flexible user interfaces. She and her interdisciplinary team will develop a prototype using input from dermatologists to refine the search process for images of various skin conditions. We need to involve users from the very beginning, said Prof. Haake, professor of information sciences and technologies at the B. Thomas Golisano College of Computing and Information Sciences. This is especially true in

the biomedical area where there is so much domain knowledge that it will be specific to each particular specialty. Prof. Haake understands the genuine need to make biomedical images useful. She began her career as a developmental biologist before pursuing computing and biomedical informatics. This project combines her two strengths and was inspired by research she conducted while on sabbatical at the NIH National Library of Medicine. Dr. Cara Calvelli, a dermatologist and a professor in the physician assistant (PA) program in RITs College of Science, has recruited dermatologists, residents, and PA students for the project. She is also helping to describe accurately the sample images, some of which come from her own collection. The best way to learn is to see patients again and again with various disorders, Dr. Calvelli stated. When you cant get the patients themselves, getting good pictures, and learning how to describe them is second best. Funding Prof. Haake won from the NSF will support visual perception research using eye

tracking and the design of a content-based image retrieval system accessible through touch, gaze, voice, and gesture; the NIH portion of the project will be used to fuse image understanding and medical knowledge. Bridging the semantic gap is the challenge facing researchers working in content-based image retrieval, according to Prof. Haake. Search functions can go awry when computer engineered algorithms trip on nuances and fail to differentiate between disparate objects, such as a ship and a whale. Constructing a system based on end-user knowledge can prevent semantic problems from occurring. Pengcheng Shi, director for graduate studies and research in the Golisano College, is providing his expertise in image understanding. For many years computing/technical people have said we can write algorithms such that it will work, he noted. But people start to realize that machines are not all that powerful. At the end of the day we need to put the human back into it. What are the physicians looking at and how are they looking at it in order to make their decisions?

Imaging Algorithm Reduces Cumulative Radiation Exposure from CT Scans

large academic medical center has implemented an imaging algorithm that allows radiologists to reduce effectively the cumulative radiation exposure and the number of computed tomography (CT) angiography (CTA) and CT perfusion studies performed on patients with aneurysmal subarachnoid hemorrhages according to new findings. The algorithm acts as a guide to physicians regarding the most appropriate time points at which to detect vasospasm (a condition in which blood vessels spasm, leading to vasoconstriction) with CTA and CT perfusion imaging. The study, performed at the New York

Presbyterian Hospital Weill Cornell Medical Center (New York, NY, USA; www.nyp.org), included 60 patients with aneurysmal subarachnoid hemorrhages: 30 in the baseline group (before implementation of the imaging algorithm) and 30 patients in the postalgorithm group. With the new algorithm, the mean number of CT examinations per patient was 5.8 compared with 7.8 at baseline, representing a decrease of 25.6%, said Michael L. Loftus, M.D., lead author of the study. The number of CT perfusion examinations per patient decreased 32.1%. Overall, there was a 12.1% decrease in cumulative radiation expo-

sure. Our results are promising, showing that guidelines for utilization of CT can lead to reduced radiation exposure of individual patients and the population. Our overall goal is to apply to other patient populations this concept of imaging algorithms as utilization guidelines for CT. Application of these methods to other patient populations with the high use of CT may reduce cumulative radiation exposure while the clinical benefits of imaging are maintained. The studys findings were published in the July 2010 issue of the American Journal of Roentgenology (AJR).
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IT/PACS UPDATE

Computer-Simulation: Women in Their 40s Have Lower Mammographic Tumor Detectability

he reduced effectiveness of mammographic screening in women in their 40s is principally due to lower detectability instead of faster tumor growth rate, according to recent findings. Mammography screening outcomes, gauged in terms of tumor size, lifetime gained, and mortality, have typically been poorer in women in their 40s than women in their 50s, somewhat because tumors of younger women are inclined to grow more quickly, so by the time they grow to a detectable size, they would have probably already been detected by a routine examination. Younger women also tend to have denser breast tissue, which can hide tumors, reducing their detectability on mammograms. To investigate which aspect faster tumor growth rates, or reduced mammographic detectability contributes to poorer mammography screening

outcomes in younger women, Dr. Sylvia K. Plevritis, from the department of radiology at the Stanford University School of Medicine (Palo Alto, CA, USA; http://med.stanford.edu), and colleagues, utilized a computer-simulated model to estimate the relative effect of biology and technology on mammograms of women in their 40s, compared to women in their 50s and 60s. The researchers utilized the Breast Cancer Screening Simulator to create hypothetic screening situations whereby they could estimate the median tumor size detectable on a mammogram and the mean tumor growth rate in women aged 40-49 and 50-69. The researchers concluded from their simulation model that lowered mammographic tumor detectability accounted for 79% and faster tumor volume doubling time accounted for 21% of the poorer sensitivity in mammography

screening among younger women, compared with older women. The studys findings were published online July 27, 2010, in the Journal of the [U.S.] National Cancer Institute. The authors wrote, The age-specific differences in mammographic tumor detection contribute more than age-specific differences in tumor growth rates to the lowered performance of mammography screening in younger women. One limitation of the analysis, according to the investigators, is that it did not take into account that low mammographic tumor detectability could be considered a breast cancer risk factor. They reported, More research is needed to not only establish a better relationship between mammographic breast density and breast cancer risk but also understand the differences in tumor characteristics in dense vs. nondense breast tissue.

