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All-seeing eyes
ANN - Friday, February 4
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Kuala Lumpur (The Star/ANN) - It is not hard to imagine radiologists rubbing their hands together in glee and thinking that Christmas had come early after taking a look at all the new imaging "toys" displayed at the recent Radiological Society of North America's (RSNA) annual meeting in Chicago.
The conference, which attracts imaging professionals in the tens of thousands from all over the world, is held every year in the Windy City the weekend after Thanksgiving (observed on the fourth Thursday of November in the United States).
With such a high attendance rate, it is no wonder that companies like Philips Healthcare take advantage of their clients' presence in one place to show off the latest they have to offer in imaging technology.
The technical exhibits themselves took up three huge hangar-like halls, with the major players Philips Healthcare, General Electric (GE), and Siemens taking up the largest spaces.
But the recent conference was an unusual one for one of them in particular, even by the standards of the top three companies in healthcare technology.
"On average, we usually have one or two new products per year.
"This year, we have 15 new products," Philips Healthcare Imaging Systems general manager Gene Saragnese told international media at a briefing on the sidelines of the conference.
He added the products were a mixture of "new new" and "not so new". "A number of them have been in development for a number of years. But we took a step back on some of them in order to integrate them into the new products," he explained.
In addition, the products were introduced under a new concept called Imaging 2.0. "Imaging 2.0 is specifically founded on the radiology community -- understanding their needs and meeting it," said Saragnese.
"We came up with the concept after speaking to over 3,000 radiologists all over the world, and based it on what they wanted."
And what radiologists wanted, according to him, was more seamless integration between their technologies, more collaboration with their colleagues, better decision support, and good relationships, not only with their patients, but also with the imaging industry.
Therefore, Imaging 2.0, he said, was centred on three pillars: clinical collaboration and integration, patient focus, and increasing economic value.
Philips Healthcare Asia Pacific senior vice-president and chief executive officer Wayne Spittle elaborated: "We're listening to doctors, radiologists and cardiologists who we actually work with, and asking what they really want.
"And then, looking at the patient, how it actually affects the patient.
"And -- this one's really important -- economy. What we can actually do to make practices more viable and provide governments with cheaper imaging facilities."
Decreasing operator injury
A good example of this is the ultrasound. Said Saragnese: "The ultrasound, which is the largest growing market in imaging, is used in many settings all around the world. It can be used in a very sophisticated manner or more simply in a rural setting in Africa."
The latest update to the company's iU22 ultrasound system includes a brand-new transducer, the X6-1 PureWave xMATRIX.
Said Spittle: "That transducer is on a platform that is tried, tested and proven, and shows you the quality of the platform going forward."
He added that one of the issues sonographers shared with them was the frequency of wrist and shoulder injuries they suffer from. This is because ultrasound operators need to continually twist the transducer (the T-shaped instrument that is placed on the patient's body) in order to obtain a two-dimensional image of the area they are looking at.
The new transducer is designed to decrease the incidence of this problem as it allows operators to scan two dimensions by just manipulating the trackball on the machine while just holding the transducer in place on the patient's body.
This allows radiologists to obtain twice the amount of information in the same amount of time, thus allowing them to increase their workflow, as well as decrease waiting time for patients.
The quality of the image produced has also been improved significantly. Spittle shared that the company's representatives at the ultrasound station had tried scanning themselves, and actually thought they had discovered something wrong as they saw parts of their body previous ultrasound scans had not picked up before.
"One of the girls picked up the transducer, scanned herself and she saw the fluid surrounding the capsule of the liver, and they've never seen that before (in an ultrasound scan)."
He added: "They can actually relate and show people the images that they produce -- what stands out as being different -- so the learning process is dramatically improved."
Improving the MRI experience
Many patients get freaked out when they have to undergo a Magnetic Resonance Imaging (MRI) scan. For one thing, they have to lie completely still in a narrow tube running through the MRI machine. Not good for those who suffer from claustrophobia!
Add to that the loud thumping noise the MRI machine makes while it is in operation, and you can see how it makes for a rather unsettling experience for the patient.
That is why many would probably appreciate the new open design of the Panorama High Field Open MR. Instead of being completely surrounded by the machine, patients in this machine get a sense of space as it is mostly open on the sides.
Not only is it more conducive for claustrophobic patients, but the design also facilitates the imaging of obese patients, those who cannot lie straight (for example, patients with scoliosis or kyphosis), and children, as they can see their parents standing at the side of the machine.
Another MRI product that stood out was the Ingenia MRI machine. Previously, signals from the patient's body, which are received by radio frequency coils in the MRI machine, had to pass through a long cable to get to the computer, which then processes them into images.
As the signals pass through the cable, their clarity decreases as they encounter electrical "noise" -- a problem that cannot be avoided as long as physical material is used.
The Ingenia MRI machine has done away with the cable, and instead, digitises the signals through a chip in one of the coils and sends it via a wireless signal to the computer to be processed.
Philips Healthcare MRI Marketing vice-president Deepak Malhotra told the media at a briefing that going digital has improved the signal-to-noise ratio (SNR) by about 45%.
According to Utrecht University Medical Centre Assistant Professor Dr Tim Leiner, who tested the machine with his patients, the higher SNR has resulted in better image quality.
Previously, patients also had to have heavy coils put onto them to obtain the best imaging quality for specific body parts.
Now, the coils have been miniaturised into something resembling light body armour and can be selectively switched on and off to scan only the relevant body parts.
Said Spittle: "In the past, you had a thorax coil for cardiology, an abdominal coil, etc; now, you just throw this little mat on and it does everything.
"And the electronics only turn on in that part of the coil that you want to scan, so if you're only doing a small part -- a wrist or whatever -- you only use the wrist coil, and it takes the rest of the coils out of the picture."
The time taken for scanning has also been shortened.
Dr Leiner said that the five most commonly requested MRI scans -- of the brain, knee, spine, liver, and foot or ankle -- can now be done in seven-and-a-half minutes, compared to the 15 to 30 minutes previously.
Another feature of the Ingenia MRI machine is that it has a wider bore or tunnel, which is 70cm in diameter. This allows obese patients to be scanned, as well as decreasing the sense of claustrophobia for patients, said Malhotra.
He added that the channel independent architecture of the machine means that any future upgrades will cost less and be easier to add on, rather than having to buy a completely new machine.
Another product, which is claimed by Philips Healthcare Computed Tomography and Nuclear Medicine Marketing vice-president Dominic Smith as "the newest modality in 10 years", is the Ingenuity TruFlight PET/MR.
In this system, the Ingenuity MRI machine is placed three metres apart from the PET (positron emission tomography) machine, with a rotating platform in between.
The machines have been shielded in such a way that the magnetic field of the MRI machine does not interfere with the electronic function of the PET.
University of Geneva Nuclear Medicine chief Prof Dr Osman Ratib, who tested the system, believes that patients with prostate cancer and breast cancer in particular will benefit from this machine, as both modalities will combine to provide greater detail and information about the tumours and metastases in the body.
Another tester, Mount Sinai School of Medicine Translational and Molecular Imaging Institute director Prof Dr Zahi Fayad, said that the advantage of having both systems together was the ability of doctors to now merge both anatomical (MRI) and functional (PET) information.
"You are also reducing radiation, and this is very important to the patient, especially those who need repeated exposures," he said.
Another advantage to patients is also the decrease in examination time.
Said Prof Fayad: "Don't underestimate the difficulties of scheduling between two (imaging) departments, and getting information from both of them."
A point that many patients who have to go to different departments in the hospital can well appreciate!
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