Bill Lacy, vice president, Medical Informatics at FUJIFILM Medical Systems U.S.A., Inc. discusses Synapse 7x, a convergence of the company’s server-side technology designed to cover all the different areas of diagnostic visualization, as well as overall enterprise viewing, with ITN Consulting Editor Greg Freiherr. Demo Synapse 7x at HIMSS 2020 booth #4559.
EIZO medical monitors were showcased recently at RSNA 2019. Learn how the EIZO approach streamlines the effectiveness of your readings. From the NEW 30.9 inch, super-high-resolution, 12 megapixel multi-modality Radiforce RX1270, to the EIZO built-in features such as Point-and-Focus, EIZO holds to the ideal to harmoniously combine performance, ease-of-use and comfort. Learn the Shape of Comfort with EIZO. Stop by and visit with us at HIMSS, booth #4087.
At RSNA19, GE Healthcare introduced its Edison Open AI Orchestrator. The software has been designed to operate smart algorithms that might save radiologists time. ITN Contributing Editor Greg Freiherr discusses its benefits with Karley Yoder, vice president and general manager of artificial intelligence for GE.
Related GE Edison Platform Content:
ProFound AI is an FDA-cleared artificial intelligence (AI) system for reading 3-D breast tomosynthesis images. At RSNA19, ITN Contributing Editor Greg Freiherr spoke with iCad Chairman and CEO Michael Klein about the system, which has been clinically proven in a large reader study to produce an 8% average improvement in sensitivity, 7.2% average reduction in recall rate and 52.7% reduction in average radiologist reading time.
Imaging Technology News Contributing Editor Greg Freiherr interviewed Henry Izawa, vice president of modality solutions, Fujifilm Medical Systems U.S.A., Inc. about Fujifilm's latest innovations in mammography.
In this video, Izawa announces the latest imaging advancements available for the Aspire Cristalle digital mammography system with digital breast tomosynthesis, including S-View, a synthesized 2-D image reconstructed from DBT and other patient enhancements such as the comfort paddle to provide a noticeably more comfortable exam for the patient.
Watch the video to hear all about Fujifilm's updates.
To learn more, visit www.fujimed.com
GE Healthcare's iCenter is a cloud-based management software that provides 24/7 visibility to customers' visual and operational data. In this Conversations video, Contributing Editor Greg Freiherr discusses iCenter with GE and Microsoft Executives at RSNA 2019.
ITN Editor Dave Fornell takes a tour of some of the most innovative new medical imaging technologies displayed on the expo floor at the Radiological Society of North America (RSNA) 2019 meeting.
Technology examples include a robotic arm to perform remote ultrasound exams, integration of artificial intelligence (AI) to speed or automate radiology workflow, holographic medical imaging display screens, a new glassless digital radiography (DR) X-ray detector, augmented reality for transesophageal echo (TEE) training, moving DR X-ray images, 3-D printed surgical implants created from a patient's CT imaging, DR X-ray tomosynthesis datasets, radiation dose management and analytics software, and new computed tomography (CT) technologies.
Elizabeth M. Hecht, M.D., professor of radiology, Columbia University, New York, explains the latest advances to help visualize the difficult to image pancreas. She was a moderator of a session on pancreatic imaging advances at the 2019 Radiological Society of North America (RSNA) meeting.
She explained computed tomography is the front line imaging modality, followed by MRI for more detailed examination of the soft tissue details. MRI tissue elastography can also help to differentiate pancreatitis from pancreatic cancer. Hecht also said PET-CT and endoscopic ultrasound also play roles in pancreatic imaging. She said new software is helping automate measurements and artificial intelligence (AI) is in development to help improve pancreatic imaging and to find new radiomic markers that might be missed by the human eye to better detect disease or risk stratify patients.
Karen Ordovas, M.D., MAS, professor of radiology and cardiology at the University of California San Francisco (UCFS) School of Medicine and a Society of Cardiac Magnetic Resonance (SCMR) board member, explains how cardiac MRI can help in women's heart disease and to better define complex congenital heart anatomy. She spoke at the 2019 Radiological Society of North America (RSNA) meeting.
She specializes in cardiac and pulmonary imaging, and has particular expertise in using CT and MRI techniques in cardiovascular imaging and the differences of presentation in imaging between male and female cardiac patients. Ordovas is helping advance education around heart disease in women and bring great awareness of quality tools to diagnose heart disease and how heart MRI can help. She also is heavily involved in the use of heart MRIs for pregnant women, since there is no radiation, and patients with congenital heart disease where detailed imaging of the complex anatomy is required.
