The Smart Magazine About Medical Technology Innovations
When Imaging Goes Hybrid
“The future of radiology is bright,” according to Katrine Åhlström Riklund, president of ECR 2016. Hybrid imaging, which combines two different imaging modalities, is a good example. This technology has been on the market for the past 15 years. But the development of new tracers and the growing use of big data have infused it with renewed promise. PET/MRI technology, still mostly used in research, could prove an added plus especially if it one day becomes available for clinical use.
Progress also has been made in reducing radiation exposure. Today’s new materials and techniques better protect physicians.
In this issue, you will also travel to Denmark to discover innovative, video-based projects for the home treatment of COPD patients and those suffering from liver failure, heart disease and psychiatric disorders.
Hybrid imaging was much in the news during recent major annual radiology events, such as RSNA and ECR. MedicalExpo talked with Dr. Katrine Åhlström Riklund, president of the European Congress of Radiology 2016 and professor of radiology and nuclear medicine at University Hospital of Umeå in Sweden about new trends in...
Using X-rays, computed tomography and magnetic resonance imaging, interventional radiologists and other clinicians can today carry out a number of minimally-invasive procedures that in the past would have required time-consuming and expensive surgery. However, this has also meant that more clinicians are potentially exposing themselves to high levels of radiation.
Cardiologists, cardiac surgeons and vascular surgeons are performing more and more percutaneous cardiac valve repairs and endovascular aortic repairs. In neuroradiology, the number of stroke treatments with thrombus aspiration is rapidly increasing and interventional therapy of liver metastasis with radionuclides is a new technique.
A small subgroup of doctors working with ionizing radiation may be exposed higher than before.
Currently, clinicians working in interventional fluoroscopy are exposed, on average, to around two millisieverts (mSv) of radiation every year – well below the recommended annual maximum of 20 mSv. If clinicians take the recommended precautions, they should stay well below these limits, he added.
Nevertheless there are sometimes unshielded parts of the body which may receive significant exposure, like hands and fingers, brain, eye-lens and thyroid gland, if protective devices are not or not always correctly used.
A discussion has started about whether interventional radiologists are developing a higher rate of brain tumours.
There are 10 ways clinicians can reduce their exposure to radiation, Prof Loose said. These include limiting the length of time of exposure; reducing the dose as much as possible; maintaining distance from the source of radiation; and shielding with the use of aprons, thyroid shields, glasses and gloves.
Lead has been the traditional material for shielding but companies such as Wolfxray and Xenolite are beginning to use alternatives as lead is toxic, heavy and cannot be disposed of in landfill. Lighter weight materials include composites of tin, rubber, PVC, antimony, tungsten, bismuth or other elements. Thenew materials tend to be more expensive and a middle option, produced by Xenolite for example, is a composite of lead and other materials.
A Protective Lead Cabin with Holes for the Arms
Courtesy of Lemer-Pax
Pierre-Marie Lemer, chief executive of Lemer-Pax, a French company making protective radiological equipment for the healthcare, aviation and nuclear industries, has been working on alternatives to lead for the last 20 years.
Hospitals are still using lead because it is the cheapest metal. However, they don’t think of the total life cycle of the product. Our products are more expensive at the beginning but in the long run they will save a hospital money.
He explained that his company’s protective aprons are 35% lighter than an equivalent lead product. “Our products are much better for the people wearing them as they won’t be straining their shoulders or working so hard.”
Another solution produced by Lemer-Pax is a protective lead cabin with holes for the clinician’s arms. This avoids the need for heavy protective clothing – just a pair of gloves – but may not be the easiest equipment for carrying out delicate procedures.
Dosimeters That Track the Amount of Radiation
Other more technological products include dosimeters that track the amount of radiationboth patients and clinicians have been exposed to. Guidelines produced by the Joint Commission in the US, which came into effect last year, had a suite of recommendations, including that healthcare providers monitor radiation doses received by patients and staff.
Courtesy of Philips
Phillips DoseWise system includes the DoseAware personal dosimeter which gives staff immediate feedback on how much radiation both they and their patients have been exposed to and how their behaviour has affected it. Dominic Siewko, radiation health and safety officer at Phillips, said the product should be used with the normal protective equipment such as aprons, shields and gloves.
“The Joint Commission is asking HCPs to track and analyze patient dose with the intent to identify trends and opportunities to lower dose. Providers realise they need software to help them [monitor the dose] automatically. While this could be done manually it would be very time consuming,” he explained.
The Center for Innovative Medical Technology (CIMT) at Odense University Hospital (OUH) in Denmark is developing innovative technologies to improve patient care and clinical work flows. Claus Duedal Pedersen, Chief Consultant at the OUH innovation unit, talked about a video-based project to treat COPD patients at...
The use of augmented reality could change the world of healthcare and plastic surgery. ILLUSIO is a California-based company which is using this cutting-edge technology to offer for the very first time patients an accurate, real-time 3D picture of how they will look after reconstructive or cosmetic breast surgery.
To produce these images, the surgeon only needs the ILLUSIO augmented reality software, an iPad or Android tablet and a special black band that covers the patient’s breasts.
“That black band has a marker on the front of it, and the die on that marker is what is recognized by the camera on the iPad. That enables the software to lay a virtual breast image on the patient and the image stays on the patient,” explained Ethan Winner, CEO and co-founder of ILLUSIO, in an interview with MedicalExpo e-magazine. The iPad works like a virtual mirror. “You can go closer to the patient or further away and the breast model stays in correct proportions to the body.”
