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14 MEdIcAL tEcHnoLoGY Hospital Post Europe 04/08 Tumours and certain inflammatory conditions can lead to tissue hardening and loss of elasticity. Assessment and visualization of elasticity can provide potentially vital information for disease diagnosis. Hitachi’s Real-Time Tissue Elastography (HI-RTE) module uses an extended combined autocorrelation methodology to produce an elasticity image in real time. Clinical evaluation of the modality has shown that lesions can be characterized more rapidly and with a higher degree of accuracy when elastography is built into the conventional examination. In breast applications, HI-RTE has been shown to improve both the accuracy in differentiating between benign and malignant tumours (especially if smaller than 1 cm), and specificity compared with US BIRADS classification, for benign lesions. As a result, elastography can reduce the biopsy rate in atypical cysts, and may suggest appropriate workup for cancers with atypical presentation. Hospital Post Europe spoke with Dr. Anke Thomas, Head of the Gynaecological Ultrasound Research Labor atory, Charité Berlin/Germany, about her experiences in this field. Hospital Post Europe: Please describe the technical and methodological approach of elastography. What are the advantages of this technique? A. Thomas: Aside from B-image diagnostics and Doppler sonography, sonography includes the option of elastography. It can be carried out with the same Relying On Ultrasound Russell McLaughlin, Consultant in Emergency Medicine at Ulster Hospital in Belfast, Northern Ireland, is relying on ultrasound for a wide variety of applications in the emergency department. “We have become quite dependent on ultrasound imaging in emergency medicine,” the consultant explained. “I use it daily, mainly for assessing trauma patients or looking for abdominal aortic aneurysms. I also use ultrasound to identify soft tissue abscesses, hip effusions, pulmonary oedema, and deep vein thrombosis, for placing lines, and for performing bedside echocardiography. In fact, I’d rather go to work without my shoes on than without the ultrasound machine!” McLaughlin also teaches on a number of emergency ultrasound courses throughout Europe that frequently depend on the SonoSite MicroMaxx hand-carried ultrasound systems to give the attendees good hands-on experience. “The SonoSite systems are very portable, robust, and user-friendly, with good image quality, which are particularly important features in emergency medicine. I know straightaway where to find critical controls such as gain and depth. The uses of these systems are endless – the more I use ultrasound the more applications I seem to find for it!” www.sonosite.com Supporting More Precise Diagnosis HI-RTE Delivers Results in Elastography On-line Dr. Anke Thomas, Head of the Gynaecological Ultrasound Research Laboratory, Charité Berlin transducer and requires no extra effort. Elastography means that elasticity of tissue can be measured. This is done by relating pressure to the resulting elongation of the tissue. In other terms – how much pressure is required to deform a specific tissue. Tissue is subject to changes – for reasons such as age, inflammation, or tumours; these modifications are made apparent by elastography, supporting the diagnostic process. Due to the fact that this approach is rather new regarding convenient use in practice, elastography still needs to be evaluated scientifically. Studies correlating the method with histology are available. The question is, will the application of elastography in acquiring a diagnosis add certainty in decision making. Transcranial Doppler Device to Detect Brain Injuries A new portable Transcranial Doppler (TCD) device from Multigon Industries, featuring Sabic Innovative Plastics’ LNP Faradex compound, provides a new way to detect unseen, yet traumatic, brain injuries in the field – whether a football field or a battlefield. The Neurovision 500P pocket TCD, with electromagnetic/radio frequency interference (EMI/RFI) shielding provided by LNP Faradex compound, makes it easier for doctors and other medical personnel to evaluate a potential brain injury on site, possibly improving outcomes from head injuries through early diagnosis and intervention. Before the use of TCD technology, assessing a possible brain injury in the field was an inexact process: ask questions; check speech patterns; look for dilated pupils. However, lacking these clues and access to a CT scan, an injured athlete or soldier might be sent back into action instead of receiving treatment. To meet the need for a highly precise yet highly portable diagnostic tool, Multigon developed the handheld Neurovision 500P device. The company sought a solution for the housing that would offer shielding yet help keep costs down to spur wide adoption and minimize weight for maximum portability. The Neurovision TCD requires EMI/RFI shielding to prevent interference that could impair its performance. Multigon turned to Sabic Innovative Plastics to find a cost-effective and lightweight shielding solution for the housing. Traditional plastic using a copper overspray is expensive, labor-intensive, and may result in uneven application that can affect performance. The company supplied LNP Faradex DS 1003 FR