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.

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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.

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.

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. 

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.

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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.

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.

The Basics of Radiation Dose Monitoring in Medical Imaging

How to Understand and Communicate Radiation Risk — Image Wisely

Radiation in Medicine: Medical Imaging Procedures

FDA White Paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging

Radiation Dose in X-Ray and CT Exams

Radiation Dose from Medical Imaging: A Primer for Emergency Physicians

Radiation risk from medical imaging

FDA: Medical X-ray Imaging

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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. 

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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. 

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.

More coverage of ASTRO 2019

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.

More coverage of 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.

Related Content

CMS Proposes New Alternative Payment Model for Radiation Oncology

ASTRO Releases Comments on Proposed CMS Radiation Oncology Alternative Payment Model

Additional ASTRO 2019 coverage

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.

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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. 

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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.

This is a quick walk around of the new Siemens Somatom Go.top cardiovascular edition compact computed tomography (CT) scanner on display at the Society Of Cardiovascular Computed Tomography (SCCT) 2019 meeting in July. It is aimed at cardiology office based imaging and was released this past spring at the American College of Cardiology (ACC) meeting.

The system has removable tablets on each side of the scanner where the tech can adjust the machine, review scout scans and trigger the scanner. The idea is to improve workflow and allow the tech to remain at the bedside longer to be with the patient, rather tucked away in a remote control room using an intercom.

The entire system is built into the gantry seen here, so there is no need for extra equipment in a closet, cabinet or server tower.

It comes in a 128 slice configuration with 4 cm of anatomical coverage per rotation.

It uses the Stellar detector and tin filtration to eliminate low energy photons and help lower dose. It can be programmed to aid workflow by automatically removing bone, create cured planar reconstructions, lung CAD and other post-processing features so more time can be spent on reading scans. The scanner also comes with a HeartFlow FFR-CT starter pack.

Find more information on this system in these related articles:

New Cardiovascular CT Technology Entering the Market

New Technology Highlights on the ACC 2019 Exhibit Floor

Association for Medical Imaging Management (AHRA) President Chris Tomlinson, CRA, FAHRA, and President-elect Jacqui Rose, CRA, FAHRA, discuss some of the most important clinical topics at the 2019 AHRA Annual Meeting and how the association plans to help its members embrace technological change in the coming years. Among the main focuses at the meeting were clinical decision support (CDS), artificial intelligence (AI) and the use of data analytics to improve equipment and personnel performance. 

Watch the VIDEO: Assessing Cardiovascular Risk in Ultra-endurance Athletes, an interview with Colorado State University graduate research assistant Nate Bachman at AHRA 2019.

Mark Ibrahim, M.D., FACC, assistant professor of medicine and radiology, associate program director, advanced cardiac imaging fellowship, University of Utah, explains what radiologists and cardiologists need to know what is needed from CT imaging prior to ablation procedures for atrial fibrillation (AF) and ventricular fibrillation (VF). He spoke at a joint session of the Heart Rhythm Society (HRS) and the Society of Cardiovascular Computed Tomography (SCCT) at the 2019 SCCT meeting. 

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Arthur Agatston, M.D., clinical professor of medicine, Florida International University, Herbert Wertheim College of Medicine, is the name-sake of the Agatston score used in CT calcium scoring. He explains the history of the scoring system from the early 1990s and the evolution of CT technology for cardiac imaging. The latest American Heart Association (AHA) 2018 cholesterol guidelines now include the use of CT calcium scoring, which was a big topic at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting.

Related CT Calcium Scorining Content:

VIDEO: New Cholesterol Guidelines Support CT Calcium Scoring for Risk Assessment — Interview with Matthew Budoff, M.D.

CT Calcium Scoring Becoming a Key Risk Factor Assessment

ACC and AHA Release Updated Cholesterol Guidelines for 2018

VIDEO: CT Calcium Scoring to Screen For Who Should Take Statins — Interview with Matthew Budoff, M.D.

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