Medical Imaging Special: Imaging of Acute Stroke Patients

Volume 35 Issue 1
IHE February-March 2009
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MEDICAL IMAGING SPECIAL

Imaging of acute stroke patients
Also in this issue:
Hospital medical emergency teams: pros and cons

Pain and activity monitoring in joint replacement patients
RFID systems for managing hospital equipment
Real-time UltraSound Portable Compact yet

merged with CT, MR spirometer - Page 31 powerful ultrasound
and PET - Page 20 system - Page 22
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Editor’s Letter 3 – Issue N°1 – Feb/March 2009
Lessons from the Hudson hero?

One of the most to overcome the all-too pervasive surgical interventions to carry indeed be lessons to
impressive exam- mind-set within the medical com- out an extensive debriefing probe learned.
ples of calm and munity of not being open to rec- cedure to determine whether, in
efficiency under ognising and learning from errors. future cases, different, or the same,
extreme pressure Certain statutorily obligatory courses of action should be taken.
was the recent safe post-operative procedures have Pressure of work is often cited as
emergency land- to be taken and minimal explana- justification for this paucity of Comments
ing of a US air jet plane with more tions given after operations result- briefing/debriefing, an argument
than 150 passengers aboard, on the ing in the death of the patient. unacceptable in aviation.
on this article?
please feel free to post them at
Hudson river in New York City. Only However, in general, very few The contrast with the aviation www.ihe-online.com/comment/lessons
a few minutes after having taken off efforts are made after complicated industry is marked. There may
from La Guardia the airliner struck a Video Laryngoscope Series 5
Designed & manufactured by Aircraft Medical
flock of geese whose impact disabled
both engines of the two-engined
plane. In literally only a few min-
utes time critical decisions had to be
taken, for example to assess the pos- Video Laryngoscope Series 5
sibility of refiring the engines and to Designed & manufactured by Aircraft Medical
evaluate the few alternative options

available (return to the departure
airport? — aim for an alternative
airport?) before finally preparing
for the option chosen, namely an Video Laryngoscope Series 5
extremely dangerous landing in the Designed & manufactured by Aircraft Medical
Hudson river. The fact that all this

was achieved successfully with no
7:45am,
loss of life was explained modestly
Theatres:
by the pilot as simply (!) the result
Obese patient
of putting into action procedures
with limited mouth
which had been well practised on
simulators. In fact the only slightly opening and a history of
frustrated note struck by the pilot difficult intubation.
was a couple of weeks after the event 9:30am, Intensive Care
when he bemoaned the fact that Department: Patient on whom multiple
he had not yet been able to return intubation attempts have been
to active flying, since he was still made with a rigid laryngoscope.
being debriefed on all aspects of the
dramatic incident. 3:27pm, Emergency
While there is a limit to the extent Department: Semi-sedated
to which they can be drawn, there patient with collar rushed in,
are undoubtedly parallels between direct visualization
flying a modern jet airliner and not possible.
certain modern medical situations,
or more particularly critical surgi-
cal, interventions. Both flying and
critical surgery generally involve
sophisticated high tech instrumen-
tation, unexpected developments
can occur in both situations, and,
crucially, human life can depend on
the correct decision being taken. In
both cases decisions have to be taken cut the cable
rapidly and without the luxury of a Wherever your next difficult airway occurs make
leisurely review of the situation. sure you have the rescue device that’s always ready.
In the light of all this, several
voices are being raised within Aircraft Medical Limited
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ing the application of a briefing/ www.aircraftmedical.com For details of your local distributor visit:
COPYRIGHT 2009 © Aircraft Medical Limited Doc No. AD 001 v1.0 www.aircraftmedical.com/distribution/europe
debriefing system similar to that
used in aviation. The aim of this is
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CT, MR and PET system Managing Editors
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a.barclay@panglobal.be
Frances Bushrod, Ph.D.
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Arthur Léger
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FEATURES Bernard Léger, M.D.
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[6 - 8] Emergency medicine Astrid Wydouw
[6 - 7] ospital medical emergency teams (METs):
H a.wydouw@panglobal.be
pros and cons Webmaster
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[8]
5 mm X-ray grid 3 mm X-ray grid
Critical care news in brief
©2009 by PanGlobal Media bvba-sprl. Production &
[10 - 23] Medical imaging special Lay-out by Studiopress Communication, Brussels.
[12] Evaluation of a wireless DR detector Circulation Controlled by Business of

Performing Audits, Shelton, CT, USA.
[14 - 15] Lowering the radiation dose with obese patients
The publisher assumes no responsibility for opinions or state-
[16 - 19] Neuroimaging in stroke patients ments expressed in advertisements or product news items.
[20 - 23] Medical imaging product news The opinions expressed in by-lined articles are those of the
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[24 - 25] Orthopaedics
Monitoring pain and activity in hip and knee replacement patients
[26 - 27] Hospital management Coming up in April/may 2009

Keeping track of portable hospital equipment Anaesthesiology special
CT update
Patient monitors
REGULARS For submission of editorial material, contact Alan

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[3] Editor’s letter
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[28 - 29] News in brief
Volume 35 Issue 1
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IHE February-March 2009
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[30 - 33] Product News MEDICAL IMAGING SPECIAL

Imaging of acute stroke patients
Astrid Wydouw at a.wydouw@panglobal.be
[34] Calendar of upcoming events
Also in this issue:
Hospital medical emergency teams: pros and cons

Pain and activity monitoring in joint replacement patients
RFID systems for managing hospital equipment
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– Issue N°1 – Feb/March 2009 6 Emergency medicine
The pros and cons for having medical

emergency teams (METs) in hospitals
Typically composed of an ICU doctor, nurse and other appropriate personnel, effect. However, from an evidence-based medi-
Medical Emergency Teams (METs) were first introduced in certain hospitals in the cine point of view the level of evidence is fre-
1990s. Since then METs have been widely implemented; their mission is to provide quently weak and most of these studies can be
considered as Level 2 evidence at best, with a sig-
a medically-based critical care resource to critically ill patients wherever in the
nificant likelihood of bias. At least there does not
hospital it is needed. METs should be able to be summoned to a medical emer- seem to be any suggestion within the literature
gency in a similar manner and with comparable urgency as a traditional cardiac that METs are actually harmful in some way.
arrest team. Although METs seem on the surface to make intuitive common-sense,
the data regarding their benefits are not clear-cut, and can even show them to be The case against METs
inefficacious. A recent paper by Price and Cuthbertson evaluated the cases for and One of the most fundamental arguments against
METs is that surprisingly there is no clear-cut evi-
against METs [1]; this article presents their principal conclusions.
dence in favour of cardiac arrest team systems,
which have served as the model on which most
METs have been designed. The more detailed evi-
The basic rationale for the creation of dedicated rapid response team; a governance/administra- dence against METs comes from a rigorous analy-
Medical Emergency Teams (METs) is to address tive structure to supply and organise resources; sis of the studies that on the face of it purported
the situation that can occur if a patient on a gen- and a mechanism to evaluate crisis antecedents to show benefits. The question being raised is
eral ward develops critical illness and there are and promote hospital process improvement to simply this: are the data in such studies flawed
insufficient resources (both in terms of person- prevent future events. to the extent that they cannot be trusted. For
nel and equipment) to meet the clinical need. In example, some studies involved the comparison
response to these considerations, the concept of The case for METS of hospitals using the MET system with others
a Rapid Response System (RRS) has emerged. In The rationale for a MET is both obvious and that didn’t. Clearly differences between the basic
addition to being known as MET, the respond- intuitive: the provision of a rapidly responding case composition of the different hospitals could
ing team can also be known as a rapid response team should overcome the situation in many bias the results. A priori, the use of studies in the
team (RRT) or critical care outreach (CCO) but hospitals, where there are inevitable delays same hospital before and after the introduction
whatever the name, all are designed to provide within a hierarchical structure that consists of of METs should minimise this problem, but even
early intervention by individuals with critical care individuals who may not possess the appro- here problems still exist, such as seasonal varia-
competencies. The recommendations of an inter- priate skills for the treatment of deteriorating tions, differences in case mix and general changes
national consensus conference on METs were patients. With a MET, costs may thus be saved with time of the overall health care provision.
that hospitals should implement a rapid response via a reduction in the length of ICU and hos-
system, consisting of four elements [2]. These are pital stays. Many studies have been set up to try Accepting the limitations of such “before and
an afferent, “crisis detection” and “response trig- to quantitate the benefits of the implementation after studies”, two studies have shown that there
gering” mechanism; an efferent, predetermined of METs and some have demonstrated a positive is no demonstrable benefits to the introduction
Key points for clinical practice

as recommended by Price and
Cuthbertson [1]
1. T he overall success of METS depends on
the individual components. Thus, the
individual scoring system used to trigger
the call for MET needs to be appropriately
sensitive and specific and the team itself
should of course be appropriate for their
intervention.
2. D ata so far suggest that METS are not
efficacious. Future implementation
of METs should only take place if and
when the track and trigger systems are
validated.
3. T he failure to adequately measure cost-
effectiveness of METS prior to widespread
implementation may produce a reaction
No studies have yet shown conclusively that the implementation of Medical Emergency Teams is leading to disinvestment in the field.
cost-effective.
7 – Issue N°1 – Feb/March 2009
of METs. In a UK study, Kenward using METs. Various theories have for their implementation remains 3. K
enward G et al. Evaluation of
et al [3] looked at the effect of the been advanced to explain the appar- seriously flawed. a Medical Emergency Team one
introduction of a MET on the inci- ent lack of efficacy in the MERIT yearafter implementation.
dence of cardiac arrest and in-hos- studies. One is that the triggers used References Resuscitation:; 2004: 61: 257.
pital death. The study was carried to call the MET [Table 1} were not 1. Price RJ and Cuthbertson BH. Should 4. H
illman K et al. Introduction
out over a period of one year before specific or sensitive enough. Likewise hosiptals have a medical emergency of the medical emergency team
and one year after the introduction the use of a composite outcome cri- team? in Controversies in Inten- (MET) system: a cluster-ran-
of MET. For both outcome param- terion of unexpected death, cardiac sive Care medicine ed by Kuhlen R, domised controlled trial. Lancet
eters, no benefit was shown for the arrest and unplanned ICU admis- Moreno R, Ranieri M and Rhodes A, 2005; 365:2091.
existence of METs. sion may have been inappropriate. pub by Medizinisch Wissenshftliche
Other explanations could be inap- Verlagsgesellschaft 2008 Comments
The MERIT study (Medical Early propriate staffing or inappropriate 2. DeVita MA et al. Findings of the first
Response.InterventionandTherapy) or inadequate interventions. How- consensus conference on medical
on this article?
is the largest and most robust study ever until clear evidence for the ben- emergency teams Crit Care Med 2006; www.ihe-online.com/comment/MET
of METS and involved 23 hospitals efits of METs is presented, the case 34: 2463.
in a prospective cluster-randomised
trial [4], with the primary outcome
being the composite of unexpected
death, cardiac arrest and unplanned
ICU admission. The studies were
designed such that for each hospital
there was a baseline period of two
months prior to the introduction of
METs in the test group of hospitals.
Of course, in the control group of
hospitals, no METs were set up after
the baseline period. It was found
that a significant improvement in
the outcomes between the baseline
period and test only occurred in the
control group of hospitals (i.e. those
with no METs)! Direct comparison
of the test and control hospitals
showed no statistically significant
improvement in those hospitals
Table 1. Typical example of a MET