HI com- What is special about Hitachi’s Real-Time Tissue Elastography? A. Thomas: There are various approaches to elastography differentiated, e.g., by off-line or real-time analysis of data. Off-line analysis required more time, and can only be evaluated after the patient exam, making it harder to integrate the method into clinical routine. The method of real-time elastography, developed by Hitachi, allows to assess elasticity, in unclear findings in focuses or tissue types, just by adding this option at the ultrasound device. The usual B image is dyed, as with colour dopplers, and the various defined colours relate to a certain density of the tissue. Soft, easily compressed tissue is coloured red, tissue which is hard to compress is dyed blue. This image, acquired in real time, instantly provides additional information. For which symptoms can the technique be used? A. Thomas: Until now, it has been applied in various studies to the mamma, cervic, liver, thyroid, and prostate. What is of particular interest is the breast exam: When a woman with an unclear finding from palpation sees a physician, he/she will first palpate, and then offer an ultrasound of the breast. Elastography can be provided instantly, by way of the colour codes in the B image. This way, to the diagnostic process to ascertain focus findings – benign, suspicious, highly suggestive of malignancy (BI-RADS) – in the B image, elastography can be added as an additional criteria. Studies have demonstrated that elastography lends itself, in particular, to increase certainty in unclear focus findings, for a posite, a polycarbonate-based material infused with stainless steel fibers. By avoiding the secondary metalspraying operation, LNP Faradex compound reduced manufacturing costs while delivering equivalent or better shielding performance. Improved Performance “We initially used a copper overspray to provide shielding for the Neurovision housing,” said William Stern, vice president, Multigon Industries. “However, the time and labor associated with spraying added a significant amount to the cost of producing the housing. We also were concerned about inconsistencies in the application that could impact performance. By working with Sabic Innovative Plastics, we found a much better solution that not only cut our costs by 60 percent, but also provides uniform shielding performance. LNP Faradex compound helps us keep costs down to drive adoption of the Neurovision 500P.” benign/malign diagnosis. If, e.g., a focus in the mamma is presented as green, or medium hard, this correlates with a benign diagnosis (e.g. a fibroadenome). If the focus finding shows significant blue colour – meaning the focus cannot be compressed – this supports a malignity diagnosis (mamma carcinoma), requiring validation by punch biopsy. What are the future perspectives for the application of this approach? A. Thomas: One of the benefits we expect is a more precise diagnostic distinction between benign and malign tumours – e.g., an exam being sufficient in benign cases, requiring no further histological validation. This would save cost and provide instant reassurance of patients. In order for this diagnostic method to be considered safe, additional evaluation is needed. A kind of CAD (Computer Aided Diagnosis) system may also be an option – in diagnosing a focus, elastography is applied, with automated indication of the category which determines whether the tumour is benign or malign. This means that a large number of studies needs to be carried out, with the aim of standardizing focus findings in elastography, and integration into existing diagnostics. Contact: Priv.-Doz. Dr. Anke Thomas Head of the Gynaecological Ultrasound Research Laboratory Charité Berlin, Germany Tel.: +49 30 450564172 www.uslab-charite.de The Neurovision 500P TCD Device’s Housing is Shielded with LNP Faradex Composite from SABIC Innovative Plastics. The new system opens up new possibilities for TCD exams and patient care. Its small size, portability, and full feature set, as well as low cost, make it a perfect diagnostic tool for any setting. Intuitive and convenient one-handed operation helps clinicians conduct exams accurately and efficiently. Completed studies are stored on removable flash cards and transferred to a personal computer for post-processing and patient report generation. By using a complete range of Doppler probes, the Neurovision 500P can be used for transcranial, carotid, and peripheral Doppler analysis. LNP Faradex DS 1003 FR HI compound leverages stainless steel fibers to provide enhanced shielding performance without the need for secondary metalcoating operations. It also provides flame retardance that supports requirements for elimination of halogenated additives, as well as high impact resistance performance and low shrinkage. www.sabic-ip.com