Speech Recognition Reduces Turnaround Time of Radiology Reporting by 85%


new speech recognition system offers front-end dictation possibilities for radiologists to easily produce and distribute authorized reports after-hours and during weekends. Nuance Communications, Inc. (Burlington, MA, USA; www. nuance.com), a supplier of speech solutions, reported that its speech recognition technology has been utilized by the Nuance partner SolitonIT to reduce the time needed to create radiology reports, at the department of medical imaging, Nambour General Hospital (QLD, Australia), by 85%. Public radiology in Queensland is faced with a shortage of radiologists to do the reporting; which had led to significant delays in our report turnaround times. In the past, some reports would take six to seven days to be produced, explained David Ward, director of medical imaging services, Southern Cluster, Sunshine Coast-Wide Bay Health Service District. The average report-turnaround time, before the implementation of speech recognition at Nambour Hospital, was at 33 hours, now it is decreased to five hours. Together with the speech recognition technology, SolitonIT has delivered a fully integrated environment that links together key elements within the imaging department, the radiology information system (RIS) and the picture archiving and communication system (PACS). Workflow is far more efficient and risk of error has been minimized. Previously the tran-

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scriptionists were constantly fighting with a backlog of audio files waiting to be typed. They never had a sense of achievement. They left on Friday evening, knowing that on Monday morning the report backlog would have further increased. It was demoralizing, remarked David Ward. Thanks to an integrated workflow and speech recognition our transcriptionists are much happier people. Centrally installed and managed at Nambour General Hospital, the system was quickly expanded to give Radiologists at Caloundra and Gympie Hospitals access to speech recognition. SolitonITs workflow solution utilizes the award winning Nuance speech recognition, SpeechMagic. An HL7 [Health Level 7] interface to the RIS and full desktop integration to the hospitals PACS means that it is now virtually impossible for transcriptionists to type the wrong report for the wrong patient, explained David Ward. Nuance speech recognition learns and adapts to the users. Recognition accuracy is constantly being improved and a site-specific vocabulary and ConText is continuously updated. We have a number of young radiologists who embraced the speech recognition-enabled reporting system and encouraged others to come on board. We didnt have any acceptance problems, said David Ward. Physicians at Nambour Hospital work with the solution that SolitonIT deployed, which includes Nuances SpeechMagic platform.

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The Ambient Experience is designed as a patient-friendly environment for imaging areas in healthcare facilities. The custom-designed environment helps reduce patient movement, which can contribute to shorter examination times and increased throughput.
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The Astraia software is a modular database application specifically for obstetricians and gynecologists. The software is intended for use with the Aplio and Xario platforms, to reduce time and costs spent on daily administrative processes.
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The Opal-wRIS platform delivers a full range of RIS features, including scheduling, full modality worklist, dictation and transcription, automatic report distribution, and full HL7 inand out-bound interfaces. The software solution is intended to automate the radiology exam lifecycle.
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MRI-Compatible Interventional Device and CAD System Developed for the Prostate Gland
he first commercially available fully magnetic resonance imaging (MRI)-compatible interventional device has been designed for transrectal interventional MRI of the

prostate gland. The removable device is designed to affix to an MR imaging table with an open design that allows for flexibility in coil choice and a cleanable foam pad for extra patient

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comfort. Invivos (Pewaukee, WI, USA; www. invivocorp.com) DynaCAD for Prostate solution provides physicians with a comprehensive, customizable set of sophisticated visualization tools for performing realtime analysis of prostate MRI studies. The pairing of DynaCAD for Prostate with DynaTRIM then enables a physician to conduct targeted MRI interventions of suspicious areas within the prostate gland, reducing the number of cores acquired during biopsy. The better the sample, the more uniformity in diagnosis and interobserver variance, explained Dr. David B. Kaminsky of Palm Springs Pathology Services (CA, USA). I have personally witnessed the calm reception of the patient during set-up and biopsy procedure which cultivates the patients participation in navigating his illness and reduces anxiety to foster compliance with the technique, he added. Bernadette Greenwood, prostate product manager at Invivo, stated, The synergistic integration of two commercially available technologies is demonstrated illustrating the potential for fast, safe, and effective minimally invasive MR-guided prostate intervention. On June 9, 2010, Invivo was rec-

ognized with a 2010 Gold Medical Design Excellence Award (MDEA; www.MDEAwards.com) for its DynaCAD [computer-aided detection] for Prostate and DynaTRIM (transrectal interventional MRI) clinical solutions.
Image: A screenshot from DynaCAD for Prostate (Photo courtesy of Invivo).

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IT/PACS UPDATE

Workflow Software Supports Multidisciplinary Liver Imaging Evaluations


ew imaging workflow software provides a novel toolset for real-time interactive assessment and volumetric quantification of liver, liver lobes, hepatics lesions, and vessels. With the intuitive and easy-to-use tools, physicians may in realtime perform virtual simulation of resection, lobular/segmental/vascular manipulation and quantification to achieve desired planning result typically within minutes. Edda Technology (Princeton, NJ, USA; www. eddatech.com) announced that the number of clinical cases evaluated for pre- and post-operative assessment using IQQA-Liver in hospitals has exceeded 1,000 examinations, since the first commercial system installation in Q2 2009. IQQA-Liver, now marketed worldwide, is a comprehensive workflow solution supporting modern multidisciplinary liver imaging evaluation and management. Primary liver cancer represents one of the most common malignancies worldwide and accounts for almost 1.25 million deaths yearly. In the United States, liver disease is among the 10 major causes of death. The management of hepatic tumors presents a challenging problem. Advanced preoperative imaging assessment is vital in determining appropriate treatment, and requires the participation of a multidisciplinary team of surgeons, oncologists, hepatologists, and interventional radiologists specializing in liver malignancy. IQQA-Liver is designed to cope with such a challenge. Eddas proprietary information technology (IT) allows enterprise-wide deployment of IQQALiver via web so as to rapidly share data and results anywhere anytime among the multidisciplinary liver team. IQQA-Liver has clearance by the U.S. Food and Drug and Demonstration (FDA), China SFDA, Taiwan DOH, and carries the CE marking. It is currently in use at numerous prestigious liver transplantation/surgery/interventional centers worldwide, including University of Colorado Hospitals Denver (USA), and in China, Shanghai Zhongshan Hospital, Shanghai Ruijin Hospital, Tianjin First Center Hospital, Beijing You'an Hospital, and Nanjing Gulou Hospital. In one study, University of Colorado Hospital Denver employed IQQA-Liver to evaluate retrospectively the entire living liver donor (LLD) candidate studies rejected in a two-year period, and found that about 48% that were previously rejected due to anatomic abnormalities by conventional computed tomography (CT) visualization could have favorable anatomy for LLD. According to Dr. Igal Kam, chief of

transplantation, and Dr. Paul Russ, professor of radiology, IQQA-Liver allows for better understanding of surgical anatomy and surgical planning in the preoperative evaluation. This will have positive outcome on available livers and LLD selection. Results will soon be presented at the 23rd International Congress of the Transplantation Society in Vancouver (BC, Canada).
Image: An image taken using the IQQA-Liver software (Photo courtesy of Edda Technology).