scoring system.This one was used in the
MERIT study which involved 12 hospitals
in Australia that had implemented
METs compared with 11 that had not.
The interpretation of the findings was
that the MET system greatly increased
emergency team calling, but did
not substantially affect the incidence
of cardiac arrest, unplanned ICU
admissions, or unexpected death [2].
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Critical care News in brief 9 – Issue N°1 – Feb/March 2009
Constant compressions critical to CPR delayed, the appendix can rupture, causing of “fractional flow reserve” (FFR), in which a tiny
Interrupting chest infection and even death. For almost a century, wire with a sensor is threaded through the coro-
compressions dur- open appendectomy was the standard treat- nary artery to the point of occlusion and blood
ing resuscitation ment for appendicitis, until the 1980s when flow is measured to determine if the lesion is
reduces the chances laparoscopic appendectomy first gained popu- restricting blood flow and causing ischaemia.
of heartbeat return larity. This transition was based on data that The study, conducted in 20 European and US cen-
after defibrillation. suggested the operation, in which a laparoscope tres, randomised more than 1000 patients with
New research pub- is inserted through small incisions in the abdo- multivessel coronary disease to either of the two
lished in the open men, was associated with reduced pain, faster methods for placement of stents. Results showed
access journal BMC recovery and better cosmetic results. that one-third fewer stents were used in the FFR
Medicine shows This retrospective study examined 235,473 group and the difference in composite outcome
that for every sec- patients who underwent open or laparo- at one year was significant: the FFR group showed
ond of a pause in scopic appendectomy between 2000 and 2005. a relative 28% lower incidence of major adverse
compressions there is a 1% reduction in the Length-of-stay, costs and complications were cardiac events (repeat angioplasty, heart attack
likelihood of success. assessed by stratified analysis for uncompli- or death) - 18.3% vs. 13.2%. The implication in
Kenneth Gundersen from the University of cated (n=169,094) and complicated (n=66,379) these results is that placing stents in lesions not
Stavanger, Norway, worked with a team of appendicitis. Regression methods were used to responsible for ischaemia is not only unnecessary,
researchers to quantify the effect of compres- adjust for covariates and to detect trends. but may cause worse outcomes.
sion interruptions on the probability of a The study demonstrated that the odds of hav-
return of spontaneous circulation (ROSC). ing any kind of complication were signifi-
He reported that the researchers analysed data cantly higher in the laparoscopic group among
from 911 interruptions and found that every patients with uncomplicated appendicitis
second without the blood perfusion generated (p<0.05, odds ratio = 1.07), and that there was
by chest compressions had a negative impact no difference among patients with complicated
on the estimated probability of ROSC. appendicitis (p=0.74). The only complications
The American Heart Association’s first aid reduced by using the laparoscopic approach
guidelines were updated last year, suggesting were infections in the uncomplicated group,
that the ‘mouth-to-mouth’ component of CPR and infections and pulmonary complications
was unnecessary. This new research supports in the complicated group. http://content.nejm.org/cgi/content/full/360/3/292
that position, in that the pause in compres- The adjusted costs for laparoscopic appendec-
sions required to perform artificial respiration tomy were 22 percent higher in uncomplicated ARDS mortality unchanged since 1994
may reduce the patient’s chances of recovering appendicitis and 9 percent higher in patients Mortality in patients with acute respiratory
a heartbeat. with complicated appendicitis (p<0.001). The distress syndrome (ARDS) has not fallen since
Gundersen said that the first priority when increased expense for laparoscopic appendec- 1994, according to a comprehensive review of
witnessing a cardiac arrest was to make an tomy are most likely related to higher operating major studies that assessed ARDS deaths. This
emergency call. Beyond that, the team’s results room costs, including greater expense for opera- disappointing finding contradicts the com-
showed that performing powerful chest com- tive instruments and longer operative times. mon wisdom that ARDS mortality has been
pressions with minimal interruptions was of According to the study, laparoscopic appendec- in steady decline. The study was published in
utmost importance. The message is that the tomy did result in a reduced length of hospital the February issue of the American Journal of
quality of CPR matters and everyone should stay for both the uncomplicated and complicated Respiratory and Critical Care Medicine.
practice their CPR skills at regular intervals. groups (p<0.001 and p<0.0001, respectively). The authors reviewed all prospective obser-
http://www.biomedcentral.com/bmcmed/ http://www.journalacs.org/article/ vational and randomised controlled trials
S1072-7515(08)01540-8/ between 1984 and 2006 that included more than
Laparoscopic surgery for acute 50 ARDS/ALI patients and reported mortality.
appendicitis increases costs Stent placement should be determined Contrary to the suggested benchmark mortal-
and complications by arterial blood flow measurement ity of all ARDS and related acute lung injury
Reperfusion therapy in the form of percutane- (ALI) cases being 25-30 percent, the authors
ous coronary intervention (PCI) is now the rec- state that their findings suggest a benchmark
ommended first treatment for victims of acute mortality of 40- 45 percent. The results high-
myocardial infarction. New European guidelines light the need for future effective therapeutic
issued in November 2008 emphasised speed of interventions for this highly lethal syndrome.
action and the importance of reperfusion therapy
to restore blood flow to the heart and improve
survival rates.
The cornerstone of PCI is the technique of angi-
oplasty, by which either bare-metal or drug-releas-
New research published in the February issue of ing stents are located within the coronary arteries
the Journal of the American College of Surgeons at points of occlusion. The FAME study, reported
suggests that a traditional, “open” appendectomy in the 15 January issue of the New England Jour-
may be preferable to a less-invasive laparoscopic nal of Medicine, was a randomised trial designed
appendectomy for the majority of patients with to assess the most effective method of locating
acute appendicitis, contrary to recent trends. the stent in patients with multivessel disease.
Appendectomies to treat appendicitis are con- These are respectively conventional angiography http://ajrccm.atsjournals.org/cgi/content/
sidered a medical emergency. If treatment is (visualisation of the artery) or a new technique full/179/3/220
Reducing the dose in CT:
the constant challenge
One of the paradoxes of computed tom-
ography X-ray scanning (CT) is that its
ionising radiation involved is less than
that received in a trans-atlantic flight?).
Feb/March 2009
very success has resulted in a net increase
of the quantity of ionising radiation to No-one disagrees with the recommen-
which both patients (and perhaps more
worryingly) asymptomatic subjects are
being exposed.
dation that, whenever possible, an alter-
native imaging modality such as ultra-
sound or MRI that does not involve
Medical
imaging
ionising radiation should be used instead
of CT. The fact is however that the CT
...It has been estimated that image quality and availability of systems
means that CT looks set to remain the
Special
one third of all CT scans are not dominant routine imaging modality for
justified by strict medical need, the foreseeable future.
so literally millions of patients are The good news in all this is that the major
companies that manufacture CT equip-
being irradiated unnecessarily... ment are not only well aware of the dose
issue but are responding to the challenge of
dose reduction through the innovative use
Evaluation of a
In the radiology field as a whole, while of technology. The move to multislice sys- wireless DR detector
there are of course variations between tems (MSCT), by its very nature means that
countries, regions and even between at least one source of unnecessary radia- Page 12
hospitals in the same country, the over- tion (that located in the penumbra region)
all trendlines are inexorable. The total is proportionally significantly reduced.
number of examinations being carried
out involving X-rays in one form or The very latest single dose dual energy CT
Lowering the
another is more or less constant. The system such as the Somatom Definition radiation dose with
number of standard radiographs being Flash from Siemens had dose reduction
taken is also more or less constant but as its main design criterion. Incorporating obese patients
there is a significant and steady decrease several technological innovations includ-
in the number X-ray examinations being ing an increased rotation speed, the dose Page 14 - 15
carried using fluoroscopy. This decline reduction that can be achieved with the
in fluoroscopy is being compensated by system means that sub-mSv cardiac scans
a huge increase in the number of CT
examinations being carried out.
are now perfectly possible. Neuroimaging in
stroke patients
By its very nature, the radiation doses
used in CT examinations are significantly ...the major companies that Page 16 - 19
greater than those used in other radio-
logical procedures, although, as pointed
manufacture CT equipment
out by Brenner and Hall in their seminal
New England Journal of Medicine paper
are not only well aware of the A selection of the
(N Engl J Med 2008; 29;357(22); 2277- dose issue but are responding latest products in the
84), this is typically not fully (or even not to the challenge of dose
at all) appreciated by most radiologists. medical imaging field
reduction through innovative
The result is that for the first time, the Page 20 - 23
cumulative burden of ionising radia- use of technology...
tion generated by medically adminis-
tered examinations is greater than that
to which we are exposed from natural Technological advances are however only
sources. (How many unnecessary or “just part of the answer to dose reduction.
to make sure” repeated scans must have Ultimately it is up to the radiologist to
been mentally justified by radiologists justify the risk/benefit ratio of using the
through the thought that, after all the technology on his/her patients.
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– Issue N°1 – Feb/March 2009 12 Medical Imaging
Evaluation of a wireless DR detector

system in a busy radiology department
The new wireless cassette-sized DRX-1 detector from any system is the quality of the images it pro-
Carestream Health was launched to great acclaim by the radiology duces. In this respect, we have no problems —
community at the end of last year. the image quality is very good.
In practice the data we collect from the DRX-1
At that time, the newly-launched system was still officially are used in a comparison study with storage
described as a “work in progress”. The DRX-1 is expected to be phosphor imaging.
available in many parts of the world first half of 2009.
Q: Apart from its ease of use and qual-
IHE decided to catch up with one of the first in-field evaluation ity of the results, another feature that
Prof. Thomas Vogl is test sites to see whether the potential of the new system was Carestream claim about the new wire-
director of the Department
of Diagnostic and actually being realised in an every-day clinical environment. less system is that it is easy to install
Interventional Radiology of and that no modifications are needed to
the University Hospital of We spoke to Prof. Thomas Vogl, M.D., Director of the Depart- existing X-ray systems. Users can con-
Frankfurt where the new
Carestream DRX-1 system ment of Diagnostic and Interventional Radiology in the University tinue to use the Bucky with CR or film-
has been under evaluation
Hospital of Frankfurt, Germany. based cassettes if desired. Was this true
for three months.
in your case?
Q: For how long have you been using the Q: Your department already has an A: Yes. The new system was installed very
DRX-1 system ? impressive list of radiology systems rapidly, with no facility modification being
from various different vendors. Did needed. And while it’s true that we could go
A: We decided to evaluate the new system in your staff have any problems getting back to using film-based cassettes, we find
two phases, first by carrying out a purely tech- used to the new system or have a long the advantage of the wireless functionality of
nical and scientific evaluation of the system; “learning curve”? the DRX-1 to be so great that we keep it in
only when we had satisfactory results in this constant use.
phase would we begin real use of the system in A: Not at all. The staff had no particular problems
clinical cases. getting used to the new system. Of course, in this
The first, purely technical evaluation of respect it helps that the system itself is very user- The new DRX-1 system
the system started in October of last year. friendly to operate. Our staff are now well-trained
By the end of December we were satis- on the new system and are well adapted to it.
fied that we could safely use the system for
real-life cases. Q: H
ow about the clinical quality of the results ?
We thus now have approximately one month’s
experience in this second phase. With the A: That’s an easy question to answer. The
high work-load in our department, this overall impression of the system is absolutely
means that we already have quite a large outstanding. Of course from a clinician’s point
“hands-on” experience. of view one of the most important aspects of
The innovative system features the world’s

The Department of Diagnostic and Interventional Radiology, first wireless cassette-sized DR detector, which
University Hospital Frankfurt. simply slides into the table or wall-stand
of the largest in Europe, the hospital has 1500 beds Bucky. Alternatively, it can be used for table-
and has also a large throughput of outpatients. The top projections, just like a conventional cas-
hospital covers all medical specialities. sette. After exposure, the 35 x 43 cm detector
As for the Department of Diagnostic and Inter- wirelessly transmits digital images to the sys-
ventional Radiology, it serves approximately 150 tem’s capture console for immediate viewing
000 patients per year and offers all diagnostic and and manipulation. From the console, images
interventional procedures. Currently the staff in can be quickly forwarded to a printer, PACS
the radiology department numbers approximately archive, or other network destinations. The
200 people, 30 of whom are clinical doctors or detector’s light weight (3.9 kg) and wireless
medical assistants. operation provide convenient handling—and
Frankfurt’s University Hospital is one of the largest The department is extremely well-equipped and has, unprecedented DR positioning flexibility.
in Europe among other modern instruments, one of the latest
Located in the centre of Germany, in the middle of the CAT-scan systems that uses dual source technology, a Carestream Health
Rhine-Main area, the University Hospital of Frankfurt PET/CT system, a wide bore 1.5 Tesla MRI system, and Rochester, NY, USA
serves a population of one to two million people. One an Ultra high magnetic field MRI system (3 Tesla). www.ihe-online.com & search 45201
– Issue N°1 – Feb/March 2009 14 Medical imaging
Lowering the radiation dose with

obese patients
Medical imaging manufacturers are on an ongoing quest to improve image quality,
reduce patient exam times and lower radiation doses. For average-sized patients,
new digital imaging modalities offer many advantages over film-screen methods
and are gaining worldwide acceptance. For obese patients, the benefits remain
elusive, primarily due to the amount of radiation exposure necessary to penetrate
the patient, the amount of scatter radiation that hampers image contrast and the Smit Röntgen, Hi-5™ Standard
5 mm X-ray grid 3 mm X-ray grid
increased incidence of retakes to establish a definitive diagnosis.
By Thomas T. Spees Figure 2. Larger patients inherently create more

scatter. The increased height of 5mm versus 3mm
lamellae captures more scatter, and at the same time
the fiber-interspacing allows more primary radiation
Obesity continues to be a public health con- Attaining detailed film-screen images of obese transmission to reach the image receptor.
cern in the United States and throughout the patients to diagnose disease remains a challenge
world. Recent studies published by the Cent- for radiographers. X-ray imaging, especially of improve body part contrast, excess scatter can
ers for Disease Control and Prevention in the abdominal region, is severely hampered by be successfully minimised with improvements
Atlanta, Georgia, show that more than one- the presence of excess body tissue. To be able to anti-scatter grids.
third of US adults — over 72 million people to penetrate the increased thickness, higher
— were classified as obese (Body Mass Index exposure settings are required. At higher kV, Radiographic imaging of large patients is com-
>30). While the situation in Europe is not the penetrating power of X-ray increases, but promised by X-ray scatter. Optimisation of
(yet) quite as bad as in the US, worryingly, the contrast between different parts of the body digital X-ray imaging systems used for pro-
the European trend is inexorably upwards. decreases. Also, the amount of scatter increases jection radiography requires the use of the
dramatically, which also hampers contrast [4]. best possible anti-scatter grids [5]. In projec-
Obesity increases the risk of many diseases tion radiography, primary radiation from the
and health conditions including coronary Large patient exams are even more difficult X-ray source is captured by the image receptor
heart disease, hypertension, type 2 diabetes, with digital systems than film-screen because and some radiation bounces off tissues and is
liver and gallbladder disease, osteoarthritis digital image capture is more sensitive to redirected toward the receptor. This unwanted
and sleep apnea [1, 2, 3]. scatter radiation. While little can be done to radiation is known as scatter, which is radiation
that does not emanate from the X-ray source.
Grids are designed to absorb the scatter radia-
tion before it can reach the receptor but allow
primary radiation to pass through [Figure 1].
Anti-scatter grids prevent unwanted radiation
from reaching the image receptor, whether its
film, image intensifiers, computed radiography
or direct capture digital radiography [6].
Anti-scatter grids
All grids are constructed with lamella consisting
of a strip of lead and a strip of interspace mate-
rial. Grids are differentiated by the interspace
material (aluminum or fibre) used between the
lead strips. Conventional grids use aluminum
as the interspace while advanced grids use a
fibre interspace material. Fibre material has less
radiation attenuation, allowing better primary
transmission. Fibre absorbs 20%-40% less pri-
mary radiation than aluminum; this means
imaging can be accomplished at 20%-40%
reduced dose levels.
Dunlee, a division of Philips Healthcare, intro-

