Digital Radiography News

A study set to be featured in the upcoming December issue of Anesthesiology suggests a part for brain imaging in the evaluation and potential treatment of chronic pain. University of Michigan researchers are the very first to employ brain imaging procedures to track the clinical action of pregabalin, a drug known by the brand name Lyrica® that is prescribed to patients suffering from fibromyalgia and neuropathic pain. “The significance of this study is that it demonstrates that pharmacologic therapies for chronic pain can be studied with brain imaging,” said lead study author and assistant professor of anesthesiology at the University of Michigan, Richard Harris, Ph.D. Three various brain imaging procedures were performed; proton magnetic resonance spectroscopy, functional magnetic resonance imaging, and functional connectivity magnetic resonance imaging, in 17 patients with fibromyalgia. Fibromyalgia is a chronic pain disorder thought to be a result from a disturbance in the way the central nervous system processes pain. It affects an estimated 10 million people in the United States and 3 to 6 percent of the world’s population. Patients with fibromyalgia may suddenly report pain throughout their bodies although there is no inflammatory or anatomical damage. In addition to chronic pain, patients may also suffer from related mood disturbances, such as anxiety and depression. Prior research has demonstrated that fibromyalgia patients may have heightened neural activity in an area of the brain involved in processing pain and emotion called the insula, and that this surplus activity may be related to elevated levels of the excitatory neurotransmitter glutamate. Brain imaging performed at the U-M Health System suggests pregabalin works in part by diminishing the concentration of glutamate within the insula, which is consistent with animal studies. These deductions in glutamate were also met by decreases in insula connectivity and reductions in clinical pain ratings. This sort of brain activity imaging may aid the development of new pain medications and personalized chronic pain treatment. “The results could point to a future in which more targeted brain imaging approaches can be used during pharmacological treatment of chronic widespread pain, rather than the current trial-and-error approach,” concluded ... Read more

German researchers employed a CT scanner and a 3-D printer to re-create a copy of a dinosaur fossil that has been wrapped up in protective plaster for decades, with the real trick being that they could accomplish such a feat without ever removing the plaster. In this week's issue of the journal Radiology, they report that the technique could be used to study and share objects that are too rare or fragile to be moved and passed around. "The most important benefit of this method is that it is non-destructive, and the risk of harming the fossil is minimal. Also, it is not as time-consuming as conventional preparation," said radiologist at the Charite Campus Mitte in Berlin, said in a news release from the Radiological Society of North America, Ahi Sema Issever. Fossils are usually wrapped in plaster casts, or jackets, to protect them from damage during transport or storage. To study the fossil, researchers often have to remove the plaster as well as the sediment surrounding the specimen. However, researchers don’t always know what the plaster contains and therefore are afraid of taking a risk and damaging what’s inside the wrapping. CT scans have been used to trace the structure of dinosaur brains, look at fossilized whale bones inside their plaster jackets, and make out the face of a 49 million-year-old spider wrapped in amber. Therefore it wasn’t too much of a hassle to apply the technique on a mystery fossil from Berlin's Museum für Naturkunde. The fossil, concealed in its protective plaster jacket, was part of a collection that was buried beneath piles of rubble in the museum's basement after a World War II bombing raid. Some of the exhumed specimens have been difficult to identify. Therefore, Issever and colleagues took one of the unidentified chunks of plaster and put it through their CT scanner. The plaster, sediment, and fossilized bone absorbed X-rays differently, generating a clear picture of a dinosaur vertebra inside. The researchers matched up the picture with a sketch detailing fossils from an excavation that was conducted from 1910 to 1927 in a clay pit south of Halberstadt, Germany. They could also see that there were several fractures and damage to the front rim of the vertebra. The detailed re-construction from the CT scan was then fed into a 3-D printer, which generated an accurate reimaging of the fossil through selective laser sintering. It's not uncommon to see reproductions of dinosaur fossils. The best-known dino-copies include plastic reproductions of Sue, the multimillion-dollar Tyrannosaurus rex skeleton that's on display at Chicago's Field Museum. But advances in 3-D printing are likely to make artificial fossils much more available and much less expensive. "The digital dataset and, ultimately, reproductions of the 3-D print may easily be shared, and other research facilities could thus gain valuable informational access to rare fossils, which otherwise would have been restricted. Just like Gutenberg's printing press opened the world of books to the public, digital datasets and 3-D prints of fossils may now be distributed more broadly while protecting the original intact fossil,” said ... Read more

