MedicalExpo e-Magazine - #12 – Imaging’s New HorizonsMedicalExpo e-Magazine

The Smart Magazine About Medical Technology Innovations

Imaging’s New Horizons




Ongoing improvement in imaging techniques is considered perfectly normal. However, a complete overhaul of those techniques is more surprising. This issue is about the big changes in the works. On the one hand, there are key improvements like breast tomosynthesis, a technology aimed at taming the fears surrounding 2D mammography.

 

And on the other, we have smarter equipment, as seen at RSNA. Not only is imaging becoming more and more portable, it’s also acquiring intelligence. It is now able to screen results for physicians.

 
Oh, by the way…be careful with imaging systems. We interviewed TrapX about how malware and other hacking tools have infected numerous medical devices in hospitals. Among them was a PACS. The bad guys are after medical data, and that’s not good news.

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Analyzing images quickly, identifying which may be normal or abnormal, and triaging the images in the work flow
The Vitrea Advanced Visualization Vessel Probe tool (Photo: Vital Images)

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In today’s world, imaging has become highly sophisticated. The use of imaging intelligence is changing the way radiologists look at scans by providing a wealth of information beyond what meets the eye, paving the way toward better diagnosis by processing a wealth of data faster and more efficiently than ever.

 

“At the end of the day, making a diagnosis requires knowledge of patterns or disease processes,” said Jonathan Goldin, professor of radiology at the University of California, Santa Monica.

“And what we can do now is have an image, have the computer look at the image with us, and go into big data sets and recognize patterns that have looked like that in vast numbers of other cases, so improving our accuracy of diagnosis.”

UCLA Medical Center in Santa Monica uses standard acquisition technologies but adds its own algorithms to analyze images quickly, identifying which may be normal or abnormal, and triaging the images in the work flow, he said.

Intelligent Imaging Suites

Elsewhere, intelligent imaging suites are becoming commonly used in breast MRI, for screening the lung disease COPD, and even for creating 3D and 4D images of organs like the heart prior to surgery.

ME12_toshibaSome leading medical manufacturers in this arena include Vital — a division of Toshiba — which sells its Vitrea Advanced visualization software to enable visualization and analysis of 2D, 3D and 4D images of CT, MRI, PET scans and ultrasound data “contribute to fast, confident analysis and improved patient outcomes,” according to its website.

A second product, VitreaView Universal Viewer “provides images, reports and other key radiologic data across the medical enterprise, supporting a longitudinal and holistic view of the patient’s care record and helping care teams formulate and monitor treatment plans.”

Among Hitachi’s offerings are the Hitachi Content Platform, which offers data storage and management solutions to help deal with a growing volume of unstructured data. The platform works in concert with Pixcelldata Collibio, a web application that helps manage, store, protect and retrieve digitalized pathology images and data.

Displaying up to Eight Image Series

Siemens seeks to address the problem of managing an increasingly large and diverse number of images — and integrating treatment planning — with its syngo.via RT Image Suite.

By allowing the concurrent display of up to eight image series on up to two monitors,  the system provides radiation oncologists “with a clear and comprehensive view of their patients, clinicians are empowered with a solution that results in easier and more intuitive clinical decision-making,” it said on its web site.

In September, Royal Philips received US Food and Drug Administration (FDA) clearance for its Spectral Diagnostic Suite (SpDS), a set of advanced visualization and analysis tools designed for the Philips IQon Spectral CT.

SpDS promises “a new level of flexibility and clinical information for CT users.” A key feature is capturing spectral information in each scan, without planning or set-up in advance, so that clinicians can spare the patient from returning for another scan and “analyze the spectral data in any image retrospectively, using a variety of spectral viewing tools”. The goal is to  “achieve better clinical decision support without any added complexity of special modes or workstations that disrupt user workflow.”

The package includes enhanced cardiac analysis, vessel analysis and tumor tracking.

 

Next Step: Artificial Intelligence

While Goldin declined to comment specifically on any of the latest technologies on offer, he said the promise of the field as a whole is to use artificial intelligence to complement human abilities.