The use of cardiac MRI in congenital heart disease is common in serial imaging of patients with Tetralogy of Fallot (TOF), one of the most common congenital heart diseases for which patients are referred for post-operative magnetic resonance (MR) imaging evaluation. In the past few decades, surgery has proved successful, but most patients require repeat imaging throughout their lives and MRI can offer more detailed soft tissue imaging without the use of radiation.
Related Cardiac MRI Content:
VIDEO: Advances in Cardiac MRI Technology — Interview with James Carr, M.D.
An experienced technologist and two Agfa executives talk about what distinguishes the new Agfa 100s. Three key highlights include the quality of images that users can get out of the system for the certainty of the diagnostic; more flexibility that has been designed around the user; and its revolutionary platform.
The Arietta 850SE provides facilities with numerous features and functionality to get the most out of a system. The CMUT probe performs the role of multiple probes while the single-crystal C252 probe gets increased penetration. eFocusing simplifies scanning techniques and shearwave elastography provides unique feedback on tissue stiffness.
Hitachi announced the FDA clearance of its newest CT – Scenaria View – at RSNA2019. The View offers an 80 cm wide bore, 550 lb table capacity and powerful 84 kW generator as well as a 200 mm lateral shifting table. Installs in Georgia, Ohio and Florida are underway with more to come in the new year.
At RSNA19, David Widmann, president and CEO of Konica Minolta Healthcare Americas, discussed innovation, stressing the importance of academic relationships.
In this Conversations video at AHRA, Ryan K. Lee, M.D., describes the harm extravasation can do and why using power injectors to administer saline beforehand increases patient safety based on his experiences at the Einstein Healthcare Network.
Ajay Choudhri, M.D., chairman of radiology, Capital Health, Hopewell, N.J., explains his center's experience using an artificial intelligence (AI) application to help auto detect intracranial hemorrhage. There are several AI stroke auto detection apps now available with FDA clearance or in development that were shown at the Radiological Society Of North America (RSNA) 2019 meeting. These are being adopted by hospitals and multi-center radiology practices the U.S. to flag suspected cases of ischemic stroke or brain bleeds for immediate reads.
The software also offers a second set of eyes for more difficult to detect cases. Quickly determining is a stroke is ischemic or hemorrhagic is critical to the path of treatment. If caught early enough, TPA can be injected into patients to clear clots causing an ischemic stroke, but can cause massive brain damage or death if injected into a patient with a brain bleed. At advanced neuro-interventional centers, quickly determining the type of stroke is needed to know if they need to revascularize a patient or manage a hemorrhage.
This is a demo of the EOS orthopedic X-ray imaging system at the recent 2019 Radiological Society of North America (RSNA) meeting. The system allows for weight bearing exams. EOS Imaging System the first technology capable of providing full-body, 2-D and 3-D images of pediatric patients in a standing position at a low dose of radiation. The vendor said the scans are much lower dose than computed tomography (CT).
EOS captures bi-planar images with two perpendicular X-ray beams that travel vertically while scanning the patient from head to toe. In less than 20 seconds, the EOS exam produces simultaneous frontal and lateral, low dose images. The two resulting digital images are processed by EOS' proprietary sterEOS software to generate a 3-D model of the patient's spine and/or lower limbs. These detailed images with only 20 seconds of radiation were previously unachievable before EOS technology.
This is a hologram of a fracture from a computed tomography (CT) scan displayed by the start up company Voxon at the 2019 Radiological Society Of North America (RSNA) meeting. The technology uses a half millimeter thick glass plate that pulses up and down very rapidly while projecting 4,000 images per second. It can display standard DICOM radiology files or STL files used for 3-D printing.
There were at least four vendors showing holographic screens to display advanced visualization 3-D renderings of anatomy from medical imaging. All four of these screens could be viewed in true 3-D using normal vision without the need for special glasses or a virtual reality visor.
The images in this example flickers because of the different frame rates of the system and the iPhone used to film it, but the actual images appears much more stable.
This technology was also included in the VIDEO: Editors Choice of the Most Innovative New Radiology Technology at RSNA 2019
Gillian Newstead, M.D., director of global breast imaging and former professor at the University of Chicago, explains a large breast MRI screening study presented at the 2019 Radiological Society of North America (RSNA) meeting.
The DENSE Trial Study Group included 40,000 women from the Netherlands who underwent standard mammography. Of these, 8,061 women were identified as having dense breasts and were offered supplemental MRI screening, and about half took advantage of the additional screening. Dense breast tissue which can obscure cancer on conventional mammograms but not on MRI. The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1,000 screenings.