One common complaint patients make is how tight and claustrophobic magnetic resonance imaging (MRI) machines feel. Therefore, Bronson Advanced Radiology Services has introduced a new MRI that is more spacious to suit the comfort of their patients. "The increase in the size of the American population is all too well documented and that plays a part in that, but we have a fairly large population of claustrophobic people as well. With those things in mind, Bronson made that investment into the new scanner," said system director of diagnostics at Bronson, Josh Scheller. Bronson's new MRI machine is a Siemens Skyra 3 Tesla (3T) Wide Bore that is part of a $2 million investment by the health care organization. It says the machine is the only imaging system of its kind in all of Kalamazoo, MI. It will serve as a permanent replacement of a mobile MRI system that Bronson Advanced Radiology Services has used at its 524 S. Park St. location for around five years. "One of the nice things about the wide-bore system is the space is distributed around the whole patient," said Scheller. The wide-bore machine has a diameter of 70-centimeters (27.6 inches). That is as close as the patient comes to the opening through which he or she passes.  Standard open system machines have 50 centimeters (19.7 inches) at their widest points, yet those points are largely to the right and left of the patient as he or she passes through. “It's not atypical for patients who suffer with claustrophobia to have to reschedule an MRI test and have it done after their physician can administer a general anesthetic or anti-anxiety medication. The wide-bore machine design is good for patients who are claustrophobic or who may be larger in size because many exams can be performed with the patient’s head outside of the bore. At the same time, he said the new machine provides more detailed and higher-resolution images. Replacing the mobile, leased machine with one that Bronson now owns at a fixed site, will lower the costs associated with it. Bronson has two other MRI machines. Each is typically in service about every 45 minutes,” noted ... Read more

A provisional study conducted by Italian researchers revealed that utilizing a modeling program in conjunction with IPSS and dosage measure can foretell the seriousness of acute urinary symptoms in patients with early prostate cancer who have received radiotherapy. Quantitative models predicting the risk of acute (and late) genito-urinary (GU) toxicity in patients treated with high dose radiotherapy for prostate cancer are lacking. This work represents one of the first attempts to provide radiation oncologists with quantitative tools to reliably predict the risk of moderate-severe acute GU effects based on both clinical and dosimetric individual parameters," said Dr. Cesare Cozzarini of the San Raffaele Scientific Institute, Dept. of Radiation Oncology in Milan, Italy. Cozzarini presented the study’s findings at the 5th European Multidisciplinary Meeting on Urological Cancers (EMUC) held in Marseille. A potential group study (DUE-01) which started in April 2010, Cozzarini and colleagues sought to develop predictive models of genito-urinary (GU) toxicity and erectilse dysfuction following high dose radiotherapy (RT) for prostate cancer. Patients treated with standard (1.8-2Gy/fr, CONV) or moderate hypo-fractionation (2.5-2.7Gy/fr HYPO) were included. In their ad-interim analysis, the researchers also planned to find a correlation between pollakiuria (POLL), dysuria (DYS) and nicturia (NICT) as measured by IPSS at RT end and clinical/dosimetric risk factors. IPSS questionnaire at the beginning and at the end of RT were prospectively collected by the researchers and planning data were gathered and analyzed with a dedicated program (Vodca, MSS GmbH, Zurich), including absolute (cc/cm2) and % bladder dose-volume/surface (DVH/DSH) guidelines referred to both the entire treatment and to the weekly delivered dose (DVHw/DSHw). For this study, pertinent clinical factors were also prospectively gathered including T stage, concomitant morbidities and drugs, use of hormonal therapy (HT), previous surgery, smoking, age, body mass index (BMI), and prostate volume. In IPSS, each article ranges from 0 to 5 with increasing score which points to increasing toxicity severity: for every question, a score?4 at the end of the therapy was regarded as the end point. During the time of the analysis (January 2013), 339 patients had been enrolled by nine institutes. Clinical data of 212/339 patients were available (93 CONV and 119 HYPO). Of 172/212 patients both baseline and end-RT IPSS were gathered. For 179/212 patients. DVH/DSH was also available. Questions POLL, DYS and NICT (respectively 2, 3 and 7) demonstrated the higher increase of the fraction of patients with scores ?4 between basal and end questionnaire; consequently, the analysis focused on these symptoms. The number of patients with scores?4 increased from 8 to 30 for POLL, from 5 to 20 for DYS and from 12 to 34 for NICT. At MVA (overall ... Read more