duced the new Hi-5 line of Smit Röntgen grids
Figure 1. Anti-scatter grids play an important role in projection radiography by transmitting a majority of at the 2008 Radiological Society of North
primary radiation and selectively rejecting scattered radiation. By allowing primary x-rays to be transmitted America (RSNA). These grids are the first
and scattered x-rays to be absorbed in the grid, image contrast is significantly improved [7]. products designed to improve image quality
References
1. www.cdc. gov/ncdphp/dnpa/obesity/trend/maps/
2. www.cdc.gov/nchs/data/databriefs/db01.pdf
3. www.cdc.gov/nchs/products/pubs/pubd/hestats/
obese/obse99.htm
4. Kok C. Improving digital imaging quality for larger
patient sizes without compromise. Smit Röntgen,
February 2008, pp.1-16.
5. Fetterly K, Schuler B. Experimental evaluation of
fiber-interspaced anti-scatter grids for large patient
Figure 3. Clinical studies completed at leading medical institutions showed dose rate reductions of 20%-40% imaging with digital x-ray systems. Physics in Medi-
using the new Hi-5 grids.
cine and Biology, Volume 52, Number 16, 21 August
while dramatically reducing dose for average as are average size or grossly large, all radiographic 2007, pp. 4863-4880.
well as obese patients. modalities benefit from these fibre-interspaced 6. Spees T, Nuijts P. Smit Röntgen grids for low-dose
grids, particularly in fluoroscopy, computed imaging. Radiological Society of North America,
Advantages of the new grids radiography (CR) and digital radiography (DR) 2 December 2008, conference presentation, pp.1-17.
Hi-5 grids are interspaced with fibre instead of applications. Clinical disciplines that are very con- 7. w ww.upstate.edu/radiology/rsna/radiography/
aluminum, allowing better radiation transmission scientious of dose, such as mammography and scattergrid/
and less attenuation. This results in a lower dose cardiology, primarily use fibre interspaced grids.
for the patient. The grids are further optimised The author
for better scatter reduction by utilising lamellae Conventional radiography has been slower to Thomas T. Spees, Director,
that are 5mm high versus the normal 3mm height incorporate fibre grids into imaging systems. Dunlee,
in conventional grids [Figure 2]. In clinical evalu- Concerns include replacement costs and a pre- 555 North Commerce Street,
ations conducted at leading healthcare facilities, sumption that existing equipment will have to Aurora, IL 60504 USA.
studies have shown a dose reduction up to 20% be modified to incorporate new grids. In fact, tspees@philips.com
in average-sized patients and approaching 40% in the new grids are easily swapped into existing www.ihe-online.com & search 45215
severely obese patients [5,6]. systems, requiring no special retrofit hardware. Dunlee and Smit Röntgen are divisions of Philips Healthcare
Although fibre grids are priced slightly higher
Although the new grids are 2mm thicker than than aluminum grids, the benefits of lower dose,
conventional grids, great care has been taken in adaptability to varying patient sizes and ability to
Comments on this article?
Feel free to post them at
their design so that they can be easily retrofitted enhance images make these grids well worth the
www.ihe-online.com/comment/Grids
into existing imaging systems. Whether patients replacement cost.
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Rapid neuroimaging of acute stroke patients

Stroke patients can respond well if
rapid diagnosis is followed by prompt
and appropriate therapy. For example
in ischaemic stroke timely administration
of thromobolytic or “clot-busting drugs”
can prevent the progression of symptoms
from transient to permanent. Delays in
diagnosis can however lead to irrevers-
ible cerebral damage. The principal
diagnostic challenge in overall stroke
management is to differentiate brain
ischaemic attacks from haemorrhages
and stroke-like disorders. While timely
non-contrast CT imaging distinguishes
between haemorrhagic and ischaemic
stroke, many hospitals cannot offer con-
tinuously available CT scanning in the
Figure 2. The US National Institute of Nerological disorders (NINDS) urges that CT imaging be completed within
radiology department. A dedicated, 25 minutes of the arrival of the patient in the ER. The time necessary to transfer the patient to the central radiology
head/neck scanner in the ER facilitates department frequently means that this recommendation cannot be made. The use in the ER of a dedicated head/
neck CT scanner, ready at a moment’s notice for an arriving patient, can significantly accelerate the taking of the
rapid differential stroke diagnosis.
scan and the vital differential diagnosis between ischaemic and haemorrhagic strokes.
by Dr David B. Weinreb
Room (ER) is challenging, both for small com- transient to permanent. However, thrombo-
munity hospitals and large academic centres. lytic agents may be contraindicated in many
Stroke is the third most frequent cause of mor- There are numerous, frequently-encountered patients. First and foremost, clinical guidelines
tality after ischaemic heart disease and cancer, clinical scenarios for which there is an urgent dictate that thrombolytic drugs be adminis-
and the primary cause of disability in adults need to briskly transport patients to the radiol- tered within three hours of symptom onset. If
worldwide. In 2005, there were an estimated ogy suite: suspected intracranial haemorrhage, administered after this three-hour window, the
62 million stroke survivors. Over 15 million pulmonary emboli or ruptured aneurysms. potential risks of bleeding complications tend
people suffer a stroke each year and of these, Delays in obtaining the appropriate diagnostic to outweigh the benefits. For example, in about
approximately five million will die as a result, imaging study create delays in correct manage- 83% of acute stroke patients their symptoms
and another five million will be permanently ment. This is particularly significant for patients are secondary to a clot starving the brain of
disabled. One of the most important chal- presenting to the ER with signs of acute stroke. oxygen [1]. For the remaining 17% the stroke
lenge facing physicians globally is to reduce the may be consequent to a site of haemorrhage
unacceptable burden of stroke. Thrombolytic, or “clot-busting,” drugs offer in the brain [1]. In all such cases, administra-
tremendous hope to stroke patients, breaking tion of a clot-busting drug will exacerbate
Prompt differential diagnosis is essential, but apart the clots that deprive the brain of oxygen, the hemorrhage. It is crucial to rapidly image
achieving rapid imaging in the Emergency preventing symptoms from progressing from such patients and “triage” them accord-
ingly: those with oxygen-depriving clots may
indeed be candidates for thrombolytic drugs;
haemorrhage within the brain is an absolute
contraindication to such therapy.
Non-contrast CT imaging
The first step in the evaluation of acute stroke
patients is to distinguish between patients
whose symptoms are due to bleeding (haem-
orrhagic stroke) and those patients presenting
with stroke due to clots (ischaemic stroke). This
can be achieved with non-contrast CT imaging
[Figure 1a and 1b]. Within the few hours of
the onset of a haemorrhagic stroke, the non-
contrast CT scan will identify the presence of
haemorrhage. These patients require close
neurological monitoring and possible neurov-
Figure 1. The first step in the evaluation of acute stroke patients is to distinguish between haemorrhagic stroke ascular/neurosurgical interventions to control
and ischaemic stroke. This can be achieved with non-contrast CT imaging. the bleeding.
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However, the situation may be quite differ-

ent in smaller community hospitals, and such
differences have constructed barriers to ideal
care. First, many community hospitals may
not have a CT scanner in the ER; their imag-
ing facilities may be located in another building
and, in many cases, off-site. Additionally, the
CT department may not be staffed 24 hours a
day. These obstacles to the “25-minutes to CT”
guideline represents challenges facing smaller
community hospitals. This is particularly and
painfully relevant given that the overwhelming
majority of stroke patients initially present to
community hospital ERs.
Use of a dedicated
head/neck CT scanner
First, one creative solution is a dedicated
head/neck CT scanner, stationed in the ER,
ready at a moment’s notice for an arriving
stroke patient. One manufacturer, Neuro-
Logica Corporation in Massachusetts, has
developed a light-weight (700-lb), portable
8-slice scanner [Figure 2]. Designed specifi-
cally for head imaging, this scanner is stored
in the ER, eliminating the need for stroke
patients to be transported to the radiology
suite. In many of the community hospitals
Figure 3. «Request to CT Scan» times in stroke patients before and after the introduction of a dedicated
head/neck scanner.It can be seen that significant reductions in request to scan times are achieved with the
where this novel scanner is currently oper-
use of the ER dedicated scanner. ating, it has helped clinicians achieve the
“25-minute” guideline [3].
By comparison, within the first hours of an National Institute of Neurological Disorders
ischaemic stroke, non-contrast CT imaging and Stroke (NINDS) urges that CT imag- A recent investigation has explored the clinical
may likely be completely normal: the clot is ing be completed within 25 minutes of the utility of the portable CT scanner for ER patients
barricading the flow of oxygen-rich blood to patient arriving in the ER; the images should [3]. The study was conducted in the 16-bed ER
the brain, but it is too early to see any changes be interpreted within 45 minutes [2]. For of Salem Hospital/North Shore Medical Center
in the brain apparent on CT imaging. Gener- various reasons, compliance with these time (Salem, Massachusetts). At Salem Hospital, it
ally, greater than 24 hours after the onset of guidelines may be more easily attained in typically took 25-35 minutes from the time of
symptoms, repeat CT imaging will demon- large academic centres. Specifically, these initial arrival at the ER door until the CT scan
strate areas of low attenuation, corresponding larger institutions may have a stroke team was completed. This delay in transporting the
to brain territory that has been deprived of consisting a specialised nurse and stroke patient to the radiology suite for CT imaging was
blood flow. neurologist on-call to evaluate patients in one of the several factors that slowed the entire
the ER. Additionally, the radiology depart- process of clinically assessing patients present-
Non-contrast CT imaging should there- ment may have continuously available CT ing with an acute ischaemic stroke. Thus, inter-
fore be performed as briskly as possible in scanning in the ER, staffed around the clock ventions were necessary to provide more rapid
patients with suspected acute stroke. The by teams of technologists. diagnostic imaging for ER patients.
Book review to the controversy and to summarise the data with a clinically useful and valid
recommendation for our practice. Virtually all fields of intensive care medicine
Controversies in intensive care medicine are covered in more than 50 chapters dealing with controversies over treatment
Edited by R. Kuhlen, R. Moreno, M. Ranieri and A. Rhodes options in acute illness states, organising and providing care for acutely ill patients,
Published by MWV Medizinisch Wissenschaftliche Verlagsgesellschaft as well as how to answer ethical questions arising in critical care medicine every
OHG (2008), 534pp, e64,95 day. Accounts by the leading international experts in intensive care medicine
The theme of last year’s congress of the European Society are organised in sections on acute respiratory failure, acute circulatory failure,
of Intensive Care (ESICM) ‘Controversies in intensive care acute kidney injury, sepsis and infection, neuro-intensive care, acute bleeding,
medicine’ resulted in this book that reflects the themes of organisational issues, surgical intensive care and trauma and adjunctive issues.
the conference. In recent years, many clinical interventions This volume will be invaluable for nurses, physiotherapists and other allied
in intensive care medicine have been based on clear scientific evidence. However, healthcare professionals as well as physicians in intensive care medicine including
at least as many clinical interventions still remain the subject of controversy, either anaesthesia and other discipline.
due to a lack of rigorous data or due to the existence of conflicting data. In this
book, these controversies are discussed by experts of international renown in their MWV OHG
respective fields. The goal is twofold: to provide us with a balanced and unbiased Heidelberg, Germany
presentation of the subject, explaining the different ‘schools of thought’ relevant www.ihe-online.com & search 45214
Following the implementation of a The CereTom portable CT scanner is an 8-slice CT scanner that deliv-
dedicated scanner in the ER, these Portable CT Scanner
ers the highest quality non-contrast, angiography, contrast perfusion and
times was drastically reduced to less xenon perfusion scans in every conceivable patient location. It is designed
than 17 minutes; a large percent of for use in the emergency room, operating room, intensive care units,
ER stroke patients were imaged interventional suite or any medical clinic. It is portable enough however
fewer than 12 minutes [Figure 3]. to be able to be installed in ambulance. In the near future its capabilities
These preliminary results suggest will be expanded to facilitate use by orthopedic surgeons and dental spe-
that increasing the availability of cialists. Its combination of rapid scan time, flexible settings and immedi-
CT in community or rural hospi- ate image viewing, make it an indispensable tool to any clinician needing
tals may have a tremendously posi- real time data on critically ill patients.
tive impact on the ability to these
hospitals to more effectively care NeuroLogica Corporation
for acute stroke patients. The Portable CT scanner is small enough Boston, MA, USA
IHEeven to be installed
Junior Page:IHE in an ambulance.
Junior Page www.ihe-online.com
5/2/09 13:29 Page & search
1 45216
In summary, providing rapid diag-
nostic imaging when and where it
is needed the most is an enormous
challenge. Nowhere is this challenge
more apparent than in community
hospitals, faced with the arrival of a
FITS. DOESN’T FIT.
stroke patient within the three hour
period for thrombolytic interven-
tions. The emergence of new tech-
nologies is helping to surmount this
challenge, though new approaches
and strategies at the community
level are still needed.
References
1. “What is a Stroke?” Published by the
American Stroke Association. Avail-
able on 10/05/2008 at www.stroke-
assocation.org.
2. Proceedings of a National Symposium
on Rapid Identification and Treat-
ment of Acute Stroke, National Insti-
tute of Health, December 12-13, 1996.
Bethesda, MD: National Institute of
Neurological Disorders and Stroke.
3. Weinreb, DB and Stahl JE. The
Introduction of a Portable CT Scan-
ner is Associated with a 68% reduc-
tion in Door-to-Scan Times in a
UNBOX. INSERT. IMAGE.
280-bed Community Hospital.” In
press, Radiology Management.
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Comments
on this article? © Carestream Health, Inc. 2009.
Want to find out more?
please feel free to post them at ecr.carestreamhealth.com
www.ihe-online.com/comment/stroke_CT