The use of supplemental magnetic resonance imaging (MRI) screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a two-year screening period. The results were published in the Nov. 28, 2019, issue of The New England Journal of Medicine and presented earlier at the European Congress of Radiology (ECR) 2019.
Kevin Little, Ph.D., assistant professor and medical physicist, Department of Radiology, at The Ohio State University, explains how hospitals can better manage their computed tomography (CT) imaging protocols across their fleet of CT scanners from various vendors. He moderated a session on this topic at the 2019 Radiological Society of North America (RSNA) meeting.
He stressed the importance of CT protocol management to an imaging practice and showed examples of tools that can be used to develop consistent protocols across multiple systems. Little said it is important to develop awareness of the Management of Acquisition Profiles (MAP) IHE profile and features that should be requested from CT scanner vendors.
CT protocols, which include all clinical and technical parameters for a given study, are the starting point for achieving high-quality images with reasonable radiation and contrast doses. An imaging practice that desires to follow the "as low as reasonably achievable” (ALARA) principle and produce high-quality images should have standardized protocols across their enterprise. Accreditation standards require a periodic review of all scanner protocols. However, variations among vendors, models, and clinical indications mean that managing and optimizing dozens of parameters for each protocol on every scanner in a health system is challenging. Even when variations between systems are limited, managing protocol names and parameters across multiple systems can be difficult. The purpose of this symposium is to identify tools and techniques that may be used to manage protocols across multiple systems and to provide a framework for protocol optimization.
James Carr, M.D., chair of the Department of Radiology, Northwestern University, and incoming 2020 President of the Society of Cardiac Magnetic Resonance (SCMR), explains why MRI is an ideal cardiac imaging modality, at the 2019 Radiological Society of North America (RSNA) meeting.
Heart MRI offers advantages over computed tomography (CT) and echocardiography because of its excellent soft tissue delineation and its ability to offer information beyond anatomical imaging, such as perfusion, morphology and metabolism. MRI can be technically challenging and the exams requiring a long time, but recent advances have helped cur cardiac imaging times down significantly. Automation and artificial intelligence (AI) also is making post-processing and quantification mush faster, brining it closer to the time it takes to scan and post-process CT imaging.
Northwestern is was one of the early adopters of cardiovascular MRI. Carr said heart MRI was not common in regular clinical use until the past decade at some luminary centers. In 2005, Carr was given the opportunity to develop a clinical cardiac MRI program at Northwestern.
He said MRI scanners have improved, and now much faster than a decade ago. They are also more optimized for cardiac imaging. While heart MRI is well known in large hospital centers, Carr said it still needs to develop and expand to community hospitals and rural hospitals outside major population centers.
Artificial intelligence is playing a significant role in cardiac MRI automation of speeding workflow and quantification. Carr said these technologies will become mainstream in the next few years. AI also will play an increasing role in risk prediction based on new image analysis algorithms in development.
For more information on cardiac MRI, visit SCMR's website www.heartmri.org.
Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, treasurer of the American Association of Physicists in Medicine (AAPM),a board member of the American College of Radiology (ACR), presented a late-breaking study on how medical imaging radiation dose has started to drop over the past decade. He is the co-chair of the National Council on Radiation Protection and Measures Report (NCRP), and presented the most recent NCRP data analysis at the 2019 Radiological Society of North America (RSNA) meeting.
The new NCRP 184 report covers the period between 2006 and 2016, the period of the most current CMS data. It shows a decrease of about 20 percent in the radiation dose the U.S. population receives from medical imaging, compared to the NCRP 160 that covered the period of up to 2006.
Key findings of the study include:
• CT dose dropped about 6 percent, despite a 20 percent increase CT scans since 2006;
• Drop of more than 50 percent for nuclear imaging scans, mainly due to fewer procedures being performed;
• A 15-20 percent decrease across X-ray imaging modalities.
Mahesh says this shows the impact of using "as low as reasonably achievable" (ALARA) principals, new dose guidelines outlined jointly by numerous medical societies, and dose reduction initiatives like Image Wisely, Image Gently, and the American College of Radiology (ACR) Dose Index Registry.
He said there was growing concern a decade ago when the last council report was published, which showed a steep increase in radiation dose. This was mainly due to a rapid increase in the use of computed tomography (CT) and other types of X-ray based and nuclear radiotracer medical imaging. This prompted the ACR to create the Image Wisely program and push for the use of more thoughtful imaging doses based on patient size, using the "as low as reasonably achievable” (ALARA) principle. While CT dose was lowered, he said the biggest decline over all was in nuclear imaging.
Related Medical Imaging Radiation Dose Resources:
VIDEO: Radiation Dose Monitoring in Medical Imaging — an interview with Mahadevappa Mahesh, Ph.D.