“What they lack at the moment is full intelligence, but what they can do better than a human is they can do repetitive tasks, without fatiguing, they will always do the same thing each time, they are very reproducible and they can quantitate a lot better,” said Goldin.

The art side of medicine — the ability to bring together a wealth of other knowledge bases — is something only doctors can do, he said.

“I think we are on the upslope now of a major transformation of the way imaging is handled,” said Goldin.

“We are going to move away from the fact that a picture represented patterns that perceptually we could classify as being likely to be a type of disease, to automating those processes so that many more images can be processed in a more efficient way.”


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    Even if measuring blood pressure is one of the most common examinations, most physicians do not know how medicine achieved the capability to determine exactly what is happening inside our veins. Like most other modern medical technologies, devices for blood pressure measurement depend on the research of doctors from numerous countries that lived centuries ago.

    The knowledge about the fact that blood circulates in our body, recorded in 1628 by English physician William Harvey, can be considered as a basis for the following findings on blood pressure measurement. Almost 100 years later, in 1713, Stephen Hales conducted the first – rather bloody and deathly – blood pressure measurement: He inserted a long glass tube into a strapped horse’s artery to observe the rising level of blood inside the tube. He published about this invasive catheterisation method in 1733.

    ME12_korotkoff

    The Russian doctor Nikolai Korotkoff

    Finally, in the 19th century, with the auscultatory and oscillometric method, techniques were introduced to determine blood pressure more sustainably: German physiologist Karl von Vierordt, Austrian Pathologist Karl Ritter von Basch and French physician and inventor Etienne-Jules Marey developed different types of the sphygmograph (meaning “pulse writer”). This apparatus, attached to the patient’s wrist, could document the pulse graphically and determine the blood pressure as graphic amplitudes.

    Introducing the Rubber Cuff

    “However, the determination of the absolute blood pressure was not yet feasible”, explains Dr. Siegfried Eckert, head of angiology department at the Clinic for Cardiology in Bad Oeynhausen, Germany. He told Medical Expo in an interview that “the next milestone for the development of blood pressure measurement was the introduction of rubber in Europe.”

    The Italian internist Scipione Riva-Rocci invented a cuff around the upper arm made of this rubber material in 1896. By inflating it, he interrupted the blood stream so that the pressure – palpable at the pulse – disappeared. When deflating the cuff, he determined the blood pressure in the moment when blood started flowing and becoming palpable again. But it was only the systolic blood pressure. The diastolic value was still not measurable.

    “Due to Russian doctor Nikolai Korotkoff we can today also determine diastolic blood pressure”, says Dr. Eckert. In 1905 Korotkoff combined the compression of the brachial artery according to Riva-Rocci with listening to the swirling sounds of the blood with a stethoscope (auscultative method). His famous ‘Korotkoff sounds’ blazed, together with the findings of his ancient colleagues, the trail to modern blood pressure measurement.


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    Videogaming consoles with motion sensors, such as Microsoft Kinect or Nintendo Wii U, have been used for quite some time to improve patient activity. Now, the FDA clearance accorded Reflexion Health marks a turning point in serious medical gaming.

    Their Vera solution differs from others in its feedback feature. Not only are patients asked to practice rehabilitation exercises using Microsoft Kinect technology, but they are monitored, as well. Like a video game recording successful dance moves or enemies avoided, Vera records patient movements, tracking adherence to the plan set up by the physician.
    Doctors can customize treatment and rehabilitation exercises in Vera, adapting them to specific musculoskeletal problems. By fine tuning a program and getting to know how good patients are at applying it, Vera could improve the quality of home care for seniors or patients recovering from operations such as joint replacement surgery.


    CONTRIBUTORS



    Celia Sampol

    Celia Sampol has been a journalist for 15 years. She worked in Brussels and Washington for national medias (Agence France Presse, Liberation). She’s now the editor-in-chief of MedicalExpo e-magazine.


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    Ludovic Nachury

    Ludovic Nachury has been innovation enthusiast for more than 10 years.


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    Kristina Müller

    Kristina Müller is a freelance journalist writing mainly about nautical and medical issues.


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    Kerry Sheridan

    Kerry Sheridan is an authors and health journalist based in Miami, Florida.


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