– Issue N°1 – Feb/March 2009
20 Medical Imaging Product News
Radiography phantom patient thus providing improved comfort and Breast PET-guided biopsy feature
faster exams. This makes it ideal for imaging Designed for use with the company’s high-res-
ambulatory, wheelchair and stretcher patients. olution organ-specific PET scanner, the Stereo
This flexibility also dramatically increases room Navigator is a Positron Emission Mammogra-
utilisation and overall operational efficiency. phy (PEM)-guided biopsy accessory, indicated
for the localisation of lesions in female breasts
Toshiba Medical Systems Corp as identified on a PET image. This guidance
Tustin, CA, USA system enables physicians to guide compatible
www.ihe-online.com & search 45200 interventional devices towards abnormalities
visible on PET. This biopsy feature represents
Also suitable for use with CR/DR systems, the the cutting edge of targeted molecular imaging
Model 903 Radiography/Fluoroscopy QA Phan- MR flow analysis
tom can be used for initial QA assessment and An MR flow analysis functionality has been
routine monthly QA testing to help ensure added to the CAAS MR product range. This FRONT COVER PRODUCT
that patients are receiving the best possible software enables health professionals to per-
X-ray examinations. form analysis of Phase Contrast Angiography Real-time UltraSound merged with
Manufactured from PMMA-equivalent epoxy, MR images (PCA). Such images can be used for CT, MR and PET
the Phantoms offer the same X-ray attenuation quantitative assessment of blood flow and veloc-
properties as acrylic but with significantly greater ity. The software allows vessel edge detection and
durability. The overall phantom measures 25 cm contour propagation, analysis of four Regions
wide x 25 cm long x 20.7 cm high and consists (ROIs) per series and anatomical designations
of three attenuation plates, one test object plate for direct calculation of clinical results. An intui-
and a detachable stand for easy, reproducible set- tive user interface as well as reliable and repro-
up. Test objects include high-resolution copper ducible segmentation are provided. Images from
mesh targets from 12 – 80 lines per inch and two the major MRI scanner vendors are supported.
separate contrast-detail test objects.
Pie Medical Imaging BV
Computerized Imaging Reference Maastricht, The Netherlands
Systems, Inc. www.ihe-online.com & search 45193
Norfolk, VA, USA
www.ihe-online.com & search 45197 Foremost among many new ultrasound
Certified high resolution display products just introduced by GE Healthcare
is the new Logiq E9 ultrasound system for
Digital X-ray system radiology and vascular applications. The new
system fuses ultrasound images with others
from different imaging modalities such as CT
and MR. The Logiq E9 features an innova-
tive tool known as Volume Navigation, which
itself incorporates two key components. These
are the “Fusion” system which enables the
combination of the advantages of real-time
ultrasound imaging with the high spatial and
The Dome E4c system from NDS Surgical Imag- contrast resolution of CT, MR or PET. The
ing is a 4MP, medically certified, high-resolution second technological advance is a “GPS-like”
display ideal for diagnostic review. The unit is a system to track and mark a patient’s anatomy
bezel-less, 30-inch (76 cm) display with a wide- during the ultrasound exam, bringing confi-
screen, 16:9 format. Equivalent to two 2MP dis- dence and productivity to both diagnostic and
Featuring increased productivity and patient plays, the E4c simplifies comparison studies by interventional studies.
comfort while eliminating film, the Kalare R&F eliminating the bezel split and has the ability to In this way, the new system helps to address
system combines a superior user interface and show 15 full size 512X512 images at the same one of the biggest challenges in ultrasound
feature set with true all-digital imaging for fluor- time. With a broad colour spectrum, the system radiology and vascular care, namely how to
oscopic and radiographic examinations. With its provides the advantage of being able to view, on leverage clinical images from previous diag-
high-resolution, removable, flat panel detector, a single viewing station, various colour modali- nostic imaging studies for interventional or
all digital images can be captured and displayed ties such as PET/CT, fusion, ultrasound, CT and diagnostic ultrasound procedures. The devel-
instantly on dedicated digital workstations. MR as well as 2-D colour imaging, image fusion opment of this new ultrasound architecture,
ln today’s healthcare environment, maximis- and 3-D reconstruction. The display is ideal for which gives clinicians the advantages of sev-
ing imaging resources and improving patient use in the operating room, for the review of radi- eral imaging modalities involved close collab-
throughput is critical to success. This X-ray ology images as well as the display of any other oration between GE Healthcare and a global
system helps medical centres to accomplish electronic medical record applications. The team of radiologists and sonographers.
these goals while lowering costs and improving system is fully DICOM calibrated.
patient care. The system is specifically designed GE Healthcare
to accommodate the needs of busy facilities. lt NDS Surgical Imaging Solingen, Germany
allows clinicians flexibility to obtain images San Jose, CA, USA www.ihe-online.com & search 45194
from virtually any position without moving the www.ihe-online.com & search 45211
Medical Imaging Product News 21 – Issue N°1 – Feb/March 2009
in the breast. The possible image quality on the first shot. It uti- Protective coverlets for mammography
accessory uses a lises advanced image processing algorithms and
stereotactic frame automatically applies optimal image shutters.
fixed between the Images can then be fine-tuned using automatic
scanner’s paddles processing settings optimised for bone, soft
to guide the inser- tissue and organs.
tion of a compati- In addition, the i4 DR features a highly customis-
ble interventional able clinical workflow with Graphical UserInter-
device into the face (GUI)-integrated generator controls that
breast. Accurate targeting is possible due to allow for optimised X-ray and image processing
the high-resolution 3-D tomographic images parameters. Eliminating the generator console
acquired. Localisation of the abnormality is and thus creating a cleaner, more efficient work- Designed to remove the chill from the bucky/
verified using a PET-visible line source that space, i4 DR was also designed with the OEM receptor plate, Bella Blankets protective coverlets
is inserted into the needle track allowing the business model in mind in that it can interface help patients feel more at ease during a mammo-
user to confirm trajectory and position. The with a variety of flat panel detectors, and is flexible, gram. Patient satisfaction levels are improved and
accessory is compatible with most breast adaptable, upgradeable and configurable for use complaints that the bucky/ receptor plate is cold
biopsy systems. with next generation flat are minimised. Made of a fabric-like material, the
panel detectors for faster coverlets also help with positioning by immobi-
Naviscan, Inc. speed to market. This, in lising small breasts or those prone to perspiration.
San Diego, CA, USA addition to the company’s Covering both the top and front of the bucky, the
www.ihe-online.com & search 45198 global onsite service sup- coverlets are intended for single use, providing
port, 24-hour customer added protection for each patient. Patients with
service and 36-month thin skin, cuts in the inframammary fold or those
Digital radiography imaging technology standard digital system who require a second image after undergoing
The i4 DR system was designed to provide the warranty, enables i4 DR needle localisation will especially benefit from
highest level of image quality while reducing the to lower the total cost of the coverlets. Available in two sizes, artifact-free
amount of radiation that patients and medi- ownership compared to and easily disposable, the coverlets are compatible
cal staff receive during X-ray procedures. The similar systems. with both digital and analogue units.
technology behind this superior image quality
is the recently developed InfiVision Automatic InfiMed Beekley Corporation
Image Enhancement software. InfiVision’s Liverpool, NY, USA Bristol, CT, USA
one-click image processing allows for the best www.ihe-online.com & search 45196 www.ihe-online.com & search 45195
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Cranio-caudal CTLM ® view of the right breast. Standard

MIP reconstruction show a normal vessel (yellow
arrows), tubular in shape and in normal anatomical
location. The red arrows outline a large area of neo-
vascularity, sphered in shape (non-anatomical), and
extending across the breast to involve the skin.

22 Medical Imaging Product News
Rapid, low dose CT scanner scan speed; the patient is moved through the CT tube more than twice as
A new dual-source CT fast as with any conventional system.
featuring two X-ray tubes
that simultaneously revolve Siemens Healthcare
around the patient’s body, Malvern, PA, USA
the SOMATOM Definition www.ihe-online.com & search 45177
Flash CT scanner requires
only a fraction of the radia-
tion dose that systems pre- Oncology-specific image management and storage solution
viously required and can Providing oncology profes-
rapidly scan even the tini- sionals with a reliable, scal-
est anatomical details. For able way of archiving and
instance, a spiral heart scan accessing the images and
can be performed with less than 1 millisievert (mSv), whereas the average data that impact decisions
effective dose required for this purpose usually ranges from 8 mSv to 40 about a patient’s course
mSv. With the fastest scanning speed in CT (i.e. 43 cm/s) and a temporal of treatment, OncoView
resolution of 75 ms, complete scans of the entire chest region, for example, is designed specifically to
can be carried out in just 0.6 seconds. Thus patients are no longer required archive information cover-
to hold their breath during the exam as was necessary in the past. The ing the entire cancer treatment process from diagnosis to survivorship
gantry (i.e. the X-ray detector system surrounding the bore) rotates about and follow-up. Clinicians are using more images to make decisions and to
its own axis in just 0.28 s. It is this rotational speed that enables the rapid monitor progress over the course of cancer treatments. For image-guided
radiotherapy, new images are generated at every step in the treatment proc-
ess, resulting in a vast number of images and related information that must
be stored, and so clinicians need a reliable system for easily archiving and
instantly accessing this information in a meaningful way. The Oncoview
2009
image management system supports archiving of the most commonly used
imaging modalities in oncology care, including CT, MR, PET, kV X-rays,
cone-beam CT and electronic portal images. The system also stores non-
Manchester Central, UK imaging data, including radiotherapy treatment plans, dose levels and
other important treatment details. The system is designed to supplement a
8-10 June 2009 hospital’s existing picture archiving and communication system (PACS)
by making it ‘oncology capable,’ or to operate as a stand-alone solution for
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Medical Imaging Product News 23 – Issue N°1 – Feb/March 2009
centres that don’t have such a system. Important information can be stored previous generations of instruments. The system features several innovative,
within a specific archive or within hospital PACS through industry standard advanced clinical applications. Dual Energy Subtraction eliminates overly-
communication protocols such as HL7 and DICOM, supporting the trend ing bone obstruction from chest or abdominal images, providing a standard
in medicine toward paperless and filmless clinical operations that speed PA radiograph, a soft-tissue only image with the bones removed, and an
workflow and improve cost efficiencies. OncoView interfaces seamlessly image of the bones highlighting foreign objects and calcified abnormalities.
with any standards-based clinical information management system. VolumeRAD allows multiple high-resolution slice images of the human
anatomy, including the chest, abdomen, extremities and spine, using an
Varian Medical Systems, Inc. X-ray system. VolumeRAD is performed by a single sweep of the overhead
Palo Alto, CA, USA tube assembly across the patient. During the sweep, multiple, low dose expo-
www.ihe-online.com & search 45173 sures are acquired. The acquired data are then reconstructed (similar to CT
exams) and displayed as a set of images (parallel to the detector plane). Sev-
eral automated features that are geared to improving workflow and patient
Hand-carried diagnostic ultrasound systems experience are also offered. Auto-image paste, auto-positioning, protocol
An addition to the ProSound fam- assist, auto-processing and Repeat/Reject Analysis functions help reduce
ily of diagnostic ultrasound systems, exam times as well as wait time for processed images. Additionally, the flex-
the ProSound C3 series of hand-car- ibility of a portable detector has been added to enable customers to choose a
ried diagnostic ultrasound systems configuration that best fulfills their clinical and workflow requirements.
is available. Diagnostic ultrasound
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ANNONCE Germany
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due to their greater convenience. The series is available in two models. The Pro- Manufactured
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suitable probe from a wide range including phased array sector, convex sector,
linear and endo-cavity probes according to the application. The series also fea-
tures a short-cut function from a backlit full keyboard and a slide-out opera-
tion panel exclusively designed for ultrasound imaging to enable direct access
to the desired imaging mode and system functions, reducing examination time.
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– Issue N°1 – Feb/March 2009 24 Orthopaedics
Monitoring pain and activity in hip and