How to Understand and Communicate Radiation Risk — Image Wisely
This is an example of an augmented reality (AR) training system for transesophageal echo (TEE) created by the simulation company CAE. Rather than just looking at an overhead screen, this system allows the user to use a HoloLens visor to see the impact their probe manipulation has on the cardiac ultrasound imaging and better shows the orientation of the ultrasound probe, the 2-D ultrasound image slice and the relation to the anatomy. It was displayed at the 2019 Radiological Society Of North America (RSNA) meeting.
ITN Editor Dave Fornell and ITN Consulting Editor Greg Freiherr offer a post-game report on the trends and technologies they saw on the expo floor of 2019 Radiological Society of North America (RSNA) annual meeting. This includes artificial intelligence (AI), augmented reality, holographic imaging, cybersecurity and advances in digital radiography (DR) with a glassless detector plate, X-ray tomosynthesis, dual-energy X-ray and dynamic DR imaging.
Join Chris Toth, president of Varian’s Oncology Systems business, for a peek at the history of machine learning/AI in radiation oncology, plus other highlights in 2019:
- Ethos therapy: the world’s first AI-powered adaptive radiotherapy.
- Noona cloud-based application for capturing patient-reported outcomes.
- Varian’s multi-room configuration for ProBeam 360 proton therapy.
- The promise of FLASH, an ultra-high-speed treatment that is in pre-clinical testing, and represents an exciting and potentially promising new direction in the treatment of cancer.
Vieworks to present NEW DR detectors, VIVIX-S V series. This is a strategic model that will open up a new era of digital radiography. VIEW it now. You will know.
Modus QA is proud to offer a superior phantom for quantifying geometric distortion in modern MRgRT applications. Watch this video to discover how the entire QA process including set-up and data analysis can be completed in under 10 minutes.
David Sjostrom, Ph.D., deputy chief physicist, Herlev Hospital, Department of Oncology, Division of Radiotherapy, Herlev, Denmark, shares the first clinical experience treating cancer patients with the Varian Ethos radiation therapy system. He spoke to ITN at ASTRO 2019, where he presented information on the first 5 patients in the world being treated with this new technology. It uses artificial intelligence to take the onboard cone beam CT scans to automatically create an adaptive plan for any changes in patient weight loss, bladder volume, or change in tumor size. The plan can be available in minutes while the patient is on the table. It enables sparing of more healthy tissue and makes adaptive therapy much easier to use.
Lorraine Drapek, DNP, nurse practitioner, radiation oncology, GI service, Massachusetts General Hospital, explains the roles of advanced practice providers in radiation therapy. She spoke on this topic at ASTRO 2019 at a session that reviewed the integration of APPs into radiation oncology practice to enhance clinical care. This includes but is not limited to: on-treatment management, symptom and acute toxicity management during treatment, inpatient consultations, procedural assistance, treatment planning, follow-up, survivorship and research.
Kristin Higgins, M.D., medical director of radiation oncology, Emory Clinic at the Winship Cancer Institute, explains considerations when treating previous radiation oncology patients again at the same or other tumor sites. She spoke on this topic at the American Society for Radiation Oncology (ASTRO) 2019 annual meeting in Chicago.
Bill Hartsell, M.D., medical director of the Northwestern Medicine Proton Center in Warrenville, Ill., discusses the outcomes of a trial investigating the use of a hydrogel spacer to hold the rectum away from the prostate during radiation therapy treatments. The trial was presented at the 2019 American Society for Radiation Oncology (ASTRO) annual meeting.
Read the article "Latest Advances in Prostate Cancer Radiotherapy"
Candice Johnstone, M.D., MPH, Medical College of Wisconsin explains the need for palliative radiotherapy and patient selection considerations at the American Society for Radiation Oncology (ASTRO) 2019 annual meeting.
Despite improvements in the survival of some populations of cancer patients, some patients are not candidates for ablative therapy and need symptom relief. Cases will be used to highlight evidenced based approaches to palliative radiation therapy. A significant proportion of patients do not benefit from immunotherapy and need standard palliative radiation. The best palliative radiation utilizes the fewest number of fractions to achieve the desired effect, minimizes side effects of treatment and treatment related costs.
Clifford Robinson, M.D., associate professor of radiation oncology, chief of the SBRT (stereotactic body radiation therapy) service, director of clinical trials, Washington University, St. Louis, Washington University School of Medicine in St. Louis, explains the longer term results of cardiac radiotherapy ablation to treat ventricular tachycardia.
The results of the ENCORE-VT study were presented at ASTRO 2019.
