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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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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.
Image: The Selenia digital mammography system (Photo courtesy of Hologic).
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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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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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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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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).
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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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).
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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).
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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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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).
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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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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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).
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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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).
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.
Medical Imaging International November-December/2010
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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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The Plasma DR offers direct conversion selenium coating, a large imaging area, and very low noise readout ASICS. The DR detector eliminates dead pixels, reduces electronic complexity, and does not degrade over time, ensuring quality performance throughout the detectors lifetime.
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The digital StereoLoc II upright breast biopsy system provides an easy transition from digital mammography to stereotactic breast biopsy. The technology uses the digital image receptor on a Selenia digital mammography system, ensuring optimal image quality.
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The HQ-YDX2000A/B mobile system integrates a high-frequency, Xray generating device, image reinforcement, and CCD video. Applications for the unit include orthopedics, general and urological surgery, abdominal imaging, and pacemaker installation procedures.
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The IMIXHorizon family of detectors combines high reliability with enhanced image quality. The detectors are available in either the Focus series or Elite series, and are delivered complete with IMIXs comprehensive Control Station software.
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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).
Medical Imaging International November-December/2010
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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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C-ARM SYSTEM
Landwind Medical
MEDICAL LCDS
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Neusoft Medical Systems
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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The SharpRay ZKXC-10 offers four levels of noise reduction, and four frames images storage capacity. The system also features last image hold, image rotation and reverse, high-resolution image intensifier, and is considered ideal for both radiography and fluoroscopy imaging.
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The MultiSync 90 series includes ultra-thin-frame LCDs from 19-30 diagonal. Key benefits include high contrast ratio, uniformity correction, automatic black light adjustment, pivot capability, and backlight sensor. Applications include PACS, CT, MRI, and 3D image rendering.
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The Superstar 0.35T offers strong and stable performance, high-field technologies, and phase array platform. Additional features include comprehensive scan packages, prompt network support, cost-effectiveness, and large magnet with open format, ideal for all patients.
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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.
Medical Imaging International November-December/2010
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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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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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Reliant Medical Systems
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Siemens Healthcare
The MySono U5 features SRF, DMR Lite, tissue harmonic imaging, and pulse inversion harmonics. Additional benefits include high-performance linear probes, ergonomic control panel, rechargeable battery, and compact carrying case.
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The Aurora digital radiography system can be floor supported or wall mounted for user convenience. The system is DICOM 3.0 ready, offers a high resolution DR imager, and features three different positioner options for individual requirements.
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The Biograph mCT provides fiveminute whole-body imaging, with increased patient comfort via quick scan times. Additional features include TrueV extended field of view, high-definition PET, time of flight, and IRIS CT that allows the user to reduce the dose by more than 50%.
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The FilmStation UP-DF750 delivers enhanced speed, image quality, and flexibility in a compact footprint. The imager uses a thermal printing system and blue thermal film, producing images in 604 dpi with a print time of 90 sheets per hour.
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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.
Medical Imaging International November-December/2010
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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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Teratech
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Wandong Medical Equipment
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Orion Electric
The t3000 platform with dual realtime operator interface features an ergonomically designed user console. The portable system provides enhanced image quality, workflow efficiency, standard network connections, and cost-effectiveness.
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The New Oriental 1000 multifunction system is designed with an automatic control system to achieve a more convenient workflow. Other benefits include high performance CCD detector, stable bucky system, Invaray image processing platform, and high performance generator.
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The NEO30 super-slim illuminator cycles on and off without noticeable delay, offering a uniformity of brightness of the observation area. The NEO30 also provides no significant flickering to interfere with observation, and offers enhanced safety and easy lamp replacement.
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The AFS-5000 full digital doppler system is PC-based and includes powerful software and a wide range of accessories. The AFS-5000 is user-friendly, can save images easily, and offers applications in abdomen, Ob/Gyn, small parts, urology, and cardiology.
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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
MAMMOGRAPHY SYSTEM
Dongmun
QC TOOL
PacsGear
DR SYSTEM
Reliant Medical Systems
MRI-COMPATIBLE LIGHTING
Sunnex
X-RAY PRODUCTS
Varian
The DMX-300 features full AEC mode, auto release compression after exposure, and high performance dual focus system. Other benefits include two collimation formats.
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The GEARView QC provides functionality for viewing, importing, editing, burning, and sending DICOM studies to PACS/EHR. It allows users to fix common errors and visually edit studies.
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The NeoRay DR for neonates offers multileaf adjustable collimation, an Intel DuoCore 2.8G workstation, and stationary anode X-ray tube.
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The OnGuard chest Xray CAD system automatically circles suspicious nodules on a standard chest X-ray, which may have gone previously unnoticed.
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Lighting options for the MRI suite include such products as the Celestial Star, which is unaffected by the magnets associated with various MRI procedures.
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Products available include medical X-ray tubes for CT and RF procedures, as well as mammography. Other products include a range of flat panel digital image detectors.
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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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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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PRODUCT NEWS
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WEB-BASED PORTAL
Carestream Health
VIEWING SOFTWARE
Intelerad
IMAGING SUITE
KJAYA Medical
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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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.
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AUDIO/VIDEO SYSTEM
K_Space
SUPPORT SOLUTION
MedCurrent
QIC SYSTEM
PeerVue
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 lifeIMAGE Inbox, called lila in the enterprise version, makes it possible to securely collect, view, and share diagnostic cases among hospitals, physicians, and patients. The open and flexible architecture is easy to use, and supports multiple browsers on both Macs and PCs.
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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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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?
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).
Medical Imaging International November-December/2010
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IT/PACS UPDATE
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.
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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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PRODUCT NEWS
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IMAGING ENVIRONMENT
Philips Healthcare
SOFTWARE SUITE
Shina Systems
OB/GYN SOFTWARE
Toshiba Medical Systems
RIS PLATFORM
Viztek
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 3Di cloud-based (3D/4D) software suite is designed to turn any Internet-enabled PC into a comprehensive image processing workstation. 3Di delivers imaging data, reformatting and viewing tools, in a cloud environment. The 3Di suite is intended for a range of application needs.
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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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Medical Imaging International November-December/2010
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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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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).
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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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-
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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).
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.
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
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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
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
V I S I T
MedImaging
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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
Medical Imaging International November-December/2010
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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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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