Hospital Post Europe 04/08 “Control Inside” Aimed at all those involved in the field of radiological science and attracting around 3,000 delegates annually, the 2008 UK Radiological Congress (UKRC) brought together professional medical and industry delegates at the NIA, ICC, and Austin Court in Birmingham at the beginning of June. Matrox display controller boards were demonstrated by partners at UKRC’s technical exhibition, close to 100 companies in total. Well-represented within PACS solutions throughout the show floor, the vendor’s products were found inside numerous workstations including those from Carestream Health and Sectra. Carestream Health chose the company’s AuroraVX Series to drive the triple-display RIS/PACS workstation in their booth, while Sectra chose the MED Series to drive their 5-megapixel mammography workstation. Display partners and integrators of Matrox were also present at UKRC 2008, including Eizo, NEC, Richardson Electronics, Hospital Services/Taramed, and Parity Medical. Eizo bundles MED, RAD, and AuroraVX Series with RadiForce panels and featured MED5mp driving the Eizo RadiForce GS520. This 5-megapixel display was designed for displaying mammography images and features the smallest pixel size (0.165 mm) amongst current medical monitors of the company, providing highdefinition and high-density display without shadings appearing granular. NEC showed Matrox TheatreVUE in their booth, which is designed to clone the entire main display or any portion of it onto a second display or projector. The company’s demonstration convinced UKRC visitors that radiology images displayed on a NEC grayscale display running at 2560 x 2048 may be viewed at a distance in an educational theatre or meeting room environment, using the NEC LCD6520 DICOM preset 65” display running at 1920 x 1080 resolution (2.1 MP). Products of Parity Medical include mobile carts which can be configured to carry multiple monitors as well as fixed and variable height wall-mounts. Their solutions are designed to allow clinicians in all areas of the hospital (including Radiology, Clinics, Recovery, and Theatres) to access including PACS. A unique combination of displays from top manufacturers including Image Systems, NEC, and Planar, plus mounting solutions, specialized imaging hardware, and peripherals is offered by Richardson Electronics. A variety of Matrox solutions are offered within their integrated systems and the company’s boards were driving the majority of their displays at UKRC. Taramed Distribution carries medical display from a variety of manufacturers including Totoku and MeDiSol (a division of Rein EDV), available bundled with Matrox display controller boards including MED3mp and MED5mp. Monitors on display at UKRC included the new MS51i2 5-megapixel display equipped with ISV (Independent Sub-pixels Drive) technology. www.matrox.com MEdIcAL tEcHnoLoGY 15 Science – “A Diplomacy of Trust“ – Symposium Heidelberg-Israel, Science and Culture The German Cancer Research Centre (DKFZ), the city of Heidelberg, and the University, as well as the Higher Education Institution for Jewish Studies located in the city organized, mid-July, a symposium as part of the German-Israeli Year of Science and Technology 2008. Insights in cancer research were at the top of the agenda. “Contacts in Academia had paved the way, fifty years ago, for diplomatic relations between Israel and West Germany; they form a cornerstone of these relations until today,” organizers explained: the city of Heidelberg and research institutions .artundwork designbüro located there made significant contributions. The event served to commemorate the 25-year anniversary of the jumelage with Rehovot, which is home to the wellreputed Weizmann Institute of Science. Since 1983, the University of Heidelberg entertains a partnership with the Hebrew University in Jerusalem, and there has been scientific co-operation in the field of cancer research for more than 30 years. The symposium, opened with an address by Germany’s Federal Research Minister Dr. Annette Schavan, presented – besides topics from, e.g., Hebrew lit- Hitachi Real-time Tissue Elastography: Discovering with all senses. Hitachi Real-time Tissue Elastography (HI-RTE) HI-RTE is an emerging ultrasound modality for the assessment and real-time colour display of tissue elasticity. The value of this 2nd generation ultrasound modality has been proven in a variety of different clinical areas, including breast, urology, endoscopy and many more. Hitachi Medical Systems Europe Holding AG · Sumpfstrasse 13 · CH-6300 Zug www.hitachi-medical-systems.com Hitachi Medical Systems Europe Holding AG · Sumpfstrasse 13 · CH-6300 Zug www.hitachi-medical-systems.com erature, archaeology and environmental physics – current knowledge in oncology research. Prof. Dr. Dr. Wolfhard Semmler, DKFZ, gave an overview of the German- Israeli scientific co-operation in oncology; a keynote lecture on “Adhesion, migration, and cancer metastasis” was held by Prof. Dr. Benny Geiger, Weizmann Institute, and Prof. Dr. Varda Rotter of the same Institute spoke on “Tumour suppressor gene p53 – our cell guardian”. MR This unique HI-RTE modality... · Extracts strain data ensuring that quantitative measurements are available from the Strain Ratio tool · Is easy to perform, fast, accurate and reproducible · Incorporates an adjustable colour transparency feature, enabling instant correlation between the native B-mode and elasto image · Is available for the new range of HI Vision platforms Germany’s Federal Research Minister Dr. Annette Schavan speaking with Ilan Mor, Deputy Ambassador of the State of Israel, as well as keynote speaker and literature expert Prof. Dr. Anat Feinberg, College of Jewish Studies Photo: courtesy DKFZ
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