knee replacement patients
The number of hip and knee replacements required is increasing due to ageing based on ’snapshots’ of subjective measures
populations, and as governments seek to meet demand and contain costs, there is of activity and pain provided by the patient
a need to take a fresh look at how costs can be reduced whilst improving patient from time to time, often at intervals of many
weeks. What is considered very active by
care. Currently clinicians make treatment decisions on hip and knee replacement
one patient may be considered inactive by
patients based on their physical activity and pain levels but without having good another. Established scoring systems such as
visibility of those two indicators of patient well-being. If clinicians are given remote the Oxford Knee Score, Harris Hip Score and
and time aggregated access to that information along with clinical analysis of it, SF-12 are widely used and have some merit
decisions all along the care pathway can be better informed with the result that but they cannot provide quantitative trends
patient outcomes are improved and cost savings are realised. that would show the rate at which a patient is
declining pre-operatively, or if recovery is on
track post-operatively. Moreover, there are
by D. Heaton, Dr I. Revie and Dr M. Slomczykowski very few published data on the activity char-
acteristics of patients according to their dif-
ferent physical characteristics. For instance,
Clinical need recovery, potentially damaging the integrity what does the decline in mobility of a regu-
Each year there are approximately one mil- of the joint, in which case the life of the joint lar tennis player look like compared to the
lion primary hip and knee replacements car- will be compromised, and a revision will decline of someone who leads a more sed-
ried out in Europe, with the number growing probably be required. entary life, but is still in pain and frustrated
at over 4% annually. North America, the Mid- by declining mobility? Obviously, there will
dle East and Pacific Rim also have a signifi- Compliance with the prescribed exercise be a broad spectrum of activity profiles for
cant and growing number of replacements. regime is important for patient outcomes different patients. These need to be known
With an ageing world population, it is likely and for reducing the costs associated with and presented as a baseline for comparison
that the demand for hip and knee replace- poor outcomes and/or revisions. Currently as recovery progresses. Absolute measures
ments will continue to grow while the funds the only method of measuring compliance of activity alone would be a step forward,
to resource them become more scarce. is by asking patients how much exercise but would not yield the ‘whole picture’ or
With this in mind, Activ4Life Healthcare they are taking. This is time consuming and maximum benefits. Clearly, more is needed.
Technologies Ltd, initiated discussions with unreliable, as it is subjective and reliant on
clinicians to determine where there were areas the patient’s memory. Furthermore, patients If data on patients’ activity and pain levels
for improvement. What they found was that who are not complying for whatever reason were made visible to clinicians, and refer-
the two key reasons for carrying out hip and are unlikely to be detected until the damage enced to norms, treatment decisions would be
knee replacements were to increase patients’ is irreversible. better informed. This would improve many
mobility and reduce their pain, both param- stages of overall patient care including triage
eters that are not currently economically At present, clinicians have to make treat- of those presenting with joint pain; deter-
measurable over time. In addition to being ment decisions using minimal information mination of optimal time for intervention;
a key reason for joint replacement, activity
is a vital part of the recovery and rehabilita-
tion process, but again, this is currently not
effectively measured in patients.
As the ability to walk is a frequent discharge

criterion, it is important to ensure that this is
maintained in the period early after discharge
when hospital staff are no longer available to
provide support. It is important to ensure
that patients continue to increase activity
over several weeks to re-establish mobility.
If patients do not show a clearly increas-
ing trend in activity levels post-operatively
there may be additional complications which
warrant attention. Without sufficient exer-
cise muscles will weaken leading to a poor
outcome and the real possibly of a negative
effect on the stability of an operated joint.
However, over- exercising a joint early post-
operatively can also be a significant risk to Figure 1. Schematic diagram of the patient activity monitoring system.
recovery prediction, appropriate exercise closely as would be ideal and thus discharge
regime planning, exercise compliance moni- planning is often conservative. The instant
toring, hospital planning and early detection availability of activity trends during the hos-
of complications. Enhanced well as improved pital post-operation period, together with
efficiency and cost savings. increased patient confidence from knowing
monitoring will continue at home, allows
The ProV3.8 monitoring system an earlier discharge from hospital with
Recognising these needs, the ProV3.8 system associated cost benefits.
was developed to deliver effective reporting of • If activity levels are much lower than expected,
patient activity and pain. Designed to be used or pain levels consistently higher, alerts that
on each patient for several months pre- and there may be a complication are generated to
Figure 1. The variation with time of activity levels
post-operatively, the system comprises three the clinicians. Such alerts also notify patients
at different phases during patient care. The green
separate components: line shows the typical long-term activity profile for and their surgeons of inappropriate post-
a patient having a primary hip replacement. This operative activity such as excessive or too
• Patient hardware: a very user-friendly activ- is characterised by a steady, then steep, decline in demanding or too early exercise.
ity monitor and associated dock with a pain activity prior to the operation followed by a rapid, • Once patients are discharged from hospi-
reporting facility then slower, increase in activity after the operation. tal and are back at home, monitoring and
The red line shows the benefit of carrying out the
• Analysis against clinical “personas”: a compar- operation at the optimal time, i.e. not too late and
reporting results in increased se|f-awareness,
ison against a specific activity profile matched before the loss in activity is dramatic. Post-opera- encouraging self-management of care. In the
to the user tively, a sustained higher level of activity is attained longer term studies have shown that people
• Reporting: regular reports to the user and more quickly. who are able to quantify their activity lev-
clinicians responsible for that user’s care els tend to take more exercise, the obvious
clinicians and to the patient. Additionally, resulting health benefits.
Patient hardware should activity levels fall outside predeter-
At the start of each day the patient fixes the mined boundaries, alerts can be generated Summary
activity monitor to the waist, under clothing, to the clinician. Such alerts would allow an The implementation of this system allows bet-
using a double-sided medical grade adhesive instruction to the patient to change their exer- ter clinical decision-making for hip and knee
patch. The activity monitor, about the size of cise behaviour appropriately. In the case of replacement patients, leading to improved
a wrist watch and weighing only 15g, is unob- under-exercise this would improve outcomes; outcomes and cost savings from:
trusive and discreet. A 3-axis accelerometer in the case of over-exercise a revision could be
and onboard processor are utilised to count avoided in some patients. • Triage of patients presenting with joint pain
steps and record each one against time. At the • A reduction in incorrect referrals from
end of the day the patient removes the activ- Improved outcomes and cost savings primary to secondary care
ity monitor and inserts it into the dock. This How the reports feed into the decision-mak- • A reduction in unnecessary procedures
incorporates an integral mobile phone mod- ing process along the care pathway can be • Quicker discharge from hospital
ule that transmits the data to a secure server. illustrated by considering the different phases • Fewer post-operative visits to clinicians
At this point the patient is given the opportu- of the patient’s care in Figure 2. The green line • Quicker recovery post-operatively
nity to record pain level for the day on a scale shows a typical long-term activity profile for a • Informed patient self management
of 1 - 10 simply by pushing one of two but- patient having a primary hip replacement. • Recovery to a higher level of activity
tons. There is no requirement for the patient • Throughout the period of care, remote mon- • Early detection of complications allowing
to have an internet connection or any other itoring and visibility of the patient’s well- more conservative treatment options and less
equipment such as PC, PDA or mobile phone. being can reduce the number of visits to cli- remedial work.
The patient does not have to be familiar with nicians: primary care doctors, surgeons and • Compliance with common government poli-
modern communication technology demands physiotherapists. cies of patient self-management, improved
on the user. All that is required is to wear the • It is well documented that delaying interven- quality at lower cost, measurement of quality,
activity monitor during the day and place it tion for too long can result in a sub-optimal better use of ICT and data management.
in the dock overnight. Pain recording involves recovery; the patient takes longer to recover
only the push of a single button. and the eventual plateau of activity level The authors
reached is lower than for earlier interven- David Heaton BSc,
Analysis against personas tions. The red line illustrates the benefits of Sales and Marketing Director,
Each patient’s data is compared against an operating at the optimal time; a sustained Dr Ian Revie PhD, CEO,
assigned “persona”: a researched activity norm higher level of activity more quickly. Con- Activ4Life Healthcare Technologies Ltd.
based on BMI, age, gender, operative state and versely, an intervention before the optimal Dr Mike Slomczykowski MD PhD,
lifestyle. This persona thus fits the patient’s char- time is inefficient as it increases the likeli- Medical Director,
acteristics, and is displayed with the patient’s hood of a revision later in life. In addition, Healthcare Technologies Ltd.
activity data in the weekly reports. This persona the benefits, as perceived by the patient, are www.A4LHEALTH.com
profile is also used in setting patient activity less. Enabling an informed decision on when enquiry@A4LHEALTH.com
targets, both pre- and post-operatively. to operate will, in some cases, allow the use www.ihe-online.com & search 45212
of conservative, lower cost treatment options
Reporting in the short term, thus allowing those
Reports are generated from the analysis and with a more urgent need to be referred to
show activity performance and trend lines secondary care earlier.
Feel free to post them at
against expected activity. These reports • Limited healthcare resources means that
www.ihe-online.com/comment/Patient_activity_monitoring
are delivered both to the decision-making patients’ activity cannot be monitored as
– Issue N°1 – Feb/March 2009 26 Hospital management
RFID tags make hospital equipment