Based on a recent study performed by a group of researchers from Tubingen and Munich in Germany, treatment of pelvic nodes in individualized by inclusion of sentinel nodes (SN) can be easily incorporated into an IMRT-based treatment plan. The intended volume perception seems to correctly cover individual pelvic nodes, which is made clear by the nonexistence of any nodal recurrence within five years of follow-up. The results of the study were presented at the 5th European Multidisciplinary Meeting for Urological Cancer (EMUC) in Marceille, France. "Radiation treatment with long-term-androgen deprivation has level 1 evidence as treatment option for high risk prostate cancer patients," noted lead author of the study Dr. Arndt-Christian Müller of the Eberhard-Karls-Universität Tübingen. "However, there is a discussion with regard to toxicity and efficacy concerning the inclusion of pelvic nodes into the radiation portals. With high conformal techniques such as IMRT for irradiation of pelvic lymph nodes, target volume contouring becomes highly important. There are standard lymph node radiation target volumes, yet the individual lymph drainage of different patients is not taken into account." The researchers mention that this new data on individual inclusion of sentinel nodes into the pelvic standard radiation target volumes with intensity modulated radiation therapy (IMRT) propose that toxicity in accordance with advanced treatment techniques is low. "With regard to efficacy, the absence of any nodal recurrence in the pelvis indicates that the sentinel node based target volume concept correctly covers individual pelvic lymph drainage," said Müller. In regards to the risk profile in this sequence, such as high risk defined in one third by Gleason score 8-10, outcome parameters were at least equivalent to available data of the same treatment period. Therefore, this sentinel node-based strategy confirms further assessment including current dose-escalation strategies to prostate in a larger prospective series. "Firstly, we conclude that treatment of pelvic nodes individualized by inclusion of SN is feasible with IMRT. Secondly, the absence of any nodal pelvic recurrence within five years of follow-up indicates efficacy of this individualized treatment concept. We expect an improvement of PSA control and with longer follow-up and higher patient numbers a survival benefit for patients with individual inclusion of sentinel lymph nodes,” said Müller. According to the authors, the results of the study could be followed up by further assessment of dose-escalated IMRT to prostate +/- SN-guided pelvic IMRT or treatment stratification after SN-biopsy with IMRT of prostate-only for node negative patients and IMRT of prostate +/- SN-guided IMRT in case of affected pelvic ... Read more

A new tablet-based ultrasound system built to meet and achieve all applications in the point-of-care field, which is among the fastest growing medical field in the healthcare industry. Samsung Electronics America, Inc., a subsidiary of Samsung Electronics Co., Ltd. (Seoul, Republic of Korea), revealed its first tablet-based ultrasound system, the Samsung UGEO PT60A. With its performance, slender, and compact size, and easy to use, this latest development is among a number of novel medical imaging products. Samsung displayed the new system at the American Society of Anesthesiology (ASA) annual meeting in San Francisco (CA, USA). Equipped with advanced clinical technology, the UGEO PT60A features include: a 10.1-inch light-emitting diode (LED) touch-screen monitor; Needle Mate, for exact identification of the needle’s location; SDMR feature, which offers clearer imaging with a new noise reduction filter; and finally, SCI, which provides spatial and contrast resolution. “We are excited to launch the groundbreaking Samsung UGEO PT60A ultrasound system, which is uniquely engineered to meet the ever growing needs of the portable healthcare market. This system underscores our continued commitment to introducing increased innovation to the healthcare market through our health and medical business unit,” said director of sales for Samsung’s health and medical equipment unit, Brian Keith. Using the one-touch measurement features of the portable and compact UGEO PT60A, exam findings are provided with exceeding effectiveness. The system’s Auto IMT (intima media thickness) and swift diagnosis report can help providers make vital decisions more easily. Subsequently this allows for fast and timely treatment for the ... Read more