Helping Patients Overcome Fear of Surgery
Dr. Kyle Song, another company co-founder and its Chief Medical Officer, has already used this technology on a hundred patients. The ILLUSIO team started offering access to the software in January for about $500 a month. It quickly became extremely popular. ILLUSIO has been contacted by surgeons and distributors from all over the world. Even the Stanford University School of Medicine has shown interest. Dr. Song told MedicalExpo:
Courtesy of ILLUSIO
This technology answers the need for patients undergoing breast surgery to really feel comfortable with their decision. It helps them develop trust in their surgeon and really takes away a lot of fear about the unknowns of surgery.
According to him, breast augmentation is now the most popular cosmetic procedure in the United States, with almost 300,000 surgeries a year.
“A woman’s breasts are such a part of her feminine identity that there is always a lot of anxiety and fear that goes along with the surgery. There hasn’t been any great imaging or projection software that can show a woman what she is going to look like after surgery. And especially none that does it in real time,” Dr. Song said.
A Powerful Communications Tool
Each surgeon has a different technique for breast augmentation. To Dr. Song, the beauty of this software is that there are no algorithms or measurements to enter into the system. It is done “entirely artistically.” Each surgeon creates a rendering of what the desired or anticipated result will be based on his or her experience and on the patient’s breast anatomy, body type, skin type and similar factors.
ILLUSIO creates a visual bridge between the surgeon and the patient.
“It has become such an effective tool for communication and has so increased the number of surgeries I’ve done, that I use this for every single breast surgery patient that I see,” explained Dr. Song
Women are also able to download a patient version of the software to recreate their experience in the doctor’s office at home, where they feel more comfortable. Later this year, the ILLUSIO team wants to extend the technology to abdominal procedures and eventually to facial features, like nose reconstruction. It also can be used for reconstructive surgery, such as after an accident.
“It creates a visual bridge between the surgeon and the patient. There is an enormous futurefor augmented reality,” stated Winner.
The Digital Imaging Adoption Model was presented during the European Congress of Radiology in Vienna in early March. Developed by HIMSS Analytics and the European Society of Radiology, it aims at assessing hospital imaging departments in terms of IT capabilities in order to identify best practices and push the market. MedicalExpo met with Jörg Studzinski, Senior Consultant at HIMSS Europe.
MedicalExpo e-magazine: How does DIAM work?
Jörg Studzinski: We have developed a kind of model or roadmap that imaging departments can use in order to know how they can progress over time in terms of IT capabilities. It goes from stage 0 to stage 7. Stage 0 means that they have relatively low capabilities in terms of IT support for imaging. Stage 7 would be the highest stage, with very advanced use of information technologies, population health management, big data, etc.
For that model, we created a survey and checklists that we send out to hospitals and external imaging centers for free. We use their responses to calculate a score showing where they are in the model, to identify what kind of gaps they might have and help them improve. As a neutral organization, the only recommendations we make is how to close the gaps or what actions they need to take in order to reach higher stages in the model.
We have developed a kind of model or roadmap that imaging departments can use in order to know how they can progress over time in terms of IT capabilities.
ME e-magazine: What kinds of questions do you ask in this survey?
Jörg Studzinski: There are 10 focus areasthat we assess. We ask about software infrastructure that is available within the organization. Do they have a radiology information system and is it integrated into the electronic medical records of the hospital? Do they have an image management solution like a PACS (picture archiving and communications system) or archives? Do they use speech recognition?
There is also a section about health information exchange. With which external organizations do they exchange imaging studies? What is the geographic scope of external data exchange activities? What kind of technology do they use for external data exchange? There is also a section about workflow and process security, and one on data mining.
ME e-magazine: What is the purpose of DIAM?
Jörg Studzinski: To make organizations aware of potential workflow or infrastructure gaps so they can create a better strategy for the future. We also want to identify best practices. If we find organizations at the higher stages of the model, we would like to make the public aware of them, to show how they achieved this level and how others can learn from them.
Last but not least, we also want to push the market so that the industry is delivering the right products and to help organizations request leading technologies and capabilities from their vendors.
ME e-magazine: How did you come up with this idea?
We created a survey and checklists that we send out to hospitals and external imaging centers for free. We use their responses to calculate a score.
Jörg Studzinski: HIMSS Analytics has a similar model for electronic medical records in hospitals that has been used for 10 years. We have rated over 9,000 hospitals already with that model. The ESR was aware of it and thought it might be good to have a similar model for imaging departments. So they asked us if we could create it.
ME e-magazine: Is the model only for radiology departments?
Jörg Studzinski: Since we collaborate with the ESR, we wanted our first survey to assess only radiology departments. Next, we want to roll out a model for other imaging departments. We’ll need to make some changes to the survey so it will be suitable for cardiology, oncology, dermatology or other areas. The goal is to be able to assess an entire hospital with that model. For example, we would assess the three major imaging services in the hospital and create a composite, a sort of average of the three. This would give us a score for the organization as a whole.
Researchers from McGill University in Canada have managed to take a series of 3D images of a megaenzyme in action, as reported in a study recently published in Nature. Those important proteins play an active role in producing many common antibiotics, including penicillin and cyclosporin.
Since these molecules are very small and are in constant motion, it is very hard to take clear pictures of them. Researchers used chemical traps to capture the protein in the desired position. They then used a technique called X-ray crystallography to take a series of 3D pictures of a little piece of this crucial drug-synthesizing protein in action.
Put in the context of a larger piece of the protein, these 3D images can help scientists understand how many antibiotics are produced. Eventually, this could lead to the development of improved next-generation antibiotics, according to the McGill scientists. It could also have positive implications for a worldwide crisis that is threatening public health: antibiotic resistance.