management easier
From the organisational and management point of view, a modern hospital is an the hospital’s IT department to remotely moni-
extremely complex system. Efficient running of a hospital can therefore be a daunt- tor the temperature of the room from anywhere
ing task but is nevertheless called for more and more since increased efficiency in in the hospital, or even to transmit alerts to the
home of the appropriate facilities engineer.
the management of hospital facilities can not only result in significant savings but
also in improvement in patient outcomes. “The new system has made a significant improve-
One of the most difficult aspects of modern hospital management is keeping track ment in the way we operate,” said Daniel Loos,
of the many portable and movable pieces of equipment, whose physical location manager, information technology, at St. Trudo.
in the hospital can vary enormously, depending on the use the patient is making “The staff are more satisfied and much more
efficient with their time. With the new system,
of the equipment.
we have been able to increase the utilisation of
Items such as IV pumps, specialised mattresses or even apparently mundane pieces expensive mattresses, IV pumps and wheel-
of equipment such as wheelchairs can at any one time be located almost anywhere chairs, as well as reduce expenses related to rent-
in the hospital. Frequently, hospitals are required to compensate for their ignorance ing extra equipment. Best of all, we can improve
service and care for patients who require the use
of the precise whereabouts of their own property by purchasing more items than
of the tracked equipment.”
would otherwise be necessary. The use of modern Radio Frequency Identification
(RFID) systems is a cost-effective method of managing such movable but important Jan Yperman Hospital,
equipment. Here we look at how two Belgian hospitals have implemented their Ypres, Belgium
RFID systems. Housed in a brand new building inaugurated
in 2007 and featuring state-of-the-art telecom-
munications systems, the Jan Yperman hos-
St Trudo Regional Hospital, The specialty mattresses, known as anti-decu- pital in Ypres, Belgium, has about 550 beds,
Sint Truiden, Belgium bitus mattresses, help prevent pressure sores in 1,000 employees and 100 doctors. Each year,
Located in the Flemish-speaking part of Bel- patients who must remain in the hospital for the hospital accepts 15,000 patient admissions
gium in the town of Sint Truiden, the St. extended periods. The hospital’s mattresses, as and 18,000 one-day hospitalisations. The hos-
Trudo Regional Hospital is a 310-bed hospital well as the IV pumps and wheelchairs are in con- pital has opted for for a “Wi-Fi–Based Active
that serves the Limburg and Vlaams-Brabant stant use and continual movement throughout RFID solution”, based on a Telindus LAN and
regions of the country. Its 700 employees and the facility. Before installing the new asset track- WiFi system for tracking patients and medical
80 doctors care for more than 11,000 patients ing solution, staff often had to manually search equipment in real time.
admitted to the hospital annually. The hospi- the entire facility to locate needed equipment,
tal recently installed a wireless network and which wasted a substantial amount of time and Approximately 1,000 pieces of equipment
uses this infrastructure to support Wi-Fi- reduced overall utilisation of the patient care (infusion pumps, wheelchairs, beds, patient
based active radio-frequency identification equipment. Moreover, when the required equip- monitors, etc.) were fitted with Aeroscout
(RFID) tags, in particular to track and manage ment wasn’t readily available, the hospital often Active RFID tags, not only saving medical
expensive specialty mattresses, IV pumps and had to rent others, incurring significant expenses staff precious time in locating these assets, but
wheelchairs that are required throughout the and delays. also making it easier for managers to main-
facility. St. Trudo also uses the wireless network tain them, establish an inventory and reduce
to accurately monitor the temperature inside To solve this problem, St. Trudo implemented the risk of theft.
the hospital’s data centre. Wi-Fi-based RFID tags and AeroScout’s Mobi-
leView software. The tags are attached to the Temperature-monitoring tags are used for
specialty mattresses, IV pumps and wheelchairs, refrigerators containing lab specimens, blood
enabling accurate, real-time visibility and man- bags and other temperature-sensitive items.
agement of those assets. The system is also set up Such continuous monitoring ensures safe
to alert hospital personnel when the number of operation and correct temperatures.
wheelchairs available for use reaches a critically Approximately 400 tags with call buttons
low level, or whenever a wheelchair is inactive ensure better protection for medical staff,
for two hours so that it can be returned to the who are sometimes confronted with aggres-
reception area. sive patients. The tags are also a useful tool for
keeping track of disoriented patients such as
In addition, Wi-Fi-based temperature-monitor- those suffering from Alzheimer’s disease.
ing application is installed in St. Trudo’s server
room (see technology primer opposite). The
application also uses the wireless infrastructure
The fitting of RFID tags to movable equipment, such Feel free to post them at
as weelchairs, means that the location of the asset to transport information — in this case, temper-
www.ihe-online.com/comment/RFID
can be determined directly using Wi-Fi networks. ature readings — to the network. This enables
The technology behind Asset Locations Systems temperature sensor can communi- battery that can be used as a partial or
cate environmental temperature (as complete source of power for the tag’s
The configuration at St. Trudo’s hos- In the so-called Chokepoint detection used in St Trudo), or a tag can be con- circuitry and aerial. Some active tags
pital is based on three components: configuration, the passage of a tag nected to equipment/vehicles to com- contain replaceable batteries capable
through a defined area such as a gate municate maintenance status, fuel of years of use; others are sealed units.
1) A Wireless Network. or doorway, can be used to trigger level and other critical information. It is also possible to connect the tag to
This was based on Cisco’s Unified “events” such as alarms, tag behav- an external power source. The major
Wireless Network system (www. iour modification, or data retrieval. 3) Active RFID tags. advantages of an active RFID tag are
cisco.com). This is designed to In addition to simply locating assets, These were also supplied by Aeroscout that it can be read at distances of thirty
deliver optimal wireless LAN secu- configurations exist for the han- (www.aeroscout.com), the develop- metres or more, greatly improving the
rity, innovation, and investment dling of valuable status information ers of the original active RFID tag. utility of the device; in addition it can
protection and supports real-time such as Telemetry and Sensor data. An active tag is distinguished from a have other sensors built into it that use
business-critical applications. The For example, tags with a built-in passive tag in that it is equipped with a its electrical source for power.
Network creates a secure, mobile,
interactive workplace for organi-
sations deploying WLANs and
delivers greater reliability and
higher throughput based on the
IEEE standard (802.11n) for the
implementation of WLAN com-
puter communication in the 2.4,
3.6 and 5 GHz spectrum bands.
In the Jan Yperman hospital, the
network is a Telindus system,
www.telindus.com.
2) Visibility system.
This was Aeroscout‘s Unified Asset
Visibility system (www.aeroscout.
com) which has already been
installed in over 100 hospitals
around the world. Aeroscout is
the only Wi-Fi Visibility solutions
provider endorsed by the Ameri-
can Hospital Association (AHA).
The Unified Asset Visibility sys-
tem is a platform that is able to
provide enterprise visibility over
a single infrastructure, combining
multiple types of visibility includ-
ing Real Time Location Systems
(RTLS), Active RFID, Passive
RFID, sensors and telemetry.
This means that a user can moni-
tor all of the valuable data about
their mobile assets from a single
interface in real-time, and apply
a consistent set of context-based
rules, no matter what the source
of those data might be. There are
several possible configurations of
the Visibility system in addition to
the RTLS used in St Trudo, which
wirelessly determines the precise
location of tags.For example, in
situations where the presence or,
sometimes more importantly the
lack, of an asset is deemed to be
critical, the system can be con-
figured based on the use a single
Access Point or receiver to detect
these crtical tags.

– Issue N°1 – Feb/March 2009 28 NEWS IN BRIEF
New guidelines for use of breast MRI Breast MRI is a relatively new clinical tool for By attaching radioactive material to a particular
to supplement standard imaging detecting breast cancer and techniques for antibody, radiation can be targeted at specific
using the sensitive equipment vary by site. cells that express the corresponding antigen,
Many clinicans have urged that clear standards minimising damage to other tissues. This level
for technical parameters be established, as well of specificity is not possible with existing forms
as performance measures at clinical sites that of radiation therapy.
offer MRI. The MRI guidelines adopted by the RIT was originally developed as a therapy for
NCCN state that MRI examinations should be cancer treatment and has been the most suc-
performed and interpreted by an expert breast- cessful therapy used so far in treatment of non-
imaging team working in concert with a multi- Hodgkin lymphoma, the cancer that originates
disciplinary diagnosis and treatment team. in cells of the immune system.
Breast MRI exams require dedicated equip- Since viruses are quite different from cancer
ment and breast-imaging radiologists who are cells, devising radioimmunotherapy for HIV
Updated guidelines for physicians that rep- familiar with the technical details for image poses significant challenges. Viruses easily avoid
resent best practices for using MRI to newly interpretation. The NCCN guidelines also say radiation directed at them and can readily
diagnose breast cancer and to make treatment that imaging centres need to have the ability to repair any damage that might occur. In addi-
decisions have been published in the Journal perform MRI-guided needle biopsy sampling tion, HIV is present in immune cells keeping
of the National Comprehensive Cancer Net- of lesions detected by MRI to properly evaluate the virus beyond the reach of antibodies. The
work (NCCN), a non-profit alliance of 21 of the possible abnormalities. RIT devised by the Einstein researchers con-
USA’s leading cancer centres. Breast radiologists http://www.ingentaconnect.com/content/jandb/ sists of an antibody for glycoprotein 41 (gp41)
and surgeons at the Seattle Cancer Care Alli- jnccn/2009 and a radioactive isotope, namely Bismuth-213,
ance (SCCA) and the Roswell Park Cancer Insti- bound together by a ligand. The gp41 antibody
tute in Buffalo, NY, authored the paper upon Radioimmunotherapy: was selected because the corresponding gp41
which the guidelines are based. Among the key promising treatment for HIV infection antigen is reliably expressed on the surface of
recommendations are the following: Scientists at Albert cells infected with HIV. In addition, unlike other
• MRI is not a substitute for screening or diag- Einstein College of HIV-related glycoproteins, gp41 antigen usually
nostic mammography and, when indicated, Medicine of Yeshiva is not shed into the bloodstream, which would
diagnostic breast ultrasound. MRI supple- University, USA, lead many of the radioactive-labelled antibod-
ments the use of these standard imaging tools have used radio- ies to miss their target. Bismuth-213 was chosen
in appropriately selected clinical situations. immunotherapy because of several characteristics, including a
• For women with diagnosed breast cancer, MRI (RIT) to deliver half-life of only 46 minutes. Such a short half-
provides enhanced detection in both the breast doses of radiation life allows just enough time for the treatment
known to have cancer and the opposite, or that selectively tar- to be administered and for the radioactive anti-
“contralateral,” breast. get and destroy bodies to exert their effect. After four hours,
• S urgical decisions should not be based solely on microbial and HIV- Bismuth-213 falls to negligible levels. The treat-
MRI findings because not all suspicious lesions infected cells. The ment has been shown to effectively eliminate
on MRI are cancer. Suspicious lesions should experimental treatment holds promise for treat- HIV-infected human cells in both laboratory
be biopsied before a surgery plan is devised in ing various infectious diseases, including HIV and animal studies, the latter involving two dif-
order to avoid surgical overtreatment. and cancers caused by viruses. The research was ferent models of mice with HIV. The team is now
• In the rare instances where cancer is found in presented at the annual meeting of the Ameri- conducting pre-clinical testing of the therapy’s
the lymph nodes but not the breast, an MRI can Association for the Advancement of Science efficacy and safety in preparation for a Phase I
can find the location of cancer in the breast in (AAAS), the world’s largest general scientific clinical trial in HIV-infected patients.
nearly 60 percent of women. society and the publishers of the journal Science. http://www.aecom.yu.edu/home/news.asp?id=301

NEWS IN BRIEF 29 – Issue N°1 – Feb/March 2009
MRI shows brain atrophy pattern that is predictive adults in the study received no training. Prior to the study they rated eight
of Alzheimer’s drinks on a scale of one to five. Wearing a headband fitted with fibre-optics
Using special MRI meth- that emit light into the pre-frontal cortex of the brain, they were shown
ods, researchers have two drinks on a computer monitor, one after the other, and asked to make
identified a pattern of a mental decision about which they liked more. When the brain is active,
regional brain atrophy in the oxygen in the blood increases and, depending on the concentration, it
patients with mild cogni- absorbs more or less light. In some people the brain is more active when
tive impairment (MCI) they don’t like something, and in some people it’s more active when they do
that indicates a greater like something. After allowing the computer to recognise the unique pattern
likelihood of progression of brain activity associated with preference for each subject in the study, the
to Alzheimer’s disease. researchers accurately predicted which drink the participants liked best 80
The findings are pub- per cent of the time. In future, a portable, near-infrared sensor that rests on
lished in the online edi- the forehead and relies on wireless technology could be developed, opening
tion of Radiology. The up the world of choice to children who can’t speak or move.
study’s lead author, Linda K. McEvoy, Ph.D., assistant project scientist in http://www.iop.org/EJ/abstract/1741-2552/6/1/016003
the Department of Radiology at the University of California San Diego
School of Medicine in La Jolla, USA said that previously this pattern had Multivitamins have no impact on risk of cancer or
been observed only after a diagnosis of probable Alzheimer’s disease. The heart disease in postmenopausal women
current results show that some individuals with MCI have the atrophy The largest study of its kind concludes that long-term multivitamin
pattern characteristic of mild Alzheimer’s disease, and these people are use has no impact on the risk of common cancers, cardiovascular dis-
at higher risk of experiencing a faster rate of brain degeneration and a ease or overall mortality in postmenopausal women. The results of the
faster decline to dementia than individuals with MCI who do not show Women’s Health Initiative study, led by researchers at Fred Hutchin-
that atrophy pattern. son Cancer Research Center, were published in the February issue of
For the study, Dr McEvoy and colleagues set out to determine if they could the Archives of Internal Medicine. The study focused on the effects of
identify a pattern of regional atrophy characteristic of mild Alzheimer’s multivitamins because they are the most commonly used supplement.
disease in order to aid in the prediction of cognitive decline in patients It assessed multivitamin use among nearly 162,000 women enrolled
with MCI. The researchers analysed brain MR images from 84 patients in the Women’s Health Initiative, one of the largest U.S. prevention
with mild Alzheimer’s disease, 175 patients with MCI and 139 healthy studies of its kind and designed to address the most common causes
controls, using semi-automated, individually specific quantitative MRI of death, disability and impaired quality of life in postmenopausal
methods. The results showed widespread cortical atrophy in some patients women. The women were followed for about eight years. Nearly half of
with MCI, involving all cortical areas except those involved with process- the study participants reported using multivitamins on a regular basis.
ing of primary motor and sensory information. However, most indicative Multivitamin users were more likely to be white, live in the western
of future cognitive decline were atrophy in parts of the medial and lat- United States, have a lower body-mass index, be more physically active
eral temporal lobes and in the frontal lobes. This pattern was also present and have a college or higher degree as compared to non-users. Multi-
in the patients with mild Alzheimer’s disease. Although these individuals vitamin users also were more likely to drink alcohol and less likely to
were reporting problems mainly with memory, the atrophy involved more smoke than non-users, and they reported eating more fruits and veg-
than just memory areas, extending into brain regions involved in plan- etables and consuming less fat than non-users. During the eight-year
ning, organisation, problem solving and language. Follow-up data were study period, 9,619 cases of breast, colorectal, endometrial, renal, blad-
available for 160 patients with MCI. The patients exhibiting atrophy in the der, stomach, lung or ovarian cancer were reported, as well as 8,751
brain regions described above showed significant one-year clinical decline cardiovascular events and 9,865 deaths. The study found no signifi-
and structural brain loss and were more likely to progress to a probable cant differences in either risk of cancer and heart disease or longevity
diagnosis of Alzheimer’s disease. MCI patients without that pattern of between
IHE the multivitamin
- RESCUE LIFE 2008 users and non-users.
22-01-2009 16:38 Pagina 1
atrophy remained stable after a year. http://archinte.ama-assn.org/cgi/content/full/169/3/294
Dr McEvoy hopes that these findings will have an impact on the design of
M E D I C A L
clinical trials to test medications that may slow or halt the progression of E Q U I P M E N T
Alzheimer’s disease. S O L U T I O N S
http://radiology.rsnajnls.org/cgi/content/full/ 2511080924
Optical brain imaging decodes preference

Researchers at Canada’s largest children’s reha-
bilitation hospital, namely Bloorview Kids
Rehab, have developed a technique that uses
infrared light brain imaging to decode prefer-
ence, with the goal of ultimately opening the
world of choice to children who can’t speak or
move. In a study published this month in The
Journal of Neural Engineering, Bloorview sci-
entists demonstrate the ability to decode a per- RESCUE LIFE
son’s preference for one of two drinks with 80 State-of-the-art technology for diagnosis and first aid
per cent accuracy by measuring the intensity
The DEFIBRILLATOR
www.dart-sas.it
of near-infrared light absorbed in brain tissue.