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IT/PACS UPDATE

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Neuroscience Toolset Developed for Analyzing 3D/4D Biomedical Data


ew tools have been developed for neuroscience research with a variety of new features and improvements. Visage Imaging, Inc. (San Diego, CA, USA; www.visageimaging.com), a wholly owned subsidiary of Pro Medicus, Ltd. (Richmond, VIC, Australia), announced the release of Amira 5.3, a new major version of its market-leading software platform for visualizing, analyzing, and presenting complex three-dimensional (3D) and 4D biomedical data. Amiras entirely new Neuro option contains a comprehensive set of tools for neuroscience research, specifically magnetic resonance (MR) diffusion tensor imaging (DTI) as well as computed tomography (CT) and MR brain perfusion imaging. The new option provides efficient calculation of perfusion results as well as analysis and display of multichannel functional image data including gradients, tensors, and fiber tracking. With the new version of Amira, I finally get all the brain imaging tools I need, integrated in a single platform. The results from different modalities and functional calculations can be combined, processed,

and presented together in very flexible ways far superior to any other solution I know, said Prof. Dr. A. Brawanski, head of neurosurgery at the Regensburg University Hospital (Germany). Moreover, Amira 5.3 comes with a large number of new tools and improvements, such as DemoDirector, an easy-to-use graphical front end for creating animations and presentations using the popular DemoMaker module; a largely redesigned set of tools for spreadsheets and statistics; a number of enhancements to the popular FilamentEditor; and a full integration of the widely used Insight Segmentation and Registration Toolkit (ITK) into Amiras Developer Option. Amira 5.3 is the most powerful and reliable Amira ever with hundreds of improvements and dozens of new modules and enhancements, designed in collaboration with leading research institutions all around the world. I am always impressed to see the level of activity and innovation in the ever-growing Amira community. Their contribution is what makes Amira so strong and so unique, remarked Dr. Hartmut Schirmacher, director of product management for Visage Imaging.

Amira 5.3 is available for 32 bit and 64-bit Windows, Mac OS X, and Linux platforms. Visage Imaging is a global provider of scalable enterprise visualization, radiology information system (RIS), and picture archiving and communication systems (PACS) solutions for clinical and preclinical imaging. Pro Medicus [ASX: PME] is a leading medical information technology (IT) and e-health provider. The company provides a full range of integrated software products and services to hospital, imaging centers and healthcare groups worldwide.
Image: An image taken using Amira 5 software (Photo courtesy of Visage Imaging).

3D Cardiac Imaging Revolutionized with New Slice Technique


leading British cardiologist is the first in the world to develop a unique technique to slice three-

dimensional (3D) images of the heart into intricate sections using computer software. The advanced method,

known as multiplane review (MPR) 3D echocardiography, allows the user to identify heart defects much more accurately than on traditional 2D or standard 3D scans and is revolutionizing the accuracy and speed of diagnosis. Consultant congenital cardiologist Dr. Joseph Vettukattil pioneered its development at Southampton General Hospital (Hampshire, UK; www. suht.nhs.uk) to identify heart abnormalities that are present from birth. It is believed the technology, which lets the user see the three dimensions of the heart move simultaneously for the first time, could eventually replace the need for magnetic resonance imaging (MRI) for most aspects of cardiac imaging. The most important aspect is the operators ability to slice the dynamic cardiac structures in infinite sections through all the three dimensions, which was not possible before we developed MPR 3D echocardiography, said Dr. Vettukattil. You can chop the heart into small pieces and see what is wrong and exactly where it is wrong on the screen. By using MPR, because you are slicing and seeing it in three different planes, you can get a clear understanding of a patient especially in a child whose heart is congenitally malformed. Traditionally, diagnosis of heart defects has been made using 2D scans with the addition of invasive cardiac catheterization. The 2D images show

pictures of the heart in two planes, so it just takes one slice of the heart and, because it has not been easy to know without doubt what the problem is, surgeons have often had to perform exploratory operations as well. Now, though, we are able to visualize even more than a surgeon can during an operation, minimizing the need for additional and invasive assessments. Dr. Vettukattil made the finding after an upgrade from conventional 2D imaging on echo machines in the childrens heart unit at Southampton General; however, the new basic 3D method of examination only enabled users to view a full cube shape and not definitively dissect the defective part of a patient's heart on screen. This led Dr. Vettukattil to set up two personal computers (PCs) with 3D software programs to read results from the echo scans in a small side room where he went on to develop MPR after many hours of study. He has since traveled to hospitals around the world and continues to hold international workshops to train people in MPR 3D, as well as receiving scans from colleagues abroad that he is asked to analyze and report back on. People across the world are constantly asking me to teach them how to use MPR, he said. I have been to hospitals in Germany, Sweden, Denmark and I am soon to visit India and Malaysia, while there is also interest from heart specialists in America.
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IT/PACS UPDATE
vides fast and easy access to patient-related image data for reviewing and direct reporting. Moreover, the TomTec integration offers advanced measurement functionality and 3D, 4D processing tools for cardiac and vascular ultrasound examinations for offline analyses. Both options function fully integrated with the Agfa Healthcares CardioVascular Information System (CVIS), streamlining image review with structured clinical reporting. TomTec and Agfa HealthCare have worked together to support customer needs in the past, albeit on a regional basis. This agreement expands on that successful cooperation and enables both companies to blend their leading systems into a solid solution, and make it available to customers across Europe, stated Frank Schlau, CMO at TomTec Imaging Systems, GmbH. We look forward to a successful cooperation.