Anne Hubbard, MBA, director of health policy for ASTRO, explains the details and purpose of the proposed Radiation Oncology Alternative Payment Model (RO Model) at the ASTRO 2019 meeting.
In July 2019, the Center for Medicare and Medicaid Innovation (CMMI) issued a proposed rule establishing the RO Model. It requires participation from about 40 percent of radiation oncology practices in a model that dramatically changes the way Medicare pays for radiation therapy services. The RO Model is designed to test whether prospective episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPDs) and freestanding radiation therapy centers for episodes of care would reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. CMMI proposes launching the model as early as Jan. 1, 2020.
ITN Associate Editor Jeff Zagoudis speaks with Vinai Gondi, M.D., co-director of the Brain Tumor Center at the Northwestern Medicine Cancer Center, about the long-term results of a radiation therapy technique called hippocampal avoidance to preserve neurocognitive function for cancer patients with brain metastases at the 2019 American Society for Radiation Oncology (ASTRO) annual meeting.
Watch the VIDEO: Advancements in Radiation Therapy for Brain Cancer and the VIDEO: Multidisciplinary Treatment of Brain Tumors, a previous two-part interview with Gondi.
A new area for proton therapy in treatment of eye cancer, because of the ability to control the tissue penetration and eliminate full beam lines through a multitude of critical structures in the head. RaySearch unveiled a new treatment planning software for the eye at the American Association of Physicists in Medicine (AAPM) 2019 meeting. The vendor showed some of the first patient cases coming out of the Westdeutsches Protonentherapiezentrum Essen (WPE) proton center in Germany. RaySearch said several U.S. proton centers had interest in the technology at the conference.
This is an example of the Mirada DLCExpert deep learning software that automatically identifies organs, segments and auto-contours them as the first step in creating radiation oncology treatment plans. This example of a segmented prostate computed tomography (CT) scan being used to plan radiotherapy was created without any human intervention. It was demonstrated at the American Association of Physicists in Medicine (AAPM) 2019 meeting.
This example shows OAR Space hydrogel (outlined in blue) injected to create space between the prostate and the rectum to prevent damage to that radiation sensitive structure. The gel is hard to identify on the CT scan because it looks like part of the rectum or prostate. But the softwares AI has been trained to identify it when present.
The DLCExpert software was cleared by the FDA in July 2018 and was first shown at ASTRO 2018. It automatically identifies anatomical structures and contours them to save staff time. The files created by the software are vendor neutral and can be imported into any vendor’s treatment planning system. Read more about this software.
This is a quick demonstration of the Varian Identify image-guided patient positioning system at the American Association of Physicists in Medicine (AAPM) 2019 meeting. It helps align patients on the radiotherapy system treatment table to match the position they were in when the computed tomography (CT) scan was created. This ensures the radiation beams are delivered according to the treatment plan and will not be aimed accidentally at health tissue. It uses real-time tracking of the surface of the patient's skin using three visible light emitters, so it does not add dose, such as when on-board X-ray imaging is used. The system compares the patients position to the treatment plan CT scan and color codes in red any areas that are not in the proper position. It also uses RFID tags on the table to help know the exact position of the patient.
The system can show the radiotherapist if the patient is no longer aligned with the plan and the therapist can manually stop the therapy. The vendor said in the future, they plan to integrate the system with Varian's therapy systems so treatment will be stopped automatically by the Identify system.
The system also uses a biometric scanner to ensure the correct plan is being used with the correct patient.
This is a lung cancer tumor radiotherapy treatment plan for the Accuray CyberKnife system demonstrated at the American Association of Physicists in Medicine (AAPM) 2019 meeting. The blue lines are the radiation beam lines that are shot from different positions to all intersect in the tumor to deliver the prescribed amount of radiation and prevent damage to surrounding healthy tissue. The beams also are planned around the critical structure organs near the target tumor to limit their dose. The organs are color coded to differentiate them on the treatment plan and to help with the estimated radiation dose each receives based on the plan. After the plan is optimized, it is fed into the radiotherapy treatment system computer to deliver the treatment once the patient is positioned on the treatment table exactly as they are in the CT scans used to create the plan.
This is a quick walk around of a mobile 32-slice computed tomography (CT) scanner used for surgery, brachytherapy and proton therapy on display by Mobius Imaging at the 2019 American Association Of Physicists in Medicine (AAPM) meeting. The system simply plugs into a standard wall outlet and all of the required hardware and software is built into the gantry. There is no need for an equipment closet, cabinet or server tower. The company said the CT system was created by some of the same developers who built the O-arm mobile CT system, but they said this CT scanner is much more compact.