Based on a recent study conducted at the University of Colorado Cancer Center and published in the journal Physics in Medicine and Biology reveals that endorectal balloons generally used during exact radiation treatment for prostate cancer can ... Read more

New positron emission tomography (PET) image reconstruction technology has been designed to provide better image quality, reduced acquisition time, and lower injected agent dose. Present PET iterative reconstruction technologies, such as time-of-flight (TOF) and ordered subset expectation maximization (OSEM), do not have the capability of controlling noise when the number of iterations increases, which leads to a trade-off of quantitative accuracy in favor of image quality.  When deciding whether a particular cancer treatment is effective or not, physicians not only want to identify the tiniest of lesions, but also the capability of determining earlier whether the metabolic activity is being alleviated under the current treatment. For precise treatment response assessment, a physician needs accurate quantitative applications. General Electric (GE) Healthcare’s GE Healthcare (Chalfont St. Giles, UK) Q.Suite tools exhibit the importance of eliminating variability such as respiratory motion. Q.Suite allows physicians to assess treatment response more accurately than ever before, allowing them to effectively evaluate biologic changes in a patient during and over the course of treatment. GE Healthcare showcased the Q.Suite T Imaging and Reconstruction tools at the 2013 European Association of Nuclear Medicine Congress (EANM), held October 2013 in Lyon (France). GE Healthcare’s interactive educational experience on PET standardized reconstruction technology presented at the Congress demonstrated what is possible when forcing a choice between image quality or quantitation accuracy is no longer necessary. PET standardized reconstruction technology that was displayed at EANM interactively shows the potential of full convergence PET imaging.  “We know that cancer patients don’t always respond to their initial course of treatment. If we can give clinicians a more accurate, reliable, and faster tool to confirm that a change in treatment is needed, the patient will benefit greatly. For example, PET/CT can help clinicians determine whether chemotherapy is working after as few as one to two cycles, saving patient’s unnecessary procedures and a significant amount of money,” said president and CEO of GE Healthcare’s MICT (multiple image computed tomography) ... Read more

Based on a recent study conducted by researchers from the Manchester Cancer Research Centre, the genetic make-up of a patient’s tumor could be used to personalize their treatment and help determine whether they would benefit from receiving supplemental medication as part of their radiotheapry treatment plan. Tumors with lower levels of oxygen, known as hypoxia, aren’t known for responding too well to radiation therapy. There are numerous agents that can be administered to patients prior to radiotherapy to help decrease hypoxia, but these are not issued as standard. Being able to calculate how well-oxygenated a patient's tumor is would enable doctors to identify which patients have the most to gain from treatment with hypoxia reducing agents prior to radiotherapy. Hypoxia has previously been examined by looking at the appearance of certain genes, and Manchester researchers have devised a genetic profile for tumors that should be able to specify the overall level of oxygenation. Researchers at The University of Manchester, part of the Manchester Cancer Research Centre, performed the study in patients diagnosed with cancer of the bladder and larynx. These patients then underwent either traditional radiotherapy or radiotherapy with the addition of two agents which in combination are known to increase oxygenation: nicotinamide and carbogen. The team tested patients' tumor samples for 26 genes in order to categorize them as more or less hypoxic, and then analyzed whether this hypoxia score related to the results of treatment. "Our goal is to find ways of predicting how patients will respond to different treatments. Future cancer treatments will be personalized so that patients get the best therapy for their tumor. Personalizing therapy will not only increase the number of people surviving cancer but also decrease side-effects, as patients would be spared from having treatments that are unlikely to work in their tumor,” said lead researcher Professor Catharine West, from The University's Institute of Cancer Sciences. A paper recently published in Clinical Cancer Research details how the group discovered that for laryngeal tumors, those specified as more hypoxic saw a considerable benefit from receiving additional agents in accordance with radiation therapy. However, in bladder cancer, patients with more hypoxic tumors did not benefit from adding extra agents. "We will now test how the hypoxia score works in the clinic in a trial starting in December in patients with head and neck cancer. I have studied ways of measuring hypoxia in tumors for many years so this is a very exciting finding that could help us optimize how we use radiotherapy to get the best outcome for patients,” said ... Read more