Cardiovascular PACS Integrated with Image-Arena Analysis for Multimodal 2D/3D/4D Data
gfa HealthCare (Mortsel, Belgium; www.agfa. com/healthcare), a leading provider of diagnostic imaging and healthcare information technology (IT) solutions, announced that it has signed an agreement with TomTec (Unterschleissheim, Germany; www.tomtec.de), a company active in the sector of echocardiography image analysis, reporting, and data management, for the integration of its Image-Arena solution into Agfas Impax Cardiovascular picture archiving and communication system (PACS). TomTec provides a wide range of two-dimensional (2D) and 3D/4D technologies for visualization, analysis, reporting, and archiving of echocardiography imaging data.

Image-Arena will expand the functionality of Agfa HealthCares Impax Cardiovascular by enabling it to offer analysis and quantification of 2D/3D/4D data from a wide range of echocardiography systems. TomTecs Image-Arena solution will deliver a smooth workflow oriented towards the off-line analysis of echocardiography images, from basic echo measurements to advanced left ventricle (LV) wall motion analysis, 4D mitral valve analysis, or right ventricle (RV). Agfa HealthCares Impax integration with TomTecs Image-Arena combines the benefits of a leading image review solution with that of a highend analytic package. The Impax review station pro-

Belgian Hospital System Installs Hospital-Wide PACS Technology


elgiums largest single campus hospital is installing the first example of a hospital-wide picture archiving and communications system (PACS). The technology will make it the first Belgian hospital to engage all departments in one central image-enabled archive system. As the largest single campus university hospital in Belgium, UZ Gent employs 6,000 people, housing 1,062 patient beds. The hospital focuses on the number of patients cared for and the throughput of day patients in 2008, the hospital completed more than 101,000 procedures. The continuation of this upward trend will rely on optimized care being provided at every stage of patient recovery. UZ Gent needed the ability to store multimedia and emerging imaging technology. Prof. Sijnave searched for a hospital-wide system that was more than just a bolted together bunch of software; it needed to be able to communicate with every caregiver, to be able to share idata using a vendor-independent platform, and the system it chose had to support that efficiently, molding itself to the working practices at UZ Gent. Carestream Health, Inc. (Rochester, NY, USA; www.carestreamhealth.com) has designed a data workflow engine that is now at work in some of the biggest health maintenance organizations and hospitals worldwide. This made it the obvious choice for Prof. Sijnave. At UZ Gent the PACS will hook up over 40 different departments to one clinical archive. The enterprise-wide system will simplify IT administrative functions and reduce cost, delivering a multitier repository for industry-standard data such as XDS (Extended Data Services), XDS-I, Digital Imaging and Communications in Medicine (DICOM), HL [Health Level] 7, as well as other nonDICOM objects.

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Native 64-Bit Image and Report Access Software Designed for Mac Users
new application has been designed that is intended for radiology groups who wish to provide fully featured image and report access to referring physicians with a Mac preference. Intelerad Medical Systems (Denver, CO, USA; www.intelerad. com), a developer of medical imaging picture archiving and communications systems (PACS) and workflow solutions, today announced the availability of InteleViewer. Specifically designed for referring physicians, InteleViewer for Mac combines the benefits of Mac computer systems, (developed by Apple, Inc.; Cupertino, CA, USA; www.apple.com), with Intelerads leading-edge medical imaging solutions. Mac users will experience the Mac OS X 64-bit Intel high-speed viewing, as well as full support for U.S. Food and Drug Administration (FDA)-approved medical-grade displays. Intelerads native 64-bit InteleViewer for Mac comes with high-performance streaming of data for remote viewing and customizable layouts, which will accommodate even the most demanding specialists in orthopedics or neurosurgery. Administration tools let radiology groups define user and application preferences as well as access permissions, making InteleViewer for Mac a fully HIPAA (Health Insurance Portability and Accountability Act of 1996) -com-

pliant application. Easy to use from home or from the office, InteleViewer for Mac supports the entire range of Mac systems running Mac OS X Snow Leopard from MacBook notebooks and iMac desktops to MacPro workstations allowing radiology groups to meet the demands of modern physicians practices. InteleViewer for Mac allows radiology groups to provide highperformance access to images and reports to previously overlooked Mac users, said Chris Henri, founder and chief technology officer at Intelerad. It is a key component of our strategy to help our customers strengthen their position in the marketplace. InteleViewer for Mac will be offered under an enterprise-wide licensing model for a versatile use and will be available concurrently with the upcoming IntelePACS and InteleOne releases. Intelerad Medical Systems is a developer of medical imaging PACS and workflow solutions. IntelePACS relies on a scalable, flexible, and fault-tolerant architecture. Intelerad solutions, such as InteleOne, are known for their effectiveness, flexibility, and performance in complex, multisite environments with challenging workflows.
Image: The InteleViewer viewing software for Mac systems (Photo courtesy of Intelerad Medical Systems).

Breast Imaging PACS Software Provides Secure Access to Multimodality Images


digital mammography picture archiving and communication system (PACS) solution allows radiologists to achieve considerable efficiency gains. Intelerad Medical Systems (Montreal, Canada; www.intelerad.com), a developer of medical imaging PACS and workflow solutions, announced that Insight Medical Imaging (IMI) is using the IntelePACS Breast Imaging solution for its screening and diagnostic mammography studies. Insight is a group practice of over 20 radiologists reading nearly 300,000 studies yearly. It offers services for X-ray, ultrasound, nuclear medicine, magnetic resonance imaging (MRI), fluoroscopy, computed tomography (CT), and mammography at 13 clinics in Edmonton and the surrounding area. An accredited member of the Canadian Association of Radiologists, Insight participates in the Alberta Breast Screening Program and delivers screening results to referring physicians through the NetCare Provincial Repository. Insight looked into different options for their software solution when the decision was made to purchase eleven digital mammography units. They could have used the equipment manufacturers software, but the cost for multiple dedicated workstations and the inconvenience