Most brain-computer interfaces designed to read thoughts require train- www.progettimedical.com
www.progettimedical.com
ing. For example, in order to indicate yes to a question, the subjects need to +39 011 644738
do an unrelated mental task, such as singing a song in their head. The nine
30 PRODUCT NEWS
Carbon monoxide monitors to detect tobacco smoking 6 micrometers diameter, necessary for the treatment of
Measuring alveolar carbon monoxide concentration pulmonary alveoli, can be generated. The model IH 50
in ppm, as well as percentage carboxy-haemoglobin, features a nebulisation method that uses an ultra mod-
the Micro CO operates from a single 9V PP3 battery, ern oscillating membrane, which is partially porous, to
which allows 8000 tests to be carried out. Measure- nebulise the inhalant with a capacity of >0,3mL/min.
ments are easily obtained from a single expiration, Requiring only a short inhalation time, the IH 50 is
facilitated by an auto-zero function when the moni- suitable for treating children with respiratory diseases.
tor is turned on, combined with a breath hold count- Its compact design and battery operation make it ideal
down timer. Results are displayed instantly on the when travelling. The inhaler is supplied with a storage
large LCD display, and additional green, yellow and box, mouthpiece and masks for adults and children.
red lights indicate heaviness of smoking. Models IH 25 and IH 20 are designed to treat the upper and lower respiratory
tract in case of colds, asthma or similar disorders. Here, the liquid medica-
Cardinal Health Gmbh tion is nebulised using compressed air technology with a capacity of > 0.21
Hoechberg, Germany mL/min (IH 25) and > 0.18 mL/min (IH 20). Both these devices operate
www.ihe-online.com & search 45210 on mains power and feature a compact, light design. They are supplied with
mouthpiece, nosepiece, masks, extra-long compressed air tube and filter.
New range of nebulisers Beurer GmbH

Based on aerosol generation technology, in which the medication is nebulised Ulm, Germany
into an ultra-fine
Vien09 mist able
IHE 101x178 to penetrate 18/01/09
ad:Vien09 deep into patients’
22:59bronchial
Page 1tubes or www.ihe-online.com & search 45203
pulmonary alveoli, a new range of nebulisers is available. Particles smaller than
Data collection and processing

Arioform, a new digital form management solution, offers a faster, more
accurate and efficient method of collecting and processing the data acquired
by mobile personnel. Suitable for healthcare centres, the software eliminates
the need for personnel to return to the office to re-enter form data collected
in other hospital locations. Instead, forms can be simply completed on-site,
using either a digital pad or a digital pen, and the data can be transmitted to
the relevant office electronically. Paper copies of the form can be provided
22nd annual congress for the client or service user. Suitable for any type of form, including patient
files, health and safety checklists, surveys, maintenance reports, order forms,
inventories and meeting minutes, the software is available in two versions,
European Society of namely Arioform Enterprise and Arioform Vista. The former version, which
is a server-based system, is designed for use by multiple personnel; the lat-
Intensive Care Medicine ter version is designed for capturing digital data on single pageforms. Form
data can include tick boxes, radio buttons, boxed fields and free text fields,
which can be stored graphically. Arioform Vista software also incorporates
Vienna, Austria handwriting recognition technology, which enables workers to convert their
handwritten forms into digital data on their PC.
11-14 October 2009
Selwyn Electronics
Sevenoaks, Kent, UK
For physicians, nurses
and other allied healthcare
professionals
Silver antimicrobial technology
Abstract submission deadline Recent comprehensive studies have shown that
15 April 2009 silver ion technology, applied to both equipment
and furniture, reduced levels of bacteria in a
healthcare environment by up to 95.8%. Further
results showed that products treated with silver
ESICM VIENNA 2009 For more information, contact harboured 92.6% fewer bacteria on their sur-
European Society
of Intensive Care Medicine faces than similar untreated products in the same
(ESICM) environment. The products tested included waste bins, hospital beds, blinds,
Annual Congress secretariat tiles, door handles and light switches. A number of leading manufacturers of
Mrs Estelle Flament
Avenue Joseph Wybran, 40 healthcare equipment and furniture now incorporate BioCote silver ions into
B-1070 Brussels their products at the manufacturing stage. The silver ion additive gives the prod-
Tel +32 2 559 03 55 ucts built-in antimicrobial protection, and can be incorporated into a variety of
Fax +32 2 527 00 62
public@esicm.org materials including plastics, fabrics, paints, powder coatings and papers.
www.esicm.org
BioCote Ltd
Wolverhampton, West Midlands, UK
PRODUCT NEWS 31 – Issue N°1 – Feb/March 2009
Laser system for kidney stone removal procedure. Urologists will be able to perform a simple once-a-year treat-
Providing flexibility to treat any stone in the bladder, ure- ment under regional anaesthesia that has proven to be more effective than
ter or kidney, the Odyssey 30 Holmium Laser System can conventional treatments that have to be repeated frequently.
also be used to treat tumours and urethral strictures. Using
patented, variable pulse width technology, the system allows Allium Medical
surgeons to minimise stone migration as well as offering the Caesarea, Israel
flexibility to switch from disintegration of stones to ablation www.ihe-online.com & search 45191
and coagulation of soft tissue. The system is equipped with
enough power to treat any renal stone, regardless of size,
position or composition, as well as incorporating a green IR sources for capnography and
aiming beam to enhance visibility of the treatment site. anaesthesia monitoring instruments
New research has predicted an increase in the proportion of the popula- Infrared sources from Leister Technologies are micro-machined, electrically
tion affected by kidney stones due to dehydration and diet. In the UK alone, modulated thermal infrared emitters featuring true black body radiation
stones occur in nearly 12 of every 100 men and four of every 100 women characteristics, low power consumption, high emissivity and a long lifetime.
at some point in their lives. With the incidence of kidney stones increasing, Based on a resistive heating element integrated onto a thin dielectric mem-
the need for innovative technology in operating theatres is vital. Although brane, which is suspended on a micro-machined silicon structure, the IR
there are many treatments and surgical options available for kidney stones, sources are ideal for capnography and anaesthesia monitoring instruments.
fragmentation with a laser is very precise. It causes minimal damage, and the
results are typically much better at immediately removing the obstruction. Leister Process technologies
Kägiswil, Switzerland
Cook Medical Inc www.ihe-online.com & search 45190
Bloomington, IN, U.S.A.
Removable posterior urethral stent

Providing a viable solution for patients recovering from complications of
bladder and prostate cancer operations, the Allium Bladder-neck Stent is a
removable posterior urethral stent for patients who have developed a steno- NOT JUST ANY STERILISER
sis at the bladder neck after radical removal of the prostate or the bladder From the first pre-vacuum table-top steriliser in 1993,
because of cancer. The device is a super-elastic structure inserted into the to the third generation Millennium product line,
posterior urethra of patients who have undergone radical prostatectomy you can count on Mocom for innovation, reliability
(for prostate cancer) and radical cystoprostatectomy (for bladder cancer). In and performance.
up to 18% of these patients a stenosis may develop at the anastomosis site,
necessitating repeated dilatations to allow for reasonable voiding of urine.
Currently, the conventional management of these stenoses is frequently per-
formed by mechanical dilations, endoscopic incisions or laser vaporisation.
The success rate of these procedures is low and patients have to undergo
repeated treatments. The bladder-neck stent provides a viable option that
does not require a highly specialised reconstructive bladder neck repair
FRONT COVER PRODUCT

Portable spirometer
A small portable spirometer with the
latest technological advances, the DAT- Millennium 17 and 22 liters
OSPIR MICRO is available in three dif- > Single-piece stainless-steel
chamber with, brilliant
ferent models, two of which are fitted electro-polishing for longer
with graphic touch screens (PDA type) durability and easy cleaning.
that facilitate operation. The instrument > Instant steam generator gives
allows different configurations for use high quality saturated steam Millennium 5,5 liters
ONLY
and faster cycle times.
both in the clinic and at home. A USB port provides connection to a 18
minutes
> Only 18 minutes
> High performance fractionated (drying included) to sterilise
PC or an external printer, as well as to other devices via Bluetooth con- vacuum pump. and dry wrapped hollow
nectiontechnology; data can be exported to other management systems (handpieces) and solid loads!
> Stainless steel wire trays for fast ONLY
and a PIN security system is available. Incorporating a large number drying. 9
minutes
> Only 9 minutes
(drying included) to sterilise
of parameters related to FVC, VC and MVV, as well as a pulseoximetry > Robotized door-locking and dry unwrapped
(SpO2) option, the spirometer has a database capable of storing up to mechanism with triple solid instruments in the
1000 tests; a programme for quality control of tests is included. Acoustic protection for added safety. Emergency cycle!
incentives ensure that the instrument is ideal for use with children.
SIBEL S.A.
Barcelona, Spain Mocom srl
www.ihe-online.com & search 45115 www.mocom.it • mocomcom@mocom.it