Researchers from the Shin-Yokohama Yamasaki Clinic, report that almost half of rheumatoid arthritis patients show pulmonary abnormalities in computer-assisted tomography (CT) chest scans. “Of 355 patients studied, high-resolution CT revealed pulmonary abnormalities in 177 patients, including 91 who were diagnosed with interstitial lung disease,”said medical director of the Shin-Yokohama Yamasaki Clinic, Yokohama, Japan, Masaomi Yamasaki, MD. “Of those 91 patients, 12 were observed to have honeycomb lung, and those who were symptomatic were treated aggressively with high-dose steroids, cyclophosphamide, azathioprine, cyclosporine, and mycophenolate mofetil,”Yamasaki said during a presentation at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals. He noted that in three cases, the aggressive treatment appreared to have assuaged the progressive disease; while in the other two patients the disease continued to spread, leading to their death. "Because of various factors that are unique to Japan and Japanese people, it could be that these findings are not in line with other ethnic, national or regional groups. We do not recommend routine CT for these patients because there is risk of radiation exposure." However, he also mentions that findings of irregular chest x-rays or lung symptoms in rheumatoid arthritis patients should be investigated with supplemental imaging tests. He noted that the honeycomb lung findings point to fibrotic changes that happen in end-stage interstitial lung disease and those fluctuations are linked to a poor diagnosis. Of the 12 patients who exhibited honeycomb lung patterns, five were discovered to have aggressive, symptomatic disease, the researchers reported. The findings corroborate that lung abnormalities arise frequently among patients diagnosed with rheumatoid arthritis and call for observation of lung disorders in this population, even among asymptomatic patients. For this study, researchers observed and followed the patients at the hospital for 1 year. They were all given the high-resolution CT examinations on their original visit. The patients in the study consisted of 66 men and 289 women. The median age of the patients was 59.2 years and they had been diagnosed with rheumatoid arthritis for a median of 14.2 years. The 177 abnormal lung CTs comprised of 154 cases of bronchitis or bronchiectasis; 91 cases of interstitial lung disease, including five symptomatic patients; 29 cases of emphysema; and one lung tumor. Yamasaki said 26 men and 65 women were found to have interstitial lung disease. And of the 86 cases in which the finding occurred in asymptomatic patients, the researchers diagnosed 80 occurrences of non-septal linear attenuation; 18 cases of ground-glass attenuation; 12 cases of honeycombing; and 12 cases of extensive interstitial lung disease. "This study suggests that when doctors are treating rheumatoid arthritis patients with pre-existing honeycombing lung they must be aware that rapidly progressive interstitial lung disease can develop," said Yamasaki. "We are generally aware that rheumatoid arthritis patients are susceptible to cardiovascular abnormalities. However, we also have to be concerned about the lungs of patients with rheumatoid arthritis. Pulmonary complications are the second most common non-skeletal manifestation of rheumatoid arthritis. I don't think the Japanese study findings are unique to any nationality or ethnic group but broadly impact people living with rheumatoid arthritis,” said senior physician at Radboud University, Nijmegen, the Netherlands, Inger Meek, ... Read more