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of having to read from different viewers were major obstacles. Contrary to this, with its enterprisewide licensing model, Intelerad IntelePACS Breast Imaging is used by as many radiologists as needed and it provides secure access to multimodality images. Our radiologists have been using IntelePACS for several years now, so it was natural to turn to Intelerad for our breast imaging solution, said Dr. Roger Holub, radiologist at Insight. IntelePACS Breast Imaging allows us to work from the same interface for all studies and priors, including mammography. We achieve significant efficiency gains with the ability to provide final results as soon as we get the studies. Now we have the capability to offer a better service to referring physicians and patients with same day results for all digital exams. We truly appreciate working with Insight, and we are confident that the addition of IntelePACS Breast Imaging will help deliver better quality care for the Alberta Breast Screening Program and womens health, said Chris Henri, founder and chief technology officer of Intelerad Medical Systems. Intelerad Medical Systems is a developer of medical imaging PACS and workflow solutions. IntelePACS relies on a scalable, flexible, and fault-tolerant architecture.
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INDUSTRY NEWS
customer and help improve and save lives, said Steve Rusckowski, CEO for Philips Healthcare. As with the other recent deals in this space, also the acquisition of Wheb helps us to further strengthen our offering especially geared towards facilitating high-growth markets such as Latin America. Founded in 1999, Wheb has approximately 190 employees and installations in more than 230 hospitals. Clinical informatics systems integrate information among various hospital departments (e.g., radiology, cardiology), and they serve an increasingly vital role in todays healthcare environment as the need to streamline workflow and manage costs, all while providing high-quality care, is universally chief in mind for governments, insurers, hospital administrators, and medical teams. Wheb will become part of Philips Healthcares patient care and clinical informatics business. The acquisitions of both Tecso and Wheb make Philips one of Brazils leading clinical informatics companies. This enables Philips to bring specifically sophisticated clinical decision support to the Brazilian market. Philips has already expanded its healthcare business in this market in recent years with the acquisitions of Dixtal Biomdica e Tecnologia, a leading Brazilian manufacturer of inhospital patient monitoring, in 2008 and VMISistemas Medicos, a Brazilian imaging diagnostic company, in 2007.

Philips Acquires Clinical IT Company

hilips Healthcare (Best, The Netherlands; www.philips.com) announced that it has agreed to acquire Wheb Sistemas (Blumenau, Brazil; www.wheb.com.br), a provider of clinical information systems (CIS) inn Brazil. This acquisition marks the next step in the execution of Philips Healthcares strategy to expand its clinical informatics range with solutions that increase its ability to meet the diverse and growing needs of the different markets around the world. It follows the March 2010 acquisition of Tecso Informatics (Rio de Janeiro), one of Brazils leading radiology information systems (RIS) firms, and August 2010s agreement to acquire the business of CDP Medical, Ltd. (Kiriat Arie Petach Tikva, Israel), a provider of picture archiving and communication systems (PACS). The acquisition of Wheb, the third clinical informatics acquisition in recent months, is another important step on our journey to complete our global portfolio of clinical informatics and patient care solutions that simplify clinician workflow, improve financial outcomes for our

Alliance in Radiation Monitoring Software


ACSHealth joined SWEDUS, LLC, a U.S. based unit of Sapheneia, to form PHS Technologies Group (PHSTG). The new company is the developer and marketer of DoseMonitor, software that monitors the calculated cumulative radiation dose received during ionizing radiation procedures. DoseMonitor answers the call for radiation dose tracking by regulatory agencies following reported cases of overexposure to radiation from diagnostic imaging procedures. Using mathematical algorithms and the standardized dose values of diagnostic imaging equipment, DoseMonitor calculates a patients historical radiation exposure and provides a customer-defined red/yellow/green type alerts. In addition, by using dose values from imaging equipment, devices and procedures that no longer meet safe dosage specifications can be identified. DoseMonitor will be introduced at the upcoming meeting of the Radiological Society of North America (RSNA) during November 28 December 3, 2010 in Chicago (IL, USA). Sapheneia, AB (Stockholm, Sweden; www.scpab.eu) is an imaging services company, which provides products and applications development services globally, specializing in diagnostic and analytical image processing product solutions for medical and scientific imaging. PACSHealth, LLC (Scottsdale, AZ, USA; www. pacshealth.com) is a software development company specializing in systems for medical imaging.

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Medical Imaging International November-December/2010

INDUSTRY NEWS

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. Paravertebral Sonography for Anaesthesia and Pain Medicine. March 18-20, Hong Kong SAR, China; Web: http://usgraweb.hk Abdominal Radiology Course 2011. March 2025; Carlsbad, CA, USA; Web: www.sgr.org 11th International Congress of the European Society of Magnetic Resonance in Neuropediatrics (ESMRN). March 24-26; Amsterdam, The Netherlands; www.esmrn2011.org ChinaMed 2011 - International Medical Instruments and Equipment Exhibition. March 25-27; Beijing, China; Web: www.chinamed.net.cn 36th Annual Scientific Meeting of the Society of Interventional Radiology (SIR). March 2631; Chicago, IL, USA; Web: www.sirmeeting.org SEACare 2011 - 14th Southeast Asian Healthcare & Pharma Show 2011. March 29-31; Kuala Lumpur, Malaysia; Web: abcex.com

Global MRI Device Sales Projected to Reach $6 Billion by 2015

he global magnetic resonance imaging (MRI) systems market is expected to grow at an estimated Compound annual growth rate (CAGR) of 5.5% from 2010 to 2015, according to a recent market research report. The closed MRI systems submarket commanded the largest share within the MRI market. This is mostly due to the high clinical value delivered by the systems. Increasing applications such as identification of multiple sclerosis and technologic advancements are driving the global MRI systems market, according to MarketsandMarkets (Dallas, TX, USA; www.marketsandmarkets.com), a global market research and consulting firm. MarketsandMarkets studied the MRI market based on technologies and applications and analyzed major market drivers, restraints, and opportunities for the MRI systems market in North America, Europe, Asia, and ROW (rest of the world).