32 PRODUCT NEWS
Shock-proof aneroid blood Anaesthesia machine for use to store clinical DICOM data objects, including
pressure meter with MRI scanner DICOM encapsulated non-imaging objects such
Blood pressure as waveforms, structured reports and PDFs. A key
meters are very benefit of the solution is that care providers are
sensitive and bang- able to easily access various datasources within
ing or dropping the hospital or regional enterprise through one
them can damage mechanism. The solution delivers clear patient
the internal mech- management benefits as exams and results will
anism leading to be available at every location in the Hospital
false readings. This Enterprise, consequently enhancing patient care.
can of course be The system is designed to meet the needs of new
disastrous for patients and their treatment. A The MRI 508 is the first anaesthesia machine technologies such as multi-slice CT and allows for
‘two components’ technology has been devel- designed for safe, reliable use right tnext to an the extension of PACS into other image-intensive
oped that avoids any potential impact and pro- MRI scanner. Tests in collaboration with leading clinical departments, including cardiology and
tects the measuring system against shock. The MRI scanner suppliers show diagnostic images orthopaedics. Due to its adherence to open stand-
shock-proof R1 aneroid blood pressure meter, are undisturbed and performance superb in all ards, the IMPAX Data Center can be part of any
which utilises this technology, is shock-proof up seven ventilation modes. Operators familiar with existing or new Agfa HealthCare PACS, or exist
to a falling height of 120 cm. Its unique features the company’s innovative Siesta i range will need in legacy or multi-vendor environments, further
include a new patent-pending metal air channel, no extra training as the user interface and patient increasing data sharing and disaster recovery.
which results in stable needle deflection in both system are identical. The space-saving design
directions. The high-precision air release valve incorporates even ventilation modes including Agfa Healthcare
can now be turned without any resistance. The pressure support ventilation (PSV) and pressure Mortsel, Belgium
tube connection at the top of the pressure gauge regulated volume target ventilation (PRVT). This www.ihe-online.com & search 45181
ensures an unhindered blood pressure measure- is a lung-protective ventilation mode that com-
ment. A further advantage of this blood pres- bines the advantages of volume-controlled ven-
sure meter is the possibility of pumping up the tilation and PCV, enabling optimum ventilation Aerosol disinfection system
device in minimal time due to a new ball design and oxygen delivery during surgery, which in Offering efficient
with an integrated spoon. Tests show that regu- turn reduces the risk of post-operative complica- infection control,
lar meters can deviate by up to 10mmHg after tions and promotes faster recovery. An integrated the MobiWatch
shock and vibration damage, whereas this blood breathing system (IBS) and high-level safety fea- MaxiBIO dry mist
pressure meter hardly ever deviates by more than tures are provided. The IBS includes a bag-in- decontamination
3mmHg, i.e. well within the accepted limit. The bottle, absorber and patient circuit integrated in system ensures
instrument is available in a variety of different one system, which significantly reduces tubing that absolutely all
sizes and cuff options. In addition, a special set connections between machine and patients. The surfaces are fully
including three different cuff sizes and a storage same bag-in-bottle can be utilised for adults and decontaminated. The system effectively elimi-
box is offered. infants. Unique vertical inspiration/expiration nates microorganisms when used in conjunc-
valves with fast response reduce deadspace, and tion with MicroSol3+ Sporicide, providing an
Rudolf Riester GmbH a built-in manual ventilation valve is provided efficient deep cleaning procedure for any labora-
Jungingen, Germany above the manual ventilation bag connection. A tory or clinical environment. The system com-
www.ihe-online.com & search 45182 large TFT screen displays all relevant values. prehensively decontaminates not only accessible
areas but also out-of-reach surfaces, and can
Dameca a/s quickly and effectively treat spaces up to 500m3,
General purpose test lung Roedovre, Denmark with personnel being able to return to the treated
Providing a broad www.ihe-online.com & search 45179 area within four hours of decontamination. The
spectrum of ben- pressurised MicroSol3+ Sporicide solution is
efits to the respi- automatically sprayed within the targeted area via
ratory care field, Imaging infrastructure solution a dry-mist nozzle, which generates <10micron
the EasyLung is an particles, providing 100% saturation of the area
affordable, versa- and giving a sterile and residue-free environ-
tile general pur- ment. The system is operated by a timer, which
pose test lung. It allows personnel to safely leave the area that is to
is ideal for ventilator manufacturers validating be disinfected before the procedure begins. This
the safety of their products, for ventilator train- system provides a comprehensive, low cost, deep
ing and for biomedical engineers perform- clean without any labour-intensive procedures,
ing general service procedures. The EasyLung thus freeing up personnel time; the process is
combines a specific design with high-quality, completed within a matter of hours minimising
replaceable parts. The entire instrument is Providing large-scale multimedia storage for all overall downtime. The unit’s small footprint and
autoclavable at 134°C. Its unique double- types of medical images and diagnostic results for light weight (345mm x 320mm x 320mm, 11
conus multi-connector also ensures a direct hospital groups, regional healthcare organisations kg) allows it to be easily moved to decontaminate
connection to all tubing systems. and national medical archives, the IMPAX Data areas where and when required.
Center solution consolidates the data from dispa-
imtmedical AG rate systems into a single point of storage to serve Anachem
Buchs, Switzerland the needs of the enterprise. A highly scalable and Luton, Bedford, UK
www.ihe-online.com & search 45180 fault tolerant DICOM archive system is designed www.ihe-online.com & search 45183
PRODUCT NEWS 33 – Issue N°1 – Feb/March 2009
System for delivery of NCPAP wall, making it an ideal solution for physicians
Continuous Positive Airway who wish to conserve space or place the instru-
Pressure (CPAP) is a treatment in a discreet location. Although it is a very
ment modality in which air is economical device, the system produces uro-
slightly pressurised and pro- flow charts of excellent quality as well as highly
vided to the patient through- accurate flow rate and volume measurements.
out the breathing cycle.
CPAP is necessary for infants Life-Tech, Inc.
with a number of respira- Stafford, TX, USA
tory conditions, as well as for www.ihe-online.com & search 45171
very low birth weight infants
(VLBWIs). It is widely used in
neonatology as an alternative Online hospital management system
to intubation and mechani- and patient records system
cal ventilation. Nasal CPAP
(NCPAP) is administered
through the nose.
The nCPAP 200 is an effec-
tive solution for the delivery
of NCPAP to infants. This system provides air
through soft nasal prongs. Alternatively, physi- www.ihe-online.com & search 45139
cians may opt for using a mask. The pressure,
flow rate and oxygen concentration of the air
delivered to the baby can be controlled accu-
rately using the instrument. Apnea monitoring A fully integrated online hospital management
can also be carried out using this system. Fea- system, which improves the day to day running
turing a large, clear display and superior tech- of hospitals and the way patient information is
nology, the system has no moving parts. The stored and accessed, is now available. A revolu-
controls are easy to use and the system is very tionary online medical records service, which
compact and operates quietly. allows patients to access their own medical
As always, Phoenix has designed the system records, dating back from the day they were
with the utmost safety of the infant in mind, born, is also available. Both systems, namely
and reliable alarms have been provided. Medsystem Online (designed for healthcare
professionals to run healthcare institutes) and
Phoenix Medical Systems Pvt. Ltd. Medrecord Online (the online health record
Tamil Nadu, India designed for patients) work seamlessly together,
www.ihe-online.com & search 45170 offering a valuable online service and a unique
way of accessing data.
Medsystems Online runs the functions of a
Compact, economical uroflowmeter hospital, including patient appointments,
Enabling the non- shift patterns, patient’s results such as blood
invasive screen- tests, fully integrated PACS (X-rays, scans
ing for urinary ultrasound), bed admissions, referrals to
obstruction by specialists and also telemedicine. The built-
measuring urine in referral system and messaging means that
flow over time, there is no chance of losing data; confidential-
the Microflo II is a ity is carefully respected. Medrecord Online is
compact and eco- an online health record system, which stores
nomical uroflow- people’s medical history, allowing individuals
meter. Uroflow- to access and control their own health records.
metry is widely Each person carries a Medcard; this is a ‘dumb
carried out by card’ allocated to a person, which has a unique
urologists, urogy- number on it as well as a bar code on the back.
naecologists, gynaecologists, rehabilitation No data are stored on the card so any loss of www.ihe-online.com & search 44933
specialists and general physicians. the card is without consequence. The system is
This uroflowmeter offers exceptional value cheap to replace, easy to use and offers 100%
without sacrificing speed, accuracy or dura- data protection and security. All users have
bility. With one button push, the instrument to do is log-in and access the information for
automatically calculates and reports all stand- which they are looking. Both systems use the
ard clinical uroflow measurements. It performs latest cutting edge technology.
the complete test and print-out in less than HAVE YOU RENEWED YOUR
two minutes. An auto-scaling feature optimises Meddserve Limited FREE SUBSCRIPTION ?
the appearance and readability of the printed Brentwood, Essex, UK
record. The instrument can be mounted on the www.ihe-online.com & search 45172
www.ihe-online.com
34 show preview
Telemedicine: Delivering the Evidence Calendar of events

seminar brings together representatives from March 24-27, 2009 June 8-10, 2009
all major hospitals and other industry stake- ISICEM - 29th International UKRC 2009
holders in Luxembourg as well as various Bel- Symposium on Intensive Care and Manchester, UK
gian healthcare institutions, and presents busi- Emergency Medicine Tel. +44 20 7307 1410
Brussels, Belgium Fax +44 20 7307 1414
ness cases from a number of industry leaders Tel. +32 2 55 3631 e-mail: conference@ukrc.org.uk
The 7th annual Med-e-Tel conference in Lux- and their clients who draw from successful Fax +32 2 555 4555 www.ukrc.org.uk
embourg, which will be held from 1st - 3rd experiences. This year, the seminar will reflect e-mail: sympicu@ulb.ac.be
www.intensive.org June 23 - 27, 2009
April, will focus on proven and tested telemed- upon the short and medium term IT priori-
CARS 2009
icine applications and provide evidence on ties and on making optimal choices for each April 1-3, 2009 Berlin, Germany
clinical effectiveness and economic efficiency individual hospital, each department and the 13th SE Asian Healthcare & Tel. +49 7742 922 434
as well as on user aspects and satisfaction, healthcare system as a whole; the seminar will Pharma Show 2009 Fax +49 7742 922 438
Kuala Lumpur, Malaysia e-mail: office@cars-int.org
and on some do’s and don’ts of telemedicine feature some of the most interesting experi-
Tel. +45 62 21 79 12 www.cars-int.org
implementation in care processes. ences in the region and beyond, and show the Fax +45 62 20 23 37
The European Health Telematics Association benefits, as well as the conditions for success e-mail: bhullar@abcex.com June 24-26, 2009
(EHTEL) will be among the contributors to and the difficulties and resistance that can be www.abcex.com TopClinica - Medical equipment
and solutions
the opening session of this year’s Med-e-Tel met during implementation.
April 1-3, 2009 Stuttgart, Germany
conference programme, which will feature Another important feature will be a work- Med-e-Tel Tel. +49 711 18560 2312
additional contributions from the Interna- shop by the European NETC@RDS project, The International eHealth, Fax +49 711 18560 2275
tional Society for Telemedicine & eHealth, the which will focus on the deployment of an telemedicine and Health e-mail: ulrike.hetzel@messe-stuttgart.de
ICT Forum www.topclinica.de
Russian Telemedicine Association, the Euro- online service for the electronic European Luxembourg
pean Commission, the International Telecom- Health Insurance Card (eEHIC). NETC@ Tel. +32 2 269 84 56 September 16 -18, 2009
munication Union and several others that will RDS’ long-term initiative is to improve access Fax +32 2 269 79 53 Medical Fair Thailand 2009
provide insights into current initiatives and to the healthcare systems in different regions. e-mail: info@medetel.lu Bangkok, Thailand
www.medetel.lu Tel. +65 6332 9620
future directions in telemedicine and ehealth. Currently the project already has installations Fax +65 6332 9655 / 6337 4633
Furthermore, Med-e-Tel 2009 will feature a in 16 European countries. April 18-21, 2009 e-mail:
workshop by the Telenursing Working Group, The programme will also include sessions on CMEF Spring 2009 medicalfair-thailand@mda.com.sg
China International Medical www.medicalfair-thailand.com
initiated at last year’s Med-e-Tel, which has disease management, services for the ageing,
Equipment Fair
been set up within the framework of the Inter- teleconsultation, nursing informatics, open Shenzhen, China October 1-3, 2009
national Society for Telemedicine & eHealth source software, ehealth in developing coun- Tel. +86 10 6202 8899 ESMRMB 2009
(ISfTeH). The goal of the group is to bring tel- tries, elearning, mobile solutions, ehealth in Fax +86 10 8202 2922 Antalya, Turkey
e-mail: Tel: +43 1 535 13 06
enursing experience to nurses worldwide and primary care, environmental conditions and
yiqi.fan@reedsinopharm.com Fax +43 1 535 70 41
enhance networking with key industry stake- telehealth, economic efficiency and national http://en.cmef.com.cn e-mail: office@esmrmb.org
holders, by organising sessions and meetings ehealth programs and initiatives. Overall, www.esmrmb.org
at existing events like Med-e-Tel. Med-e-Tel promotes and enhances coopera- April 18-24, 2009
ISMRM 17th Scientific Meeting October 11-14, 2009
A regional (BeLux) hospital administrator tion opportunities and is the place to meet
& Exhibition International ESICM 2009
seminar, endorsed by the Luxembourg Minis- and network with some 600 healthcare and Society for Magnetic Resonance 22nd Annual Congress of the
try of Health and CRP-Santé (Public Research industry stakeholders from more than 45 in Medicine European Society of Intensive
Centre for Health), will focus on “priorities, countries in Europe and beyond. Honolulu, Hawaii Care Medicine
www.ismrm.org/09 Vienna, Austria
benefits and budgets for health IT in the 21st More information is available at Tel. +32 2 559 03 55
century.” A recurring feature at Med-e-Tel, this www.medetel.eu or via info@medetel.eu. June 2-5, 2009 Fax +32 2 527 00 62
Hospitalar 2009 e-mail: Vienna2009@esicm.org
São Paulo, Brazil www.esicm.org
www.hospitalar.com/ingles
October 19-22, 2009
June 3-6, 2009 Jordan International MedExpo 2009
EFORT Congress 2009 Amman, Jordan
Milan, Italy Vienna, Austria www.me-medexpo.com
2009
Tel. +41 44 448 4400
Euroanaesthesia
The European Anaesthesiology Congress
Fax +41 44 448 4411
e-mail: event@efort.org
www.efort.org
November 18-21, 2009
MEDICA 2009
Düsseldorf, Germany
June 6-9 e-mail: info@medica.de
June 6-9, 2009 www.medica.de
Euroanaesthesia 2009
Milan, Italy November 29 –
Tel. +32 2 743 3290 December 4, 2009
Fax +32 2 743 3298 RSNA 2009
e-mail: registration@euroanesthesia.org Chicago, IL, USA
www.euroanesthesia.org http://rsna2009.rsna.org
Symposia
Refresher Courses For more events see www.ihe-online.com/events/
Workshops
Industrial Symposia & Exhibition Dates and descriptions of future
Abstract Presentations Deadline abstracts: ESA Secretariat events have been obtained from
December 15th 2008 Phone +32 (0)2 743 32 90 usually reliable official
CME Accreditation Online submission: Fax +32 (0)2 743 32 98 industrial sources. IHE cannot be held responsible
EACCME - UEMS www.euroanesthesia.org E-mail: registration@euroanesthesia.org for errors, changes or cancellations.

What is the next dimension
in ultrasound?
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expand clinical insight.
The ACUSON S2000™ ultrasound system isn't just a step up, it's a giant leap forward. The first in Siemens next
generation ultrasound, the ACUSON S2000 system uniquely masters acoustics to expand clinical utility in ways
never before possible. Delivering unprecedented image quality, built-in knowledge-based workflow and precision
ergonomics, the ACUSON S2000 system is the future of the ultrasound. Now. www.siemens.com/ultrasound
Answers for life.

A91310-8273-A1-4A00 © 03.2009, Siemens Medical Solutions USA, Inc.

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Volume 35 Issue 1

IHE February-March 2009

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MEDICAL IMAGING SPECIAL

Also in this issue:

Hospital medical emergency teams: pros and cons

Real-time UltraSound Portable Compact yet

The Magazine for Healthcare decision Makers

Lessons from the Hudson hero?

evaluate the few alternative options

Hudson river. The fact that all this

[12] Evaluation of a wireless DR detector Circulation Controlled by Business of

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Hospital medical emergency teams: pros and cons

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The innovative system features the world’s

Lowering the radiation dose with

By Thomas T. Spees Figure 2. Larger patients inherently create more

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Optical brain imaging decodes preference

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[12] Evaluation of a wireless DR detector Circulation Controlled by Business of