A new study has revealed that a new mechanized three-dimensional (3D) cell-imaging platform could effectively identify lung cancer in sputum samples with high rates of sensitivity and specificity. The Cell-CT technology, developed by VisionGate, Inc. (Sydney, Australia), a company developing a noninvasive test for the early detection of lung cancer, utilizes an approach called optical projection tomography to image cells in 3D. A cell is transferred through the Cell-CT’s glass micro-capillary by applying pressure to a gel that inserts cells. As the capillary spins, the cell is scanned from various angles, providing a series of pseudo-projection images.    These images are then merged together using a technique known as filtered back-projection, producing the final 3D cell volume. These new findings were presented at the International Association for the Study of Lung Cancer (IASLC) 15th World Conference on Lung Cancer, held October 27-30, 2013, in Sydney (NSW, Australia). The pilot study looked at and examined sputum samples from patients with lung cancer and from healthy individuals. The findings showed that the Cell-CT platform and the LuCED sputum test successfully detected the existence or nonexistence of lung cancer cells in patient sputum from an impulsive cough. Of the 53 individuals studied up till now, LuCED and the Cell-CT achieved a sensitivity of more than 95% and specificity of 99.8%. The high sensitivity demonstrates that the Cell-CT detects most tumors, and the high specificity means that the rate of false-positive readings is considerably low. This indicates a far greater accuracy than has been previously shown with any other lung cancer-screening test.  “Lung cancer remains the leading cause of cancer death in the US, primarily because it is not detected until after the cancer has spread. Results to date from this ongoing clinical study suggest that LuCED and the Cell-CT correctly identify more than nine out of every 10 cases of lung cancer with virtually no false-positive results, supporting the goal of developing a new lung cancer screening paradigm that is both accurate and cost-effective,” said  founder and CEO of VisionGate, Alan Nelson, PhD. The automated Cell-CT platform generates exceptionally clear and detailed 3D digital images of the cells contained in sputum. It uses sophisticated algorithms to identify the existence or nonexistence of cell biosignatures tied to malignant or normal status, making it possible to determine with a high rate of accuracy whether a patient has cancer.  Low-dose computed tomography (CT) screening can detect lung cancer at early stages and save lives. However, CT screening has an exceedingly high rate of false-positive results, which can lead to expensive and invasive follow-up procedures. The large US National Cancer Institute (NCI; Bethesda, MD, USA) National Lung Screening Trial revealed that more than 96% of the “positive” results from CT screening were actually false-positives. Consequently, its use is recommended only in the highest-risk individuals. The potential ability of VisionGate’s Cell-CT platform to noninvasively and cost-effectively confirm or denounce positive findings from CT scans would make widespread use of lung cancer screening a more achievable possibility. “The urgency of developing accurate, cost-effective tools for early detection of lung cancer is highlighted by the thousands of preventable lung cancer deaths each year. These data showing that the Cell-CT platform can detect lung cancer with high accuracy from sputum samples in patients at all stages of the disease, as well as identifying those who are cancer-free, is very encouraging. We look forward to continuing to work with VisionGate to enlarge the study population and generate the data needed to advance development of this promising lung cancer screening test,” said  director of clinical research, Cancer Treatment Centers of America Western Regional Medical Center (Goodyear, AZ, USA), Glen J. Weiss, MD. Previous research had verified that analyzing cells in sputum could be useful in the early detection of lung cancer. However, the characteristically poor sensitivity of raw sputum analysis and the labor-intensive nature of the process made it unfeasible for widespread use. The Cell-CT’s high-resolution 3D technology and its automated image analysis software for the first time make a cell-based diagnostic approach using sputum samples logistically not only possible, but cost-effective. “We soon expect to supplement these exciting efficacy results with peer-reviewed economic analysis data that confirm the cost-effectiveness of our approach. We also are expanding our collaborative efforts with a variety of institutions as we focus on generating the additional data needed to gain FDA regulatory clearance of LuCED and the Cell-CT platform for adjunctive use with X-ray CT screening, and then possibly as a stand-alone test for lung cancer screening that would be readily available at moderate cost to the broader population,” said president of VisionGate, Scarlett ... Read more

Based on new research published in the November issue of The Journal of Nuclear Medicine, patients who fail to respond to existing first-line and second-line treatments for colorectal cancer liver metastases, also known as salvage patients, ... Read more