The global MRI market is expected to grow from $4,470.5 million in 2010 to $5,844.4 million in 2015, at an estimated CAGR of 5.5% from 2010 to 2015. The closed MRI systems submarket commanded the largest share within the MRI market. This is mainly due to the high clinical value delivered by the systems. Increasing applications such as identification of multiple sclerosis and technologic advancements are driving the global MRI systems market. The high-field MRI market commands the largest share of the overall MRI market in terms of value. Therefore, the 1.5T systems are considered as the gold standard of the industry and systems with field strengths of 1.5T is highly manufactured. The applications of such MRI systems include brain exploration, pulmonary MR angiography, peripheral MR angiography, bone and joint imaging, abdominopelvic imaging, and cardiac imaging.

DECEMBER 2010
National Diagnostic Imaging Symposium 2010. December 5-9; Lake Buena Vista, FL, USA; Web: www.worldclasscme.com EUROECHO 2010 - European Association of Echocardiography. December 8-11; Copenhagen, Denmark; Web: www.escardio.org 26th JERDO - Journes dEndoscopie et de Radiologie Digestive Opratoire. December 910; Paris, France; Web: www.jerdo2010.com 2010 Chicago Multidisciplinary Symposium in Thoracic Oncology. December 9-11; Chicago, IL, USA; Web: www.thoracicsymposium.org 29th Annual Head to Toe Imaging Conference. December 13-18; New York, NY, USA; Web: http://tools.med.nyu.edu

APRIL 2011
ACC 2011 60th Annual Scientific Session and Expo of the American College of Cardiology. April 2-5; New Orleans, LA, USA; Web: www.accscientificsession.org 70th Annual Meeting of the Japanese Radiological Society (JRS). April 7-10; Yokohama, Japan; Web: www.secretariat.ne.jp Radiology Update 2011: Annual Convention of the American Osteopathic College of Radiology. April 11-15; Palm Beach; FL, USA; Web: www.aocr.org 59th Annual Meeting of the Association of University Radiologists (AUR). April 12-15; Boston, MA, USA; Web: www.aur.org. 2011 Annual Meeting of the American Brachytherapy Society (ABS). April 14-16; San Diego, CA, USA; Web: www.american brachytherapy.org 2011 Annual Convention of the American Institute of Ultrasound in Medicine (AIUM). April 14-17; New York, NY, USA; Web: www.aium.org 2011 Annual Scientific Meeting of the Australasian Brachytherapy Group. April 2830; Perth, WA, Australia; Web: www.abg.org.au 4th Arab Radiological Congress (ARC 4). April 28-30; Beirut, Lebanon; Web: www.lsradio.org JPR 2011 Sao Paulo Radiology Meeting. April 28-31; Sao Paulo; Web: www.spr.org.br 74th Annual Scientific Meeting of the Canadian Association of Radiologists. April 28 May 1; Montreal, QC, Canada; Web: www.car.ca 93rd Annual Meeting of the American Radium Society (ARS). April 30-May 4; Palm Beach, FL, USA; Web: www.americanradiumsociety.org

JANUARY 2011
The 4th Leuven Course on Head and Neck Cancer Imaging. January 6-8; Leuven, Belgium; Web: www.kuleuven.be 21me Journes Europennes de la Socit Franaise de Cardiologie. January 12-15; Paris, France; Web: www.sfcardio.fr IROS 2011 German, Austrian and Swiss Congress of Interventional Radiology. January 13-15; Salzburg, Austria; Web: www.irosonline.org MR 2011 Garmisch 14th International MRI Symposium. January 13-15; GarmischPartenkirchen, Germany; Web: www.mr2011.org 3rd Meeting of the Intraoperative Imaging Society (IOIS). January 16-19; Zurich, Switzerland; Web: http://kongress2.imk.ch Society for Nuclear Medicine 2011 Mid-Winter Meetings. January 20-23; Palm Springs, CA, USA; Web: http://interactive.snm.org Arab Health 2011. January 24-27; Dubai, UAE; Web: www.arabhealthonline.com IRIA2011 - 64th National Annual Conference of the Indian Radiological & Imaging Association. January 28-31; New Delhi, India; e-mail: iriadelhi2011@gmail.com; Web: www.iria.in

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FEBRUARY 2011
13th Jornadas de la Sociedad Espaola de Radiologa Msculo-Esqueltica (SERME) y 4th Curso: Miembro Superior. February 10-11; Palma de Mallorca, Spain; Web: www.geyseco.es Annual Symposium of the American Society of Spine Radiology (ASSR). February 23-26; Honolulu, HI, USA; Web: http://theassr.org ISUOG 2011 7th Scientific Meeting of the International Society for Ultrasound in Obstetrics and Gynecology. Feb 25-27; Macau SAR, China; Web: www.isuogmacau2011.com

MAY 2011
2011 Annual Meeting of the American Roentgen Ray Society (ARRS). May 1-6; Chicago, IL USA; Web: www.arrs.org 18th Asian Pacific Congress of Cardiology. May 5-8; Kuala Lumpur, Malaysia; Web: www.apcc2011.org 19th Scientific Meeting and Exhibition of the International Society for Magnetic Resonance in Medicine (ISMRM). May 7-13; Montreal, Quebec, Canada; Tel: 1-510-841-1899; E-mail: info@ismrm.org; Web: www.ismrm.org. ESTRO Anniversary Congress European Society of Therapeutic Radiology. May 8-12; London, UK; Web: www.estro.org Imaging in Italy. May 11-13; Lucca, Italy; Web: www.phoenixconf.com Servei 2011 7th Congreso Nacional de la Sociedad Espaola de Radiologa Vascular e Intervencionista. May 11-14; Valencia, Spain; Web: www.geyseco.es American College of Radiology (ACR) Annual Meeting & Leadership Conference. May 14-18; Washington DC, USA; Web: www.acr.org ICNC10 - Nuclear Cardiology and Cardiac CT. May 15-18; Amsterdam, the Netherlands; Web: www.escardio.org 27th Iranian Congress of Radiology. May 1720; Tehran, Iran; Web: www.icr2011.ir 22nd Annual Meeting of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). May 21-24; Venice, Italy; Web: www.esgar.org 5th Russian National Congress of Radiologists. May 24-26; Moscow, Russia; Web: www.radiology-congress.ru 25th International Symposium on Cerebral Blood Flow, Metabolism Function and the 10th International Conference on Quantification of
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MARCH 2011
2011 Congress of the European Society of Breast Imaging (EUSOBI). March 2-3; Vienna, Austria; Web: www.eusobi.org ECR 2011 European Congress of Radiology. March 3-7; Vienna, Austria; web: communications@myesr.org; Web: www.myesr.org SORSA RSSA 2011 Imaging Conference Joint Initiative of the Society of Radiographers of South Africa & Radiological Society of South Africa. March 4-6; Durban, South Africa; Web: www.2011sorsarssa.co.za 2011 Annual Meeting of the Society of Thoracic Imaging. March 6-9; Bonita Springs, FL, USA; Web: www.thoracicrad.org Society of Skeletal Radiology (SSR) 2011 Annual Meeting. March 13-16; Scottsdale, AZ, USA; Web: www.skeletalrad.org 6th BSCMR Annual Meeting - British Society of Cardiovascular Magnetic Resonance. March 16; Leicester, UK; Web: www.bscmr.org KIMES 2011 27th Korean International Medical and Hospital Equipment Show. March 17-20; Seoul, Korea; Web: www.kimes.kr International Symposium on Spine and

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INTERNATIONAL CALENDAR
Brain Function with PET. May 24-28; Barcelona, Spain; Web: www2.kenes.com Hospitalar 2011. May 24-27; Sao Paulo, Brazil; Web: www.hospitalar.com International Congress of Pediatric Radiology (IPR). May 28-31; London, UK; Web: www.espr.org Heidelberg, Germany; Web: www.esti2011.org EHRA EUROPACE 2011. June 26-29; Madrid, Spain; Web: www.escardio.org The 2nd Joint Symposium of the European Society of Neuroradiology (ESNR) and American Society of Spine Radiology (ASSR). July 1-3; Barcelona, Spain; Web: www.spineinternational.org

JUNE 2011
92. Deutscher Rntgenkongresses und des 6. Gemeinsamen Kongresses von DRG und RG. June 1-4; Hamburg, Germany; Web: www.roentgenkongress.de SIIM 2011 - Annual Meeting of the Society of Imaging Informatics in Medicine. June 2-5, Washington, DC, USA; Web: www.scarnet.org SNM 2011 - Annual Meeting of the Society for Nuclear Medicine. June 4-8, San Antonio, TX, USA; Web: www.snm.org 49th Annual Meeting of the American Society of Neuroradiology (ASNR) June 4-9; Seattle, WA, USA; Web: www.asnr.org UKRC 2011 United Kingdom Radiological Congress. June 6-8; Manchester, UK; Web: www.ukrc.org.uk European Society of Musculoskeletal Radiology (ESSR) 2011 Annual Scientific Meeting. June 911; Crete, Greece; Web: www.essr.org ASCI 2011 5th Congress of the Asian Society of Cardiovascular Imaging. June 17-19; Hong Kong SAR, China; Web: www.asci-heart.org 6th European Molecular Imaging Meeting. June 19-21; Leiden, The Netherlands; Web: www.e-smi.eu CARS 2011 Computer Assisted Radiology and Surgery. June 22-25; Berlin, Germany; Web: www.cars-int.org FLAUS 2011 15th Congreso de la Federacin Latinoamericana de Sociedades de Ultrasonido. June 23-26; Asuncion, Paraguay; Web: www.flaus.cl 15th Annual Meeting of the Clinical Magnetic Resonance Society (CMRS). June 23-26; Orlando, FL, USA; Web: www.cmrs.com Joint Educational and Scientific Meeting of the European Society of Thoracic Imaging (ESTI) and the Fleischner Society. June 23-25;

AUGUST 2011
SOLACI 2011 17th Congress of the Latin American Society of Interventional Cardiology. August 3-5; Santiago, Chile; Web: www.solacicongress.com RANZCR 2011 - Annual Scientific Meeting of the Royal Australian and New Zealand College of Radiologists. August 5-7; Wellington, New Zealand; Web: www.ranzcr2011.co.nz FIME 2011. August 10-12; Miami Beach, FL, USA; Web: www.fimeshow.com CSANZ 2011 - 59th Annual Meeting of the Cardiac Society of Australia and New Zealand. August 11-14; Perth, WA, Australia; Web: www.csanz2011.com 39th Annual Meeting of the Association of Medical Imaging Management. August 14-18; Grapevine, TX, USA; Web: www.ahraonline.org 13th World Congress of the World Federation for Ultrasound in Medicine in Biology (WFUMB). August 26-29; Vienna, Austria; Web: www.wfumb2011.org European Society of Cardiology (ESC) Congress 2011. August 27-31; Paris, France; Web: www.escardio.org

SEPTEMBER 2011
2011 World Molecular Imaging Congress. September 7-10; San Diego, CA, USA; Web: www.wmicmeeting.org 45th Annual Meeting of the American Society of Head and Neck Radiology (ASHNR). September 7-11; Coronado, CA, USA; Web: www.ashnr.org 41st ASUM Annual Ultrasound Congress Australasian Society for Ultrasound in Medicine. September 8-11; Melbourne, VIC, Australia; Web: www.asum.com.au

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INTERNATIONAL CALENDAR
CIRSE 2011 - Cardiovascular and Interventional Radiological Society of Europe. September 10-14; Munich, Germany; Web: www.cirse.org Medical Fair Thailand. September 14-16; Bangkok, Thailand; Web: www.mdna.com 2011 Annual Scientific Meeting of the American Society of Emergency Radiology (ASER). September 14-17; Miami, FL, USA; Web: www.erad.org 23rd Annual Meeting of the Eastern Neuroradiological Society (ENRS). September 15-17; Chatham, MA, USA; Web: www.enrs.org 21st ISUOG World Congress on Ultrasound in Obstetrics and Gynecology. September 18-22; Los Angeles, CA, USA; Web: www.isuog.org 2011 Annual Conference of the American College of Radiology Imaging Network (ACRIN). September 21-24; Arlington, VA, USA; Web: www.acrin.org 2011 Annual Conference of the Society of Diagnostic Medical Sonography (SDMS). September 22-25; Atlanta, GA, USA; Web: www.sdms.org 35th Congress of the European Society of Neuroradiology (ESNR). September 22-25; Antwerp, Belgium; Web: www.esnr.org 46. Jahrestagung der Deutschen Gesellschaft fr Neuroradiologie. September 22-25; Aachen, Germany; Web: www.dgn.org 39th Annual Meeting of the North American Society for Cardiovascular Imaging (NASCI). September 24-27; Baltimore, MD, USA; Web: www.nasci.org Biology. October 6-8; Leipzig, Germany; Web: www.esmrmb.org 62nd Annual Scientific Meeting of the Royal Australian and New Zealand College of Radiologists (RANZCR). October 6-9; Melbourne, VIC, Australia; e-mail: melbourne@wsm.com.au; Web: www.ranzcr.edu.au 18th Symposium of the European Society of Urogenital Radiology (ESUR). October 12-16; Dubrovnik, Croatia; Web: www.als.hr EANM 2011 - Annual Congress of the European Association of Nuclear Medicine. October 15-19; Birmingham, UK; e-mail: info@eanm.org, Web: www.eanm.org 43rd Annual Meeting of the Western Neuraradiological Society. October 20-23; Rancho Mirage, CA, USA; Web: www.wnrs.org Advances in Sonography - 21st Annual Meeting and Postgraduate Course of the Society of Radiologists in Ultrasound (SRU). October 21-23; Chicago, IL; USA; Web: www.sru.org JFR 2011 Journes Franaises de Radiologie. October 21-25; Paris, France; Web: www.sfrnet.org 2011 IEEE Nuclear Science Symposium and Medical Imaging Conference. October 23-29; Valencia, Spain; Web: www.nss-mic.org 8th Asian Oceanian Congress of Neuro-Radiology. October 26-28; Bangkok, Thailand; e-mail: aocnr@aocnr2011.com; Web: www.aocnr2011.com

NOVEMBER 2011
BSIR 2011 Annual Meeting of the British Society of Interventional Radiology. November 2-4; Glasgow, UK; Web: www.bsir.org WINFOCUS 2011 7th World Congress on Ultrasound in Emergency and Critical Care. November 2-6; New Delhi, India; Web: www.winfocus.org Medica 2011. November 16-19; Dsseldorf, Germany; Web: www.medica.de RSNA 2011. November 27-December 2; Chicago, IL, USA; Web: www.rsna.org

OCTOBER 2011
28th Annual Meeting of the Society for Radiation Oncology Administrators (SROA). October 2-5; Miami, FL, USA; Web: www.sroa.org International Cancer Imaging Society Meeting (ICIS) and 11th Annual Teaching Course. October 3-5; Copenhagen, Denmark; Web: www.icimagingsociety.org.uk 26th Congresso Nazionale Associazione Italiana di Neuroradiologia. October 5-8; Florence, Italy; Web: www.ainr.it ESMRMB 2011 Congress European Society for Magnetic Resonance in Medicine and

JANUARY 2012
Arab Health 2012. January 23-26; Dubai, UAE; Web: www.arabhealthonline.com

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2D Imaging . . . . . . . . . . . . . . .36 Ampronix . . . . . . . . . . . . . . . .31 Arab Health 2011 . . . . . . . . . .39 AuntMinnie.com . . . . . . . . . . .37 C&G Technologies . . . . . . . . .14 Civco . . . . . . . . . . . . . . . . . . . .18 CMSP.com . . . . . . . . . . . . . . .30 Cool Pair Plus . . . . . . . . . . . . .20 CPI . . . . . . . . . . . . . . . . . . . . . .5 ECR 2011 . . . . . . . . . . . . . . . .41 Eizo . . . . . . . . . . . . . . . . . . . . . .7 ESGAR 2011 . . . . . . . . . . . . .43 ETS Lindgren . . . . . . . . . . . . .12 GE Healthcare . . . . . . . . . . . .44 iCRco . . . . . . . . . . . . . . . . . . . .2 Infimed . . . . . . . . . . . . . . . . . .22 Invivo . . . . . . . . . . . . . . . . . . . .9 Italray . . . . . . . . . . . . . . . . . . .27 KIMES 2011 . . . . . . . . . . . . . .35

131 121 129 118 120 127 125 108 102 110 105 122 116 112 107 114

MedImaging.net . . . . . . . . . . .40 Merge Healthcare . . . . . . . . . .34 Metropolis . . . . . . . . . . . . . . . .25 MII E-Magazine . . . . . . . . . . . .6 PacsHealth . . . . . . . . . . . . . . .38 Parker Laboratories . . . . . . . .21 Radcal . . . . . . . . . . . . . . . . . .23 Radcal . . . . . . . . . . . . . . . . . .33 RTI . . . . . . . . . . . . . . . . . . . . .29 Schiller . . . . . . . . . . . . . . . . . .11 Siemens Healthcare . . . . . . . . .3 SonoScape . . . . . . . . . . . . . . .13 Supersonic . . . . . . . . . . . . . . . .8 Ulrich . . . . . . . . . . . . . . . . . . .27 Ultrasonix . . . . . . . . . . . . . . . .19 Varian Medical Systems . . . . .15 Vidar . . . . . . . . . . . . . . . . . . . .10 Wandong . . . . . . . . . . . . . . . .17 WFUMB 2011 . . . . . . . . . . . . .42

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Medical Imaging International November-December/2010

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